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A Final Arc of Sky: A Memoir of Critical Care

Jennifer Culkin

(Beacon; US: Apr 2009)

Jennifer Culkin was a critical care nurse with specialties in neonatal and pediatric critical care. Midway into her nursing career, she mastered flight nursing, transporting critically ill patients via helicopter. 


The compelling nature of Culkin’s work lends itself to memoir. After all, only the faintest of heart will fail to be sucked into the story of Doug, a man with esophageal cancer who enters the helicopter alert, talking, charming—then dies en route, despite Culkin and her partner’s heroic efforts. As Culkin is bagging the poor man—that is, breathing for him by squeezing an oxygen bag, she notices the helicopter door is ajar. Culkin holds the door with one hand (you cannot close a helicopter door in flight) and bags with the other for the remainder of the trip.


Unfortunately, the remainder of A Final Arc of Sky fails to live up to this blasting opener. Comprised of a disparate set of vignettes whose thematic tie is ostensibly nursing, A Final Arc of Sky is disordered and full of digressions about Culkin’s parents, siblings, husband, and children. Some pieces are more successful than others—a few were published in small journals, and one essay appeared in the Utne Reader—but taken as a whole, the book is a jumbled, uneven work. 


Large portions of A Final Arc of Sky discuss Culkin’s Catholic upbringing and her belief in God: the sentence “I still believed in God then” appears numerous times. But somewhere along the way she ceased believing, deciding we are “Not even a mote in the eye of God.” Fair enough, but when and why did this reversal occur? Was it the sight of so much sadness and suffering that changed her thinking? Was it the premature infants, “gelid aberrations” who, if they survive, are likely to be brain damaged? Her own complex, deeply religious family? Culkin never says, instead jumping from babies so sick they cannot cry properly to countless overwrought passages describing the natural world.


The effect is jarring, annoying, and disappointing, because Culkin is terrific when writing about the world of nursing. There is the infant girl with ickthyosis and hydrocephalus—that is, scales instead of skin, a wasted body, and a huge, fluid-filled head. The child is too damaged to interact as normal newborns do, but Culkin cradles her anyway, noting the “little pea” takes primal comfort in snuggling. The other nurses avoid the child, appalled by her appearance, certain of her death.


And she does die: Culkin comes on shift one day to find an empty crib. But the spare description of this malformed child is surrounded by clotted, overstuffed sentences like this one: “She was a sacrifice for a primitive god, pinned on her slab by the sheer mass of her head. Entranced and alone behind the translucent leavings of her skin, a halo made of insect wings.”


From the scaled infant we move to Culkin’s courtship with husband Howard, conducted across time and continents. She finally makes her decision while living in remote Alaska:


I roiled the covers, unable to sleep ... What’s the midnight wilderness for, if not to balm the troubled mind and the overfull stomach? I dressed in the dark and set out under the brooding lip of the ridge that overhung the northwest side of town ... I was completely alone at the edge of the civilized universe. A creature at large in the nighttime wonder of this world, alone with mountains and the howl of storm and sea. It was a state of being I’d been aiming for without knowing it for a long time ... [Howard] was a part, somehow, of that moment’s grand conjunction of woman, earth, and cosmos ... Some inner planet had just shifted on its axis, given me its pagan blessing.



Coupled with the scrambled timeline, tangled passages like the above threaten to topple the book. What finally kills it, though, is Culkin’s admission, on page 181 of a 237 page book, that she has multiple sclerosis. Holding this fact back in a book about nursing is shocking. Adding insult is Culkin’s description of her parents’ deaths. Both her mother and father are intransigent patients who ignore medical advice, refuse to discuss their care, and avoid end-of-life planning.


As the family nurse, much falls to Culkin. When death finally comes, first to her mother, then her father, the scenes are grim indeed. Culkin is exhausted and understandably furious with her parents, yet seems oblivious to the ways her behavior mimics theirs. She is far too skilled a nurse not to know her diagnosis, yet spends two decades pushing her body relentlessly, finally ending up on her couch, flattened. Now on medical disability, Culkin is learning to live with the maddening symptoms of MS.


Certainly Culkin deserves our sympathy, and, depending on your point of view, credit for fighting so hard. But in so doing she went against everything she knows about nursing and illness. That’s difficult to accept. On a strictly technical level, a better writer would weave her worsening symptoms through the text. Culkin does make an early remark about lugging her heavy infant up a flight of steps, but the non sequitur is in no way Chekhov’s proverbial gun. 


There are other significant mechanical flaws. Culkin “girds her loins” three times. She uses the term “neuronal” repeatedly. These observations sound petty until winding through yet another thicket of words about her mother’s death, when you don’t want to choke on that clunky word yet again. Nor do you want to know Culkin felt “punky” upon learning of a helicopter crash that injures Steve, one of her favorite pilots. Word choices are the bricks that build sentences: good writers choose bricks carefully, lest you notice them instead of the story. 


Culkin closes where she should have begun: with a discussion of flying’s inherent dangers. She is expert on “med rigs”, writing knowledgeably about the mechanical workings of helicopters and the many things that can go wrong with them. Her friend Ben, who teaches flying when not working medical rescue, is killed while teaching a student. He left a wife and four small children. Steve is killed three years after his first crash, along with the two nurses on board, Erin and Lois. Culkin is close to all of them, and ends up driving Lois’ car back to her Seattle home. 


Books like A Final Arc of Sky make for difficult reviewing. Culkin is a likable woman with an interesting story to tell. She is clearly an excellent nurse whose illness robbed her of a career. So she has turned to new one, writing, which is more forgiving when dealing with what MS-affected poet Lucia Perillo calls “the meat cage”.  Unlike the massively talented Perillo, Culkin lacks the inner ear for rhythm, order, and pacing that make a random collection of words coalesce into that magical thing: a book. And that’s a shame.

Rating:

Diane Leach has a Master's Degree in English Literature from Humboldt State University. Her work has appeared in the Los Angeles Times, New Mobility, and The Collagist. She can be reached at dianesleach@gmail.com.


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