By Karen Feldcher

On this impossibly brilliant, impossibly clear September day, Mary is probably going to die.

This is what Stewart Fenniman knows as soon as he begins to examine her. Mary (not her real name) has suffered the kind of head trauma from which it's nearly impossible to recover. Fenniman has seen such injuries all too often.

A paramedic who graduated from Northeastern's certificate program in 1994, Fenniman works for Boston MedFlight, the critical-care transport service that shuttles seriously ill and injured patients to emergency rooms or trauma centers by helicopter, small airplane, or ambulance.

The call about Mary came in just after 7 a.m., as Fenniman and nurse Beth Pahigian drank their morning coffee in MedFlight headquarters at Hanscom Air Force Base, in Lexington, Massachusetts. Mary was a pedestrian who'd been hit by a truck. She'd already been taken to Gloucester's Addison Gilbert Hospital. Now she needed to get to a trauma center immediately.

Within five minutes of the call, Fenniman and Pahigian had zipped on their one-piece royal-blue uniforms, hurried through a hangar kept cool by dozens of fans spinning in the vaulted roof, and hopped aboard a Eurocopter BK-117, one of three MedFlight helicopters.

During the fifteen-minute ride to Gloucester, Fenniman and Pahigian joke amiably with Rick Ruff, a former military pilot and six-year MedFlight veteran. Their white helmets are equipped with earphones and a mouthpiece so they can communicate above the roar of the motor and the rotors. They chuckle over a story about a bride who, unused to drinking, had to be carried out of her own wedding reception.

MedFlight staffers kid around a lot. They apologize for sometimes sounding irreverent. But, they say, keeping things light fosters camaraderie, and helps them deal with the stress that goes along with handling medical emergencies.

Of the thirty-six-person medical staff at MedFlight, nearly a third are NU graduates. Some, for instance, have earned paramedic-technology certificates from the Institute of Emergency Medical Services. Others have nursing or MBA degrees.

All have something in common: a passion for their job.

"MedFlight is the epitome of how you can operate as a paramedic," says Fenniman, an energetic and wisecracking thirty-nine-year-old. He's been with MedFlight for two years, after working ten years as a police officer, then becoming a paramedic at Concord's Emerson Hospital eight years ago (he still works there per diem). "It's always fast-paced, always different. It's like controlled chaos. We treat patients the best we can in the shortest amount of time possible.

"We work hard," he says. "Play hard. And sleep hard."

On-the-go ICUs
When people hear the name MedFlight, they tend to picture helicopters landing on highways to whisk accident victims off to hospitals. But such dramatic rescues represent only about 20 percent of what Boston MedFlight does, says Andrew Farkas, N'87, who joined the organization thirteen years ago and is now one of its two chief operations managers.

Mostly, he explains, MedFlight handles hospital-to-hospital transport. Often, its helicopters bring patients from the area's regional hospitals to a Boston hospital that handles severe trauma or cardiac cases. Sometimes, the airplane shuttles patients from a Boston hospital to a hospital or a rehab facility in another city. Other times, Medflight simply moves patients the old-fashioned way: via ground transport.

But whether they travel on the interstate or in the sky, MedFlight vehicles are not ordinary ambulances. They are mobile intensive-care units. Staffed with both a nurse and a paramedic, each carries a slew of high-tech devices—such as ventilators, heart monitors, defibrillators, and transvenous pacemakers—and a large backpack filled with medical equipment. When needed, other special equipment, such as neonatal isolettes, can be loaded aboard.

Boston MedFlight, which last year earned program-of-the-year honors from the Association of Air Medical Services, specializes in transporting children and adults who have suffered trauma, head or spinal-cord injuries, or burns; patients with cardiac conditions or respiratory failure; women with high-risk obstetrical conditions; and high-risk infants.

Calls are assigned to a helicopter, ground vehicle, or airplane according to the patient's condition, the weather, the location of the destination hospital, and the availability of a helipad or a landing space. (The helicopter pilots keep lists of potential landing sites for everyplace they fly.)

A nonprofit program, MedFlight celebrated its twentieth anniversary this year. It's affiliated with six major teaching hospitals: Beth Israel Deaconess Medical Center, Boston Medical Center, Brigham and Women's Hospital, Children's Hospital Boston, Massachusetts General Hospital, and Tufts–New England Medical Center.

In fact, says Farkas, MedFlight is probably the only cooperative venture among these six institutions. Supported by the partner hospitals—as well as by insurance reimbursements and donations—the program, to date, has cared for more than 28,000 critically ill and injured patients.

MedFlight is part of another cooperative group, the Northeast Air Alliance, an affiliation of air-medical programs. This is also atypical, Farkas says. In many other parts of the country, air-medical programs compete with one another, which can lead to confusion—and occasionally, tragically, to accidents as well.

In 1985, MedFlight began operating out of Hanscom with one helicopter and twenty staff members. Today, the service has three helicopters, an airplane, two ground vehicles, a second base at the Plymouth airport, and eighty staffers. The Hanscom headquarters has remained unassuming—just a plain cinderblock building with a small sign that reads "Boston MedFlight/Hangar 1727."

Everyone on the medical staff is required to keep current, says Christine Kociszewski, MBA'00. A self-described "perennial student," Kociszewski says the emphasis on education makes MedFlight a great place for her to work. (The royal-blue flight suits, which she pronounces "very cool," don't hurt either.)

"They demand a lot of us, timewise," says Fenniman. "But they give so much back to us. There's constant education through lectures and staff meetings, and there are clinical assignments we're all required to attend in hospitals. We get all the newest literature, and the medical director is always keeping us up to par on things. You really can't get that anywhere else."

A serious case
The MedFlight helicopter sails toward Gloucester at a zippy 130 knots. Below lies the lush late-summer carpet of the North Shore. The coastline, sparkling in the early-morning sun, is peppered with a mosaic of docked boats.

Swooping in over a football field and a baseball diamond, the copter lands in a swirl of dust in a parking lot next to a deserted skateboard park. The landing site's perimeter is ringed with local emergency vehicles, as well as police officers, ambulance staff, and firefighters, their arms akimbo, faces serious. The MedFlight crew hops into the back of a waiting ambulance for the short ride to Addison Gilbert Hospital.

Inside the emergency room, behind a curtain, Mary lies unconscious. Fenniman and Pahigian take stock. The patient has a head injury along with broken bones and bruising on her left side. Her blood pressure is dangerously low. Her eyes are barely open and unfocused; one is grotesquely swollen.

A few minutes later, the crew has wheeled Mary into the ambulance, ridden back to the helicopter, loaded up, and lifted off.

The ride back to Boston is quiet. No joking anymore. Fenniman and Pahigian continually check Mary's vital signs. She's attached to IV bags that hang from hooks in the copter's ceiling. Fenniman periodically squeezes a pale purple bag, connected to an oxygen mask and an endotracheal tube, to keep her breathing. As the heart monitor pulses in the background, Pahigian says, "I don't like her heart rate."

Fenniman examines an X-ray he holds up against a window. He palpates Mary's skull. "Her head feels intact," he says. "But she really needs blood."

"We need a quick ride," Pahigian tells Ruff, then rests a hand on one of Mary's and says she can't feel a pulse. She and Fenniman exchange worried glances.

Only ten minutes to Boston. At about 8:30 a.m., Ruff is bringing the craft over the Tobin Bridge, crammed with cars heading into town, and around the perimeter of the city, past Long Wharf, the Custom House, Rowes Wharf, Chinatown, and the Southeast Expressway, around to a sudden bird's-eye view of gleaming skyscrapers. Then he's easing the helicopter down. It shudders and tilts its way onto Boston Medical Center's helipad, adjacent to the tall glass-walled building that houses the hospital's generator.

An ambulance is on hand to take Fenniman, Pahigian, Ruff, and Mary one block to the Boston Medical emergency room. As the MedFlight crew accompany Mary into the hospital, they're quickly joined by the attending ER doctor, nurses, and a host of residents on hand to learn the ropes.

On a count of three, Mary is shifted from the MedFlight stretcher to the hospital examination table. Then Fenniman, speaking loudly enough so everyone in the room can hear, describes her injuries and treatments.

That's it for the MedFlight group—for now. They stop for coffee and a quick bathroom break (Pahigian jokes she takes every opportunity she can). And it's back onto the helicopter for the ten-minute flight to Hanscom.

Unpredictable encounters
At MedFlight, employees say, there's no such thing as a typical day on the job.

"The only thing that's typical is that you're coming to work and you're leaving work," says ten-year MedFlight veteran Kociszewski (pronounced Kotch-i-SHEF-ski), who earned her paramedic certificate from Cape Cod Community College in 1990, then got a Northeastern MBA to learn more about the medical field's business side.

"I love the unpredictable nature of this job," Kociszewski says. "In the morning, I could be on Martha's Vineyard, in the afternoon I could be in Nashua, by evening I could be in Worcester, and at night I could be in Bermuda."

"You never know what's going to come through the doors," says Kathy Moynihan, N'89, who's been with MedFlight for three years. "Here, most people like not knowing what's going to happen. If you need order, this isn't the place to be."

Some days are crazy. Kociszewski remembers one in particular, at the Plymouth base about six years ago.

"We were outside doing training," she says, "when suddenly we looked out the window and saw a plane go head over heels. It was just a ball of fire. There were two men on the plane. They were able to get out, but they were fully engulfed in fire. We brought the backpacks over and dialed 911, got local response from Plymouth and Carver, and activated the second copter from Hanscom. Each patient ended up going to a different hospital."

One man survived and is doing well, she says. The other man died the next day. His partner visited the MedFlight staff later and thanked them for giving her

an extra twenty-four hours with him to say goodbye. "It was heart-wrenching," says Kociszewski.

Moynihan remembers one of her difficult days. "We were down on one of the islands trying to intubate a baby," she says. "It turned into a long ordeal, trying to get the right kind of tube in, to make sure he was oxygenated in the right way. This baby was nine months old. My own was ten months old at the time. His mother was in tears, and I was in tears. It was very emotional."

For paramedic Mark Saia—who's had many points of intersection with Northeastern, earning an associate degree in respiratory therapy in 1987, an EMT certificate in 1990, and a paramedic-technology certificate in 1993; he currently teaches in NU's paramedic program—the roughest day came in September 2004. Several children had been injured when a car jumped a sidewalk outside a Stoneham school.

Saia helped save a little boy who was six, the same age as one of Saia's sons. "He had extensive leg injuries," Saia recalls. "He was telling me he needed to get to his hockey game. After we brought him to the hospital, we stayed for a while. I felt like I needed to get some kind of closure before I left and know that he was going to be okay."

He was. But he lost a leg. In a small-world turn, Saia's wife was at a birthday party recently, and there was the boy, now equipped with a prosthetic leg. The boy's mom made a special point of thanking her for her husband's efforts.

"That felt amazing," says Saia.

The crew's shifts can be uneventful, or long and grueling. On the day of Mary's injury, Fenniman worked from

7 a.m. until 9:30 p.m. But you don't hear many complaints, from him or from any of his colleagues.

"We're providing a public service, taking care of sick people," says Farkas. "So you can't say, ‘I'm going in at seven o'clock today, and I'm getting out at seven.' You have to do what you have to do. You can't say, ‘I've got a family commitment tonight.' I think, Gee, it could be somebody in my family, or somebody I know.

"This is such a good group of people here," he adds. "They're doing it because they want to do it. They don't consider it a job. They're doing something right that makes a difference."

"It's not just a job," agrees Fenniman. "It's a lifestyle."

One long day
Fenniman and Pahigian have been back at Hanscom for less than fifteen minutes when another call comes in. They dash to the helicopter, this time for a quick trip to Wellesley, where a twenty-nine-year-old construction worker has taken a two-story fall.

The copter descends slowly toward its landing zone, the Wellesley Fire Department parking lot, with Ruff carefully avoiding the tangle of telephone poles and suspended wires.

Just after the landing, an ambulance pulls up with the patient. Fenniman and Pahigian jump in the back of the vehicle to assess the situation.

Darren (not his real name) is conscious but doesn't remember how he fell. He says his right side hurts a lot. Before Fenniman administers any medication, he asks Darren if he has allergies to anything.

"Shellfish," Darren replies.

"So—no shrimp cocktail on this flight, right?" Fenniman jokes.

After the crew has loaded Darren onto the helicopter and set him up with an IV drip and an oxygen mask, Pahigian asks, "How's the pain, sweetie?"

"Gone," Darren replies. His face looks peaceful now.

"Sub-q fentanyl," says Fenniman, grinning, referring to the commonly used painkiller, administered subcutaneously, or under the skin. "Does the trick every time."

This call, the trip to Boston isn't so grim. Fenniman and Pahigian can tell the patient is most likely going to be fine. Although a coworker at the scene reported that Darren fell about twenty-five feet onto some sort of pole, remarkably he doesn't seem to have a serious injury.

The copter flies low over the Charles River, Fenway Park, and the old Sears building, and onto the helipad on the roof of Brigham and Women's. Darren is moved into an elevator that goes to the ground-floor emergency room. As the MedFlight crew grab sodas and start heading back to the copter, they hear Darren scream, "Ouch! OUCH!"

Pahigian and Fenniman look at each other and exchange grimaces.

Once they get back to Hanscom, they check on Darren's status. As they thought—his prognosis is good.

The crew has time for lunch and some report writing. But the day is young. The third call: Transport a fifty-one-year-old man in cardiac arrest from Anna Jacques Hospital, in Newburyport, to Brigham and Women's. Fourth call: Fly a sixty-four-year-old man, intubated for respiratory failure, from Merrimack Valley Hospital, in Haverhill, to Brigham and Women's. Last call: Get to Route 24 in Brockton, land on the highway, and care for a twenty-nine-year-old man stabbed in the neck and the chest (probably by a passenger in his car), who then drove into the back of a truck. He's brought to Boston Medical Center.

"Needless to say, it was a long drive home," Fenniman reports later. "But, man, did I sleep well."

Scoring cool points
People who meet the MedFlight staffers are often impressed by what they do.

"They say, ‘That's really cool!' says Kociszewski. "You get questions like, Do you wear helmets? What kind of clothing do you wear? How do you prepare for a disaster? How do you urinate in there?"

The answer to the last question, she says with a laugh, is "before you get in." She admits it's an important consideration. "The two big personal concerns are going to the bathroom and always having something in your stomach," she says.

Fenniman says many people he meets tell him they've always wanted to ride

in a helicopter. Plus, working for MedFlight scores him "cool points" with his twelve-year-old son. "He sees us fly over all the time," Fenniman says.

"Sometimes when you're working, you forget you're flying," says Moynihan. "Other times, the patient's fine, and you look out and think, This is really cool. I still say to myself that I can't believe I do this."

Nancy DeFilippis, director of Northeastern's Institute for Emergency Medical Services, part of the School of Professional and Continuing Studies, says aspiring paramedics see working for MedFlight as "amazingly sexy." She explains, "I mean, they're landing on helipads and highways; they're delivering the highest level of care that can be given to a patient other than at the hospital.

"It's a hard job to get," DeFilippis says. "But at least a third of the applicants to our program express a dream to work at Boston MedFlight."

Okay, there's glamour in flying, but what about the dangers? Are they greater for MedFlight staffers than for ordinary medical personnel?

If weather conditions are questionable, MedFlight's very experienced pilots decide whether it's safe to fly. The pilots are deliberately not informed about the individuals they might transport, so emotion doesn't color their decisions. If anything, observers say, the pilots err on the side of caution.

Safety reminders—bold yellow lettering on color Xeroxes of helicopter photos—are posted all over the plain but comfortable Hanscom workroom: "Bad can turn worse." "Abort for weather."

In its two-decade history, MedFlight has never had a crash.

At first, staffers say, the idea of helicopters was a little intimidating. Before MedFlight, Saia had never flown in one. "There was a certain degree of anxiety," he says. "But I also found it very exciting."

In 1995, just before Kociszewski was hired, a private helicopter crashed into the Charles River, killing four people. "It gave me cause for concern," she says. "But it sort of makes you safety-savvy. You look at everything twice, and make sure you're never tired."

For the most part, though, MedFlight staffers say they're so focused on taking care of patients, they don't worry about what could happen in the air. Instead, they worry about how being in the air limits their options.

Saia explains, "In an ambulance, if there's an emergency, you can pull over or pull into the nearest hospital. If you're fifteen hundred feet in the air over Nantucket Sound, it's always in the back of your mind that you can't just land. So you think: If something were to happen right now, where is my nearest landing zone? What would I do for this patient?"

Type-A rushes, rewards
Then there's the question of stress.

There's no denying, say employees, that MedFlight's a stressful job. But it's another thing they don't spend a lot of time thinking about.

"The stress is different for different people," says Farkas. "We take care of very sick people, some very tragic cases. You develop—I don't know if it's a wall, but it's a sense that you've got to take care of the patient. You deal with the emotional part of it later."

Saia agrees. "It's after the fact, when we're done with the call, that it hits."

Fenniman says, "We deal with the worst of the worst, the sickest of the sickest. People ask, ‘How do you deal with it?' I deal with it by knowing I did everything I could to help them."

As an organization, MedFlight pays attention to the emotional toll the job takes. After Saia cared for the boy who eventually lost his leg, he got a call from MedFlight medical director Dr. Susan Waddell, asking if he wanted to go home or needed any counseling. "We have an amazingly supportive staff at MedFlight," says Saia. "Everyone made a point to call my partner and me."

Perhaps the members of this air force aren't overly troubled by stress because, in a way, they thrive on it. "These guys are kind of adrenaline junkies," DeFelippis says. "It's really not just an average job. It's sort of like being a Green Beret or a Navy Seal."

"It's intense here," agrees Moynihan. "You can't be wishy-washy. You have to know your stuff, and know the protocols, and know the drugs, and be able to do the job. And work well with other people."

"We have all these Type-A personalities who work in this field," says Fenniman. "You get the rush when the radio goes off and the phone rings."

But, quite apart from the heart-pounding thrills and chills, the MedFlight staff love the feeling of helping others. "It's the greatest job in the world," says Fenniman. "There's always someone who needs us. A lot of it is life-or-death stuff. It keeps everything in perspective."

He adds, with certainty, "There's nothing more satisfying."

Karen Feldscher is a senior writer.