Flight nurse Renee Grams was halfway through a 24-hour shift last September when a call came into the regional hospital in central Nebraska where she works. The flight crew of the Air Care helicopter was placed on alert.
Ten miles south of the hospital, a man lay injured in a cornfield. Both of his legs had been amputated above the knee by the blades of a silage chopper, a powerful machine used to cut corn into cattle feed. His son had discovered him, then driven frantically to the nearest telephone. With 15 years of flight-nursing experience, Renee knew how grim the man's prospects were.
"When the local paramedic service arrived, they thought the man had no chance of survival," she recalls. "He was a trauma code blue; he had a one-tenth of one percent chance to live. Then he took a breath."
With that breath, the Emergency Medical Paramedic Service at the scene began the man's resuscitation and the Sikorsky helicopter on the hospital's roof was summoned into action. "They dispatched us to the scene," Renee continues. "We assessed the man's condition and loaded him into the helicopter. He needed blood more than anything else."
That life-giving blood, along with other IV fluids and medications, was administered during the seven-minute trip back to the hospital. During a miraculous four of those minutes—unspeakably precious ones in Renee's work—the flight crew revived the man's stopped heart. Then, as the helicopter landed, they lost his heartbeat again.
The man was rushed to the trauma room. After undergoing nearly 30 minutes of intensive life-saving procedures at the hands of EMS (Emergency Medical Services) and hospital personnel, he was taken to surgery. The flight crew assisted in the trauma room, then cleaned and restocked the helicopter. Another call could come at any moment.
Coming Back to Earth
While most of us hope we'll never encounter such a situation, Renee welcomes the challenge as part of her work. Her split-second decisions routinely carry life-and-death consequences. During her shifts Renee works throughout the hospital, starting IVs, assisting in crisis situations, even rocking babies.
But when the EMS helicopter is called into action, Renee and the other flight crew members have only a few minutes to assess patient information and prepare supplies for take-off. Then they're airborne in a six-by-eight-foot "emergency room" cruising at speeds up to 225 miles per hour. It's not a job for the weak-kneed, and it's certainly not the kind of work you can leave at the office.
For Renee, the 40-mile drive home is a time to transition from the high-adrenaline pace of her work to the more peaceful life she leads as a farm wife. Well, peaceful may not be the best word to describe their family business. While Renee is away covering a 48-hour weekend shift, her husband, Craig, is busy with round-the-clock responsibilities. He manages their 2,000-acre farm and functions as "sole parent on the premises" to their four children.
Like any business owner, he knows the success of the enterprise rests with hard work and careful planning. Farming requires equal parts scientific, technological and economic know-how. The labor is mentally and physically demanding. Craig sees his share of 18-hour days. And it's a job that can keep a man awake at night.
"Commodities prices are as low as they've been in 50 years," he says. "That means all the inputs [front-end costs] are going up, but the outputs [revenues] are the same as 50 years ago. Believe me, it's a little stressful around here."
On the surface, the lifestyles led by Craig and Renee read like a formula for marital disaster—erratic hours, job stress, regular separations and constantly rotating parental and household responsibilities. The Gramses could be writing serial installments of "What Happens When Worlds Collide," but they're not. During 15 years of marriage, they have learned how to nurture a deep and happy relationship—with deliberate commitment and priority-setting. The payoff is a partnership from which both draw strength.
Renee and Craig agree on the biggest secret to their marital success: they continue to be best friends. The time spent sharing pizza, homework and long conversations as college students supplied a framework that held their relationship together during a less-than-idyllic first year of marriage.
"The first year really stunk." As he says it, Craig smiles and shakes his head. "We came back from our honeymoon and went right into Renee working nights and me working corn harvest. When we did see each other, we were both so tired."
"I worked five night shifts a week," says Renee. "I'd get home about 8:30 in the morning, then sleep until 4:30 in the afternoon. I'd get moving by 5 or 6, run out to the field and ride the combine with Craig for awhile, then come home, shower, dress and go back to work."
Their opposing schedules meant that Craig spent a lot more time with his buddies—most of them single—than with his wife. He and Renee could feel the emotional distance between them steadily widening.
"We'd been such good friends in college and we hardly ever fought," says Renee. "We thought everything would be the same when we got married, but it wasn't. With lack of sleep and not enough time together and all those crazy hours, we finally realized something had to change."
Renee was able to reduce the number of days she spent at the hospital by reworking her nursing schedule. Craig committed to spending more time at home.
"We did a lot of growing up that first year," Renee reports.
"On my part especially," says Craig. "When you've made a commitment to a wife, you've got to leave the guys. Spending so much time with them wasn't fair to Renee."
Since that time, Craig and Renee have shared the load at home and remained close friends while pursuing the careers they love. A key to meshing their home and work lives is the wise use of transition time.
"There are a few hours when Renee gets home that both of us can sense, 'Just leave me alone for a while,'" Craig explains.
Instead of being offended, they realize it's best to save their "heart-to-hearts" until they've gained some distance from their work days. Then Renee can talk about how hard it was transporting an injured child the same age as one of their own. Or Craig can bring up an unexpected equipment repair that threatens to become a significant drain on the farming budget.
When it's time to talk—and listen—Craig and Renee are there for each other. Scenes like that injured farmer in the cornfield come back to haunt Renee. Even though the man recovered and is now back at work, she still feels the impact of the adrenaline-charged efforts that went into saving his life.
"Just before I got in the helicopter, one of the EMTs [Emergency Medical Technicians] came up and handed me the man's legs in a bag," she remembers. "I thought, 'Dear God, this is nearly half a man!' That's how heavy it was."
Debriefing sessions with other EMTs help her deal with such experiences, but for Renee, Craig's support is paramount. And during times when business concerns have seemed insurmountable, when Craig has questioned the direction of his life and his decisions for his family, Renee has offered encouragement and a fresh perspective.
"We don't spend hours watching TV," says Renee. "We rely on that time together at night when the kids are in bed and it's quiet, whether we're sitting next to each other—just being together—or getting to talk without ears around."
Another thing that helps these two stay connected is their mutual interest in each other's professional lives. Craig completed EMT training 14 years ago and serves as a member of a volunteer ambulance crew. He enjoys the challenge, and the experience allows him to empathize with Renee when she talks about the procedures and decision-making that affect her work.
Renee, who comes from a farming background, is equally interested in Craig's work life. "I'll pick up a farming journal and look at whatever Craig's reading," she says. "The two of us make almost every farm decision together."
Success at Home
How do the Gramses handle two careers plus the household demands of four children under age 12? Flexibility is the key.
"It's day to day," Craig says with a smile. "And every day is different."
No task, from packing lunches to doing laundry to replacing light bulbs, is the sole responsibility of one person. Household jobs belong to the person best able to do them on any given day. That doesn't mean there are never disagreements. But whether the topic is mowing the lawn or getting the car to town for an oil change, Craig and Renee try to keep a "think before you fight" attitude.
"When Renee's done something that's upset me, before I say anything I sit back and play it through," Craig says. "I try and look at her side."
Renee continues: "We've seen our friends get divorced. That opened up our communication—we don't want it to happen to us. So when we make each other angry, we stop and think, 'Should I blow up, or should I think about this?'"
The Gramses usually discover their disagreements began with failed communication—one person didn't fully understand the motives of the other. And these two have come to trust one another's motives. They love and depend on each other—and that forces them to deal with the personal risk inherent in Renee's job.
In 1985, a helicopter accident took the lives of three of Renee's coworkers—a pilot and two nurses. In the world of EMS flight nursing, that danger is always present.
"It's a risk we've talked about as a family," Renee says. "That's where faith comes in. I don't know how many people have told me, 'I'm always saying a prayer when I hear you go over.'
"You know you're not alone when you're out there. When your patient is getting worse and you're wondering if you're going to be able to transport them, you know there are people praying for you, trying to help you get your job done."
When Craig sees the helicopter pass overhead, he realizes the risks his wife faces. But he supports her and understands the fulfillment she gets from helping her patients.
Years ago, he says, "I can remember thinking, 'I want a normal wife who has an 8-to-5 job!'" Then he smiles at Renee. "But she couldn't handle an 8-to-5 job."
Renee and Craig keep encouraging each other while they share their day-to-day adventures. They are succeeding at one of the most difficult challenges facing any couple—keeping friendship alive in the midst of family demands and major job stress. After 15 years, they can see that their commitment to putting their relationship first just keeps paying off.
Renae Bottom is a junior high school teacher and coach and a regular contributor to Marriage Partnership. She and her husband, Mark, live with their two children in Grant, Nebraska.
1999 by the author or Christianity Today/Marriage Partnership magazine. Click here for reprint information on Marriage Partnership.