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Joanne Endres' email to friends and family

April 2005 -- Hello All! Please pardon the mass email, but I must share a profound experience that happened to me on the way home Monday from Minnesota. I was flying out of Minneapolis, alone, as Brian had stayed on in St. Paul for 2 days of business. We had gotten up to cruising altitude (about 35 min. into the flight or so) when the page came overhead would anyone with medical background please come to the front of the plane for an emergency. I stood up and headed forward, noticing immediately that I was the only one standing...as I got to the front of the plane, in the first row bulkhead aisle seat was a 54 yr old man surrounded by flight attendants (FA) getting him oxygen. He was profoundly diaphoretic (clammy sweaty), pale as a ghost and complaining of severe chest pain. He had had a heart attack 3 yrs earlier and had bypass surgery and also had a pacemaker (never a good sign). He looked awful. I briefly told the flight attendants who I was and what I did for a living, and they stepped back and let me assess him. He was carrying some nitroglycerin tablets with him, so I gave him one. I asked the FA's for aspirin, and they scrambled and got me some and I had him chew an adult tablet (if someone is having a heart attack you want to get aspirin in them ASAP), he was getting no better after the nitro. And he was very anxious. I tried to reassure him as best I could, and then I told the FA's that I was completely convinced that he was having a heart attack and was very serious and that we needed to land ASAP. We were near Fargo, so the lead FA said we'd probably go there, he was on the phone with a medic line and was reading them my notes on what I had found out about this guy and what I was doing. Several minutes later, we heard that we would be returning to Minneapolis (I still don't know why they wouldn't let us go to Fargo), anyway, by this time, he was no better, the pain was severe, and he began to vomit. (a sign of really impending cardiac arrest) I was mentally rehearsing where I would lay him in the super narrow middle aisle, if I had to start CPR. A passenger had already volunteered that she was CPR certified, so I knew I would have some help. He really wanted to lay down, but with his vomiting, I didn't want to have him flat and choke, so I reclined him somewhat as best we could. They finally got me a blood pressure cuff and a stethoscope that seemed like it came from Kmart, I couldn't hear a thing over the engine noise. I was trying hard to tell what kind of heart rhythm he was in by listening to his heart and feeling his pulse. It was very irregular and thready. I looked up and saw AED (automatic external defibrillator) marked on the opposite overhead bin. I was betting that he was having a big inferior wall MI (heart attack) because of all of his symptoms, and vomiting, and that is one of the more serious ones, because they usually lose their blood pressure and get very bradycardic (slow heart rates), so I asked the FA for the AED. His eyes were popping, but they quickly grabbed it. I put the patches on his chest and kept it near so if I had to use it, I'd have it handy. It doesn't give any readout, but if someone goes unconscious, you can press an analyze button and it will tell you if a shock is indicated, so I was totally ready to plug it in. Nothing like our LifePack defibrillators we have at work, but it was all I had. About that time, another RN on board came forward, she was a young new grad, and working OB, so she waited a bit, but came up and was very, very helpful to help keep him rouse able and comforted. The Dr. on the ground told the FA to tell me to give another nitro pill, which I didn't want to do as his blood pressure was only about 90ish and I knew the nitro would bottom it out and we'd make him unconscious. I told the FA all this, but he said the doc said give it anyway. So, I figured, here we are out about 30 minutes, maybe the guidelines are different up here and maybe it's this guys only chance. So, I gave him the second one. Pretty soon, what I thought would happen, did. He became difficult to rouse, and limp. His pulse was regular but very faint. I asked them if they had any other medical supplies on board, and they produced an advanced kit (I guess they are supposed to save it for doctors, but I said, give it here!!) Much to my relief, it had IV fluid, tubing and IV needles, first aid stuff, and all the emergency meds we give in cardiac arrests, so I started mentally rehearsing my ACLS (advanced cardiac life support) algorithms as I have with each of my recertification classes...I got ready to start an IV and the gal in the window seat next to us ripped tape off for me with trembling hands, matching my shaking hands receiving it. Luckily, he had pretty good veins, and I had no trouble. I was kneeling in front of him at this point, and the plane was kind of bumpy, so it was a challenge. I handed the IV bag to a young man in row 2 and asked him to hold it high and start squeezing the bag, so it would infuse faster, because I knew his blood pressure needed extra fluid to compensate for the nitro. He was all over it, and made a fantastic human IV pole. The patient started vomiting again, and I was running out of barf bags, so I turned to the window seat woman and asked her to get more bags, she turned around and loudly announced, "WE NEED MORE BARF BAGS!!!" and within seconds, it seemed, about 20 bags peeled forward from the rear cabin. I turned to her and she had 6 open bags ready to hand to me. Meanwhile, I was slowly watching Cal get a bit better. I kept reassuring him that we were taking good care of him and returning to Minneapolis, and as we were landing, most of the IV bag had infused into him and it was soooo exciting, I had kept my finger on his radial (wrist) pulse so I could monitor his rhythm and strength of pulse (you don't have a strong wrist pulse if your blood pressure is below 70/?. I could feel his pulse getting stronger, his color was improving, his clamminess was easing, he was resting better, his pain was easing a little tiny bit! I looked up at him and said, "you know some people will do anything to hold my hand!". He looked at me weakly, and smiled a bit, and a tear ran down his cheek, and he thanked me. Wow. I felt surrounded by a "bubble" of prayer through all those moments, I could feel the whole plane was praying for us the whole time. I have done this stuff a million times at work, and it just came automatically, but in that setting, the whole plane was watching and it was so tense. We finally landed and the medics came right on board, I gave them a report on things, and they congratulated me on making it in. :). I wished I could have gone down to their rig with them and seen what his EKG was like, to see what kind of heart attack he was having, but I couldn't leave the plane. I cleaned up the area a bit with the FA's, as it was a bit of a mess...and when I stood up to walk back to my seat, the entire plane applauded, and I had about 20 people patting me on the back, little old ladies taking my hand, teary, thanking me, and saying what a blessing it was that I was on the plane. The whole plane was a buzz, debriefing...I was asked a ton of questions about what was wrong, what I did for him, where did I work, what was it like being an ER nurse, etc. An amazing experience. No one seemed the least bit annoyed with the eventual 3 hour total delay it gave us. My highlight comment was one I overheard a passenger saying as I walked back to my seat..."she knew just what to do and there wasn't even a doctor here". Most people have no clue what nurses really do. I think for one brief period in time, the people especially in the front of the plane got a glimpse at a real "not on TV" ER nurse. It was a proud moment for me and for my profession. I had to give the flight attendant all my information, and I gave them my license and certification numbers, and I hope I get to hear how he did. I was so grateful that someone didn't have to call his daughter here in Seattle and tell her, we are very sorry, but your father died on the plane. It was very, very close. My greatest blessing of the whole experience (aside from the 2 free gin and tonics) was that I felt very renewed from this experience, and that God needs me to keep doing this for awhile longer, because most of you know how very, very burned out I've been lately as are most of my peers. I've retold and retold this story for the past 3 days at work, in fact yesterday, when the director of nursing at Evergreen heard of my experience, she had me tell it in front of 60 of my fellow (equally burned out) hospital charge nurses at our quarterly meeting. There were many moist eyes in that group. Most nurses today are so overstretched, tired and discouraged from lack of appreciation, recognition and adequate compensation. After this experience, I know I've been renewed for another 100,000 miles, and I'm hoping that it sparks others to new energy, that what we do can really make a difference for someone.

Love to all, Joanne

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