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Is There a Doctor in the House?
I travel a lot and find myself onboard a commercial jetliner once a week or so. Since my hometown airport is not a hub, trips usually involve connecting flights. On average I experience 4 takeoffs and 4 landings per trip. Yes, I memorized the safety briefing long ago!Get out your calculator: multiply the annual number of flights by 28 years (since graduating from medical school) and you'll arrive at a pretty substantial figure.
After all that air travel it wasn't until last week until I heard for the first time: Is there a doctor onboard?
The announcement came about twenty minutes after takeoff and I had already dozed off. Don't be jealous but I usually fall asleep the moment the jet pulls away from the gate. My wife gently poked me, "The stewardess needs you." Rising from my seat I responded, "These days they're called flight attendants".
I was directed to the rear galley (where they store the peanuts, stale crackers and darn little else). Funny, I expected to see someone laying prostrate across a row of seats or perhaps resting on the floor. A flight attendant stands alone and points to the restroom door. Yikes! Maybe I'll get to deliver a baby at 36,000 feet - start boiling some water! I opened the door and discover a middle-aged woman slumped over in a pile. How long had she been unconscious?
No history. No clues. The flight attendant alerts me to the overhead AED (Automated External Defibrillator). Since the passenger had a strong pulse and was breathing without assistance I figured we were in pretty good shape. Time to arouse the patient.
A brisk slap of the hand and she immediately came back to life, "I'm here! I'm okay! I'm okay!"
Reciting her name, the date, and the aircraft destination, the woman proved to me that she was fully oriented. We give her some oxygen and let her have some water. She made quick work of two bottles of water - those tiny, 8 ounce, cheap airline bottles.
When patients are alert and communicative a medical encounter typically begins with a good history. In an emergency the medical history is often the last step. Here's what I learned:
- The woman woke up very early to get to the airport
- Ate a quick breakfast but drank nothing
- Traveling to resolve a family crisis
- Stressed out about leaving two sick daughters at home
- Doctor changed her two seizure medications yesterday and she took them for the first time before boarding the plane
Thirsty, tired, stressed, and centrally medicated. Yep, that'll just about do it to anybody.
After a few more minutes the woman laid down on an available row of seats with plenty of blankets and pillows. I stayed with her to check her vital signs and to offer reassurance. Then I informed the pilot that we would not need to divert the flight. The grateful flight attendant offered me a free cocktail. "It's not even 8 o'clock in the morning! Could I get a cracker instead?"
That was that. It finally happened to me. I suppose the biggest lesson from this adventure was that folks ought not change medications immediately before traveling out of town. Sure, there are always extenuating circumstances, but most folks should continue their existing pill regimen until they return home.
Oh, and keep up on your fluids.
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