Day 107-108 (Dec 8)

Today is an unusual blog post.  I documented the trip as it happened, but since we flew through the night, I was unable to create a unique post for each day.  Here is my record of the trip that Tobias and I took to travel from Salt Lake City to Berlin on a medical transport jet.

We made it onto the flight to Berlin.  Right now we are somewhere over northern Canada, but a lot happened since this morning.

My alarm woke me at 6:30 and by 7:00 I was ready to walk out the door to the airport.  The transport team was supposed to pick Tobias up at 7am so I had plenty of time to make it to the terminal before Tobias arrived from the hospital.  Given the events of yesterday I called the hospital from the passenger seat on the way to the airport.  Tobias was again prepared for the ambulance trip to the airport, but no transport team had arrived yet.  Next I called the charter aircraft company at the airport and the front desk lady asked me to hold briefly while she called the pilot to speak with me.  He was very friendly and confirmed that Tobias was supposed to arrive at 7:30 for an 8am departure.  He did say that the doctor was still at the hotel so we would be lifting off between 30 to 60 minutes late.  We arrived a few minutes later at the airport and I met the pilot in person.  There was some confusion about whether the hospital was supposed to deliver Tobias to the airport or whether the transport team was supposed to pick up Tobias at the hospital.  The insurance company had been clear that the transport team would retrieve Tobias, but as we were trying to figure out what to do, the doctor showed up and said that he was not insured in the US so he would not be able to accompany Tobias from the hospital to the airport.  At about the same time, the ambulance arrived, but we were surprised to learn that Tobias was not in the ambulance.  A few minutes of conversation ensued and in the end we agreed that I would drive in the ambulance to return with Tobias (this is exactly the opposite of what the air ambulance contact told me was possible).  We had to wait for another 10 minutes for the ambulance crew to receive permission for me to travel in the ambulance from their dispatcher, but after 15 minutes I found myself riding in the front of the ambulance through Salt Lake City on the way to the hospital.

I was happy to retrieve Tobias so that I could speak with him and let him know that I would be watching out for him.  At least he would know that he was in the right ambulance.  It also worked out well since we didn’t find any of the liquefied food that Tobias receives through his food tube.  I didn’t realize this until I had gone through the bag of goodies that the nurse gave to me.  The ambulance had already pulled away from the hospital, but the driver just pulled to the side of the road and I walked back to the hospital.  Tobias’ nurse was easy to work with and she met me in the lobby with enough food for a 15 hour trip.  I felt more comfortable picking up the medicine, food and paraphernalia that Tobias will need for his rehabilitation.  At least this way I knew we had everything.

In ambulance 

In the midst of all of this activity, I realized that the air ambulance contact had given us a lot of information that was not thought through or was incorrect.  The pilot had been so friendly and accommodating at the airport that I figured I would ask if there is room in the aircraft to bring a suitcase for me.  I called the pilot from the hospital and he said that they would find a way to bring my suitcase along.  I imposed a big favor on my nephew to retrieve the large duffel bag from my temporary bedroom with my clothes and the rest of Tobias’ belongings that hadn’t made the final cut to get packed into the small carry-on.  He brought the duffel bag and Tobias’ university backpack to the airport and they were stored in the luggage compartment in the back of the plane.

We arrived at the airport with Tobias and he was transferred from the ambulance into the small business jet, a Learjet 45.  The fuselage is narrow enough that I can reach from one window across to the other window and even I have to crouch to walk through the plane.  Other than the pilot seats up front there are four seats on the left side (when facing forward) of the aircraft.  The right side has a ledge running the length of the seating for the patient to be strapped down onto.  At the rear of the jet there is a small room that doubles as a storage area and “emergency toilet”.  I’m not exactly sure what an “emergency toilet” is, but I was advised in a friendly, but knowing tone that I should use the indoor restroom before take-off because “we only have an emergency toilet on board.”  I hope to avoid learning underway what an emergency toilet is.  I’m envisioning removable floor boards enabling access to the exterior of the aircraft (just kidding).  It’s probably something similar to the commode arrangements my dad installed into our camper that required the use of a waterproof plastic bag and adhered strictly to the code of “carry out”.  Like I said, I’m monitoring my liquid intake to avoid any embarrassing in-flight situations.

Tobias was installed comfortably in the “hospital bed”, which is his stretcher secured to the top of a flat section in the aircraft.  The nurse was considerate to make sure that she had put Tobias in a comfortable position.  We reviewed the feeding regiment and she and the doctor read up on the medications.  Shortly thereafter the aircraft was climbing steeply into the sky.  I surprised me how fast the acceleration seemed.  Perhaps it was the size of the aircraft that accentuated the speed, kind of like how the feeling of speed in a go-cart is always more than in a larger vehicle.  The rate of ascent was also surprisingly high.  I was facing backward so perhaps this caused a greater appreciation for the angle since I wasn’t sitting back into my chair, but rather falling out of it.  Normally jets will fly all the way to my hometown, Brigham City, before turning toward he east and I was hoping to get a good view of Brigham on such a clear day but the pilot turned east before we even got to Ogden.  The view of the mountains is always beautiful and there was a ridgeline of snow to contrast with the rocky mountain tops.  We also ran into a layer of clouds shortly after passing over the Wasatch Range and were treated to the view of a carpet of soft cotton laid across the earth.  Tobias was attached to the onboard pulse-ox to have a constant reading of his pulse and oxygen levels, but 20 minutes into the flight the doctor suggested removing the finger clamp to give Tobias more comfort.  The doctor was able to tell already that Tobias’ condition was stable and he didn’t require a constant monitor.

I sat facing the nurse near Tobias’ head and she and I discussed his condition thoroughly in case I were asleep later in the flight and she needed to interact with Tobias.  I showed her how Tobias can best communicate and explained what positions he finds comfortable etc.  Everyone on the flight has been kind, friendly and accommodating.  I didn’t know what to expect after dealing with the air ambulance hotline representative.  I’m glad that the attitude the hotline lady had didn’t extend to anyone else on the transport flight.  Tobias seems to be doing better today and had his eyes open.  Yesterday he seemed exhausted and wanted to sleep as much as possible.  I asked him if he would like to listen to music and he confirmed by raising his arm.  I gave him my noise-cancelling headphones and played his favorite playlist via Bluetooth for the entire first leg of the flight.  He appeared to be comfortable and I checked his pulse several times with the finger monitor that Katja wisely purchased in the hospital pharmacy.  His heart rate stayed in the 80s for the whole trip except as we started to descend.  I noticed that he had built up pearls of sweat along his forehead and I massaged his neck and back gently to relax him only to find that he was sweating profusely down his back as well.  I told the nurse at the start of the trip that Tobias responded well to a hot wash cloth on his face, but in an aircraft without a real toilet, there was no room for heating water for wash cloths.  The nurse had given me some fresh wipes packaged individually in foil packets and advised me to sit on them to warm them up.  I had been brooding them since shortly after take-off so I used one of them to wipe the sweat away and clean his face.  He was still storming with a heart rate of 105 when we landed so I asked Tobias to help me identify where his pain was coming from.  As he occasionally does, he surprised me by saying “feet” and we discovered that his feet had been pressed into two vertical support bars at the end of his make-shift bed.  When we took off from SLC the angle was so sharp that he must have slid into them and I felt guilty for not checking him for sharp contact points during the flight.  The nurse and I pulled him forward and we massaged his feet during our stop in Toronto.  The nurse also gave him some Ibuprofen to dull the pain and Tobias reporting feeling better shortly thereafter.  We originally were supposed to fly through Winnepeg to Nunavut, but due to the one day delay, the flight plan substituted Toronto and Goose Bay, Newfoundland for Winnepeg and Nunavut.  They told me today that I was going to Goose Bay, but I wanted Nunavut.

Sunset into Toronto

At Toronto we deplaned to use the restroom and stretch our legs.  The private airport in Toronto is large and the facilities were high end.  We had to pass through customs theoretically, but no one asked to see my passport or immunizations.  The pilot had urged me in SLC to use the online registration form and it was slightly stressful to download the app, get registered and populate my transit request, but in the end it didn’t matter.  No one checked.  The private airports are incredibly simple when compared to their mainstream counterparts.  Deplaning is as simple as stepping off the plane and walking across the tarmac to the facility.  There is no waiting, no buses, no checkpoints.  I thought that we wouldn’t be able to deplane with only 50 minutes scheduled for the stopover.  It turns out we could have deplaned and reboarded with a stopover of 10 minutes.  Tobias, of course, had to stay on the plane and someone stayed with him the whole time.  The nurse watched him when I was off the plan and I returned the favor.  We also used the stopover to reposition Tobias and prop pillows under his back and knees.  Then it was on to Goose Bay.

The flight to Goose Bay was in the dark and we saw nothing of the land below.  The night sky, however, was full of stars and I’ve never seen so many constellations while in flight.  The smaller aircraft must create less light pollution because it was easy to see the heavens littered with stars.  Tobias didn’t storm again on the descent into Goose Bay, which surprised me a little.  The wind was blowing significantly and the turbulence was remarkable.  This was not a flight for Katja, but I rather enjoyed the bumping around in the air currents and had faith that the jet would hold together.  Despite the stormy weather, the pilot managed the land the plane smoothly and we eventually came to a stand still on the icy runway outside of a small building no larger than a shack.  There was no other building in site and Goose Bay was no comparison to the luxury of Toronto.  We had to walk carefully across the icy runway to the shack due to the strong winds and my baseball cap almost blew away twice.  There was several inches of snow on the ground and the wind picked up the top layer of powder and create a river of snow blowing straight down the runway.  By the time I shuffled the 30 yards into the building I was started to get a headache and my hands were turning numb.  The Newfoundlander lady inside was friendly and joked about it being too warm of a summer until she noticed that I wasn’t wearing the yellow safety vest that the crew use.  She asked if I was part of the crew and raised her voice when I said that I was the patient’s father.  “No passengers allowed in the FBO” she barked.  “No passengers allowed off of the aircraft!”.  Luckily the pilot is well known and liked and he intervened on my behalf so she reluctantly allowed me to use the facilities.

River of snow

The wind roared straight into the nose of the aircraft when we took off and the pilot gunned the engines hard to gain better control in the harsh weather.  The resulting speed felt like we were riding on an arrow piercing hard into the sky rather than an airplane.  I remember riding on commercial flights where it felt like we were going so slow that we would fall out of the sky… not the case for our little Leerjet 45.  The highlight of the flight from Goose Bay to Reykjavik was the clarity of the night sky and the northern lights glowing on the horizon.  The pilot turned off all the illumination in the cabin and called back that we should look to the north.  I’ve never seen the northern lights before and although it wasn’t the colored light show that I’ve seen in photos, it was an amazing phenomenon to see the entire northern horizon glowing like a huge metropolis lay just beyond the curvature of the earth.  Tobias was situated well.  He had notified us that his feet hurt a few times, but he seemed to be at rest.  We repositioned him several times and tracked his heart rate on the finger monitor.  His heart rate was in the 70s and I was comfortable enough to lean my head against the side of the fuselage and try to sleep a little.  I don’t think I ever dropped off, but it helped to at least close my eyes and rest for 90 minutes before we landed in Reykjavik at 3am local time.

Northern lights

I took the opportunity again to get out of the plane and stretch my legs.  Travelling in this small jet is similar to spending a night in a backpacking tent with another person.  There is room to move around, but space is severely limited and it feels good to emerge outside and have all the room one can wish for.  The cramped conditions on this trip reminded me again of the difficult situation that Tobias is in.  I feel cramped in my backpacking tent, but Tobias is stuck inside a tight sleeping bag with no ability to get outside and stretch his legs every few hours.  It makes me feel guilty and sorry at the same time.  His body must hurt from the lack of movement and he has such limited communication options that he has to bear the discomfort and pain for the most part.  We try to monitor his comfort, but he can’t communicate what he needs.  We are left with the limited options to ask yes/no questions and to proactively reposition his body and massage his muscles and joints.  I long for the day when he can communicate clearly and at length.

The scene at Reykjavik was a stark contrast to Goose Bay.  The airport was extensive and the facility was modern.  The building in Goose Bay was well appointed and comfortable as well, but it was small.  There was no winter wind blowing a river of snow across our path in Iceland and the temperature was higher.  I love the serene, intimate feeling of standing outside in a warm coat on a silent winter night.  The snow deadens any noise and, for the most part, there is no sound anyway.  The darkness wraps around me like a blanket.  It feels personal and the moment moves slowly in time.  This was the feeling at the Reykjavik airport and I thoroughly enjoyed the solitary walk from the jet to the terminal with the sound of crunching snow underneath each step.  I would have liked to sit inside for a time to bathe in the moment and record the calmness in my memory.  The stopovers are short, however, and there is only time for a quick walk around and a trip to the bathroom before the jet is refueled and ready to take off again.  The pilot and co-pilot switched out in Reykjavik and we said our thanks to the original pilots and parted ways.  The first team of pilots treated us well and the second set are also friendly.  I tried to use the wifi to send Katja a message about when we will arrive, but it didn’t go through so I may end up waiting an hour or two in Berlin while Tobias is transported to the hospital.  The app says that the message didn’t go through, but maybe it did.  I’ll find out in Berlin.  For now we are flying at 41,000 feet over the Atlantic ocean on our way home.  Tobias is resting comfortably with a heart rate in the 80s and I’m going to try to rest up so that I have a good day tomorrow/today… when the sun comes up.

I was able to sleep a little or at least rest with my eyes closed.  I checked on Tobias several times, but my attentiveness was unnecessary.  Tobias rested peacefully and his heart rate stayed in the 80s.  This helped me to relax more than the little sleep I got.  The trip has been difficult for Tobias because he got even less movement than normal.  Other than the subtle repositioning that we applied, he was stuck in the same position now for 14 hours.  When I shut my eyes to rest it didn’t take long before my body complained of stiffness and cried out to be moved.  Logically Tobias is experiencing the same aches and pains.  I must have fallen asleep because I opened my eyes to see a new day approaching from the eastern horizon.  The earth is obscured with a layer of soft clouds and the sun is not yet directly visible, but has painted a ribbon of bright gold separating the blue morning sky from the soft cotton sea that we are sailing on.  I feel a surge of gratitude for the beauty of nature and the technical miracle of this jet that is racing us homeward at 600 mph.  We’re almost home.

Der Morgen erwachet

in Berlin

We landed safely in Berlin and the ambulance was waiting to take Tobias to the hospital.  My message did go through and Chris, Emily and Eloise were waiting for me outside the General Aviation terminal.  Customs clearance was a breeze.  Two border police met the jet outside on the tarmac and checked each of the occupants.  I’m the only foreigner so one of the police sprinted into the terminal to check my documents online.  Tobias entered Germany on his German passport.  A terminal employee met me and put my luggage in a van to drive me the 50 yards to the terminal building.  That was it.  Chris drove us home and I got to see Katja for a few minutes before she departed to meet Tobias in the hospital.  The new chapter has begun.

Hope over fear.