Thirty Seconds in Hampton
A swollen airway, a five-room ER, and one provider who had already done this a thousand times in his head.
Featuring Wisam “Rob” Zeineh, MSN, FNP-C, FNP-BC, ENP-C
Emergency Nurse Practitioner, Rural Physicians Group
Every room in the emergency department was full. All five of them.
It was past midnight, and the transfer from the local nursing facility came through the doors with a complaint that shows up in triage notes every day of the week: swollen tongue, some trouble breathing. Common. Usually nothing.
Rob Zeineh took one look and knew it was not nothing.
She was drooling. Her speech was thick and hard to follow. The swelling ran up under her jawline and along both sides of her mandible, and her tongue was pressing up into her own airway. Her oxygen saturation was already sliding.
“I’ve taken care of this woman before,” Rob says. He knelt down and explained it to her plainly — that he didn’t yet know why she was swelling, that he wanted to put a breathing tube in and sedate her, that the machine would breathe for her until they figured it out.
In the strained, unfamiliar voice the swelling had left her, she told him to do what he had to do.
The Long Runway
To understand how the next ten minutes went, you have to understand the thirty-five years in front of them.
Rob has been a paramedic since he was eighteen years old, still in high school. His father owned party stores in Michigan, and Rob was behind the register at thirteen — running the drawer, talking to customers, learning people. He had a path to medical school and didn’t take it. He became a medic instead.
He worked Lansing first, then went to the fire department in Detroit. He was assigned to the far east side, the 48205 zip code, a place whose public health markers put it among the most dangerous few square miles in the country. The system was running roughly 150,000 emergency calls a year and transporting around 120,000 of them, with a small number of trucks to do it.
“You could be on a scene, a family in a house fire, with no other units available. That means there’s no other ambulance coming. You have to handle it.”
— Rob Zeineh
There were no chest tubes on the truck. No tourniquets. No phone in his pocket to look something up — just a four-inch-thick protocol book and whatever he already knew. One night, dispatched to a wreck with two people trapped and unresponsive in a crushed front seat, Rob broke out the rear window, crawled through it into the back of the car, reached forward, and intubated both of them while his crew ran CPR through the side windows.
He estimates he has intubated more than a thousand patients in his career. Some shifts in Detroit, five in twelve hours. Intubation was a badge of honor, and he wore it.
For ten years he also served as a tactical medic, and eventually as a tactical medicine instructor. That is where the surgical airway came in. The military data that came out of the last two decades of conflict reshaped how emergency medicine handles bleeding and airways, and Rob trained on those procedures over and over — on animal models, on porcine larynges, on repetition until it stopped being a decision and became a motion.
Then he went to nursing school, and then to Vanderbilt, one of the top emergency nurse practitioner programs in the world, with an acceptance rate in the single digits.
“I didn’t realize what a prestigious program it was, even when I got in,” he says. “The faculty there are writing the textbooks.”
The Call
Before the tube, there was a phone call.
Rob had run the patient’s presentation past Dr. David McAlpine — a physician with fifteen years of emergency medicine behind him — who happened to be in Tennessee at one in the morning, two nights before his own wedding. He took the call anyway.
The advice was to try ketamine and see if the cords could be visualized before committing to anything more aggressive.
Ketamine is the useful oddity of emergency pharmacology. It is a dissociative — the lights stay on but nobody is home — and unlike most induction agents, at the right dose it does not take away the patient’s drive to breathe. It blunts the gag reflex without shutting down respiration. For an airway that might not be securable, that difference is everything.
Rob gave 40 milligrams and looked.
He couldn’t see anything. The swelling had erased the landmarks entirely.
“Normally, if I can’t see those cords, I would have just put a different tube in,” he says. “But that swelling was something. I knew right away.”
Thirty Seconds
The surgical kit was already at the bedside. Nobody had asked for it.
That detail is the one Rob keeps returning to. He never announced a plan to the room. He never declared what was about to happen. The night nurse — a veteran ER nurse he calls one of the best he has worked with — had read the same patient he had, and the tray was open before he reached for it. A colleague had come down from the floor. The EMTs on site, not paramedics, still knew what was coming.
“That’s the beauty of working with people who have experience. It’s a very calm environment. There’s not a lot of screaming. There’s one voice. Everybody knows their role, and everybody knows their job.”
— Rob Zeineh
On Dr. McAlpine’s earlier advice, Rob had already marked the patient’s neck. She was tall and slender with a pronounced larynx, and the cricothyroid membrane was easy to find by feel — a distinct texture under the fingertips that you either know, or you don’t.
So all that was left was to pick up the scalpel and cut where he had already drawn.
He kept a finger in the incision so he couldn’t lose the opening, dropped the scalpel, took the tube handed to him, and placed it. The first tube had no inflatable cuff and got pulled loose in the shuffle; he had the second one in almost immediately. The patient never desaturated.
While he was doing all of this, he was telling the staff to get a helicopter in the air.
How long from the moment she rolled through the door? “This would have happened within ten minutes of her being there.”
And how much margin did he actually have? “You don’t have three minutes. You have thirty seconds.”
Asked afterward how confident he had been, on a scale of zero to a hundred, that he would get it: “One hundred percent.”
The patient stabilized, flew out to a higher level of care, and was later discharged home. She is doing fine.
Then, with the tube barely secured, the lab called about the room next door — a critical troponin of 12,000. It was, Rob notes dryly, a busy night.
The First Time in Fifty-Five Years
The next day, someone told him something he hadn’t known: in the fifty-five years since the hospital in Hampton opened its doors, no one had ever performed a surgical airway there.
Word moved fast. Staff came up to him for days afterward. Not just congratulations — something closer to recognition. We didn’t know that could happen here.
“I think the staff who hadn’t seen it before finally saw something they’d only read about,” Rob says. “And they realized that in a small critical access hospital, you can get really good emergency care.”
That is, more or less, the entire thesis of what Rural Physicians Group is building — and Rob makes the case for it better than any brochure could.
“A lot of people confuse rural with meaning lower-acuity medicine. A rural emergency department like Hampton is getting experienced providers who can treat catastrophic airways, cardiac arrest, trauma, strokes, critically ill patients — and make sure they’re stabilized or at least stable enough to get transported to a higher level of care.”
— Rob Zeineh
The downstream effects are already visible. Hampton’s census is up considerably, because patients who once would have been shipped out are staying. And they want to stay. Rob hears it directly from the gurney: please don’t transfer me.
“They value that hospital. It’s their community hospital. They don’t want to go to a bigger city hospital and deal with people they don’t know,” he says. “A lot of these patients know the nurses — they taught them in school, or they’re related. Everybody knows everybody. It has a positive impact on their healing, completely separate from the financial argument.”
The hospital puts a photo of the provider and the ER nurse on the board in every room, so the patient sees a face and a name before anything else. Rob’s is up there. Since January, he says, he has met zero resistance as an outside provider.
“It’s been such a welcoming community. They want me and my wife and kids to move there.” A pause. “Honestly, I wish I could. I just hate the snow.”
What He Says About the Job
Rob has spent a career in health care organizations that, in his telling, too often made decisions for the wrong reasons. He went back to school in part so nobody could tell him how to practice.
“I’ve never been told what I cannot do at Hampton. The message has always been: take care of the patients, do the best you can for them. Nobody’s ever told me to discharge someone before they were ready. Nobody’s ever told me to do something cheaper, or not to order a test. I can practice health care at Hampton.”
— Rob Zeineh
He is blunter than that, too: “It’s the best job I ever had.”
He is also careful, every time, to hand the credit back. “This isn’t something I did on my own. Everybody there knew what to do. We did it. Everybody worked in sync.”
Off Shift, Barely
There isn’t much off shift.
Michigan does not allow nurse practitioners to own a clinic outright, so Rob started a 501(c)(3) nonprofit instead — an urgent care clinic in Lansing and a primary care clinic in the small rural community of Charlotte. When he is home, he is in one of them. Seventy patients one week, fifty the next.
This fall he starts teaching at the University of Michigan, running nurse practitioner students through suturing, splinting, and procedural skills — mostly online, with hands-on skills days.
He has also been accepted to Vanderbilt for his doctorate, and he knows exactly what he wants to study: the critical access hospital model itself. What happens to outcomes, to census, to communities, when patients who used to be transferred get to stay home instead. He may push the start date a year. Life is crowded at the moment.
Rob stays humble, and he isn’t competing with anybody.
“No matter how much I’ve seen, there’s always more to learn. I always want to do good, but I always want to see the guy next to me do good as well. I’ve worked with people who think they’re better than everybody. I don’t think I’m better than anybody.”
— Rob Zeineh
He has been approached about chief and leadership roles more than once — his patient satisfaction scores run at 100%, which people ask him about constantly. His answer is unglamorous.
“I treat people with respect. I’m kind, and I listen to them,” he says. “It’s not always easy when you haven’t had much sleep. But to me it’s just the right thing to do.”
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