Endoscopy at 35,000 feet: Hand me that duct tape!

April 10, 2000

The elderly airplane passenger had swallowed a foreign object. Thank goodness for the author's ingenuity!

Endoscopy at 35,000 feet: Hand me that duct tape!

Jump to:Choose article section... I construct a makeshift endoscope Ingenuity's fine, but always be prepared

 

The elderly passenger had swallowed a foreign object. Thank goodness for the author's ingenuity!  

By Mark Sonnenshein, MD
Internist/Gastroenterologist
Incline Village, NV

Our chartered jet had just leveled off for its 11-hour flight to the South Pacific. Suddenly, a voice came over the speaker: "Is there a doctor aboard the aircraft, please?"

My wife and I had been looking forward to this trip to Rowatundi Club Med for several months. Work was the last thing I wanted to think about. Also, still fresh in my mind was my partner's recent trans-Atlantic experience. Always the Good Samaritan, he'd responded to a young woman experiencing chest pains. Now he was involved in a lawsuit over a missed breast lump.

I nudged my wife, a retired podiatrist, but she pretended to be asleep. Reluctantly, I raised my hand, acknowledging my willingness to help. Little did I know how much my gastroenterology skills—honed over a 53-year-long practice—would be tested in the coming minutes.

I was hustled into the first-class cabin to attend to the ill passenger. He was a spry but elderly gentleman who appeared to be approaching 90. Upon seeing Jack, as I'll refer to him, my first thought had nothing to do with his present problem. Why, I thought to myself, would a man this old be going to a Club Med? My question was answered almost at once as an attractive woman a third his age appeared worriedly by his side. He introduced her as his "niece." As he did, he grinned devilishly, making clear at once his acute problem: He was missing part of his upper bridge—which no doubt had something to do with the well-done, half-eaten piece of meat still lying on his plate.

My mind racing, I asked the flight attendant for a wire coat hanger. She gave me a quizzical look, but, no doubt owing to her strict training, promptly fulfilled my request.

Once my jacket was hung up and my tie loosened, however, I was able to think more clearly. Jack's situation probably wasn't life-threatening, but it might become very discomforting. The longer the partial denture remained in situ, the more likely that it would pass the pylorus and enter the small bowel. If that happened, there were two possible outcomes: It might travel uneventfully into the colon and be passed with his stool, or it might get stuck in the small bowel and cause an obstruction. That would necessitate prompt surgery.

Should the denture pass, it was unlikely to be recovered. Long experience has taught me that a whole grapefruit admixed with fecal effluent could easily escape unseen. Given the current, uncontrolled escalation of dental fees, Jack was likely to be out a pretty penny. And that was the better of the two possible outcomes. Should he obstruct, his advanced age—combined with the questionable availability of good surgical care and anesthesia on Rowatundi—might prove fatal after all. Something had to be done, and done now.

I construct a makeshift endoscope

My requirements were simple: A long, hollow, lighted tube to pass into Jack's stomach and something with which to extract the foreign body. But what? How? Suddenly, memories of carefree jaunts to Europe during my undergraduate years came to mind. Could it be, I wondered, that European toilet tissue was still as hard and uncomfortable as it had been decades earlier?

I rushed to the lavatory. There it was, unchanged. Thick, hoary squares of off-white toilet paper rapidly peeled away as I sought the center core. Surely, the cardboard cylinder holding this roughhewn tissue had to be of a thickness and rigidity to meet my surgical needs.

The flight attendants rounded up all the available toilet tissue—an action which later gave rise to no little distress in economy class after passengers' butter-filled breakfast omelet. With duct tape from the airplane's emergency kit, I fastened five of the cardboard tubes end to end. It was a rudimentary instrument, but an endoscope nonetheless. Now I needed a light.

Again I was in luck. Thanks to the travel agency, passengers en route to Rowatundi had been provided with any number of party favors and joke gifts. Along with thong bikinis, cut-out paper sandals, and an effusion of leis, there were an assortment of those thin, plastic glow tubes formerly so popular at bar mitzvahs and sweet sixteen parties. Break an end of the straw-like tube, and it emits a pastel incandescence for an hour or two. Perfect for my scope, I thought. I affixed two of the glow tubes inside the end of my cardboard concoction, and presto! there was light.

The long forceps proved even easier. Using cocktail stirrers and the always helpful duct tape, I concocted a stick of appropriate length. To its end, I affixed a piece of chewing gum I'd worked into just the right consistency. The contraption fit nicely inside my cardboard cylinder.

Prior to concocting the instrument, I'd instructed Jack's "niece" in the application of conscious sedation by way of a six-pack of mini-bar bourbon shots. "Do what you have to, Doc," the gapped-tooth Jack said cheerfully in giving his consent. Before long, he was well-prepped.

Ingenuity's fine, but always be prepared

We were ready to begin. Lubricated from a small tub of "buttermilk country kitchen" salad dressing, the makeshift scope slid effortlessly into Jack's stomach. The glow lights gave the mucosa a strange purplish pink hue, but all the normal gastric landmarks were readily apparent.

Then the denture we all feared had passed came into view. Working quickly because of the noxious anesthetic fumes, I passed my long swizzle stick through the endoscopic tube, affixed gum to teeth, and pulled out the tiny prize. The passengers and crew applauded wildly, and I was elated. "Skin to skin," as the surgeons like to say, in under two minutes.

Lacking a means to reverse the anesthesia, we allowed Jack to sleep it off before reaffixing his denture. By this time, the plane had landed. Now, his smile once again complete, he staggered off the airplane as I myself beamed contentedly. It had all been worth it.

Still, after returning to the states, I submitted a bill to Jack's Medicare carrier. It was initially rejected as "out of country" service, and then rejected again upon resubmission as an "unrecognized procedure." Thereafter, I let the good deed alone be my soul's reward.

The airline proved to be even less gracious. Despite a congratulatory form letter and a bottle of California champagne, they forwarded a statement seeking reimbursement for the toilet tissue and duct tape.

There's a lesson to be learned from all this—and it isn't simply that kindness is its own reward.

Nowadays, I never travel without a pediatric endoscope in my carry-on luggage or backpack. Sure, ingenuity had triumphed on this one occasion, but what if we'd been on a domestic airline with soft toilet tissue?

Editor's note: It's no coincidence that this article is running in our first April issue.

 



Mark Sonnenshein. Endoscopy at 35,000 feet: Hand me that duct tape!.

Medical Economics

2000;7:235.