Corpsman Chronicles VIII: Every Breath You Take

What's the difference between a fairy tale and a sea-story? A fairy tale begins, "Once upon a time..." A sea story begins, "This is no shit!"

I try to be careful to change names, but to the best of my recollection the events and locations are substantially correct. Of course I can only describe events from my perspective, so there's that. Readers who were present will doubtless have different recollections of any particular event. This is what it was like to serve in my tiny slice of the U.S. Navy between the late 1970's and early 1990's. It really was an adventure.

Remember,

This is no shit!

##########

A couple of days ago I wrote about the great solar eclipse of 1994.

This happened in 1983, and my phone tells me that was something like 38 years ago. WTF?



It's been a challenge to recover some of the details. It seemed like a really big deal at the time, and in a lot of ways it was, yet many of the details have become fuzzy over the years.

I wonder why that is? I don't have a good answer. Ah well.

##########

The Carrier Navy of the 1980's was rather a unique beast. Our mission was to fight the ship and airwing at the direction of National Command Authority, and our enemy during this very nearly hot war was the Warsaw Pact. That mission came first, and if it meant going toe-to-toe with the rooskies in an all-out nuclear war, we would do it.



A carrier battle group is a complex organism, and its heart is the sailors and Marines who man the ships. As hard as it may be for civilians to understand -- civilians who only see uniformity and discipline in the military -- the navy actually sees (or at least saw at the time) sailors as individual human beings rather than as parts. It values those human beings greatly.

When people get sick or become injured, medical is there. In the absence of actual war, preserving life comes ahead of everything else, and the ship, airwing, crew, and the whole U.S. Navy support system will mobilize incredible resources to save a life. Airman or Admiral, rank makes no difference.

##########

Just before my Mom had hip surgery in February I was talking to the gas-passer. He was curious about my rather advanced level of medical knowledge which prompted me to explain my naval background as a SAR Corpsman/Paramedic. He said he couldn't imagine working in the field, away from the comfort, predictability, and resource-rich environment of the hospital. Naturally, I had to share a bit of a sea story.

"So there I was," I said, "middle of a medevac with an intubated and chemically paralyzed patient, in the back of a C-2, 30 minutes after my first cat shot, when we lost a motor, dumped cabin pressure, and I lost the airway."

"Yeah, got a little sporty there for a while," I said.

##########


USS Boat, 0650, underway northwest of Souda Bay, Crete.

A very sick sailor wobbles into a compartment just below the flight deck and collapses. While shipmates rush to help him, a Master Chief lifts the phone and calls the bridge.

Bridge, 0655.

Having taken down the pertinent information, the Junior Officer of the Deck (JOOD) nods to the Boatswain's Mate of the Watch (BMOW), who clicks on the 1 MC ship-wide announcing system.

"DING-DING-DING-DING-DING-DING-DING-DING-DING! MEDICAL EMERGENCY, MEDICAL EMERGENCY, MEDICAL EMERGENCY! MEDICAL EMERGENCY IN COMPARTMENT OH-THREE, TACK TWO-TWO-OH, TACK TWO, TACK CHARLIE. VF-17 MAINTENANCE CONTROL. AWAY THE MEDICAL RESPONSE TEAM AWAY!"

Flight Deck Battle Dressing Station

When the medical emergency sounded, I was writing up the overnight log. I was not playing video games, such games having yet to be invented.

FDBDS USS Stennis. Can you believe these knotheads have video games?

As the senior night check flight deck corpsman on this deployment, I was also an airwinger, assigned to one of the Carrier Airwing fighter squadrons. On deployment I was TAD (Temporary Assigned Duty) to H Division, the ship's medical department. As an Aerospace Medicine Technician (AVT) and paramedic and the owner of a set of flight deck quals, medical had assigned me to the BDS, to "work the roof." My primary job on the flight deck was to act as a safety observer, monitor the health of flight deck personnel, and provide and coordinate immediate emergency medical aid as needed.

In the early morning hours the roof was quiet. Flight quarters had been secured at about 0300 and the Air Plan didn't anticipate any flying until the first go at 0900. I noted with pleasure that there was a VR-24 C-2A COD scheduled to arrive after the first launch. Mail! As I scribbled in the logbook, my fellow night check roof rat, Mark, was fast asleep in the corner of the BDS, curled up in a ratty, grayish-beige woolen blanket.

Then came the click and hiss from the speaker on the bulkhead, followed by the clanging of the bell. Within moments I'd grabbed up my unit one (aid bag) and charged out of the BDS. I wasn't part of the medical response team (MRT), who were standing duty down in main medical. I was a lot closer to the emergency though, in both time and space. The MRT had to muster and gear up, then go up four decks and aft about 250 yards. It would take them about five minutes to arrive at the scene. From the BDS I could be on the scene in 20-25 seconds. Down one ladder, then aft about 75 yards.

Strictly speaking, I wasn't supposed to leave the BDS, but rules are for guidance rather than compliance (hey, I belonged to a Fighter Squadron). Flight ops were presently secured and not scheduled to begin for a couple of hours. Mark would remain behind in the BDS, maintaining qualified medical coverage.

In a medical emergency, seconds can make all the difference. The MRT's five minute response could be four minutes too late.

The route

I flew down the ladder and turned inboard, slammed my way through a hatch, turned aft and sprinted down the starboard side 03 passageway, neatly leaping through knee knockers and bellowing "MAKE A HOLE!!!"

03 passageway and knee knockers. S

All along the passageway ahead of me officers, Chiefs and sailors "grabbed paint," hugging the passageway bulkheads as I pounded past. One part of my mind, the goofy, big kid part, thought about how cool it was to have the authority to run flat out down the passageway, shouting at the top of my voice, literally ordering both seniors and juniors to yield and give way.

The analytical, grownup part of my mind was very concerned. The time and location worried me. Oh-seven-hundred and Maintenance Control had "old-fat-chief-heart-attack" written all over it. We'd lost a Grumman Tech Rep to an 0700 heart attack in the wardroom only a few weeks before. And VF-17 was my squadron, so whoever was in distress was a member of my tribe and probably a friend.

I juked inboard at Ready Eight, blasting through the door and sprinting down the short aisle between the seats and heading for the door to Maintenance Control at the other end of the compartment. Along the way I sent the XO staggering one way and his coffee flying the other. "'Scuse me, XO!" The analytical and goofy parts of my mind teamed up here and agreed. "Uh-oh, I am sooooo firetrucked!"

Maintenance Control

No time for that, though. Through the inboard ready room door and into Maintenance.

VF-17 Maintenance Control. Maintenance Control Officer at the counter.

A quick left behind the counter where a very concerned crowd was gathered in a very tight space. On the floor, the crumpled form of a young man in underwear, slowly turning blue.

I elbowed several khakis aside and dropped to my knees next to the crumpled sailor. Time slowed down.

There's an old saying in trauma medicine. "In a medical emergency, take your own pulse first." It sounds counterintuitive. Time is of the essence, right? The point isn't to literally take your own pulse, though you can if it helps. The point is to take your time and do things purposefully and correctly. There's enough time, but there isn't an abundance of time. Don't squander what you have by flailing around.

Fortunately, the rules for this kind of situation -- an unresponsive patient -- are dead simple. Assess the ABC's first. Airway, breathing, circulation. If the patient is moving air in and out, A and B are covered. If his heart is beating and he isn't bleeding out, that's your C. The full set is good and means you've got the gift of a little more time.

Unfortunately, this guy wasn't moving any air and his lips were turning blue. A quick jaw thrust opened his airway and he started breathing. I slid my fingers down to his neck and felt a strong carotid pulse. Okay. Airway - open. Breathing - spontaneous and steady. Circulation - strong, steady pulse, pretty rapid, but otherwise normal. No bleeding. Relief.

"What happened?" I asked, as I continued my exam. Pupils equal, reacting sluggishly to light. No obvious trauma. Knuckle dig in the sternum elicits no reaction.

The sailor, who worked in Maintenance, had come up from his berthing compartment wrapped in a blanket and shivering, said he was really sick, then collapsed. Right now he was burning up with fever. His breathing was rather labored and sounded rough. His eyes fluttered open and he started to come around. Things were looking up.

"How ya doin', Grease?"

Grease had an unpronounceable (and pretty much unspellable) eastern European name. It didn't sound anything like "grease" but that's the name that stuck to him and to which he answered. He was an E-3 in one of the aviation paper pushing rates; iirc, he was an AZ (therefore properly an AZAN). 

He looked around at all the people standing over him, confusion written large across his face. Then his eyes rolled back, his jaw clamped tight and his spine arched as he began to have a seizure.

"Help him, Doc!," shouted the Maintenance Master Chief.

"Relax, everybody," I said. "He's having a seizure, it'll pass. Looks worse than it is. I turned to the Master Chief, who was rummaging in his desk drawer.

"Somebody call medical and give 'em his name so they can pull his chart. And tell 'em I said he's having a seizure."

The Master Chief grunted with satisfaction and produced a large, shiny tablespoon from the depths of his desk drawer and looked at me with triumph. Everybody (everyone who went to grade school in the 50's and 60's, anyway) knows that the first thing you do with a seizure patient is stick a spoon in their mouth to prevent them from swallowing their tongue.

I glared at the Master Chief and mimed phone call. He put the spoon away, and wearing the expression of a kicked puppy, reached for the phone.

I carefully rolled the sailor on his side and kept his airway open. He was obviously very sick, but what, exactly, was going on? Was this a simple febrile seizure? Could be, but that didn't really make sense. Some kind of poisoning? Overdose? Brain lesion? The seizure began to ease as the MRT showed up and took charge. I briefed the duty doc who decided to relocate Grease to sickbay most rikki-tik.

As the squadron corpsman, I needed to get to sickbay myself so I could monitor the situation and pass on the gouge to the SDO, or squadron duty officer. I turned to head back toward the BDS to turn over the watch. I had a hunch this would turn into a medevac so I'd swing by the paraloft on my way and grab my flight gear. As I exited Maintenance and entered the ready room, the XO and Skipper were huddled in their front row ready room seats. The XO had a big coffee stain down the front of his khakis. Ruh-roh. He waved me over.

"What can you tell us, Doc?" asked the Skipper.

I gave them a quick rundown, promised to report more from medical, and, desperate to escape the XO's certain wrath, started edging toward the door at the back of the ready room. "Gotta grab my flight gear, we may need to medevac him."

The XO, eyes shining with intensity, grabbed my hand and pumped it vigorously. "Damn fine job, Doc, DAMN fine. You were here before they finished calling it away. Just out-FIRETUCKING-standing!"

My surprise must have been evident (there may have been drool running down my chin from my gaping mouth), because the Skipper grinned and shook his head. These were the guys who had viciously flayed me at XOI and Captain's Mast a few months earlier following an, um, indiscretion. Not that I hadn't deserved it.

Ah well. How did Lefty Gomez put it? I'd rather be lucky than good. Something like that.

Sickbay

I arrived in sickbay only a couple of minutes behind the MRT and patient. It takes time, skills, specialized stretchers and plenty of belaying line to move an unconscious man around inside the boat.

When I walked into the treatment room things weren't exactly peachy-keen. There was a bit of a kerfuffle developing. The ship's medical officer, LCDR Smith (alias), and the ship's nurse anesthetist, LT Jones (alias) were waiting impatiently for the senior airwing flight surgeon, CDR Portly (alias) to start an IV on the ailing patient. At a glance I could tell there was about to be an explosion.

A word about medical department manning. There were about 40 enlisted corpsmen in H-DIV, ranging from Senior Chief (E-8) to Hospitalman Apprentice (HA/E-2).These fellows were permanently assigned to the ship, or "ship's company." When the ship and airwing deployed, the airwing brought another nine corpsmen to the party, one from each squadron. 

As for ship's company medical officers, there were six. The SMO, or senior medical officer, was a Captain (O-6) and qualified flight surgeon. The medical officer, LCDR Smith, was essentially the ship's general practice guy. LCDR Sharp (alias) was ship's surgeon. These three physicians were Medical Corps officers.

LT Jones, being a nurse, was a Nurse Corps officer.

LTJG Twig was the medical service corps officer (medical administration). Looking at the corps insignia, can you guess why Twigs are called twigs?

A CWO4 (Chief Warrant Officer) served as Physician's Assistant.

On deployment the airwing added a pair of flight surgeons, the aforementioned CDR Portly and LT Boston (Baahhston, and you guessed it, alias).

Now typically, the ship's medical department personnel and airwing medical personnel would have formed a strong working relationship during pre-deployment workups. This had in fact happened, however, a couple of last minute changes before deployment had thrown a bit of a wrench in the works. LCDR Smith was new, and so was CDR Portly. Smith should properly have been in charge of the situation, but was outranked by Portly, who was, to be charitable, a bit of a plodder.

Smith should have kicked Portly out of the treatment room and got on with treating the casualty. But that hadn't happened, and while Smith and Jones' faces turned crimson and blood vessels began to throb on their foreheads, Portly was gently slapping the back of the unresponsive sailor's hand trying to raise a vein in which to insert a pediatric 22 ga IV catheter. He'd obviously been trained in IV's via the Navy Nurse method.

The situation was badly firetrucked on a number of levels. In trauma medicine expertise trumps rank. The patient's welfare trumps hierarchy, privilege, and feelings. This particular patient was extraordinarily ill, and it was imperative to gain proper access to a vein. Proper access in this situation would be a large bore IV, something on the order of 14 ga rather than a dinky little 22 ga.

14, 16, 18, 20, 22, and 24 ga IV catheter sets. S

A catheter that'll stay put and stay in place, and one that you can pump lots of fluid or even whole blood through if needs be. Portly deserved a swift boot in the arse for richarding around with something he wasn't qualified to do, but that wasn't my call or my place.

Sigh. It's the burden of the enlisted. We really have no choice but to make do with what congress sends us. As a lowly enlisted swine, I couldn't provide direction. 

I could, however, intervene.

"CDR Portly," I said, "Skipper Darth (yep, alias) would like to be briefed (big hairy lie). I can start that IV for you. Skipper's in Ready Eight."

"Ah, yes," said Portly, pleased to be offered a chance to climb out of the hole he was just beginning to realize he'd dug. "I'll brief Commander Darth. I'll do it in person."

I rather rudely snatched to 22 ga angiocath out of Portly's hand as I elbowed him aside, flung the little kiddie needle toward the shitcan, and gave my fellow airwing corpsman Frank VanNoske (real name, great guy, RIP Ski) the international sign for "gimme a real firetrucking angiocath, please." Frank grinned and flipped me a 14 ga.

Blood pressures began to fall in the treatment room.

Zen and the art of peripheral percutaneous vascular catheterization

There are a lot of great sayings out there. "Take your own pulse first" is a good example, as is "see it, do it."

When I was first starting out as a corpsman, I had a terrible time with IV's. Firstly, I'd been trained by navy nurses, whose universal approach seemed to be "start at the hand and work your way up the arm." Among many other shortfalls, this approach presupposes that you're going to miss several times. I also eventually found that in addition to poor technique, I had a major lack of confidence. A senior corpsman finally set me upon the path of righteousness. "Don't do that nurse shit, man, just find a good vein, then see it, do it." His trick was to mentally visualize success. He didn't just shove the needle in and hope for the best. In his mind's eye he would watch himself successfully starting the IV. Then he'd start it. He knew it would work, because he'd just seen it work. See it, do it. Jedi mind trick? Hey, the force is strong, baby.

I quickly shifted the tourniquet from where CDR Portly had placed it on Grease's forearm to just above his elbow. The tourniquet had been hiding a big, fat venous bifurcation, the perfect place to stick an IV. I swabbed the skin with alcohol, palpated the vein, and removed the guard from the angiocath. Using the tip of the scalpel-sharp needle, I flicked a tiny two millimeter incision in the skin at exactly the right place, just as my mind's eye directed. I used my left thumb to pull the skin taut, and with my right hand deftly slipped the needle and catheter through the incision and into the "crotch" where one large vein divided into a pair of smaller veins. I slid the catheter forward, then pulled the needle out, leaving the catheter behind in the vein, and quickly plugged in the IV set. Ski fed me strips of tape and the IV was quickly secured and flowing. Easy-peasy, lemon-squeezy.

Multitasking

I'm sure I just gave the impression that everyone in the treatment room was standing around with their thumbs up their backsides, waiting for the supercorpsman to sort things out.

This was not the case at all. The little IV drama was just a few spatters of paint on a large, richly colored canvas. There was a hell of a lot of medicine going on. And medicine -- real medicine as practiced by real healers -- is both art and science.

Even while the Portly logjam was in effect, the treatment room team was busy taking vital signs, examining the patient, discussing and assessing and rediscussing and reassessing in an effort to figure out the cause of Grease's malady and find a way to fix it. It was a real beehive of activity.

Grease was, at the moment, pretty much unconscious. He was experiencing a string of seizures or perhaps one long seizure. He had a pretty high fever; somewhere north of 104 if I remember correctly. His heart was hammering away at 160 beats per minute and his breathing, when not affected by seizure activity, was rapid and shallow.

In emergency medicine there's a fairly simple hierarchy of treatment, where life threatening conditions are addressed first. Compromise of airway, breathing and circulation come first, because those kind of problems will kill a human in only a few minutes. 

Seizure activity is pretty high on the list of life threatening conditions. Seizures always cause some level of brain damage, and a severe seizure can actually destroy the brain. That's extremely life threatening. In the 1980's, medicine didn't have much in its tool box that could directly stop seizure activity in the brain. Flash forward to 2016 and this is still pretty much the case. Leaving the brain aside for the moment, seizures can cause other major, potentially fatal problems. Loss of airway, respiratory arrest, heart dysrhythmia, stroke.

In order to protect the airway, reduce stress on the heart, and stop the rampant, widespread and powerful muscle spasms caused by the seizure, the treatment was to decouple the brain from the body via chemical paralysis. The drug we used back in the 1980's was vecuronium. It's a stopgap, emergency treatment. It works fairly well to control the worst physical aspects of seizure activity, but it doesn't fix the underlying neurological problem. It's only a bandaid, and it has some downsides. Most significantly, chemical paralytics cause all the muscles, including the diaphragm, to stop working, which means breathing stops. Also, muscle tone throughout the body is relaxed. The airway muscles stop working and can no longer automatically protect the trachea and lungs from "the wrong stuff going down the wrong hole." Similarly, GI muscles relax, potentially allowing (pretty much insuring) gut contents to flow out of the body. This is unpleasant at the distal end of the GI tract, but at the proximal end stomach contents can flow up the esophagus and then down the unprotected airway. That's bad ju-ju.

Fortunately, there's an app for that. The airway is secured with an endotracheal tube, a plastic tube with a flexible, inflatable cuff. The tube is inserted through the mouth and into the trachea. The cuff is inflated, holding the tube in place and preventing gut contents or other foreign substances from invading the lungs. The proximal end of the tube has a fitting universally sized to attach to ventilating equipment. Once in place and connected the endotracheal tube allows for mechanical ventilation, where machines and/or people do the breathing for the patient. This information will be on the test.

In a well choreographed maneuver, LCDR Smith administered a dose of vec and Lt Jones deftly inserted the endotracheal tube and connected to to the anesthesia machine. This machine was an interesting device, designed to deliver various gas mixtures to the patient's respiratory system. It was equipped with oxygen of course, as well as various anesthetic gasses. It had a ventilator designed to mechanically breathe for the patient which could be calibrated to deliver extremely precise volumes and mixtures of gas.

In the line between the ventilator and the patient there was a black, football sized and shaped breathing bag. At the distal or patient end it had a fitting which would mate with the standardized fittings of oxygen masks and endotracheal tubes. At the proximal end it had an inlet valve which could be fitted either to the anesthesia machine or to standard oxygen tubing. The inlet valve had a one-way check valve. As gas flowed through the system it kept the bag filled. The filled bag was a reservoir of gas which could be delivered to the patient with a simple squeeze, and which automatically refilled so long as there was gas flowing in the system. This will also be on the test.

Anesthesia breather bag. S

An anesthesia breather bag is similar to an ambu bag, but it lacks the ambu bag's ability to self-inflate. The ambu bag, too, looks like a football, and has the same valves and fittings on each end. Modern ambu bags are constructed of a molded polymer material which returns to shape after being deformed. Back in the 80's ambu bags had an internal spring structure which forced the bag back into shape after each squeeze. In both styles the check valve allows air to flow into the bag as it returns to shape.

Ambu bag, more properly Bag valve Mask. S

The major and important difference between the breather bag and the ambu bag is that the breather bag will only fill when supplied gas is flowing from a machine or an oxygen cylinder. The ambu bag will fill itself from room air. Guess which one you would prefer to have when working in the field with limited supplies?

The plan

While supercorpsman was throwin' it down, unseen but critically important stuff was happening. The physicians had hashed out the probable diagnosis and were working on a plan with the SMO and the Twig.

The symptoms Grease was displaying were rather equally consistent with two broad possibilities. On the one hand he could be suffering from simple febrile seizure activity as the result of spiking a high fever in the course of an otherwise non-life threatening illness. On the other hand, he could be suffering from a very serious and potentially fatal problem, such as meningitis, acute adrenal-cortical failure, systemic bacterial sepsis, brain tumor, or something equally bad. There were no clear cut, pathognomonic signs or symptoms pointing to a particular diagnosis, but most of us were leaning toward meningitis. 

If the problem was simple and non-life threatening, the medical department was well equipped to provide treatment. If the problem was complex and life threatening, the ship could in theory handle the situation, but it would be better for all concerned to move the patient to a larger and more capable hospital ashore.

That hospital would be the Naval Hospital at Sigonella, Sicily.

The ship's present location was a bit of a problem, because we were beyond helo range. Not an insurmountable problem though, particularly since, by this time, the scheduled COD was overhead. The very thing!

I was a helo guy, but that didn't mean I didn't want to collect a cat shot and a trap. Of course I did. Everybody wants a cat shot and a trap. My grandma wanted a cat and a trap. In the future, which I couldn't quite grasp (it not having happened yet), I'd get plenty of both.

But I didn't really want anything to do with the C-2. Maybe because of this.


I didn't have any real choice though. As the Ship/Airwing's only trained medevac corpsman, it was my job. I wasn't all that worried anyway. Not really. The C-2 had a marvelous safety record and was a sturdy Grumman through and through. The crews were top notch. 

The Twig popped his head in the treatment room and said we were go. Having dragged my flight gear down from that paraloft it was the work of two minutes to don the proper attire. I stripped and changed right there in the treatment room. Flight suit and flight boots, LPA/SV2, gloves and helmet. No wetsuit or dry suit! It was summertime, and the weather (water temp) was fine...

While I was changing the skilled treatment room corpsmen bundled Grease for transport. They wrapped him in warm wool blankets and placed him in a stokes litter along with a big portable oxygen cylinder and the LifePak V heart monitor/defibrillator. Deft hands secured four web straps to keep Grease and all the medical impedimenta in place. I accepted a handful of meds from LT Jones and stuffed them in a leg pocket. As the stretcher bearers showed up I  grabbed a couple of underemployed junior corpsmen and had them drag the big medevac bag up to the BDS. I thought about adding a spare oxygen cylinder but decided against it. You can only carry and manipulate so much stuff, and a spare O2 tank would almost certainly go unused. In that case it would just be another heavy object that the C-2 crew would have to find a place to tie down for the cat shot. Besides, I couldn't imagine that having spare oxygen would be critical. That'll be on the test.

I accepted and pocketed a handful of paperwork from LT Twig and some last minute reminders, tips and encouragement from LCDR Smith. "Arright, let's go," I said as I took the breather bag from LT Jones and began breathing for Grease. From this moment until I delivered him to the care of Sig's medical department he was my responsibility, and I literally held his life in my hands.

We made our way out of medical to the aft mess deck where Grease and I caught a bomb elevator to the flight deck. A second relay of stretcher bearers clad in flight deck gear met us there and whisked the Stokes around the front of the island and into the belly of the COD, which was parked and turning in the Six Pack.

This wasn't the first medevac rodeo for the C-2 crewmen. They grabbed the Stokes and carried Grease and all the medical impedimenta all the way forward in the cabin, dragging me along at the end of the endotracheal tether that connected corpsman and patient.

Interior of the C-2A Greyhound, looking forward from the ramp. Grease's stretcher was secured all the way foreward on the deck, attached to the two vertical beams with web straps and carabiners.

This was my first time in a C-2, but I didn't have a lot of spare time to gawk. It was dim inside compared to the bright sunshine outside, but my eyes quickly adjusted to the light conditions. What I saw was a cramped tube with a very low overhead. Big nylon bags filled that low overhead, and I recognized them as life raft containers. There were also a pair of tiny-looking escape hatches in the overhead. I gave them a quick glance and assigned an underused part of my brain to memorize their location. If we went in the water and survived the ditching one of those tiny holes would be my exit. If such an event happened I'd be faced with a terrible dilemma; whether or not to attempt to extract a paralyzed and unconscious Grease through an overhead hatch while the aircraft sank into the sea.

Emergency egress training taught us all about the dangers of ditching, including how quickly a seemingly stable aircraft can sink. We were taught to get out as quickly as possible, and once having exited a ditched aircraft, to never, ever, reenter it. For any reason whatsoever. Not even to save the Pope. But there was no clear guidance, no written procedure, for this kind of a situation. It would depend on factors that can't be predicted ahead of time. If we went in the water and all the stars lined up perfectly I just might be able to successfully extract Grease. But then what? Naked, unconscious, and paralyzed, how could he possibly survive in the open ocean?

I was busy and didn't have a lot of spare cycles to assign to the problem. If we went in the water Grease would almost certainly perish. But we'd deal with that only if we had to, and statistically, it was extremely unlikely that we'd face that problem. These thoughts about ditching flashed through my mind in milliseconds, then were immediately shunted aside.

Five rows of aft-facing seats, four across with a tiny aisle in the middle, filled most of the remainder of the cabin. I noticed that there were airliner-style directional lighting and air vents as well as emergency oxygen mask stations associated with each seat. These were attached to the bulkhead, though, rather than above the seats in the overhead. Too many life rafts up there. Hmm, these C-2 guys seemed to take the ditching thing seriously!

A couple of rows of seats had been removed all the way forward. With practiced ease the crewmen set the stretcher on the deck alongside the medevac bag they'd already taken delivery of. They quickly secured the litter to a pair of sturdy vertical beams which were part of the cargo handling system, rigging it so that the stretcher was situated crosswise, rather than fore and aft, and tilted up on the left side by about 45 degrees so that the g forces of the cat shot would be more or less "down" into the stretcher rather than to the side. Once airborne we'd shift the straps and allow the stretcher to rest in a more normal attitude. As the loadmaster gave me the cat shot brief the ramp started to close back aft and the big turboprop began to taxi. Part of my mind recognized that the aircraft was completely empty save for Grease and I and the aircrew. Uncle Sugar had freed up an entire multi-million dollar airplane that had lots of other important stuff to be doing, all for a lowly E-3. Which was right, proper, and made perfect sense. I wouldn't have expected anything less from the navy of a nation dedicated to the proposition that all men are created equal.

So there we were. Grease was strapped into a stokes litter, naked but wrapped in heavy wool blankets. He was unconscious and paralyzed, connected to a portable heart monitor, had an IV running into his arm, and had an endotracheal tube down his throat. He was absolutely helpless and defenseless and couldn't even breathe for himself. The stretcher was strapped crosswise across the forward cargo area deep in the belly of the Greyhound. I was on my stomach just behind the stretcher, rhythmically squeezing the breather bag and monitoring the endotracheal tube, IV, heart monitor, and dozens of other indicators of Grease's condition. My feet were braced against a pair of passenger seat frames anchored to the deck. I would take my first cat shot in this position.

As the big turboprop waddled it's roundabout way toward one of the waist cats the big kid part of me wondered how many people besides Eugene Ely and myself had made their first flight from a ship without being strapped in. Other than that, the big kid was being quiet and respectful, sitting quietly with his mouth shut and his hands in his lap. He was there and drinking it all in, but he knew enough to stay the hell out of the way while the serious stuff was going on.

The airplane jerked left and right as it moved forward toward the catapult shuttle. There were a couple of nearly audible clunks and the whine of hydraulics as the wings began to unfold. The Greyhound began to shimmy as its wings bit into the air flowing across the deck, and a couple of solid thunks told me that they'd locked into the spread position. A more solid thunk and a slight lurch indicated that the nose tow bar had mated with the cat shuttle and that the shuttle had gone into tension. The only thing holding us in place now was the hold-back fitting, a precision machined dumbell of metal designed to break when the cat fired. Immediately the power came up and the aircraft began to shimmy. Just beyond the thin fuselage walls on either side of me 13.8-foot diameter, four-bladed propellers whirled up in a storm of thrust, driven by powerful T-56 turboprop engines. Air conditioning went to ram and the cabin became still and hot as the big airplane shimmied and shuddered on the cat, shakin' like a dog shittin' peach pits. The vibration liberated millions of dust particles from the deck which filled the air with a gritty mist, invading my eyes and nose and making the snot begin to flow.

Up on the flight deck the pilots were checking instruments and wiping out controls. This takes about 20-25 seconds, which can seem like a long time, especially from back aft. Finally satisfied that the pig would likely fly, the pilot saluted the shooter.



Aft in the cabin there was nothing to do but squeeze the breather bag, monitor Grease's condition, and wait for it. The hot air was close and sticky and sweat streamed down my face. Part of me was intent on caring for my patient while another part was tensed and awaiting the unknowns of the cat shot. What would it be like? What does four g's feel like? Would the straps holding Grease in place hold, or would I get a face-full of impossible?

Wait for it...wait for it...wait for it...

There was a snap and a lurch, followed almost instantly by the press of g forces. Laying on my stomach as I was, my inertial frame of reference shifted. Aft became down, and my feet felt solidly planted "down" on the seat frames. The deck suddenly became a "wall." It was as if I was standing on scaffolding in a rapidly rising express elevator, very close to the wall, with a patient and stretcher suspended on the wall above me. The g forces were very powerful, in some ways more powerful than I'd imagined they'd be. While the acceleration was massive, and it made holding and squeezing the breather bag difficult, that part wasn't as tough as I'd feared it would be.

The cat shot seemed to take a long time. Long enough to wonder at the power of the thing, long enough to listen to and feel the clatter of the cat shuttle trolley as it rattled along its track beneath the flight deck, driven hard by dual steam-powered pistons. Long enough to wonder if something had gone wrong. Then, with something I can best describe as a sudden snap, the g forces ceased, down became down again, aft became aft, and the aircraft felt like it was decelerating. It wasn't, of course; the rate of acceleration had simply fallen off sharply.


As the aircraft climbed out I was very busy. I had to keep squeezing and squeezing the breather bag. I had to keep an eye on the endotracheal tube, to make sure it hadn't shifted and that the tape securing it to Grease's nose was still in place. I had to keep an eye on the pressure gauge on the oxygen tank and be prepared to switch over to an ambu bag if the O2 ran short. I had to monitor the IV and make sure it was still open, and keep an eye on the heart monitor. I had to keep an eye on the time since the last dose of vec had been given, and be prepared to give the next dose on time or if Grease showed signs that the paralysis was wearing off.

We'd been airborne for about 45 minutes, and I'd given Grease another dose of vec about 10 minutes previously. The crew chief had just informed me that we'd be on deck at Sig in 30 minutes. I eyeballed the oxygen gauge. It was going down faster than I'd anticipated, but we should be good.

Then it all went to shit.

The starboard motor whoofed and the aircraft simultaneously yawed right and slowed markedly. The nose pitched sharply down and I felt suddenly light on the floor. My ears popped painfully and I felt a wave of pressure echoing through my guts and my sinuses. With my peripheral vision I noticed emergency oxygen masks spitting from their stowage compartments.

I wasn't terribly worried about the aircraft. We were in controlled flight and descending rapidly. I took stock of the signs and symptoms, did the math, and concluded that we'd lost an engine and cabin pressure and were headed down from the rarefied air at 28,000 feet to the more breathable atmosphere at 10 grand or so. We should be leveling out in a few minutes.

But I was terribly worried about my patient. I squeezed on the breather bag and nothing happened. The bag was full of gas but it wouldn't flow down the tube. It didn't take much troubleshooting to spot the problem. The tube was coming out of Grease's trachea.

This was a bad thing. I needed that airway to breathe for Grease, and Grease needed me to breathe for him to survive.

A closer look showed that distal end of the tube was very nearly completely dislodged. The cuff was still inflated, so there was no way I would be able to slide it back in place. When the cabin altitude had changed abruptly -- from about 8,000 feet to 28,000 feet in only about thirty seconds, that caused the problem. The higher altitude meant lower ambient pressure, and when pressure goes down gasses expand. The gas in the tube cuff expanded and the swelling cuff essentially forced the tube out of Grease's trachea. I'd have to get another tube in place. Quickly.

In the hospital environment, intubating a paralyzed patient is the easiest thing in the world. In the back of a C-2 with a steep nose-down attitude? Not so much. Although I had spare tubes and a laryngoscope in the medevac bag there was simply no way to get myself and Grease positioned properly to execute a normal intubation. Fortunately, there's an app for that.

I ripped the medevac bag open and pulled out the airway kit. There! A number 7.5 nasotracheal tube. I could do a blind nasal intubation.



Just like that. Only different. On the floor of the cargo compartment in the semi-darkness of the back of a C-2 with a steep deck angle. Easy-peasy, lemon squeezy.

The crew chief noticed my plight and came over to assist. I was up ICS but didn't have a spare hand to work the mic switch, so I shouted. As I tore open a packet of surgical lubricant and squirted it onto the NT tube the crew chief opened a 10 cc syringe for me. There was a clock ticking in the back of my mind, and I estimated that it had been about 90 seconds since Grease spit the tube. That gave me about two-and-a-half minutes to secure an airway and get the air flowing back into Grease's lungs. Mentally, I took my own pulse. "There's enough time, but there isn't an abundance of time." I scooted around to the head of the stretcher, reached down and hyper-extended Grease's neck with my left hand, carefully locating my thumb just above his Adams apple. With my right hand I inserted the tube in Grease's right nostril and advanced it while gently twisting left and right. When I felt the tip of the tube with my thumb I did a quick jaw thrust maneuver and slid the tube home. I'd done this before, and it felt right. With the syringe provided by the crew chief I quickly inflated the tube cuff. Now to see if we had an airway. I reached for the breather bag.

It was flat. The oxygen tank was empty.

No worries though, I'd just use the ambu bag.

It wasn't there. I frantically pawed through the medevac bag. Nope, no ambu bag.

The clock was ticking. Grease had been without air for about three minutes.

Firetruck!

The only alternative was mouth-to-tube. I blew into the tube and felt a wave of relief wash over me as Grease's chest rose evenly. I could tell the airway was solid and air was flowing into both lungs.

"How long?," I shouted to the crew chief.

"Thirty minutes," he shouted back.

I had my work cut out for me. If you've ever done CPR, even in a class, you know how exhausting it is to use your lungs to breathe for a patient. Because Grease had been without air for about three minutes, and because we were still at about 10,000 feet, I needed to supply a lot of air, a good 20 breaths per minute.

If you want to get a sense of what it was like, try blowing full breaths every four seconds through a length of garden hose. For thirty minutes.

Let's just cut to the chase and say I was nearly spent by the time we were on deck and the ramp opened, revealing an ambulance crew with a stretcher.

Puff...puff. "I need an ambu bag!" Puff-puff-puff-puff.

The three-person ambulance team just stood there, looking confused. An E-6 in charge, no doubt a Remington Raider from admin, lost and bewildered. Two slick-sleeves, waiting for direction.

"GET ME A FUCKING AMBU BAG RIGHT FUCKING NOW!" Puff-puff-puff-puff. The effort of shouting nearly killed me. I was seeing spots and narrowing down to tunnel vision. But I'd provided unmistakable direction to the two juniors and they snapped into action. The HM1...not so much. But that was fine, the two youngsters were on the ball.

##########

And now to put this thing out of your misery.

Grease survived. He didn't have meningitis, nor did he have any other terrible disease or condition. He'd had, at best guess, atypically severe febrile seizures. He was sitting up in bed the next morning, eating breakfast and feeling much better. He had a sore throat though, and a sore nose that kept bleeding on him for a few days. The docs at Sig decided to send him back to the states for a more intensive workup, just to be sure. Grease's cruise was over.

While Grease didn't have meningitis, it would take a few days for the lab to confirm it. Meningitis can be highly contagious and not infrequently fatal, and since I'd been doing mouth to tube on a potentially infected patient, I automatically bought a massive dose of IV antibiotics. Which wasn't all that bad.

I had to RON, of course, but that was no great sacrifice. The transient quarters were actually pretty nice at Sig.

However, since I was dressed in a flight suit, talked to the Sig ER staff like I knew my stuff, and yelled at the HM1 ambulance team leader, everyone assumed I was a flight surgeon, and the duty driver tried to drop me off at the BOQ. Worth a giggle today but kind of a PITA at the time. Nevertheless, I got a nice room, had a nice meal at the club, and knocked back a couple of strong drinks to give the bugs a headache.

The next day I collected my first trap. I'd had a grand adventure while nearly everyone else in the world -- and even on the boat -- were doing boring shit.

##########

Be well and embrace the blessings of liberty.