One physician learns firsthand that you are never really off-duty

In-flight medical events are in an area of medicine that is often overlooked but occurring more and more.

Neighboring passengers later told me that he took one bite of his sandwich and then his head dropped back. It wasn't until 10 minutes later, when his wife tried unsuccessfully to wake him, that anybody realized anything was wrong.

I was sitting in Business Class with my parents – a trip to France to celebrate my near-completion of my Intern year in Internal Medicine (just 2 weeks of night float still to go). About 15 minutes after passengers were allowed to unbuckle their seatbelts, a flight attendant ran to the front of the plane, grabbed an AED and raced back down the aisle to Coach.

I decided to check it out anyway.

Behind the curtain was a scene I will never forget: a man lying in the aisle with his feet towards the front of the plane, one flight attendant doing mouth-to-mouth, one doing chest compressions and a third attaching the AED pads. I tapped the last flight attendant on the shoulder, "Do you need help? I'm a doctor."

"We're fine," he said, which surprised me. I wasn't expecting that. Granted, I was in baggy pants, sneakers and a hooded sweatshirt, but was it protocol to decline help from a physician in a medical emergency aboard an aircraft?

I felt uneasy about leaving, so I found the patient's wife. I asked if he had any medical problems – "an abdominal aneurysm and an MI." Did he take any medication? – "yes, a lot, I'm not sure what kinds." The wife was swept away to the front of the plane and a passenger asked me if I was a doctor and then said, "I'd feel much better if you were running the show." "So would I," came out of my mouth and I climbed over the seats and passengers to position myself behind the patient's head.

He was not breathing and had no pulse. Pupils were fixed and dilated (a passenger provided a light from his keychain). The flight attendant doing mouth-to-mouth resuscitation was not using a protective barrier – I asked for oxygen, for an Ambu bag – they didn't know what that was but I was somehow handed the pieces of the Ambu bag.

I held the two pieces together as best I could, trying to minimize air leak while making sure his neck was extended and there was a good seal on the mask. I knelt on the ground, holding the piece over his mouth with my left hand and pumping the bag with my right hand against my right knee.

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