Sky doc

“A glass of red wine, please,” I replied to the flight attendant's question, even though the sight of the deep-red wine made me slightly apprehensive. My clinic that day had been a busy one. I had barely caught the connecting flight to Toronto and was now settling in for the second leg of my trip, the long haul to Vancouver. As I took the glass, my thoughts turned to the last time I had been on a long-distance flight. On that trip, too, I had asked for a glass of red wine, but before I'd even had a chance to taste it, the pilot had asked if there was a doctor on board. I'd rushed to the side of a young diabetic man who was lapsing into a coma and spent the better part of the journey home doctoring him. He recovered so well that later during the flight he actually passed by my seat to purchase duty-free merchandise — without so much as an acknowledgement of my presence. By the time I returned to my seat, my glass had been taken away. No wine, no food, no thanks.

As these thoughts crossed my mind, I stared warily at the wine. “Don't be silly,” I told myself, “you're not superstitious.” But as I raised the glass to my lips, I heard the announcement from the speaker overhead asking for a doctor. I responded immediately and followed the senior flight attendant to the side of a young woman who was hyperventilating and moaning. She was allergic to seafood and had unwittingly eaten a dish containing shrimp. I immediately asked for the doctor's kit and was given a box that contained a blood pressure cuff, a stethoscope and a few other items — but no medicines. “No, no, no,” I said, “The doctor's kit. It should be in the cockpit.” (I remembered that from the last time.) Meanwhile, I placed the blood pressure cuff around the young woman's left arm and pumped it up, but the cuff would not deflate. I continued to examine the woman, looking for swelling of her tongue and airway obstruction. Eventually, the doctor's kit arrived. I checked for the adrenaline and was ready to administer it. However, my presence seemed to calm her, and the adrenaline seemed unnecessary. I stayed beside her long enough to assure myself that she was all right. By the time I returned to my seat, the wine, and my meal, had been whisked away. Tired and hungry, I resorted to the solace of sleep.

After some time, I was shaken awake by the senior flight attendant. “Doctor, doctor,” she implored. I bolted upright, reflexes honed from serving on a cardiac arrest team, and rushed to the young woman's side. She was slumped in her seat, and I immediately thought, “Oh my God — she went into anaphylactic shock and died.” I grasped her head to open her eyes and look at her pupils. She shrieked with piercing intensity, riveting everyone's attention. I realized that she had simply been asleep.

“Doctor — not her,” the flight attendant said, “There's a man unconscious at the back of the plane.” I rushed to the rear of the aircraft to find a man flat on his face. I tried to look at his pupils, but because the light was dim and he had deep brown eyes, I couldn't see them. I felt his pulse: it was slow and thready. I asked what had happened. The flight attendant explained that he had been standing in line to use the washroom when he slumped, banged his head against the door and fell to the floor, unconscious. My quick differential diagnosis included an intracranial catastrophe, a rapidly expanding epidural hematoma or simply a faint. Being a stroke neurologist, I would think of the serious vascular causes first!

I reasoned that if this man had an intracranial mass large enough to produce compression of the brain stem and a Cushing reflex, there was nothing I could do at 35 000 feet. I concluded that he had most likely fainted, so I wanted to keep him in a horizontal position. But 2 enthusiastic passengers grabbed the patient under the arms and tried to sit him up. “No, no, I want him flat,” I said.

The man who had been vigorously lifting the patient by his left arm gave me a patronizing, contemptuous glare and proclaimed, “I have been certified in first aid by the St. John's Ambulance.”

I refrained from making use of a rich repertoire of expletives learned in several countries in my youth. I counted to 3 —no time to count to 10 — and then said calmly, “I am a doctor.” I placed the patient in the recovery position and monitored his pulse.

A woman crouched beside me. “I'm a nurse,” she whispered.

“Boy, am I glad to see you!” I replied. I asked for the 2 kits that had been supplied earlier. The nurse placed the blood pressure cuff around the young man's left arm and pumped it up, but again the cuff would not deflate. “Don't worry,” I said, “I think he's coming around.”

At about this point, the senior flight attendant rushed up, once again exclaiming, “Doctor, doctor!” I jumped to my feet, ready to run to the young woman with the seafood allergy. But the flight attendant said, “No, no, doctor, this way.” This time, I found myself at the side of a 53-year-old diabetic woman who was clutching her chest but denied any pain. After questioning and examining her, I worried that she might have had a silent myocardial infarct. I stayed by her side for the rest of the flight, except for brief visits to my other patients, both of whom appeared hale and hearty. The man was even being served a special delayed dinner. Seeing him eat reminded me how hungry I was. But how would it look for a doctor to be eating dinner while attending to a patient who might have had a heart attack?

Although my first 2 patients appeared well, I had the pilot radio ahead for an ambulance to meet the diabetic woman. As we landed, I saw on the tarmac a scene out of television: ambulances and police cars with lights flashing, uniformed police officers and ambulance attendants, and a predictably curious crowd. I did not want my patient to be frightened by the overeager paramedics, so I slung a stethoscope around my neck, stood in the doorway and signalled that there was no need to rush. Nonetheless, when the mobile staircase was brought to the rear exit, a group of uniformed paramedics stormed the plane, shoving me aside, and rushed to clamp electrodes onto the patient's chest while holding the paddles of the defibrillator high, poised for action. I fought my way back through the crowd to the patient's seat and was relieved to see that she had nonspecific electrocardiographic findings.

This time, although I did not get food or drink, I did receive thanks from all 3 of the patients, as well as the senior flight attendant, who, as she presented me with a bottle of champagne, said that in 27 years of flying she had never seen anything like it.

A few days later, I boarded the plane back to Toronto. I was glad to see that this time several of my colleagues were on board. “If there's an emergency on this flight,” I thought to myself, “let them handle it!” The flight attendant asked me what I wanted to drink. Ever the optimist, I replied, “A glass of red wine, please.”

Figure.

Photo by: Graham Ross