Crozet Annals of Medicine: Flying Solo
By Dr. Robert C. Reiser
One thing you hope never to hear as a plane is taking off is someone shouting “Help, 911!” But that is exactly how my vacation began a few years ago. The plane was still ascending when the agitated man stood up and cried out for help. My fellow passengers seemed both confused and concerned as to what this excited utterance foretold, but to my mind 911 signified not a date but a phone number, now apparently a universal cry for help.
Seeing all the shocked looks, the man quickly amended his plea, “Is there a doctor on board? I think my wife is having a heart attack.”
As luck would have it, there were actually three doctors on board. One was one of my second year residents in emergency medicine, on route to his vacation. As he and I stood up simultaneously and made our way aft in the cabin to the patient, we met the third doctor, a dentist, who was helpfully trying to support the unconscious woman’s neck. We assured him that we could manage the patient from here forward, and he returned to his seat.
We introduced ourselves to the husband and the magic words “ER docs” calmed him a little and allowed him to focus. His wife had been fine until shortly after takeoff when she complained of nausea, vomited uncontrollably (and profusely) and lost consciousness.
The medical term for this kind of fainting is syncope, from a Greek word meaning to cut short. Syncope has many causes including heart attack, blood clot in the lungs, and stroke as well as benign causes such as stress or discomfort or illness. Secretary of State Hillary Clinton was hospitalized two weeks ago after a syncopal (fainting) event that was attributed to a stomach virus and dehydration. In general, trying to determine whether the cause is a benign condition or an acute life threat makes syncope a high stakes puzzle for clinicians and patients. This was the case for Secretary Clinton, whose diagnosis continues to evolve now with a second hospitalization, and for our patient on this airplane.
Now, Jeff the resident and I had worked together in the ER in similar scenarios dozens of times, and we knew each other’s capabilities and rhythms intuitively. As the senior clinician I was the lead and Jeff looked to me briefly. I nodded and he took charge of the resuscitation. A check of the carotid artery in the neck revealed a thready pulse and she was spontaneously breathing. We both took a deep breath ourselves; so far not as bad as it could be.
Jeff reassured the husband and gradually the woman woke up. She was confused and complained of nausea and chest discomfort. The dentist’s wife, a cardiac patient herself, offered aspirin, which Jeff got the woman to chew and swallow. Rapid administration of aspirin reduces the mortality from heart attacks by as much 25 percent. Do not hesitate to give or take one 325 mg aspirin, chewed, if you are ever in a similar situation. In the ER we use 4 baby aspirins, the same dose but slightly more palatable.
Unfortunately the woman vomited again and slumped forward, once again deeply unconscious.
Oh boy. This was not looking so benign.
This time Jeff could not get a pulse and he looked to me.
“Let’s get her on the floor and start CPR. I’ll take the feet. “
This left her vomit-soaked torso for Jeff to wrestle with (hey, he is younger and stronger than I am), and he gave me a sharp look, but his professionalism took over and we got her out of her seat and flat on her back in the aisle. Needless to say, this drama in a packed airplane deeply shocked the passengers and the fear and uncertainty were palpable.
As she settled to the floor she began moaning faintly and regained some consciousness and a pulse. Okay, round two’s over. What’s next?
The flight attendant appeared with a first aid kit and offered Jeff and me gloves. Jeff glanced at his vomit-slicked hands and then at me. I shrugged. What are you going to do? We belatedly donned the gloves. Who knows, it could get worse.
The pilot summoned us forward to a phone connecting to the cockpit for consultation. I sent Jeff. It was his case and his call and I had confidence in him. I stayed with the patient with my finger on her wrist pulse continuously.
Jeff returned from the cockpit phone and told me the pilot wanted to know if he should divert the plane to the nearest airport or continue slightly further to our destination. It was late, I was tired, and diverting would surely mean missing our connection and a night in the airport. It still wasn’t clear what the cause of her syncope was. Perhaps it was a (bad) stomach virus.
I sighed and told Jeff I thought we should divert. He grinned and told me he had already told the pilot that.
Diverting a commercial airliner mid-flight without consulting me! How I love these bold young doctors. It was the right call.
In the end, after several more close calls, we landed safely with the patient lying in the aisle, Jeff’s finger on her pulse continuously. Medics were waiting to meet us and transported the patient to the nearest hospital. Jeff and I cleaned up in the airport rest room and debriefed as the adrenalin wore off.
It took a while for the plane to be cleaned and put back in service, but the airline got us to our destination and held the connections for all the passengers. Very classy. The flight attendant treated us like celebrities (she had been in a similar flight situation without any doctors and it had shaken her).
I had to turn down a number of offers of free drinks from my fellow passengers and I am sure from the fawning attention my young colleague was getting he had to turn away several phone numbers. How I love these resourceful young doctors.
I later learned through channels that the woman did well with no discernible lasting cardiac damage. It is really a measure of our collective human decency that, far from being outraged at having their plane diverted, my fellow passengers actually wanted to thank Jeff and me.
I said goodbye to Jeff in the terminal and we boarded different connecting flights. He was ready to fly solo.