The call comes at 10:15 a.m. A 4-day-old baby has had multiple seizures since she was born, and now she's more lethargic than normal. Doctors are worried.
She's already been in two hospitals, but doctors want a pediatric specialist to figure out what's wrong. The tiny girl needs to go from Modesto to Children's Hospital of Oakland, a drive that could take an ambulance at least two hours in Tracy and Bay Area traffic.
So they call REACH Air Medical Services dispatchers. A Nextel phone rings inside the Lodi base, at the north end of the Lodi Airport off Jahant Road. Three employees have been reading work e-mail, checking night-vision binoculars and drinking coffee.
By 10:23 a.m., pilot Brooke Maynulet has lifted the red helicopter into the air and is heading south, telling her crew, "OK, we're 20 minutes out."
As the chopper buzzes south over Highway 99 on a clear July day, the baby's anxious parents wait.
On this day, the crew isn't sent to a four-car pileup with possible fatalities, surrounded by dozens of onlookers. Nobody is thrown from an all-terrain vehicle in rural Clements, with major head injuries.
This baby girl is already under medical care, meaning that the helicopter's crews won't start with basic life-saving care.
That doesn't make any difference to flight paramedic Chris Shrader, who previously worked on an ambulance and has handled his share of emergency calls. "I don't think any one call is different from another," he says later, when asked about memorable calls that stand out in his memory. "They're all important."
Shrader, a paramedic who has been in the emergency field for 13 years, is one of three people on duty at REACH's Lodi base today. Working with him is Brooke McCracken, a flight nurse with years of emergency room experience behind her. And there's pilot Brooke Maynulet, who spent 10 years flying Black Hawks for the U.S. Army.
They're the ones called when urgent help is needed, when time is of the essence. They sped toward Modesto, to the sick baby.
A passionate paramedic
Shrader, 30, is a husband and father. But he obviously likes to have fun, whether it's playing a video game on his down time or getting a tattoo down his left arm.
His tender side is revealed when he coos to an ill child or calls a hospital to check up on a former patient he helped.
Shrader was born and raised in Los Banos, where he lives today. His father flew a crop duster and died six months before Shrader was born, so his mother worked a lot to make ends meet.
As a youth, he met some firefighters at the local station and they took him under their wings, which he says kept him out of trouble. He became a volunteer firefighter in 1996, then attended Columbia College in Sonora to study fire science.
He also got his medic's license, and in the process realized that his true passion was in patient care.
So he became a paramedic, and spent the next eight years on an ambulance in Salinas.
Then he got the job at REACH, which he says is "the pinnacle of our careers."
The red Bell 407 helicopter, which pilot Maynulet calls a "super giant dragonfly," has been in service since REACH opened its Lodi base four years ago. It's 37 feet long, a bit less than 18 feet tall and can hold almost 128 gallons of fuel.
A co-pilot seat and passenger seat have been removed, and replaced with a stretcher.
REACH Air Medical Services at a glanceThe medical helicopter service opened its base at the Lodi airport in April 2005. It had previously operated out of Sacramento Executive Airport, which cut the flight time by about nine minutes to rural San Joaquin County.
The Santa Rosa company opened in April 1987 as part of Santa Rosa Memorial Hospital, then became a private operation the following year. It has since opened several more bases and now operates 10 in California - the most recent opening this month in Thermal - as well as one in Oregon.
REACH was founded by Dr. John L. McDonald Jr., who graduated from medical school and then joined the military, where he served as an air wing medical officer. After leaving the military in 1966, he moved to California and began practicing medicine, eventually becoming medical director of the Santa Rosa Hospital. He died in 2000 at age 73.
The chopper cruises at an average of 130 knots, or 150 mph in laymen's terms.
Shrader and McCracken talk briefly over the headsets inside their white helmets.
They use medical lingo, with McCracken taking notes and filling out a medical chart on her purple clipboard. At one point, she pulls out a small calculator to compute the amount of medication that a 6.6-pound baby might need.
They fly over fields that appear as green, brown and yellow squares, with a cluster of black and white cows at one point.
When they get closer to Modesto, McCracken pulls out a different microphone.
"Doctors Medical Center, helicopter REACH 2," she says, using their radio call sign, which is also their base number.
Meanwhile, the pilot talks to air traffic controllers, who tell her to maintain 3,000 feet altitude for a little longer.
At 10:38 a.m., 15 minutes after they left Lodi, Maynulet gently sets the chopper's black landing skids down on the roof of the medical center.
A private security guard is waiting with a gurney, and the flight crew puts their backboard on it, along with a host of medical gear. Without stopping to enjoy the panorama from atop a roof in downtown Modesto, they wheel the gurney into the hospital and down an elevator.
The flight crew members all wear the same uniform - bright blue, one-piece suits with long sleeves and silver reflective striping around the ankles.
On one shoulder is an American flag, and the other is a REACH seal. Their name tags are black with silver writing, attached by Velcro so they can easily change suits if needed.
They've got plenty of pockets on the sleeves, chest and legs. Shrader stashes a pair of scissors in one leg, the arm pockets work well for cell phones, and McCracken keeps lip gloss and gum in a front pocket.
The heavy-duty suits can get warm, but they are flame-resistant, Shrader says. They also help make the flight crew more visible. And, he adds, there's an element of professionalism, so family members are a bit more reassured that competent and caring people are taking their loved ones away in an aircraft.
Prepping the patient
Inside the Modesto hospital, Shrader and McCracken wash their hands and then get down to business.
They enter the neonatal intensive-care unit, where various machines beep at regular intervals. Nurses stand at stations containing bassinets in which tiny babies sleep.
At a station just inside the door, a mother cradles her new baby while the father looks over her shoulder. The flight crew has come for this infant.
McCracken gets basic medical history from both parents and a nurse. The baby already has a growing medical file, but the flight crew doesn't want to sift through it all while everyone waits.
The helicopter has been called because Oakland doctors don't want to wait. They want to get patients there as soon as possible, and if the baby is coming from the Central Valley, a helicopter is the best option, according to Dr. Priscilla Joe, associate director of the Oakland hospital's Neonatal Intensive Care Unit.
Meanwhile, Shrader starts detaching various tubes, then reattaching REACH's own equipment. Before they go anywhere, he makes sure everything is working properly, including the heart rate monitor like those seen on so many dramatic medical TV shows.
Shrader sticks various small pads on the baby's chest, just in case she needs more medical care while in the helicopter. At one point they poke the baby's foot, causing her to fuss.
"I know, I know. You don't like us messing with your feet," Shrader whispers at the baby.
Finally, all tubes are reattached and taped to a miniature sleeping bag that holds the baby in place. Thick pads, like mini crib bumper pads, cradle her head and are Velcroed in place.
Shrader asks the parents if they want to give their baby one last kiss before takeoff. The mother leans over the gurney railing and softly kisses her daughter's forehead, and the father follows suit, murmuring quiet words of love.
Shrader reassures them that the vibrations of the chopper make babies go to sleep.
Then they are wheeling back through hospital hallways to the helicopter.
At 11:25 a.m., 47 minutes after the chopper touched down, it lifts off.
Shrader sits inches away from the baby's head, and he will spend the flight watching for any seizures or other medical problems. McCracken sorts through an inch-thick stack of the infant's medical records.
An able nurse
McCracken, 30, hasn't been with REACH long, but she loves the job.
The lifelong Manteca native received an associate's degree in nursing from San Joaquin Delta College. She became a nurse seven years ago and began working in labor and delivery, where she thought she would spend her career.
Then she did a stint in an emergency room.
"The first flight crew that came in, I knew that's what I wanted to do," she said.
So she set about reaching that goal. To become a flight nurse, she needed more time in trauma and intensive care, so she logged the hours.
Five years later, she finally got a job at REACH.
She then spent a month at a REACH training center, learning such things as the basics of flight procedures. In March she began working on a medical plane in Sacramento, and in May she came to the Lodi base.
Nurses and paramedics work 24-hour shifts, which means she is sometimes away from her two children, ages 10 and 7. It works, though, she said, because the kids spend those days with their father, from whom McCracken is divorced.
For a 24-hour shift, McCracken said the key is to get enough rest the day before the shift starts. Then she tries to get a nap in the afternoon, in case there's a call at night that takes hours.
REACH's Lodi base looks like a metal airplane hangar from the outside, but inside it's the equivalent of a three-bedroom home, complete with a fully stocked kitchen, living room, office, and exercise and game room.
Separate bedrooms are assigned to the on-duty nurse, medic and pilot. Each room contains a computer, desk and twin bed. They have a washer and dryer, so clean linens aren't a problem; and they can close the bedroom doors to grab naps when they're not out on calls.
The same thing goes for meals: The crew members try to stick to general eating schedules, but sometimes they're working on a call for hours.
When McCracken arrived back at base well after lunch time from a recent call, she wasted no time heating up leftover pasta she brought from home.
The helicopter is once again in the air, and the pilot says she'll soon have the air-conditioning on to cool the interior.
Shrader says no - babies are sensitive to temperature changes. The fan is OK, he says.
For the next 50 minutes, the flight suits get warm. Backs begin to sweat.
The pilot heads west, notifying air traffic controllers as she enters their space, passing over Tracy and Livermore.
"Ooh, big bug splat," Maynulet says at one point.
The windshield was spotless when the chopper took off, as was the whole aircraft, for that matter: REACH actually has a written policy that it must be cleaned three times a week, something Maynulet hadn't seen before.
What's her favorite aircraft?
Though she's only been working at REACH since May, Maynulet has plenty of aviation experience: She spent 10 years flying helicopters for the U.S. Army, including 15 months in Iraq.
The 6-foot-tall blonde grew up in southwestern Illinois, the daughter of an Army aviator. Maynulet has fond memories of running outside with her brother and sister to watch their dad fly over the house.
Her brother got an ROTC scholarship, and Maynulet followed suit. A day after graduating from the University of Illinois, she was commissioned in the military.
Army aviators are trained to fly helicopters, and Maynulet took to it quickly. She rattles off aviation lingo before catching herself and slowing down to explain that Lodi's chopper uses VFR, which stands for Visual Flight Rules - in other words, they don't fly in fog.
But Maynulet, 36, has flown in plenty of fog and other less-than-ideal situations. Before she left the Army as a captain, she was stationed in Germany, but she also went to Kosovo. When she went to Iraq shortly after the ground invasion, her group was the first to get their time extended in that country.
She left the Army in 2005 and came back to the U.S., looking for something different.
"I had no ties anywhere, so I took the first job that was thrown at me, which was flying tourists over the Grand Canyon," she said.
The job sounds more fun than it was, she said, because the salary was low and pilots actually worked mainly for tips, though they weren't allowed to ask for them. Then she got a gig flying for a news station in Las Vegas while doing the tours part-time. She made her way to Santa Maria in California, and then decided to move to Jackson, where she found a good deal on a foreclosed home.
Her job with REACH is that of a "floater" pilot, meaning that she fills in when pilots are on vacation, sick or are needed elsewhere.
What's her favorite aircraft?
"I'm always going to love my Black Hawk. They have so much power," she replies, adding that there's also a co-pilot. "But there's something to be said for being a single-engine pilot; you're on the radio, you're doing everything."
Maynulet flies toward Oakland Children's and Research Hospital, or "Cho," as the flight crew refers to it. She's still learning her way around the area, but she has both GPS and Shrader, who's flown plenty of times.
Maynulet worries about noise ordinances. Many cities have restricted aircraft to certain paths because residents complain about the noise. Pilots can get in trouble for violating those rules, so they have to know where and how they can land.
It frustrates the paramedics, who clearly care much more for their critical patients than they do for residents bothered by noise created by a rescue helicopter.
At 12:15 p.m., 50 minutes after leaving Modesto, Maynulet sets the chopper down on an Oakland roof.
Inside the hospital, a bed is waiting for the infant, and a friendly nurse gently removes REACH's medical cords to hook the baby up to hospital monitors. McCracken gives the nurse an overview of the baby's history, easily answering each question with medical jargon.
Forty minutes later, at 12:55 p.m., the REACH team's medical task is complete. The baby girl has been safely admitted to a hospital known for its work with children.
The flight crew once again takes off, and Maynulet is once again trying to avoid air space restricted by noise laws.
They fly east, crossing over the Caldecott Tunnel and passing the mammoth white Claremont Resort in Berkeley. They reach the Altamont Pass, where the rolling brown hills are dotted with windmills.
Before long, the waters of the Delta appear. Maynulet spots a boat that has apparently become trapped and abandoned on a sandbar.
Three hours after leaving Lodi, they return. The pilot makes sure no skydivers are in mid-air at the airport, as is often the case. She sets the chopper down on the ground.
It's time to refuel the chopper and eat some food in preparation for the next call that could come in moments.
REACH's bases average 30 to 40 calls each per month, according to base manager Kim Adams. But numbers vary: Last week Lodi crews handled three calls in one day, but then had no calls for a whole weekend.
Back in Oakland, the baby is getting medical care from some of the best pediatric doctors in the region.
One day her parents may tell her about a July day when time three people, dressed in bright blue suits, took her for a ride in a helicopter.