June 14, 2018 02:28 pm Kim Yu, M.D. – "Is there a doctor on board?"
How many times have you been on a flight and heard that request for help? Are you the first to stand up or raise your hand?
Some physicians struggle with this scenario. We have the duty to care for people, but we also must know ourselves. If you are returning from a long trip, conference or relief work, you might be overly tired. Maybe there are others on board better equipped to handle the situation. Maybe you fear litigation.
Sometimes, however, you might be a distressed traveler's only option.
It is not often that physicians are on the receiving end of such aid, but my family has been. It was a great reminder that we could easily be that patient who needs help, so I never wait to see if someone else responds to a flight attendant's request for assistance.
All it took for me to adopt that mindset was one glass of juice -- or what I thought was juice.
On an international flight, a flight attendant asked if we wanted juice.
"Yes, that would be great," I said. "What type of juice is it?"
"Peach and mango," she said.
"And it's just peach and mango juice, nothing else?" I asked.
"No, it's just juice," she said.
I gladly took two glasses, one for my food-allergic daughter and one for me. One sip later, disaster struck. First the coughing and sneezing. Then her lips started to swell, and the eyes followed soon after. Wheezing, choking, hives. She was red all over.
The drink was not "just juice." It also had milk in it.
We administered her EpiPen, diphenhydramine, cetirizine and steroids. A few seconds can seem like an eternity when it's your child gasping for air. She went pale and limp like a ragdoll against her seat. I thought I'd need to start CPR, but she had a pulse, so we waited.
A lot goes through one's mind at moments like this.
"I killed my daughter," I thought to myself.
I also thought that I should have asked to see the ingredients. I wished I knew Italian so I could read the label.
In the midst of this chaos, my son was vomiting from motion sickness.
By this point, the crew had asked on the overhead speaker if there was a doctor on the plane. I am a doctor, yet in mommy mode I gladly waited to see if another physician would answer the call. Quickly, a thin, tall man appeared, and he was a pediatric surgeon! At least he could do a cricothyroidotomy with a penknife and a sports bottle straw if he needed to, right? Thankfully, my daughter recovered, and she did not need additional emergency treatment. We simply monitored her for the rest of the flight, but I was grateful for the other doctor's willingness to help.
That nerve-wracking flight was six years ago, and I have experienced many in-flight emergencies since then. I've even learned to travel with my stethoscope because when I forget to bring it there is always an incident, and the stethoscopes in airline medical kits are often less than ideal.
I had my stethoscope with me on a recent flight from Beijing to Seattle, but its luck apparently ran out. We had not one but two emergencies. In those 12 hours, I learned some important lessons about teamwork, collaboration and communication.
We were about two-and-a-half hours into the flight when the first call for help came. A man in his 50s was passed out on the floor. The passenger had diabetes and a history of gastritis and abdominal pain.
In addition to me, there was an oncologist and endocrinologist on board, as well as two emergency medical technicians.
Our new patient's vitals were poor. His blood pressure was 70/40 and his pulse was in the mid-40s. A quick check showed there wasn't much in the plane's medical kit. We had oxygen but no glucose monitors and few medications.
The flight attendant turned the situation over to me, and I worked with the other physicians and the EMTs to help the passenger. This is when the beauty of teamwork came into play. Everything happened so smoothly that an observer would not have realized we were all complete strangers, each playing an important role in delivering care to our patient at 30,000 feet.
The EMTs were fantastic, jumping right in to get vitals, grab the oxygen tanks and put the patient into a reclining seat in first class. The patient's airway, breathing and circulation were all stable, and the exam was pretty unremarkable. He regained consciousness quickly, so we were able to get a history. We were able to check glucose because another passenger let us use his new glucometer, which the endocrinologist helped with.
Meanwhile, another woman appeared and started massaging the patient's feet and calves. I politely asked what she was doing. She introduced herself and said she was a complementary medicine clinician. She explained she had decades of experience and had, in fact, been lecturing about acupuncture in China.
As we had this discussion, she continued to apply acupressure, and the man's blood pressure improved. Color started coming back to the patient's face.
The woman then offered to provide acupuncture. The EMTs were initially against this suggestion, but I did not have any other supplies or medication to help. I have seen acupuncture work in similar cases, and the other physicians agreed that it likely would not hurt the patient. We discussed this option together and allowed her to continue.
It's also important to consider cultural preferences. The passenger was Chinese, and although my Chinese isn't perfect I was able to communicate with him, and he appreciated (and seemed to understand) the woman's help. When she applied acupressure and acupuncture, his blood pressure improved and his abdominal pain eased. When she stopped, his vitals and symptoms worsened.
"Whatever you are doing, please keep going," I said.
About 45 minutes into treating our first patient, we heard the flight attendant's voice on the intercom again: "Are there any more doctors on board?"
Patient No. 2 was a man in his 80s who experienced mild chest pain and hypertension after taking his blood pressure medication with alcohol. He was Vietnamese and spoke no English, but we were able to speak with his family.
The oncologist gave him aspirin, and after we put him on oxygen, his symptoms seemed better. He still had a bad headache, however, so the complementary medicine clinician was called on to provide acupuncture for him, too. His headache abated.
The EMTs now discussed whether we had enough oxygen to last for two patients. At this point, we were about five hours from Anchorage, and the pilot wanted to know if we needed to divert for landing. After some discussions with ground control, a physician on the ground (who made the decision) and the captain, we stayed on our course to Seattle.
During in-flight emergencies, planes are diverted only about 7 percent of the time. The prime reasons for diversion are acute heart attack or heart failure, respiratory distress, irregular blood pressure, shock, unconscious patients and obstetric emergencies.
For the next eight hours, we worked together in shifts, rotating between the two patients. It was exhausting, but our oxygen tanks lasted and, thankfully, both patients stabilized and improved. Times like these remind me of the great privilege we have to be family physicians, to take care of all, in any situation.
It was interesting to hear the perspectives of the other health care professionals on the plane and to orchestrate care for both patients, working together. I was grateful for their cooperation, collaboration and willingness to help. Helping one person may not change the world, but it could mean the world for that one person.
I hope that if my family is ever in that situation again, someone will step up and answer the call for help.
Kim Yu, M.D., is the past president of the Michigan AFP. Now based in Orange County, Calif., she is the director for quality and performance of ambulatory and urgent care for Vituity. Her interests include advocacy, physician well-being, health equity, global health, missions and lecturing. You can follow her on Twitter @drkkyu.