{"product_id":"a-final-arc-of-sky-isbn-9780807073292","title":"A Final Arc of Sky","description":"A critical care and emergency flight nurse, Jennifer Culkin is no stranger to death and its dramas, or the urgency that accompanies them. Her memoir plunges us into the chaos of emergency medicine at all altitudes, masterfully reflecting on the most pivotal moments of our lives and the beautiful fragility of our mortality.\u003ci\u003eChapter One: \u003c\/i\u003eThe Shadow We Cast\u003cbr\u003e  \u003cbr\u003e \u003ci\u003eChapter Two: \u003c\/i\u003eA Hold on the Earth\u003cbr\u003e  \u003cbr\u003e \u003ci\u003eChapter Three: \u003c\/i\u003eOmens \u003cbr\u003e  \u003cbr\u003e \u003ci\u003eChapter Four: \u003c\/i\u003eSwimming in the Dark \u003cbr\u003e  \u003cbr\u003e \u003ci\u003eChapter Five: \u003c\/i\u003eSome Inner Planet \u003cbr\u003e  \u003cbr\u003e \u003ci\u003eChapter Six: \u003c\/i\u003eA Little Taste for the Edge \u003cbr\u003e  \u003cbr\u003e \u003ci\u003eChapter Seven: \u003c\/i\u003eA Few Beats of Black Wing \u003cbr\u003e  \u003cbr\u003e \u003ci\u003eChapter Eight: \u003c\/i\u003eLongview \u003cbr\u003e  \u003cbr\u003e \u003ci\u003eChapter Nine: \u003c\/i\u003eNew Worlds, Like Fractals \u003cbr\u003e  \u003cbr\u003e \u003ci\u003eChapter Ten: \u003c\/i\u003eTheories of the Universe \u003cbr\u003e  \u003cbr\u003e \u003ci\u003eChapter Eleven: \u003c\/i\u003eNight Vision \u003cbr\u003e  \u003cbr\u003e \u003ci\u003eChapter Twelve: \u003c\/i\u003eOut There in the DeepIn this compelling memoir, her moving reflections on life and death interweave clinical encounters with her own life. . . . Culkin sees herself and others clearly, and poetic juxtapositions make her sentences soar.—\u003ci\u003ePublishers Weekly\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e\"A marvelous writer, mixing tragedy and reflection with luminous prose . . . We are privileged to share her passion and heartbreak.\"—Marilyn Dahl, \u003ci\u003eShelf Talker\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e\"\"With its perfect capture of the fragility of life and our vulnerable human bodies and bonds, \u003ci\u003eA Final Arc of Sky\u003c\/i\u003e . . . is a disturbing, powerful read.\"—Lynda V. Mapes, \u003ci\u003eSeattle Times\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e\"Rarely have we heard from such an eloquent yet urgent voice from the front lines of mortality. . . . Culkin writes with elegiac grace and unblinking honesty.\"—Robin Hemley, author of \u003ci\u003eInvented Eden\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e\"Absorbing . . . This former neonatal and pediatric intensive-care nurse has vivid memories of the tiny patients whose lives were in her hands, and she writes of them with warmth and clarity. . . . Powerful and lucid . . . The risks of being an emergency flight nurse-night flights, bad weather, human error-come fully alive. . . . Enthralling.\"—\u003ci\u003eKirkus Reviews\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e\"With her electrifying scenes, her gorgeous sentences, and her provocative explorations of the borderland between life and death, Culkin engaged my heart, my intellect, my artistic sensibility, and my adrenaline.\"—Ann Pancake, author of \u003ci\u003eStrange as This Weather Has Been\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e\"I loved the stories, the language, the point of view, but what I loved most was the way this book was able to break my heart—then mend it.\"—Judith Kitchen, author of \u003ci\u003eDistance and Direction\u003c\/i\u003e\u003cb\u003eJennifer Culkin\u003c\/b\u003e, winner of a 2008 Rona Jaffe Foundation Award, is a writer and longtime neonatal, pediatric, and adult critical care nurse. A graduate of Russell Sage College and the Rainier Writing Workshop at Pacific Lutheran University, her work has appeared in many literary magazines and in \u003ci\u003eThe Jack Straw Writers Anthology 2006\u003c\/i\u003e.\u003cb\u003eChapter One: \u003c\/b\u003e\u003ci\u003eThe Shadow We Cast\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003eWhen I parked my car at ten minutes to nine that summer\u003cbr\u003e morning and dragged my helmet, flight bag, food, and laptop up\u003cbr\u003e the stairs at the southernmost of our four helicopter bases, the\u003cbr\u003e last dregs of predawn coolness still lingered in the air. I was in\u003cbr\u003e a good mood. I had just blasted the B-52’s \u003ci\u003eCosmic Thing \u003c\/i\u003eon my\u003cbr\u003e car stereo, playing my favorite tracks over and over like a fiveyear-\u003cbr\u003e old for the hour and a half it had taken me to commute to\u003cbr\u003e the base from home for a twenty-four-hour shift. The National\u003cbr\u003e Weather Service had predicted temperatures in the nineties, but\u003cbr\u003e the heat hadn’t yet begun to shimmer off the helipad back behind\u003cbr\u003e the fire station where we were quartered.\u003cbr\u003e  \u003cbr\u003e The fire station is tucked into a rural corner of a mediumsized\u003cbr\u003e suburban city, next to a county airfield, and the landscape\u003cbr\u003e around it was cleared of its native forest a long time ago. It’s as\u003cbr\u003e open as farmland in Kansas, dotted with Scotch broom, an invasive\u003cbr\u003e weed that is nevertheless lush with tiny yellow blooms each\u003cbr\u003e May. The sweep of the earth falls away to volcanic mountains\u003cbr\u003e in the distance, still snow-covered even in summer, and on my\u003cbr\u003e speed walks around the fire station for exercise I’d come to love\u003cbr\u003e it, in spite of the landfill that’s practically next door. I loved the\u003cbr\u003e light and space, the foothill feeling of the land as it runs imperceptibly\u003cbr\u003e up toward the mountains.\u003cbr\u003e  \u003cbr\u003e The day felt pregnant, though—that occupational precognition\u003cbr\u003e I’ve come to trust and dread. It’s a feeling with a dart of\u003cbr\u003e fatalism in it, a blind, nonnegotiable foreknowledge, and I’ve\u003cbr\u003e learned the hard way that it’s pretty accurate. Not 100 percent\u003cbr\u003e infallible, but up there. Whenever the feeling comes on me, I\u003cbr\u003e think of the animals who head to high ground before a tsunami,\u003cbr\u003e whose nervous systems seem to warn them of earthquakes and\u003cbr\u003e floods. Rats deserting a sinking ship.\u003cbr\u003e  \u003cbr\u003e It was also a Friday in high summer, so no shit, Sherlock,\u003cbr\u003e of course we’d be busy. We could look forward to office workers\u003cbr\u003e ordering margaritas at outside tables in the hot afternoon\u003cbr\u003e and driving home wasted in the dusk. Guys with huge guts and\u003cbr\u003e crap in their coronary arteries pushing their lawn mowers in the\u003cbr\u003e heat around their acre-and-a-half yards. Stoic eighty-year-old\u003cbr\u003e Scandinavians deciding it was time to climb their twenty-foot\u003cbr\u003e ladders and clean the old moss off their roofs.\u003cbr\u003e  \u003cbr\u003e Jason was my partner. We chatted with the off-going crew,\u003cbr\u003e lingering over our coffee in the sturdy firehouse kitchen. Eventually\u003cbr\u003e we strolled out into the fine summer sunlight, across a\u003cbr\u003e short expanse of pavement, and under the main rotor to check\u003cbr\u003e the helicopter and our medical bags for completeness and readiness.\u003cbr\u003e Everything looked good. No blood splatters on anything,\u003cbr\u003e maybe just a couple of small things missing, and we replaced\u003cbr\u003e them. At the time, I had been a flight nurse for about three and\u003cbr\u003e a half years. Jason had just transferred from another base; I’d\u003cbr\u003e met him and talked to him at meetings, but we hadn’t flown\u003cbr\u003e together before. He was our youngest flight nurse, about fifteen\u003cbr\u003e years younger than me, which is to say he was fifteen years\u003cbr\u003e younger than most of us, a thing he was teased about occasionally.\u003cbr\u003e He was short and compact, bespectacled, analytical and\u003cbr\u003e smart, calm. We finished our checklists and went into the office\u003cbr\u003e to fax our supply requests to the main base.\u003cbr\u003e  \u003cbr\u003e Jason put his feet up on the desk and said it was almost a year\u003cbr\u003e to the day since he’d started with our outfit. “My first flight,”\u003cbr\u003e he said, chuckling, “was CPR in progress for thirty minutes in\u003cbr\u003e the aircraft.”\u003cbr\u003e \u003ci\u003e \u003c\/i\u003e\u003cbr\u003e “Ouch! Was it trauma?”\u003cbr\u003e  \u003cbr\u003e “Yup. A rollover on the freeway. It was . . . stressful.”\u003cbr\u003e  \u003cbr\u003e “Was CPR already in progress when you took over the care\u003cbr\u003e of the patient?”\u003cbr\u003e  \u003cbr\u003e “Yup.”\u003cbr\u003e  \u003cbr\u003e “Hah! That is stressful, especially for a first flight,” I said,\u003cbr\u003e picturing it and laughing a little. On your first-ever flight, the\u003cbr\u003e rush of foreign sensations—the vibration, the roar, the cramped\u003cbr\u003e quarters, the whizzing landscape—makes the simple act of strapping\u003cbr\u003e yourself in to the helicopter enough of a challenge.\u003cbr\u003e  \u003cbr\u003e “But to my mind it’s not the most stressful situation,” I\u003cbr\u003e added. “I mean, when you get trauma patients with CPR in\u003cbr\u003e progress, yes, it’s an exercise in doing everything possible, but\u003cbr\u003e they’re basically dead already. You can’t hurt ’em.”\u003cbr\u003e At that point, I was thinking of a physician friend, my own\u003cbr\u003e gastroenterologist. I see him for gastroesophageal reflux—\u003cbr\u003e chronic heartburn, and who knows whether it’s because of genetics,\u003cbr\u003e the two ten-pound babies I’ve borne that mashed my\u003cbr\u003e insides to a pulp, or this job. He told me once that when he’d\u003cbr\u003e first started out in medicine, he was scared to take care of really\u003cbr\u003e sick—critical—patients.\u003cbr\u003e  \u003cbr\u003e “But then I realized,” he’d confided, grinning a little, “that\u003cbr\u003e they only get \u003ci\u003eso \u003c\/i\u003esick, and then they die.”\u003cbr\u003e  \u003cbr\u003e Yeah.\u003cbr\u003e  \u003cbr\u003e “The \u003ci\u003emost \u003c\/i\u003estressful situation,” I mused aloud to Jason, “is\u003cbr\u003e when they’re lying there talking to you and \u003ci\u003ethen \u003c\/i\u003ethey code. The\u003cbr\u003e ones who roll back their eyes and die right there.”\u003cbr\u003e I can’t remember if I mentioned to Jason that it was a situation\u003cbr\u003e that had never yet happened to me in flight, but it hadn’t.\u003cbr\u003e And for all my years of experience on the ground and in the air,\u003cbr\u003e I didn’t know how well I would acquit myself if it did.\u003cbr\u003e I must have temporarily lost my mind, saying such a thing\u003cbr\u003e with that fatalism sitting like a stone in my stomach, with the\u003cbr\u003e twenty-four-hour day so early in gestation and our flight suits\u003cbr\u003e so clean, with the caffeine of the morning coffee still running in\u003cbr\u003e our veins. Saying such a thing on a Friday in summer.\u003cbr\u003e Jason snorted. The harsh fluorescent light on the office\u003cbr\u003e ceiling flashed off his stylish little glasses, and I couldn’t tell\u003cbr\u003e what he was thinking. It was probably something like \u003ci\u003eNow she’s\u003c\/i\u003e\u003cbr\u003e \u003ci\u003ecooked our goose. \u003c\/i\u003e“Well, yeah,” he said. “No question about it.\u003cbr\u003e That would be the worst.”\u003cbr\u003e  \u003cbr\u003e It was early afternoon when the pager shrieked for the first\u003cbr\u003e flight of the day. We kicked off our sandals and zipped up our\u003cbr\u003e boots and our flight suits, and off we went to a small community\u003cbr\u003e hospital, a thirty-minute flight toward the coast, over open valleys\u003cbr\u003e and rivers winking like bottle caps in the hot noonday sun.\u003cbr\u003e Brad, our pilot, dropped the aircraft down light and easy onto\u003cbr\u003e the helipad, and Jason and I slid our stretcher, bags, and monitor\u003cbr\u003e out onto a gurney. We trucked the whole thing in through the\u003cbr\u003e emergency department door and up to the ICU on the second\u003cbr\u003e floor.\u003cbr\u003e  \u003cbr\u003e Our patient was Doug. He was forty-six years old, with\u003cbr\u003e esophageal cancer and an upper gastrointestinal hemorrhage,\u003cbr\u003e and we were transporting him to an oncology referral center,\u003cbr\u003e where they had more resources to deal with his problems. His\u003cbr\u003e esophagus, which transports food from the mouth to the stomach,\u003cbr\u003e had a large tumor on it, and he had been receiving chemotherapy\u003cbr\u003e and radiation to debulk it, to shrink it enough so that a\u003cbr\u003e surgeon would have a shot at removing it. Apparently, a blood\u003cbr\u003e vessel in that region had eroded earlier that morning. It had\u003cbr\u003e gouted large amounts of blood.\u003cbr\u003e  \u003cbr\u003e A hematocrit measures the percentage of the volume of red\u003cbr\u003e blood cells in the total volume of blood and is used as quick\u003cbr\u003e guide to how much blood has been lost and how well it’s being\u003cbr\u003e replaced. A normal crit is about 40 percent. After he started\u003cbr\u003e vomiting blood, Doug had an initial crit of 17 percent. He had\u003cbr\u003e received five units of packed red blood cells and other blood\u003cbr\u003e products since that measurement had been taken, but there\u003cbr\u003e hadn’t been a repeat crit. He had not vomited any blood recently,\u003cbr\u003e and he came with a tube that had been surgically placed\u003cbr\u003e in his stomach through his abdominal wall—there wasn’t much\u003cbr\u003e output from that, either. We could assume that the bleeding\u003cbr\u003e vessel had clotted off. For the moment.\u003cbr\u003e He had other problems too. A collection of straw-colored\u003cbr\u003e fluid between his left lung and the pleura, the covering around\u003cbr\u003e his lung: a pleural effusion caused by impaired lymphatic drainage\u003cbr\u003e secondary to his tumor. The ICU staff had just drained\u003cbr\u003e 520cc—more than two cups, quite a bit. I hoped it wouldn’t\u003cbr\u003e reaccumulate too quickly. He also had a small pneumothorax of\u003cbr\u003e the right lung. This was a collection of air between the pleura\u003cbr\u003e and the lung. The problem for us was Boyle’s law: air expands\u003cbr\u003e at altitude, and aloft a small pneumothorax can become a large\u003cbr\u003e pneumothorax, collapsing the lung and, if it’s big enough, compressing\u003cbr\u003e the heart and the great vessels that transport blood\u003cbr\u003e into and out of the heart. In an ICU, a big pneumo would buy\u003cbr\u003e the patient a chest tube so air could drain continuously. At altitude,\u003cbr\u003e if it became a problem, Jason and I would temporarily\u003cbr\u003e treat the pneumo with a flutter valve—a large-bore, sharp steel\u003cbr\u003e needle that had been sterilized with a disposable-glove finger\u003cbr\u003e rubber-banded to the hub. The glove finger acts as a one-way\u003cbr\u003e valve. We’d stick the needle through his chest wall, into the\u003cbr\u003e space between the second and third rib, and it would allow air\u003cbr\u003e to escape.","brand":"Beacon Press","offers":[{"title":"Default Title","offer_id":46304761643237,"sku":"NP9780807073292","price":16.0,"currency_code":"USD","in_stock":false}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/1842\/7735\/files\/9780807073292.jpg?v=1767720463","url":"https:\/\/k12savings.com\/products\/a-final-arc-of-sky-isbn-9780807073292","provider":"K12savings","version":"1.0","type":"link"}