On my own, on top of the world

September 16, 2005

Faced with a potential emergency on a transatlantic flight, this doctor relied on his own judgment.

We were cruising at 35,000 feet when the announcement came over the PA system: "Is there a doctor on board?"

My wife and children were watching a movie on our flight from London to Los Angeles several years ago. I had dozed off and missed the announcement, but my wife nudged me. I had barely opened my eyes when the announcement was repeated. By then I was instantly wide-awake, and I stood up. The chief flight attendant rushed to my seat with obvious relief and whispered, "Thank you, sir."

When I had squeezed out of my cramped economy seat, the attendant guided me down the aisle to a seat in the rear of the plane, explaining, "A male passenger is complaining of chest pain."

"Do you have any nitroglycerin?" I asked Robert, the attendant.

"This is all we have," he replied, opening the medical bag he was carrying.

I glanced through the bag's contents and felt rising panic. I had what looked like an acute MI on my hands, and no nitroglycerin, not even an aspirin. I told Robert to make an announcement, asking if anyone on board had nitroglycerin or aspirin.

As he rushed away, I turned towards the patient and quickly checked his pulse and blood pressure. Although he was slightly tachycardic and tachypneic, his blood pressure, heart, and lungs were all normal. With a brief history, I learned that he was a London resident on his way to Los Angeles for a week's vacation with his wife. He had no prior medical problems, and had never smoked. He had just finished dinner, including a can of beer and two glasses of wine. Based on his description, the pain was epigastric and substernal with no radiation, accompanied by shortness of breath and diaphoresis.

By the time I'd finished my exam, Robert came back with bad news: No one on board had any nitroglycerin or aspirin. Here we were in the 21st century, I thought, traveling in one of the most sophisticated machines ever built, and medically speaking we were back in the 19th century.

As my patient continued to moan, and his wife began panicking, I realized that I had to do something fast. I took a moment to analyze the situation, running through the differential diagnoses. Although an acute MI was possible, it seemed more likely that the patient was suffering from epigastric pain triggered by a heavy dinner, plus the beer and wine.

Making a tentative diagnosis of acute indigestion, I rushed back to my seat and pulled out my carry-on bag, in which I always carried a box of medicines when we traveled. I found Pepcid and Pepto-Bismol, which I brought back and administered to the patient. After 10 minutes, his chest pain, dyspnea, and diaphoresis were gone, and he was relaxed. When I checked again, his vital signs were normal. He thanked me profusely.

With a sigh of relief, I headed back to my seat, but Robert said that the captain wanted to see me. I followed him up to the front of the plane, into the cockpit. "Do we need to land?" the pilot asked. He explained that in case of a life-threatening medical emergency, the airline's policy mandated landing at the nearest airport.

The captain also said that the policy required me to talk to the airline's medical consultant in Phoenix.

While I sat in the co-pilot's seat and donned headphones, he dialed the number. When the physician came on the line, I briefly described the problem. After listening, he said, "It's totally up to you, Dr. Sarkar. If you think the passenger needs medical attention, we will divert the plane to Newfoundland."

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