Frontier Nursing Service

My nose was stuffed, the day was long, and I was so tired from my pounding head when my head nurse came to me with one more job to do.

You see, Roger Lee needed transporting to a local hospital for more treatment.

The year was 1975, and I was a fairly new registered nurse who had taken a job in southeastern Kentucky working for Frontier Nursing Service.

Frontier Nursing Service was a public health type organization that covered 3 remote Appalachian county areas in southeastern Kentucky, extending over some 700 square miles, and encompassing some 15,000 residents. We nurses used jeeps or VW Things to cover the mountainous countryside, which were modern conveniences, as just 2 years prior to my employment, many nurses still rode horseback to deliver babies in these hillbilly homes.

I worked in a small hospital, if it could even be so named, as the building itself was an old two story house that was condemned a few years prior. So rotten were the floors that the flat plate x-ray machine had gone through the flooring more than once due to the weight of the apparatus.

Working on the med-surg second floor of this hospital for a 10 hour day shift caught me in a rough position. My shift was over and I had fought with a couple doctors during the day to please check over Roger Lee, who apparently had viral pneumonia, as his breathing became more & more labored. This hospital had no equipment capable of dealing with this baby’s respiratory condition, so he was placed in a crib with an old fashioned oxygen tent. I had no pediatric oxygen equipment available to use.

Just before my shift ended at 5 P.M., Dr. Lynch, the pediatrician, showed up asking why Roger Lee was still here, meaning why hadn’t anyone transferred him to another facility with better equipment. My answer was I couldn’t convince anyone to do anything. Flying into action, Dr. Lynch initiated the phone calls to Harlan Appalachian Hospital for his admission there.

Immediately thereafter, the head nurse looked at me with the question on her face of who is going to make the run? Harlan was 30 miles to the east across the mountains, meaning a twisty turning drive of an hour each way. Reluctantly, amid my sniffing, I agreed to do it, as no one else was available. A few quick phone calls were made to Wendover, the organization’s headquarters, to find a courier, a young adult volunteer who did odd jobs and errands to relieve nursing & administrative personnel for other duties, to drive a vehicle to Harlan for me as I handled Roger Lee, the 8 month old pneumonia patient.

Jenny, the courier, arrived 30 minutes later in a VW Beetle, not exactly the emergency vehicle I expected. Leslie County only had one ambulance which was an ordinary station wagon, which doubled as a hearse from the local funeral home. The VW was actually better, as I could sit upright while holding the baby, rather than riding the entire trip hunched down over him from the rear of the station wagon! Armed with all the sophisticated medical equipment available, which included a small oxygen tank, metal funnel, and a DeLee suction trap (a piece of plastic tubing attached to a 4 inch plastic cylinder where respiratory secretions were trapped after being extracted by a nurse literally sucking them out of a patient), the three of us set off for Harlan Hospital.

With the old rusty funnel positioned near Roger Lee’s face, giving him maximum oxygen I could give, we fared well the first 25 miles. I could audibly hear all the gathered secretions in this baby’s lungs, but they were so deep that the DeLee suction did nothing to clear them. His coloring was like nothing I had ever seen. I vividly remember it to remind me of purple chicken wire design, meaning he was extremely mottled and cyanotic, without much alertness at all in his eyes. Suddenly, a loud gasp with a gush of orange-yellow fluid was emitted from Roger Lee’s little body. One look told me the tale he had quit breathing. I quickly grabbed the DeLee suction trap & sucked on the end of it with all my might. What a surprise I got this time. Instead of the usual response of little to no secretions, I got a great big mouthful of the most awful tasting fluid! Needless to say, I spit it out as quickly as I had sucked it in. The subsequent suctioning was more gently done, but the results were the same copious amounts of that terrible orange-yellow stuff. I commenced CPR.

All the while I was desperately thinking of what else I could do to save this baby’s life, I also knew that the young female courier driving the VW Beetle had just recently lost her mother to a cancer death. How would Jenny react to this potentially dead baby in the backseat of her car? Would she panic? Would she get upset? I decided to gently tell her the truth. Jenny, I think the baby is gone. Get us to the hospital as quickly and as safely as possible please. If you can signal a policeman to escort us, please do. She did exactly as I instructed her to do no panic, no problem. She never was able to get anyone to pay any attention to us and I surely remember the traffic seemed much slower than usual!

We arrived safely in the hospital parking lot with me all the while continuing CPR, as I had been taught never to stop without a physician’s permission. Between breaths, I told Jenny to run into the emergency room & tell them I was here in the car doing CPR on a baby, and would someone come assist me? Jenny came back moments later, telling me the doctor said to just bring Roger Lee in there. In my heart, I knew it really didn’t matter. Roger Lee was dead. I doubt anyone could have done much for him had he gone into cardiac arrest in the hospital. His breathing struggle was finally over his tiny heart just couldn’t take anymore of that grueling work.

On the way over Pine Mountain, Jenny & I had outrun a typical mountain thunderstorm, one that usually knocked out the utility wires that were strung, not on poles, but from tree to tree. Telephone communication back to Leslie County was out. The ER doctor asked me if I wanted to leave Roger Lee there, & they would call that funeral home/ambulance company in Hyden to come pick him up. I told the MD absolutely not I was taking him back with me, as his family of 7 was extremely poor, living up some remote hollow without a telephone, and only having a couple rooms for all of them. Roger Lee was the baby, and the family favorite, like all babies are. The doctor then suggested I wrap up his little body and place him in the Beetle’s trunk. Again, I absolutely refused saying, He is a baby. I’m not doing that to him. And I didn’t. With Jenny’s permission, I carefully rewrapped Roger Lee in his blanket, and after obtaining all the necessary paperwork (signed permission slip to transport a body across county lines), picked him up & started back the hour drive over the mountain.

By the time we arrived in Hyden, the phones again functioned, and all the staff in both the clinic and the medical surgical floor knew Roger Lee had died, and we were headed their way.

After I handed off my precious package to one of the Family Nurse Practitioner students, I sat down & cried, which stuffed my already stuffy nose all the more. One of the RNs had pity on me, telling me I was taking the next day off after I took the medication they were about to give me to knock me out for a good night’s sleep. Someone apparently notified my head nurse, and another called the District clinic nurse to notify Roger Lee’s parents, as I don’t remember doing either job.

I recall this story periodically, realizing I was only 20 years old when this happened not even old enough to drink in my home state of Pennsylvania!