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Charting the Pulse of Health Care by Tamara Sellman

Two recently released nonfiction books (A Final Arc of Sky and The House of Hope and Fear) shed valuable light on the state of our local health care services at a time when health care is a critical issue nationwide, illuminating its complexity at the personal level.

If you’ve ever wondered about the safety and viability of Medevac — medical evacuation — services in Washington state, consider reading A Final Arc of Sky: A Memoir of Critical Care, the personal memoir of critical care and life-flight nurse Jennifer Culkin of Bainbridge Island.
Culkin devotes several chapters to her work as a Medevac nurse flying in helicopters over Puget Sound, and she shares her doubts about the safety of the service that transports trauma patients to critical care centers. She lost three friends in the Medevac helicopter crash near Edmonds in September 2005; it was from those headlines that recent national inquiries into privatization of the service have emerged. The final chapter of Culkin’s memoir recounts the lives of these lost coworkers, not as statistics, but as honest testimony from someone who has witnessed the dangers of airborne emergency medical services firsthand.

Culkin’s memoir is rich with stories that also draw from her experiences as an obstetric, neonatal and pediatric nurse during a career that spans 30 years. Her writing is smart, unflinching and authentic, filled with telling detail and acute observation. It’s no wonder she received the Rona Jaffe Foundation Writer’s Award ($25,000) last August.

I confess, I kept finding myself wondering how anyone could so gracefully manage such physically challenging, messy and downright dangerous work — work that would leave many of us terribly wrung out only halfway through a single shift. But it has been her accounting of raw emotions endlessly chronicled in a journal at work that has tempered her perspective and shaped the dark sense of humor she has come to adopt as a way of coping with so much trauma and death.

Culkin renders her stories with a poet’s deft use of language, as well. Her writing leads readers through a starlit interior where she questions the existence of God, while also capturing the harrowing realities of her occupation, in which patients are literally laughing at one moment and dying the next.

I won’t lie to you. There’s a lot of blood in this memoir, a lot of startling images you’ll not easily be able to erase afterward. Heroic acts occur and yet go mostly unrewarded. At the same time, you will find yourself laughing out loud at the arch ways in which Culkin compartmentalizes what are, for most of us, moments too painful to recreate with words.

A Final Arc of Sky is more than just gruesome accounts from emergency medicine, however. Culkin pulls in a variety of other personal observations to imbue her narrative with its most humane qualities, most notably about her life as a working mother and her recent diagnosis of multiple sclerosis following years of chronic fatigue that at times left her bedridden for weeks.
She also covers the tender territory so many in the sandwich generation are facing now: the failing health and eventual deaths of her parents. But she buoys up these difficult passages with stories about how she and her husband finally united after a rocky cross-country relationship, as well as the deep love she holds for her two grown sons.

This could be a tough read for some, but I think readers will appreciate what a gift it is to see the world through Culkin’s eyes, if only for the short time spent reading her life story.
The House of Hope and Fear: Life in a Big City Hospital by Audrey Young, M.D., takes a far less emotionally driven tack as the author lays bare the history of Harborview Hospital and the personalities it attracts, of both patients and staff members.

Young takes a storyteller’s approach. Hers is the tale of a hospital from the perspective of an attending physician in the early days of her career, when life right out of post-graduate medical school is still filled with ambition and idealism.

It is one thing to work the exhausting shifts expected of a new doctor, but to serve a public hospital where the policy is open-door and the patients are often without insurance (or even a home address) greatly added to the challenges inherent in honoring the Hippocratic Oath that Young faced when she was starting out in internal medicine.

Still, Young’s honest and compassionate reflections superimpose a human portrait onto the current condition of the national health care system, giving the reader ample pause to think about what’s really at stake for the uninsured. In fact, it’s her insights into the daily ideological conflicts between patients and staff and the ethical dilemmas that surround their shared commerce — right down to the way beds are arranged and made available during times of crisis — that give readers the best view on the inner workings of a Harborview.

A quote from the back jacket of The House of Hope and Fear:

“ Leading journalist Norman Cousins observed that patients bring a mixture of hope and fear with them to the hospital.”

Certainly Young has done a thorough job of capturing both the hope upon which Harborview Hospital was founded (with a special emphasis on the selfless efforts of hospital helmsman, ED director Michael Copass, and the fearless nephrologist, Dr. Fleet) with the fear that can arrive on a stretcher in the form of a tweaking drug addict or a virtual deluge of carbon monoxide victims during a winter storm, when the head counts greatly exceed the bed counts.

Her book is also a fascinating tour of the hospital system itself, internally and externally. Readers get a chance to peek in on the radio room, the Fishbowl, the VIP ward, and the infamous “wet house,” as well as gain some insight into why certain ambulances deliver (or don’t deliver) certain patients to certain hospitals during certain critical times.

Compared to Culkin’s memoir, The House of Hope and Fear is far more direct a chronicle, but it’s not without its private moments. For instance, Young does take the reader off the campus to a dinner date with Big Pharma and reveals, in that experience, her own conflicts about eating expensive meals while so many of her patients are on the street with no safe place to fully recover from their various maladies.

Young’s is a telling insider’s view of one of the busiest and most successful public hospitals in the country while, at the same time, it illuminates the relentless ideals that inspired her to become a doctor in the first place.

In that sense, she joins Culkin in sharing a resilient ethos for work that demands far more than tongue depressors and stethoscopes require.

Tamara Sellman is a freelance writer, editor and blogger from Bainbridge Island.

©Copyright 2009, Caliope Publishing Company