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A Final Arc of Sky: A Memoir of Critical Care

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Buckling herself into the rear of an Agusta A109A, Jennifer Culkin prepares for the moment of lift. The deafening thrum of the helicopter announces the unknown perils and potential havoc that await. A critical care and emergency flight nurse, Culkin treats patients who are most often in mortal danger. Aboard the Agusta, she is entrusted with the life of a seventeen-year-ol Buckling herself into the rear of an Agusta A109A, Jennifer Culkin prepares for the moment of lift. The deafening thrum of the helicopter announces the unknown perils and potential havoc that await. A critical care and emergency flight nurse, Culkin treats patients who are most often in mortal danger. Aboard the Agusta, she is entrusted with the life of a seventeen-year-old pulled from the wreckage of a headon collision as his father calls out a wrenching plea from below; she cares for a middle-aged man who is bleeding to death internally, remembering the four daughters who have kissed him goodbye, possibly for the last time. It is the arduous and acute struggle to keep her patients alive en route to the hospital that is Jennifer Culkin's most profound duty. Culkin is no stranger to death and its dramas, or the urgency that accompanies them. Her memoir pulls us into the neonatal intensive care unit, where she labors to ventilate an eleven-ounce preemie, the smallest human she has ever cared for. The tenuous lines between life and death lead us to the pediatric intensive care unit, where she looks after children seemingly too small to contain their devastating illnesses. As her personal life begins to mirror the intensity of her work, Culkin writes poignantly of attending her dying mother, who refuses to decide whether to prolong her life. She recounts with tenderness and exasperation the experience of looking after her widowed father, who faces death with dramatic stubbornness, ignoring medical advice and rejecting even basic treatment. Tempering her profound insights with humor, Culkin relates her taste for the edge, her own risky gambles, and her ongoing battle with multiple sclerosis. Finally, Culkin takes us back to flying, with the dramatic and redemptive stories of her colleagues who have perished in helicopter crashes in their very exceptional line of duty. A Final Arc of Sky does more than plunge readers into the chaos of emergency medicine; it is also a masterful reflection on the pivotal moments of our lives, on the beautiful fragility of our mortality.


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Buckling herself into the rear of an Agusta A109A, Jennifer Culkin prepares for the moment of lift. The deafening thrum of the helicopter announces the unknown perils and potential havoc that await. A critical care and emergency flight nurse, Culkin treats patients who are most often in mortal danger. Aboard the Agusta, she is entrusted with the life of a seventeen-year-ol Buckling herself into the rear of an Agusta A109A, Jennifer Culkin prepares for the moment of lift. The deafening thrum of the helicopter announces the unknown perils and potential havoc that await. A critical care and emergency flight nurse, Culkin treats patients who are most often in mortal danger. Aboard the Agusta, she is entrusted with the life of a seventeen-year-old pulled from the wreckage of a headon collision as his father calls out a wrenching plea from below; she cares for a middle-aged man who is bleeding to death internally, remembering the four daughters who have kissed him goodbye, possibly for the last time. It is the arduous and acute struggle to keep her patients alive en route to the hospital that is Jennifer Culkin's most profound duty. Culkin is no stranger to death and its dramas, or the urgency that accompanies them. Her memoir pulls us into the neonatal intensive care unit, where she labors to ventilate an eleven-ounce preemie, the smallest human she has ever cared for. The tenuous lines between life and death lead us to the pediatric intensive care unit, where she looks after children seemingly too small to contain their devastating illnesses. As her personal life begins to mirror the intensity of her work, Culkin writes poignantly of attending her dying mother, who refuses to decide whether to prolong her life. She recounts with tenderness and exasperation the experience of looking after her widowed father, who faces death with dramatic stubbornness, ignoring medical advice and rejecting even basic treatment. Tempering her profound insights with humor, Culkin relates her taste for the edge, her own risky gambles, and her ongoing battle with multiple sclerosis. Finally, Culkin takes us back to flying, with the dramatic and redemptive stories of her colleagues who have perished in helicopter crashes in their very exceptional line of duty. A Final Arc of Sky does more than plunge readers into the chaos of emergency medicine; it is also a masterful reflection on the pivotal moments of our lives, on the beautiful fragility of our mortality.

30 review for A Final Arc of Sky: A Memoir of Critical Care

  1. 4 out of 5

    Dree

    Really 3.5 stars. I was a little disappointed in this book. I was expecting more about being a flight nurse--exploring the patients, the shifts, the kind of people that do this work, the crazy ups, downs, and intense boredom between bouts of intensity. Instead, even the exciting parts aren't that exciting. Somehow she makes this job seem like any other humdrum job. Descriptions of insane trips don't feel crazy. Things that had to have been funny (and she talks about laughing) don't read funny. I w Really 3.5 stars. I was a little disappointed in this book. I was expecting more about being a flight nurse--exploring the patients, the shifts, the kind of people that do this work, the crazy ups, downs, and intense boredom between bouts of intensity. Instead, even the exciting parts aren't that exciting. Somehow she makes this job seem like any other humdrum job. Descriptions of insane trips don't feel crazy. Things that had to have been funny (and she talks about laughing) don't read funny. I wasn't expecting so much of the book to be about her parents' declining health and her family relationships. Not bad writing, just not my kind and not what I was expecting at all. Meh.

  2. 5 out of 5

    Catherine Mustread

    SA: "An eloquent and compelling memoir by a critical care flight nurse, that soars with tragedy and tenderness. A sense of fragility, and well as resiliency and strength, permeate Culkin's life and calling." SA: "An eloquent and compelling memoir by a critical care flight nurse, that soars with tragedy and tenderness. A sense of fragility, and well as resiliency and strength, permeate Culkin's life and calling."

  3. 5 out of 5

    Americanogig

    Working in the medical field desensitizes you to a lot of things. To deal with the trauma that a flight team sees every day, you must have to develop quite the thick hide. However, I just cannot reconcile that to my feelings about the same. Honestly, emotionally, I just can't hang up my hat at the end of the day and ignore what has gone on before. Human life is just too valuable and I don't care how many dissection classes you've had and what you've seen the body reduced to...there are things be Working in the medical field desensitizes you to a lot of things. To deal with the trauma that a flight team sees every day, you must have to develop quite the thick hide. However, I just cannot reconcile that to my feelings about the same. Honestly, emotionally, I just can't hang up my hat at the end of the day and ignore what has gone on before. Human life is just too valuable and I don't care how many dissection classes you've had and what you've seen the body reduced to...there are things beyond the clinical. So, the superior attitude and sterility of the author depress and anger me.

  4. 5 out of 5

    Janet

    I really loved these slice of life essays that overall turned into a memoir of not just the authors experience as a flight nurse, but about the fragility of life, hers and all of ours. Thankfully she doesn't take it lying down but approaches each tragedy with spirit and fight. I really loved these slice of life essays that overall turned into a memoir of not just the authors experience as a flight nurse, but about the fragility of life, hers and all of ours. Thankfully she doesn't take it lying down but approaches each tragedy with spirit and fight.

  5. 5 out of 5

    Cheryl

    This book is a contemporary memoir of a critical care and emergency flight nurse who flew in helicopters in this area. It intertwines the lives and deaths and births of strangers with lives and deaths and births in her own life over a period of years. I devoured it. It was great.

  6. 5 out of 5

    Tracey Ledel

    Perhaps the best memoir on nursing I have ever read. Everything feels as if you are there in each moment. The reader can feel all of the humor, horror, poiniency, love exhaustion, exhilaration to be found in Nursing. Exciting, hilarious and heartwrenching. Read it soon!

  7. 5 out of 5

    Carolyn Tarr

    I identified so well with some of her stories it was scary...

  8. 4 out of 5

    Carrie F.

    Well written from a new author. Timely for me since I was carted by ambulance this week. I was broadsided that she wrote about having MS.

  9. 4 out of 5

    carolyn jacobs

    Great book I appreciated the discussion of a high risk area of nursing and how health care professionals adapt to it. The author also wove into this discussion how she copied with family, personal and professional crisis.

  10. 4 out of 5

    Rosanna

    Interesting, I learned a lot.

  11. 5 out of 5

    Tromometer

    The plot had so many fun moments and maintained a steady climb towards the end of the book when everything was resolved. The ending was perfect.

  12. 5 out of 5

    Rene

    A Final Arc of Sky: A Memoir of Critical Care is very well written and is a thorough pleasure to read.

  13. 4 out of 5

    Noel

    Quite a surprising ending.

  14. 5 out of 5

    Joanne

    I loved this book. It perhaps would have held together better if she had focused on either her personal history or her experiences as a medevac nurse. It was a bit scattered. But her writing is beautiful. I hope she writes more. Loved the local tie-in too.

  15. 5 out of 5

    Byron Edgington

    Here we have a memoir of life and death issues from several different altitudes. Jennifer Culkin may once have been a flight RN, but she is now a writer, an author of one of the more memorable and deftly told tales of Air Medical aviation I’m familiar with. Full disclosure: this reviewer spent twenty years in the cockpit of an Air Med helicopter, and I, too, am now a writer, so my biases apply in both directions, up and down. Culkin’s prose is exquisite, her analogies, similes and metaphors are Here we have a memoir of life and death issues from several different altitudes. Jennifer Culkin may once have been a flight RN, but she is now a writer, an author of one of the more memorable and deftly told tales of Air Medical aviation I’m familiar with. Full disclosure: this reviewer spent twenty years in the cockpit of an Air Med helicopter, and I, too, am now a writer, so my biases apply in both directions, up and down. Culkin’s prose is exquisite, her analogies, similes and metaphors are perfect throughout this book, and with her wry sense of humor and irreverent attitude toward emergency patients and trauma in general she took me back to the jump-through-your-ass world of emergency pre-hospital medicine that I once loved. In addition, woven throughout the book are references to her parents and their diminishing quality of life as seen from the viewpoint of the medically-astute daughter. Culkin also outlines her own struggle with the onset of MS and how it curtails her working life, a medical issue that ended her flying career, much the same as my own medical issue ended mine, another similarity. Indeed, much of the work describes the author’s interaction with family members and the deaths of her parents. A few reviewers have taken the author to task about this seeming diversion in the story. For me, it cuts to the heart of what emergency medical personnel are about, the unflinching need for truth and an almost cold-hearted realism in dealing with end of life issues. This trait is a common one among those who toil in the vineyard of emergency medicine, and it extends to family as well, as if they (we) never quite go off duty, never really hang up the pager and relax. Culkin would have been negligent to ignore her own parents’ slide to eternity. She hints at a need for a more clear-eyed discussion of these things, our obsession with prolonging life without deciding what ‘life’ really means running as subtext in the book. More often than the public might think, the underlying question in emergency medicine is not how quickly to respond, but whether to respond at all. If my experience as a pilot matches Culkin’s as a flight nurse, and I suspect that it does, refusal to answer that burning question drives much of the current health care debate. As for the book's shortcomings, as a former Air Med pilot, I would like to have seen more commentary from her, especially since she’s left flight nursing, on the causes and prevention of fatal Air Med accidents. The industry she and I both devoted much of our lives to has taken far too many lives of colleagues we knew and loved. I wanted to hear what she had to say about that, not just a rundown of those accidents. For that, I can read an NTSB report. Beautifully written, with elegant phrasing and intriguing connections, A Final Arc of Sky is a pleasure to read. Anyone who enjoys heartwarming human interest stories, deeply moving memoir and insightful descriptions of technically fascinating careers will love this book. Anyone who has worked in pre-hospital emergency medicine will relate to it, and love it as well. Byron Edgington, author of The Sky Behind Me: A Memoir of Flying & Life

  16. 4 out of 5

    Dana

    I loved the title and the concept. The writing is sublime and at times it is harrowing. The overall structure and execution of the book, however, fell a little short in places. When an author comes up with a title this good, you know she can put words together. Here's an example of a passage that I really loved: "From the schoolyard, I could smell the brine lifting off the confluence of Boston Harbor and the Chelsea River, a mile or two away, working on me like an elixir. What I wanted more than I loved the title and the concept. The writing is sublime and at times it is harrowing. The overall structure and execution of the book, however, fell a little short in places. When an author comes up with a title this good, you know she can put words together. Here's an example of a passage that I really loved: "From the schoolyard, I could smell the brine lifting off the confluence of Boston Harbor and the Chelsea River, a mile or two away, working on me like an elixir. What I wanted more than anything was to cross Revere Beach, my feet burning like a firewalker's on the dry, gray sand, to wade through the muck of brown seaweed at water's edge, to fold myself inch by inch into the Atlantic." Magnificent!! It really puts me there. I wish I could remember my childhood half so vividly. The book, structured as a series of vignettes, lacks a little bit of cohesion. I agree with the people who questioned the wisdom of devoting half the book to the story of her parents' deaths. It takes the book away from its strength, a peek into this amazing world of in-flight nursing, and turns it into just a memoir of Jennifer Culkin's life. I feel harsh and cynical for saying this, but everybody of a certain age has to deal with those issues -- it's just not *that* original a story. I'm not saying she should have written the book differently, but it did make the book more ordinary in my opinion. However, the final chapter, where she tells the stories of the people who lost their lives in this hazardous occupation, redeems any other shortcomings the book has. It also raises a big flag in my mind. Six deaths in less than ten years, in a company that employs a few dozen people? Does OSHA know about this? Finally, the way she writes about her multiple sclerosis is remarkable. In anybody else's autobiography, this would have been front and center. In hers, you don't even find out until the second-to-last chapter! Congratulations, Jennifer Culkin, on not letting your life be defined by your illness. I hope that it will continue to be so and I hope that they will eventually find a cure.

  17. 5 out of 5

    Aubrey

    This book was surprisingly poetic. While some of the nursing details were hard to read- both hard in that life is fragile, and hard in that they're a little graphic - I found myself devouring the book anyway. Culkin does a good mix of her career and her life. Both are tumultuous. She has amazing connections with coworkers and family, and I believe much of her strength comes from this, as well as a no-nonsense attitude. This book was surprisingly poetic. While some of the nursing details were hard to read- both hard in that life is fragile, and hard in that they're a little graphic - I found myself devouring the book anyway. Culkin does a good mix of her career and her life. Both are tumultuous. She has amazing connections with coworkers and family, and I believe much of her strength comes from this, as well as a no-nonsense attitude.

  18. 5 out of 5

    Judith Shadford

    Better than splendid! And not just 'cause I know Jennifer...ultimately didn't make a difference. The delightful combination of medical black humor, which I love, and the genuine compassion that so often is--for a lot of us--simultaneous with total annoyance. It took considerable craft to weave the multitude of stories into a cohesive narrative and dramatic arc as well. So for sheer technical ability, sheer heart and chutzpah...I loved it. Better than splendid! And not just 'cause I know Jennifer...ultimately didn't make a difference. The delightful combination of medical black humor, which I love, and the genuine compassion that so often is--for a lot of us--simultaneous with total annoyance. It took considerable craft to weave the multitude of stories into a cohesive narrative and dramatic arc as well. So for sheer technical ability, sheer heart and chutzpah...I loved it.

  19. 4 out of 5

    Ellie Revert

    Great sharing of the life of a flt nurse--for medical causes-- here in the Great PNW. The author lives on Bainbridge, and tells us about her career and also her personal life. About her folks--who refused to discuss end of life issues. Fascinating.

  20. 5 out of 5

    Andrea

    I liked this, but wish she shared more stories from flying instead of spending so much time on personal family matters. It was very touching that she included the parts about her coworkers dying in the accidents. Makes you remember how dangerous the job can be.

  21. 4 out of 5

    Sharon Barnes

    I didn't enjoy this book as much as I hoped. I was looking for more patient stories and not the author's life story. It was interesting but not what I expected and hoped for. At the end, she mentioned caring for over 4000 patients but she didn't mention nearly that many. I didn't enjoy this book as much as I hoped. I was looking for more patient stories and not the author's life story. It was interesting but not what I expected and hoped for. At the end, she mentioned caring for over 4000 patients but she didn't mention nearly that many.

  22. 4 out of 5

    Janet

    Interesting window to flight nursing. Made the more interesting because the author is from this area. Sadly, I didn't know of her medical condition and thought that she was still practicing. Interesting window to flight nursing. Made the more interesting because the author is from this area. Sadly, I didn't know of her medical condition and thought that she was still practicing.

  23. 4 out of 5

    Elizabeth Nesbit-comer

    I liked the writing style, but wish it had more storiess about the nursing. I guess I'm just not much of a personal memoir type. I liked the writing style, but wish it had more storiess about the nursing. I guess I'm just not much of a personal memoir type.

  24. 4 out of 5

    Mary MacKintosh

    Culkin writes beautifully, and I particularly appreciated her discussions of caring for her elderly parents.

  25. 5 out of 5

    Lily Taing

    I loved this book! It was very interesting about the life of a flight care nurse.

  26. 4 out of 5

    Marsmannix

    AMAZING WRITING

  27. 5 out of 5

    Amanda

    I loved this book! Any RN's, MD's, RT's would appreciate this memoir. Jennifer put into words what I as a critical care nurse, feel everyday. Bravo! I loved this book! Any RN's, MD's, RT's would appreciate this memoir. Jennifer put into words what I as a critical care nurse, feel everyday. Bravo!

  28. 4 out of 5

    Jessica Bang

    There was a lack of direction with the narrative (kept going back and forth with events), but I appreciate the honesty and glimpse at the life of an emergency flight nurse.

  29. 5 out of 5

    Deborah

    For the most part I really liked this book -- it got a bit ridiculous how many times the author went back and forth - present to past on and on Subject matter interesting

  30. 5 out of 5

    Christy

    What dedication. And a great inside look at rescue and trauma care.

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