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Anatomy of an Mid-Air Emergency

DING DING DING, WOULD ANY DOCTOR ON BOARD RING YOUR ATTEDANT BUZZER? I shake off my near slumber and go running towards the back of the plane. Two freaked out stewardesses jab their fingers at the closed bathroom door, and I wonder why if someone's having a medical emergency that they'd leave them in there. Knocking gingerly, I hear repeated retching, and there I find hovering over the toilet a young woman pale and vomiting up her guts with the most severe abdominal pain she's every experienced (and she's had 2 kids). I use my toddler tumbling lessons to reach my foot over to flush the toilet and bring the crying woman outside. As I turn towards the galley corner I find a neonatologist standing sheepishly wondering why he wandered back since he usually takes care of the littlest infants smaller you can imagine. I'm glad to see him, if not for more than moral support.

I laid her down on the jump seat with a bucket beside her head, and raise her legs to get some blood to flow back to her pale sweaty face. Her crying calms a bit, enough to explain her pain is upper belly pain like heartburn, but worse than she's every had, radiating to her back. A flash of horror passes the back of my mind as I remember a case of a young woman dying from aortic dissection, suddenly and without warning. This is remote enough a possibility that I come back and focus on the most likely reason for her symptoms, food poisoning. In fact, what was more in the forefront of my mind was the same kind of retching I myself had on the plane after enjoying a bistro platter of raw seafood while playing hooky from med school, stealing away to Paris where my girlfriend (now wife) was studying. At least this woman had the decency of containing the products of her efforts to the toilet, whereas I'd spoiled the whole galley with my gifts a dozen years ago.

With her color returning, I called for "the kit". Can you believe the medical kit has cardiac resuscitation meds? What use is that now that the defibrillator's been replaced by and AED (automated electronic defibrillator) which doesn't give me a quick look of her rhythm. I'm hoping I won't have to use any of those meds, and instead gave her 25 mg phenergan in her right buttock (with a stewardess preserving her dignity with a blocking curtain), hoping she wouldn't retch into the back of the jump seat. Fortunately, in a few minutes her mid-epigastric pain quickly improved (acid from the vomiting), only to find she still had left lower quadrant pain. My concern then turned to a possible ectopic pregnancy or a ovarian cyst, and my concern increased when in another 10 minutes her pain greatly improved, possibly representing it having burst since the pain so magically improved.

Good thing the neonatologist was there, who up to that time played assistant to me -- handing me gloves, meds, syringes and needles. It was my turn to serve, and we switched places. There was no tourniquet, so I ran back to my seat to grab my computer power cable, and cinched off her left arm, eliciting a howl such that I loosed the cinch a bit. After he got the IV in, I wondered why the saline wasn't running in, and instead blood was drifting into the IV tubing. I realized then why it's nice to have nurses do your IV's. They don't forget to undo the tourniquets after you start the IV.

As her blood pressure improved with the IV fluids flowing in, I had a chance to catch my breath before the stewardess handed me the phone: it was the pilot. He had the grand plan to let all of the passengers off before paramedics tended to my patient. I had to bicker with the pilot to let her off first to get whisked off to the nearest ER. Burst ectopics or ovarian cysts can bleed a lot and patients die quickly!

As we left the plane to meet the ambulance, a funny thing was that I knew one of the paramedics - I'd worked with one of them in a summer camp together. We reminisced as they loaded her onto a gurney to wheel off to the elevator bringing them back to the tarmac to jet off to the ER. I was just glad I kept her alive and got her into good hands.

Lessons to those who get sick in flight:
1) tell the doc who sees you that there's a complete medical kit
2) tell the doc to tell the pilot exactly the degree of risk of immediate danger you're in
3) ask for more docs if the one seeing you doesn't seem to be completely comfortable tending to a medical emergency. On our flight there were 3 docs, other than the neonatologist, there was a cardiovascular surgeon, who would be very handy if we needed to crack your chest to massage your heart, but that wouldn't be too useful without the intubation supplies missing from the medical kit. You want the ER doc, family doc, or general surgeon taking care of you, someone attuned to subtle changes in patients with dire emergencies.

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About the Author


Dr. Schwimmer's blog explores the intersection of medicine, new technologies, and the Internet.