This announcement usually quickens the pulse of any medic on board. I still remember with horror the air traveller who collapsed with a tension pneumothorax on a transatlantic flight about 15 years ago. A group of British hospital doctors were returning from a medical conference in the USA and saved the patient’s life using tubing from an intravenous giving set, a plastic bottle and wire coat hanger. I am not sure I would attempt this on my own. One thing I have learned from working abroad in remote areas is not to act like a gung-ho cowboy. I ask myself, “If this doesn’t go according to plan, what’s your exit strategy?” That thought focuses the mind perfectly.
The overnight flight from London to South Africa had dimmed the lights after midnight. Most of the passengers were asleep when the tannoy crackled into life. I paused the video I was watching (“Joe” starring Nicholas Cage) and sat up to see if anyone had volunteered. No one moved in my section of the plane so I got up and walked to the curtained off area at the back of the plane. As I did so, a strange man resembling Bilbo Baggins got up and walked down the other aisle. He looked a bit older than me, with curly grey hair, wearing an extravagantly checked lumberjack shirt with purple braces (suspenders).
Behind the curtain, a delirious passenger was being restrained in a four point seatbelt. She was arguing with the cabin crew, wanting to get free, even if this meant she would die. She said she was in pain, clutching her left breast with one hand and her neck with the other. My medical colleague asked her methodically about the pain, but her answers were vague and inconsistent. When she spoke to me, her breath smelled of stale alcohol.
We two doctors looked at each other and put our cards on the table.
“Family doctor?” I asked.
“Yes, you too?” he replied.
“Is it that obvious? Yes. Do you have any other skills which might come in useful, such as psychiatry? I know a bit about mental health,” I said.
“No,” he responded while gently attempting to prod the lady’s abdomen. She reacted angrily and swore and he retreated.
“Looks like I am in the lead role here,” I said.
My rapid initial assessment was that she was disinhibited, under the influence of alcohol. But she could be suffering from another metabolic problem, such as diabetic hypoglycaemic attack, or a head injury, or hypoxia from chronic lung disease. I needed more information. Had she declared any illness before boarding the flight? Was she taking any medication? Could the flight attendants recall how much alcohol she had been served? I drew a blank. The patient became more aggressive and insisted on going back to her seat, saying, “I don’t have a personality disorder!”
The captain left the flight deck to assess the situation in the tail. “Is this a life threatening situation?” he asked. “We are flying over Bangui in Central African Republic. Do you need me to land now?” The passenger wasn’t phased by this; she said she would rather go to a police cell in Bangui than be restrained on board the plane. I discovered that the doctor’s bag on board did not contain any tranquillisers.
The captain told the passenger that if she didn’t co-operate and quieten down, she would be handcuffed and prosecuted. She relented and a crew member undid the seat belt. She then flopped onto the floor and had to be lifted to her seat by her arms and legs. Luckily the seat next to her had been vacated. I sat down next to her and used my experience and skill to defuse the situation. The crew were happy to leave me alone with her.
We talked about her pet, her job and her holiday plans, avoiding confrontational issues. After 20 minutes, she was calm and relaxed. I encouraged her to get some sleep and she agreed.
I walked back to the crew area in the tail of the plane to liaise with the staff. In the same chair I found another passenger who had taken ill. He had passed out twice on the way to the toilet. This problem was easier to solve, probably a mixture of contributing factors – no food for 12 hours, recent antibiotics and anti-inflammatory drugs on top of his usual cardiac medication and a bit of postural hypotension when he rose from his seat. After a sugary drink, he felt much better and he was able to return to his seat without assistance. So was I.
I made an attempt to get to sleep, but I was wide awake by now. A crew member brought me a couple of forms to complete, so I would be taking responsibility for the decisions and actions I took, rather than the airline. I watched another film, a biopic about James Brown, the Godfather of Soul, which was excellent.
This isn’t the first time I have been called upon to provide medical assistance in the air. We took advantage of Cathay Pacific’s discounted airfares to fly to Queensland via Hong Kong during the SARS epidemic. It didn’t look such a bargain when I was called to see a Chinese lady who was feeling unwell on the flight to Cairns. Luckily for us both, it was just hypotension – low blood pressure after she had taken a double dose of antihypertensive pills because of the time difference. I had an unpleasant conversation over a radio telephone with the insurers about whether the captain should divert to Sandokan airport in Sabah, or did I think the passenger would not die before reaching Cairns.
On an Emirates flight to Bangkok via Dubai, a man collapsed in front of me and the crew allowed me to open the doctor’s bag so I could perform an Electrocardiogram (ECG) and check his blood sugar using a diagnostic stick. But I had to prove to them that I was a “real doctor” by providing evidence – my surgery identity badge – before they would let me loose on a glucostick.
I have heard of “good samaritan” doctors who received an upgrade on the next leg of their journey, or a complimentary bottle of champagne for ministering to the sick on board. But all I have had was thanks and gratitude from the cabin crew. My medical indemnity insurance would not have covered me for decisions I made while flying, so perhaps I should have been more demanding and assertive.