Every nurse has several off-duty nursing calls for action during daily life. Probably one of my most memorable times was when, years ago, Virginia Henderson was visiting me as a distinguished speaker in Seattle. I had just finished my grocery shopping and asked my son, Steve (then 16), to help carry in the groceries. He ran into the house to tell me dogs were barking up the street and a man was on the ground. We ran to him. I started CPR, clearing his passageway and my son compressed his chest. The man's wife looked out from her deck. I told her to call 911. We lived in a hilly neighborhood where it was difficult to find streets, but the ambulance came within five minutes.

Later in the day, another neighbor called me because her daughter was having severe abdominal pain. As I checked her for rebound tenderness, it was clear we had to take her to the ER. While there, I inquired about the other neighbor from earlier in the day. I was told that whoever had initiated CPR had done an excellent job and the man, a physician, was at a major hospital having heart surgery. He practiced medicine for at least another three years. My son had been instructed in CPR in high school in Seattle. When I took Virginia to dinner that evening, she was rather surprised at hearing that I had so much off-duty nursing in one day.A more recent event happened on a flight from London to Chicago, after I attended a meeting of international nursing editors at the Royal College of Nursing in August 2001. I responded to an announcement calling for a nurse or doctor for an emergency in first class. The man, in his 40s, was doubled up in pain on the floor after using the lavatory. He had flown from India, where he had eaten Chinese food the night before, so I thought it must be food poisoning. But he also had a history of diverticulitis.

As I checked him further and inquired if he had ever had his appendix removed, it seemed that it could have been a ruptured appendix. The captain asked if we should land in Newfoundland. I asked, "What kind of hospitals are there?" "Not much," was the answer. Then I sat in the cabin and talked with the airline doctor, who had me give the patient a pain medication. His wife was told to call his doctor and have an ambulance waiting at O'Hare International Airport in Chicago.

I spent most of the flight on the floor, monitoring his vital signs, and we were able to move him to his reclined seat before landing. Several weeks later, I received a thank-you letter from him. He had a ruptured diverticulum and was in surgery immediately. He spent about a week in intensive care and was glad that he had made it home to be taken care of by his doctor and in a major hospital.

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