True Stories: Volume VI is a wonderful collection of works produced by the graduates of The Narrative Project, an organization that supports writers in getting their books done.  

This is my first published story.  Enjoy! 

Beep. Beep. Beep. 

Blasted awake, my heart jumps in my throat. I’d been snug under a blanket, stretched out on one of three recliners in the crew “family room” at our rescue base, in the middle of a nice, warm nap. Cue three familiar warning tones from the crew handheld radio. I’m leaping up, mind in a jumble, adrenaline coursing through my veins. 

Then comes the dispatcher’s calm, disembodied voice. “Calstar 6. Scene flight to Heavenly Ski Resort for a CPR in progress.”

Striding in from the back of crew quarters, my partner, Emma, keys the mic. “Calstar 6, copies and responding. Will advise when we lift.” She turns to me. “You might want to grab your jacket, Jen. It’s gonna be cold, and who knows how long we’ll be out there.” 

We grab our helmets, gloves, and jackets and head to the helicopter, a twin turbine BO105, just a few paces outside our crew quarters at the South Lake Tahoe airport. It’s early January: a clear, frigid day. Emma has twenty years of nursing under her belt and ten years’ working on the helicopter. She is moving on muscle memory, smooth and methodical. By contrast, I am barely three months into my dream job and feel as awkward and gangly as a baby giraffe. 

The pilot is already strapping into his seat. I climb in next to the pilot and secure myself, while my partner stands outside the bubble of the cockpit. Emma is waiting to do her outside prep after the pilot signals he’s ready to fire up the first engine. As usual, we’re responding to the call before we even have the details. It isn’t until after we lift and the pilot clears us from the airport airspace that my partner can communicate with dispatch. “Calcomm, Calstar 6 lifted. Ready for further.” 

“Calstar 6, you are responding for a female snowboarder under CPR. Your LZ (landing zone) will be Galaxy-run and your ground contact will be ski patrol on Calcord for LZ instructions.”

I’m writing the info on my dive board—a hard, plastic board secured with Velcro to the right thigh of my black flight suit—while Emma confirms. “Calcomm, Calstar 6 copies. Show us with an ETA of seven minutes to scene.” Then she looks over at me. “Okay, Jen. Here we go. If we’re landing up on the mountain, most likely this will be a trauma code. We’ll assess when we get there, but let’s be prepared for all of it. Got it?”

“Got it,” I hear myself say. Trauma code means the patient’s heartbeat and breathing has stopped due to blunt force injury. I slow my own breathing, trying to control the sudden spike of adrenaline—my own heart beating out of my chest. 

Okay. CPR, I tell myself. I’ve got this: Thirty compressions to two ventilations. Secure an airway, get IV-access, get her on the monitor and see if she has any inherent cardiac rhythm, blood pressure, oxygen content, blah, blah, and go from there. We got this. I got this. 

I’ve been a nurse for seven years by this point, six of them in the ER and one in a pediatric ICU. I’ve participated in countless codes in my career, following doctors’ orders to attempt to resuscitate patients in hospital. The difference here is that, as primary nurse in the field, I am running this code. What we do for this patient, all the decisions, will be my responsibility and under my direction. What’s more, flight nurses are allowed to perform advanced interventions: securing a definitive airway, decompressing an expanded chest with a large needle, surgically cutting into a patient’s neck to access an airway if necessary—and calling a death.

We are over the LZ in less than seven minutes and circling, all eyes out of the aircraft, scanning for overhead obstructions or other dangers. On the ski slope, below, I see the red parkas of ski patrollers on their knees doing the unmistakable work of chest compressions. 

The radio mic inside my helmet crackles. “Calstar 6, Heavenly Ski Patrol. We have you in our sights. The LZ is secure and ready for you to land.”

“Copy that, Ski Patrol. Show us on short final,” Emma responds, indicating our final approach. “Please keep this channel open and silent until we are safely on the ground.” She quickly changes the channel to update our dispatch team. 

“Door and belts?” the pilot says.

“Jen is good.” 

“Emma is good.” 

Thirty seconds later, skids firmly in snow, I climb down from the still-running aircraft, open the aft door, grab the trauma bag, and head to my patient. I see a female form lying on a hard backboard in the snow, a rigid cervical collar encircling her neck, her bright-pink jacket opened, and warm base layers cut down to expose her chest. Surrounding her are three ski patrollers, two on their hands and knees performing CPR—one of them communicating via handheld radio—and one more standing by to deal with bystanders. The CPR dance continues as I approach. Once I’ve moved beyond the deafening rotor wash of the aircraft, I remove my helmet and kneel down to receive one patroller’s report. The others continue CPR.

“Approximately thirties-female, high-speed tree strike. Unwitnessed and unknown down time. She was found by a skier passing by. Obvious, massive facial trauma. Unresponsive, pulseless, and apneic upon arrival. CPR initiated and AED applied. CPR in progress for approximately eight minutes with no shocks advised.” He is telling me that AED has detected no electrical activity in this woman’s heart. It has stopped, and she’s not breathing. And nobody knows how long she’s been lying here like this.

 I am trying to breathe through the pounding of my heart. With CPR already in progress, I know that I need to initiate ACLS—advanced cardiovascular life support. I look to my partner clutching the rest of our equipment. Emma looks back, waiting for me to take charge. “Okay,” I hear myself say. “You guys are doing great CPR. Please continue while we secure an airway and get IV-access.” Emma gets down on her knees, placing our pads on the patient’s chest to read her cardiac rhythm on our monitor. Because the patient has no blood pressure, we won’t be able to find a vein for IV-access. The alternative is to infuse fluids via the marrow cavity of a big bone, so my partner drills an intraosseous catheter into the tibia—the bone in her shin. That takes care of the IV line.

Meanwhile, I gather my airway equipment. My heart hammers harder with each piece of equipment I grab—the laryngoscope, with its folding, extended metal tongue depressor (the blade), allowing me to visualize the vocal cords and slide the breathing tube into place, the ETT (endotracheal tube), and the ETCO2 detector. This will be my first field intubation. Nausea grips me and my stomach begins to roil. The patient’s young face is unrecognizable, a bloody pulp with matte, auburn hair. Ski patrol has cleaned her up enough to make her mouth visible. I direct the team to stop compressions and insert the laryngoscope blade into her mouth to find her vocal cords—the gateway to her trachea and lungs. Blood immediately fills her mouth and a few teeth float to the surface. The smell of copper fills my nose and my stomach turns. I can’t see shit. Plus, my hands are shaking so badly I can barely hold the blade. 

“Suction, please!” I say to Emma , who’s read my mind and has the suction ready to go. She suctions and clears the patient’s airway while the ski patrollers do a few more compressions. I drop the blade back into her mouth. Though her airway is clear of blood, I can’t see the cords. I reposition the blade, attempting to get a better view. But I cannot stop my hands from shaking. I feel like I’m about to vomit out my heart. I know I need to be calm, but I can’t seem to get a hold of myself. 

I don’t want to waste any more precious time poking around in her mouth. I pull out, directing the team to resume compressions. Without a word, I hand the airway equipment to my partner. Emma easily passes the endotracheal tube on her first attempt. I am relieved—but also deeply disappointed in myself. A little part of me dies inside. But I don’t have time to revel in my shame. We still have lots of work to do. 

We have an airway secured, a line is in, drugs are being delivered per ACLS protocols, and CPR continues. Every time we pause to check the rhythm of the patient’s heart, the monitor shows no pulse. Her heart is in asystole. Flatlined. 

“What do you want to do, Jen?” Emma asks quietly. She is prodding me to be decisive. 

Shit! I don’t know! I am desperately racking my brain, trying to figure out what the hell I should be doing. We can’t just keep going with CPR on this ski slope forever. The team is looking to me to direct them. I feel like a fraud. Where the hell is the doctor? 

“This is your patient, Jen. What do you want to do?” 

It feels like Emma is trying to push me in the right direction. But I am so amped and so disappointed in myself for failing the airway that I am barely thinking about this code or the fact that I’m in charge. I’m trying not to go down the rabbit hole of shame and disappointment, because right now no one gives a shit about my shame and disappointment. They just want me to direct them like I should. I look to my partner, silently begging her to please just take over. She looks over at me, waiting.

Mentally, I run through my choices. We could load her up in the aircraft and fly her to the hospital. Somewhere in the periphery of my jumbled mind, a small voice is telling me it’s not a good idea to load a patient actively under CPR into the aircraft. We won’t have enough hands between the two of us to do effective CPR. Or . . . we can transfer her to the base of the mountain, rendezvous with a waiting ambulance and paramedics, who can assist with CPR, and go Code 3—lights and sirens—to hospital. 

I look to the ski patrollers. “Let’s sled her to the base so we can tie in with an ambulance.” The patroller nods and orders up a few snowmobiles. I catch my partner’s eye, hoping to get validation that I’m making the right decision. I cannot read Emma’s expression. I have no fucking clue what I’m doing. 

Emma charges back to the running helicopter to inform the pilot of the plan. He will fly to the hospital and meet us there. Moments later, two snowmobiles arrive. Carefully but quickly, we transfer our backboarded patient onto the back of the sled. One of the patrollers straddles the patient and continues CPR, while another is at her head, delivering breaths. 

I haven’t taken two steps away from the snowmobile to help Emma gather our equipment when I hear it throttle up. I turn around to see the tail end of the speeding sled carrying my patient turn a corner and disappear. My heart drops to my feet. I look at my partner and she looks back at me. 

SHIT!

I am responsible for this patient. That became a fact the moment Emma and I made contact, took over her care, and initiated advanced life support. Since she’s currently out of my sight and care, I’ve technically “abandoned” her. That can cost me my license. Now, I am really panicking. 

We climb onto the back of the other sled, telling the driver to “hit it,” and catch the other sled. I am freaking the fuck out. It never occurs to me to simply radio the other sled and tell them to stop so I can rejoin my patient. 

It takes eight minutes to get to the base of the mountain. An entire lifetime passes before me. I should be using this time for me—to catch my breath and get hold of myself. But I don’t. 

We come in hot, skidding to a stop at the base of the mountain where my patient is already being loaded into the back of a running ambulance. I think I catch a paramedic shaking his head in silent judgement. They hardly wait for us to join them, and then we are rolling to hospital, lights flashing and sirens blaring. Calm and quick—as if by rote—the medics secure the patient while continuing CPR and ACLS protocols. I’m relieved they’re here and happily step back. Officially, I am the highest medical authority in the back of this ambulance. But by now, we’ve established that I’m a fraud.

Of course, the incident took place at the highest point on the Nevada side of Heavenly Ski Resort, the absolute farthest distance by ground to hospital, which is midway through town on the California side. Even going with lights and sirens going, we are in for a minimum twenty-minute transport. 

 I watch the paramedics continue with CPR and wonder what the hell we are doing. This poor woman has been under CPR for over twenty minutes. Even if, by an act of God, we get a pulse back, her brain will not recover. 

Goddammit. 

The first glimpses of my bad decisions become evident and dread begins seeping into my body. 

As we approach the hospital, I look at the notes on my dive board, trying to gather my thoughts so I can at least give a decent report to the ER staff. We roll into the trauma room where the waiting team effortlessly slides the patient over to the gurney. The ER doc stands at the head of the bed, directs the team to continue their efforts, and looks straight at me, waiting for my report. I hear myself verbalize the MOI—the mechanism of injury—and all of the efforts we’ve made up to this point. 

And, there it is. In this moment, I realize how badly I have botched the call. We have no business in the ER. I should have called this death on the mountain. The doctor, cool and collected, tells the team to stop CPR. He looks at the flatline on the monitor, quickly summarizes the care up to this point, looks around to the team, and asks, “Does anyone have anything to add? Any suggestions?” 

Heads shake, a few people mutter, “No.” 

 “Time of death, 1510” the doctor states in a neutral voice. 

The next morning, following a well-deserved, much-needed debrief from my chief flight nurse and the oncoming shift of nurses, I drive home, going over in my head what happened, again and again, trying to make sense of my senseless actions. The patient most likely died the instant she hit the tree. Sudden resentment flares. Why did my partner let me carry on? Nothing we did or did not do, heroic or otherwise, was going to change the outcome. Then it occurs to me that maybe this was exactly why Emma let me keep going. To see if I would go down the right path. She knew I couldn’t hurt the patient anymore. You can’t kill dead. I cling to this tiny bit of knowledge like a drowning swimmer grabbing for a life raft.

In Emergency Medical Services, we have a saying about eating humble pie, which in its simplest terms means admitting you were wrong. Acknowledging your fallibility. It’s that kicked-in-the-stomach, I-want-to-crawl-under-a-rock-and-hide feeling. However, if we can get up and keep going, it allows us to be resilient. To grow in strength, both in mind and character. Humility can inspire us to be more empathetic and compassionate.

Fast forward nine years later, and I’ve retired from the flight line. While this call was my first trauma code, it was certainly not my last. It was a harsh and profoundly humbling lesson. But I did learn. I discovered that my role as transport professional was to bring calmness to chaos, not chaos to chaos. I learned to have a sense of urgency without panic. To move swiftly, methodically, and with purpose—not just fast. I learned that within my advanced skill set, repetition is the mother of all learning. And perhaps most importantly: there’s a time and place to fake it until you make it. 

Many calls and memories have resided with me throughout my nine beloved years as a flight nurse and beyond, some wonderful, and others, excruciating. Over the years, as I gained experience, wisdom, and confidence, I thought back to my first trauma code. What a bumbling rookie I was. I’ve also thought about how brutal I was on myself. 

Humility teaches us lessons we never unlearn. Humility says out loud for others to hear, “Wow. I really blew that. But it’s okay. That was dumb, but I’m not dumb and I won’t make that mistake again.” It allows us not to focus on the present situation but see the bigger picture. It teaches us that this too shall pass.  

That event at the top of Heavenly Ski Resort left me profoundly humbled. I didn’t just take a bite of the humble pie, I ate the whole damn thing. I needed to dig deeper to believe I could take charge on scene. I needed to prove I deserved to be there. 

That winter afternoon on the snowy slopes, my highly trained, flight-nurse mind and human heart were at war. For better or for worse, my heart won the war that day. 

And that’s okay.