Jim didn’t seem phased by my words of reassurance. He continued to wriggle himself away from me and over to his wife. Cheryl was answering every question as Sam orchestrated securing her to the backboard and immobilizing her neck. I was impressed.

Harley, Sam, and the fire crew moved Cheryl to the gurney while I continued trying to corral Jim and the other two bystanders.

“But where are you taking her?” Jim was frantic. Consumed by fear of his wife’s condition mixed with alcohol clouding his mind.

I took a deep breath. My own frustration was starting to bleed through what I hoped was a calm, all-business demeanor. “We’re going to take her to the hospital where we can fly her in a helicopter to the closest trauma hospital. She’s stable and answering all of our questions, but she fell from a pretty high distance. She has a hematoma on the back of her head which means -“

“Yes, yes, I understand, I understand. This isn’t my first rodeo.” Jim said, cutting me off midsentence. For those that know me, there is one way to make me mad, and that’s by interrupting me. “But why does she have to fly in a helicopter?”

I resisted an off-color joke about how our teleporter is in the shop. “Like I was saying,” I started, “she needs to go to a trauma hospital. We don’t have a trauma hospital in the quad cities. The closest one is over an hour -“

“Yes, yes of course. But you said she was ok?” Jim put his hand up to his forehead.

I sighed. “She is stable right now, but there are all kinds of internal injuries that we can’t assess or see. We need to -“

When Jim started talking again one of the fire medics had approached and I took the opportunity to walk away. There would be time for comfort care later. Right now, my only priority was the patient.

Harley and Sam had already lifted Cheryl into the ambulance and they’d climbed in to hook up the cardiac monitor and reassess vitals. The fire medic had jumped in too, coordinating and directing the process.

I climbed into the box through the side door, closed the door behind me, and began giving directions as I grabbed my stethoscope hanging on the medic catcher. Before I could place the bell on Cheryl’s chest, I heard the side door open. Jim attempted to climb in right behind me.

“Absolutely not.” I couldn’t stop the words from coming out of my mouth. I spun around and made my five foot three self as big as possible. “I need you to step outside.”

“I need to be with her!” He bargained.

“I need you out of my way so I can help your wife.” I said, unmoved.

“I’m not in your way!”

“Yes you are. If you want to ride with her to the helipad, you can sit up front, but you will not be back here. Am I clear?”

Jim backed out of the ambulance and scurried over to the back doors. Nick, the fire medic stood at the doors and told Jim to go back to the front. Harley hurried out of the box and escorted Jim to the front seat.

“Will I be able to ride in the helicopter?” he asked as Harley led him away.

Harley shook his head. “Unfortunately it’s too small for a passenger. You can meet her at the hospital.”

Jim waved his hands around in front of him. “That’s not going to work. I need to be with her.”

Harley put a hand on Jim’s arm. “If you want to do what is best for your wife, you need to let us do our job.” Whatever effect Harley had on him worked. Jim sat in the front seat, turning around so he could see through the box window at us.

Cheryl smiled shyly. “You’ll have to forgive him. He’s just worried about me. Plus, he’s drunk.”

I nodded and smiled. “I understand, dear. We just need to focus on you. Do you understand that we are going to fly you to the hospital?”

She nodded as best she could in the full spinal precautions. “Yes, we’ve been through this once before.” Her eyes started to tear. “My son died of a traumatic brain injury while riding his bike. He had to be airlifted.”

“I’m so sorry.” I said, suddenly recalling Jim had mentioned this wasn’t their first rodeo. I suppressed the feeling for the moment to carry on with my assessment. We inserted a second IV and monitored vitals. I had mentioned to Cheryl that we would continue to ask her the same questions over and over. This was to monitor her mental status, to ensure it hadn’t changed. And if it did, we would catch it quickly.

Harley took off, mindful of the winds and turns with the patient, Sam, Nick, and me in the back. We administered pain medication through Cheryl’s IV but preceded it with anti-nausea medication. The last thing we needed was our patient throwing up while strapped to a backboard.

The fentanyl did the trick. Cheryl’s pain went away and she said she felt totally fine – all thing considered. But even the small dose we gave her, mixed with the wine she consumed earlier, made for some interesting affects.

“You know my husband cheated on me a while ago with my sister.” Cheryl said stifling a giggle. For some, pain medication – especially opiates – is a truth serum.

I locked eyes with Sam and we both mouthed “WTF”.

Jim poked his head back. “What did you say, sweetheart?” I heard the click of the seatbelt. “Do you need me?”

“Hey! You need to put that back on.” Harley hollered. I heard the click of the seatbelt reengaging but Jim stayed turned around.

Cheryl let out a laugh. “Yeah, it was years ago. It’s okay now. We’re all good.”

I darted my eyes between my patient and the other riders. “I’m glad to hear that. How are you feeling right now? What’s your pain on a scale of zero to ten?”

Cheryl rolled her eyes and let her lids flutter. “I feel amazing.” I didn’t doubt that she did.

We continued small talk on our way to the helipad, intermittently asking her questions like, “Tell me your name, what day of the week is it, do you know your address?” She continued to answer all questions appropriately.

As we arrived at the helipad Harley called back to us to let me know the helicopter hadn’t landed yet. Air17 was coming from some distance away and all of the other flights were on other calls, but our patient was stable so we had time.

Harley and Jim exited the front seat and both Sam and Nick stepped out as Jim climbed in. He sat on the bench seat while I sat opposite him on the CPR seat. I tried to quietly type my chart, ignoring his cooing over his wife.

“I’m going with you, don’t worry sweetheart,” I overheard him say.

I looked up, wanting to correct this information as clearly as I could. I knew Harley had already explained everything to him, but he was in no state to listen.

“I’m sorry, but there won’t be any room in the helicopter for a passenger. You can meet her down at the hospital but you won’t be able to fly in the helicopter.” His eyes turned hard.

“Then she’s not going.” He said bluntly.

Cheryl reached over to her husband and patted his knee. “It’s going to be okay, Jim. Steve and Jenny will drive you down.” I silently hoped Steve and Jenny weren’t the drunk friends that had just arrived in the helipad lot.

“But why does she have to go in a helicopter?” Jim took Cheryl’s hand and kissed it lightly.

I had already explained this. Harley explained it – repeatedly. My patience was wearing incredibly thin and Jim was about to burst through it like a football team at the start of a game.

“We need to get her to a trauma hospital,” I started slowly. “Our hospitals here are not trauma hospitals. She has injuries that -“

“I understand, I understand-” Jim said cutting me off for the last time.

“No I don’t think you do.” I shot back. I kept my voice even as I tried to keep my hands from shaking in frustration. “So listen and I will tell you everything you need to know. Your wife took a 10-foot header down a second story hole in the floor. She lost consciousness. She is doing great right now, but if I take her to our hospital here, and they find something that requires a trauma doctor, then she’ll have to wait in the emergency room until they can coordinate a hospital to take her and transport to the facility. That could take hours. If something is seriously wrong that we can’t see, it could affect her recovery negatively. By flying her out right now, we bypass all of that and she can get evaluated by the right people immediately without delaying any of her care.”

Jim and Cheryl looked at me and both nodded. Jim’s eyes were wet with tears.

“Thank you,” he said. “I’m just nervous. We lost our son to a serious accident and a traumatic brain injury. I just don’t want to lose her too.”

I shook my head. “I don’t anticipate that. And I’m very sorry for your loss. We just want to do everything we can to make sure that doesn’t happen again.”

The beating sound of chopper blades roared overhead and everyone outside closed the doors of the ambulance to keep papers, trash, and other materials from flying out.

“Sounds like our bird is here,” I said. “Once they land the flight medic and flight nurse will jump in here, attach you to their monitor and equipment, and then we’ll wheel you over to the helicopter on the gurney and load you in. Do you have any questions?”

They both said no, so I continued. “Now is a good time to say ‘see ya later’ so you can step out and give the flight crew room to work.” Jim kissed Cheryl’s forehead and told her he’d see her at the hospital. Then he stepped out without a fight.

The flight crew emerged through the back doors and we exchanged pleasantries before diving into the story. Within minutes Cheryl was attached to their monitor and we were rolling her to the helicopter. I glanced over my shoulder to see Jim getting into the friend’s van. Harley and Sam had instructed them when he stepped out to stay inside the vehicle while the helicopter took off and had given him the address to the hospital on a piece of scrap paper.

The helicopter lifted into the air and as soon as they were high enough they headed south in the direction of the hospital. Jim’s van took off and I saw a hand out the window waving back at us.

“Glad that’s over,” I said to no one in particular.

Harley turned to Sam. “That was one of the best trauma assessments I’ve seen in a long time. Not just for a newbie.”

I agreed. “That was great. You handled that perfectly. I didn’t have to worry about what was going on while I was dealing with the husband.”

Sam blushed. We were all very impressed and we weren’t just saying so.

“I’d be happy to have you as partner any day.” I said reaffirming our praise.

They cleaned the gurney and the back of the ambulance while I charted. The second we cleared we’d been hoping for a reprieve in the radio traffic so we could get dinner – but we weren’t so lucky. So we chatted on the way to our next call, sharing our praises for Sam and joking about how we hope the next fall isn’t through a hole in the floor.