"A Final Arc of Sky:" a memoir of crisis nursing

"A Final Arc of Sky: A Memoir of Critical Care"

by Jennifer Culkin

Beacon Press, 248 pp., $24.95

With its perfect capture of the fragility of life and our vulnerable human bodies and bonds, "A Final Arc of Sky" by Seattle-area author Jennifer Culkin, is a disturbing, powerful read.

I found myself looking forward to picking up this book each night to see where Culkin, in her memoir of her career as a critical-care nurse, including a five-year stint as a helicopter-flight nurse, would find herself next. Would she be scooping up the crushed body of an accident victim or the heart-attack patient with arteries set to clamp shut for good?

A critical-care nurse at Harborview Medical Center, Culkin, 50, writes from the heart of a 30-year career working in hospitals and medical centers from Boston to California to Alaska. A Bainbridge Island resident, she earned a master's degree in fine arts from Pacific Lutheran University in 2007. A mother of two, this is her first book.

She tells of nursing tiny preemies, including an infant whose genetic code had gone so terribly wrong that where a brain should be there was just an empty flap of flesh. You never knew so many things could go wrong with a baby, who Culkin calls "My little pea."

Riveting reading, Culkin's book is served up in the direct language that would be the mental habit of anyone drawn to, and thriving on, such a career. So read before sleep at your own risk.

Here without flinching, too, is her story of watching her own mother's decline from complications as diabetes rusts away her kidney function, confines her to a wheelchair, and finally attacks her heart, eventually forcing Culkin and her family to choose whether to continue life support or let her go.

Yet Culkin is no bland fatalist, with feelings numbed by too many deaths. She writes vividly not only of trauma heroics, but of her joy in bicycling with her sons and her own lust for speed as she bullets down hill.

She is at her strongest when her writing captures the pathos of loss and disaster and the people left behind to bear it.

"As we made the slow procession to the open door of the aircraft, out of the corner of my eye I saw the boy's dad trailing us," she says, describing her crew's efforts to save the 17-year-old victim of a car wreck. " 'Hang in there,' he kept saying to his son. 'I know you're going to make it. Don't give up.' "

After the crew is barely able to get a heart rate throughout the flight, at the trauma center comes the crush of everything modern medicine can throw at a dying patient, the "full court press. Central lines, massive amounts of warmed blood products, his chest cracked open. ... Dozens of people, somebody's hands right on his pale heart."

The patient dies, as she knew he would. And in comes the social worker, saying, "The mom's out in the waiting room. Would one of your like to talk to her?"

Culkin thinks of her own son, then 17, "Of how imagination can torture, and how much every detail will matter, when her son's body gone to the morgue, that mother drives home to find a grimy school backpack mute in the hall where he dropped it, still stuffed with books, chewed gum, an iPod and earbuds, his crumpled papers."

And yet Culkin can't push through the door to the victim's waiting mother, can't confront a loss that knows no bottom.

"I can't say why I didn't speak, only that I wish I had," Culkin writes. "Years have passed and I'm still standing there, unable to say a thing."