Mike ArgentoYork Daily Record
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When the flight crew encountered the patient, she wasn’t in good shape.
That’s not unusual. The crew often sees patients when terrible things have happened to them, on the very worst day of their lives and, sometimes, the last day of their lives.
This patient, a woman, as one crew member said, was “not doing well.” Her skin appeared gray. Her blood pressure was dangerously low. She was struggling to breathe.
They knew little about her condition, only that it was dire, the result of a freak gardening accident. She'd impaled herself with a pair of garden shears after a slip.
They went to work. They gave her blood. They inserted a long hollow needle into her chest to relieve pressure that had caused one of her lungs to collapse.
They loaded her into their helicopter and took off.
They didn’t know whether she would make it.
Not the kind of thing that happens every day
It’s not the kind of thing that happens every day, but it does happen, severe trauma that could lead to the loss of a life. The crew with WellFlight has encountered every kind of insult to the human body that can lead to premature death – from car accidents to medical emergencies to freak accidents.
WellFlight is part of a national company called Air Methods, which has been around for nearly 45 years, starting in Colorado in 1980. The company has expanded over the years and now provides air transport for trauma patients across the country. The company provided helicopters to evacuate the Tulane Medical Center in New Orleans in 2005 during Hurricane Katrina. The company’s medevac crews have provided care and transport for thousands of victims of trauma over the decades.
All of that experience could not foresee a gardening accident that left Karen Bowling hanging on to her life.
'It was like a bad movie'
May 11 started out badly. It rained early in the morning, but by 11 a.m. or so the sky had cleared, and it promised to be a beautiful spring day.
Karen went outside to do some work, trimming back some plants in the boundary of the eclectic garden that covers a good bit of the backyard of her home west of Gettysburg. The house dates to the 1870s, and despite local lore, it was not the parsonage for the historic church next door.
She and her husband, Keith, have lived in the house since March 1979, picking it up for a good price since it was a fixer-upper. The ceilings were bowed, and the porches of the two-story brick house slumped. They worked on it, and now it is a prime example of a house from that era, complete with a fireplace housing a wood stove in the kitchen.
That morning, once the weather had cleared and the sun emerged from the clouds, Karen went to her garden. She had gardened for years, the pastime, although hard work, was relaxing –her hands in the dirt and being outside in nature. She worked a variety of jobs, starting out as a commercial artist after studying at the now-defunct York Academy of Arts and retired as a teacher with the Lincoln Intermediate Unit. At 75, she had time to indulge in her hobby and loved it, planting a vegetable garden surrounded by flowering plants in her backyard.
This morning, she was trimming back some plants with a pair of Fiskars shears – just “tidying up,” she said – when she reached for a branch, placing her foot on a pressure-treated timber that served as a boundary of the garden. The surface of the timber was slippery, and even though she was wearing rubber boots, she lost her footing, tumbling onto a slight incline by the side of the garden. As she fell, one of the blades of the shears pierced her chest, her weight driving deep the sharp blade into her body just above her sternum as she fell to the ground.
“It sort of happened in slow motion,” she said. “It was like a bad movie.”
She felt some disbelief. “What’s happening here?” she thought.
She got up, the shears still embedded in her chest. She knew that she shouldn’t pull them out, she said, but she did. Instinct had taken over.
She ran to the house, stripped off her shirt and gloves and took her boots off. She grabbed a paper towel and pressed it against the wound in her chest. “There was little blood,” she said.
She stumbled to her living room, starting to go into shock. Her husband was upstairs, and she called for him. Her voice was weak, she said. “I was having trouble breathing,” she said. She didn’t know it at the time, but one of her lungs had collapsed, making it difficult to breathe and robbing her body of oxygen.
Keith heard her calls, and when he entered the living room he asked, “What in the world happened?”
He offered to drive her to the emergency room or take her to urgent care. After a few moments, though, he decided to call 911 for an ambulance.
The ambulance crew from Cashtown, just down the road, arrived in moments and immediately began working on her. They realized her injuries were life-threatening and called WellFlight for help.
The ambulance crew delivered her to the helipad at the Adams County Department of Emergency Services building a few miles away.
'She wasn't doing well'
The crew, flight nurse Melanie Lewis and paramedic Charles Kowalewski, was in the crew quarters when the call came in.
Lewis came to emergency medicine via genetics. Her father was a fire captain in her hometown of Kingman, Arizona. When she finished nursing school, there was an opening for a flight nurse in Arizona and she jumped at it. It was a chance to be a first responder and to help people. And besides, she said, “The more I learned about flight nursing, the more I liked it. You don’t know what can come in, and you just have to be prepared. And it’s fun to fly in a helicopter. It’s a job for an adrenaline junkie.” Later, when her fiancé got a job in Washington, D.C., she moved to this area; Air Methods has crews all over the country, and she was able to transfer east.
Kowalewski has been a paramedic since 2005, going into the profession via a circuitous route. When he graduated from high school, he had planned to study art history in college. He took a first-aid class, and the fire department offered him a ride-along. He was hooked, abandoning art history for emergency medical technician training and, later, training as a paramedic. He loves the work. “I love to challenge myself,” he said. “I’m a big fan of puzzles and a lot of patients don’t know what they need, and you have to figure it out. It’s something I’m really passionate about.” The job and its schedule – 24-hour shifts followed by days off – permit him to spend time with his family and help homeschool his daughter.
When the call came in on May 11, they weren’t initially told a lot about the case, just that the Cashtown ambulance was on its way and needed transport to York Hospital’s trauma center. They aren’t given a lot of information initially in many cases, not wanting to prejudge what they may have to do to treat a patient.
The chopper pilot went to the helicopter and started it up, running it to burn off some fuel. The helicopter has a strict weight limit and given the weight of the medical equipment and the weight of the patient, it would have to be lighter to fly safely.
Lewis and Kowalewski gathered the gear they would need and prepared. When the ambulance pulled up to the helipad, they went to work. It’s almost automatic, they said. It’s like being an athlete, training hard to handle all varieties of offenses to the human body – and when presented with a patient, Lewis said, the training takes over. Time is the enemy. Moments can make the difference between life and death. As Lewis put it, “It’s game time.”
They assessed Karen quickly. Her blood pressure was dangerously low, causing her complexion to appear gray. She was responsive, but because of her collapsed lung, she had trouble speaking.
“She wasn’t doing well,” Lewis said.
Kowalewski said, “The look in her eyes was not a good-outcome look.” He could see her fear, he said.
They treated her – piercing her chest with a long needle to relieve the pressure on her lungs and giving her two units of blood, about 700 milliliters and a drug to assist clotting to stanch the bleeding to restore her blood pressure – and loaded her into the helicopter’s cramped cabin. The rear of the cabin is packed with medical equipment and two small seats for the medical crew. The patient lies on a gurney that extends into a claustrophobic tunnel that extends into the chopper’s tail.
“She was never stable,” Lewis said. “We needed to get her to the ER.”
'I need to tough this out'
Karen was aware of what was happening to her. She knew she was in bad shape, but, at the same time, she wondered, “What in the world is happening?”
She doesn’t remember a lot of what happened after she arrived at the helipad. She recalls seeing “angels in blue,” she said. (The flight crew wears blue jumpsuits.)
As they put her in the helicopter, she recalled thinking, “I’ve never been in a helicopter.” She hates flying.
She thought, “I don’t think I can do this.” She thought she was “slipping away.”
She wasn’t ready to let go. “I don’t know if it made any difference, but I decided I was going to push through it. I’m not ready. I need to tough this out.”
Still, she struggled to breathe. She felt that her "body was starting to shut down.”
'We gave her time'
The chopper delivered Karen to York Hospital – a five-to-ten-minute flight – where a trauma bay had been prepared. The team of doctors and nurses had been assembled and prepared an operating room. They assessed her condition and prepared her for emergency surgery.
She was still on the edge of death and Kowalewski said, “I feel we gave her time. We gave her time to make it.” Lewis said. “I was nervous about her ability to make it.”
But their job was done. “A lot of time,” Lewis said, “when we drop off our patient, that’s usually how it ends for us. We usually don’t hear what happened.”
'Close to being the end'
Karen remembers, “There were a lot of people encouraging me and smiling.”
She had surgery to repair the damage, and two follow-up surgeries to clean out her wound and make sure infection hadn’t taken hold. “The shears were dirty,” she said. She was in the hospital for eight days.
The shears had penetrated the sac surrounding her heart and nicked her heart cardiac muscle.
“It was very close to being the end of it all,” she said.
Angels
Some months later, as Karen was on the mend, she noticed the Cashtown ambulance on her street. A neighbor had trouble breathing and had called 911 and the Cashtown EMTs responded.
Karen went to her front yard and saw some of the crew standing around the ambulance. One of them recognized her, and she soon learned that much of the crew were the same people who helped her. She thanked them and hugged them.
She knew she had to connect with the helicopter crew, too. She sent an email to Lewis.
It was unusual, Lewis said. Kowalewski said in his years on the job, he said it was rare that they even heard about whether a patient had made it, much less being able to meet them. It’s happened twice during his 18 years on the job, he said.
Karen wanted to meet them. She wanted to thank them for saving her life. She felt, “I needed to do that.”
A meeting was arranged – it was postponed once when Lewis and Kowalewski had to respond to a call when she stopped by. They talked. She hugged them. They showed her the helicopter, Lewis said, “from a different perspective.”
Lewis said, “We were wondering how she had done. It brought us so much joy to see that she had come full circle. We were so close to losing her, and now she was walking and talking and laughing. We were overjoyed that we were there for her.”
She said, “It was great. She called us angels, but she’s an angel to us.”
'Every day is a gift'
In September, Karen took a biking trip with a life-long friend, riding a few miles along the C&O in Shepherdstown, West Virginia. It wasn’t a strenuous ride, covering eight miles over three days, but, she said, it was a revelation. She felt alive. Everything seemed more vivid.
After what she had been through, life seemed even more precious.
“I’m blessed,” she said. “Every day is a gift.”
Mike Argento has been a York Daily Record staffer since 1982. Reach him at mike@ydr.com.
(This story was updated to correct a misspelling/typo.)
