By Will Dabbs, MD
Here’s a glance into the sausage factory that is the modern practice of medicine. I started med school at 32. This is my fifth career. I’m not really sure exactly what it was I was expecting out of this new profession, but it wasn’t this.
I got into medicine for the glamor. You know, the chicks, the groupies, the shaving cream ads. I’m kidding. This is quite literally the nastiest job in the world. Trust me, all the glamor evaporates the first time you manually evacuate a fecal impaction or drain a massive butt abscess. Don’t get too tooled up over the interactions with the fairer sex, either. It’s not typically the Dallas Cowboy Cheerleaders who come in with those sorts of problems.
The Setting
My wife and I were recently flying to the UK for a little down time. Don’t be impressed with that. We saved up for the trip for literally years and did it on the cheap. The least expensive way to get to Gatwick was via Portugal’s national airlines.
The Portuguese flight crew was friendly, and the plane was both clean and comfortable. I was a professional soldier for eight years. Trust me, I’ve seen worse.
Maybe two hours out from London, the chief steward came over the intercom with the query sure to strike fear in the hearts of medical providers everywhere: “Is there a doctor onboard?”
Well, crap. I briefly considered just feigning ignorance, but a caustic glance from my bride got me up and motivated. A Spanish EMT and a British medical student also answered the call, but I was the only fully-frocked sawbones. That meant this problem was all me.
Patient Presentation
The patient was perhaps late 60s and overweight. He was slumped forward over his tray table and unresponsive. To his left was a young man in his 20s. The seat to his right was empty. The flight attendant stepped aside, passing responsibility both metaphorically and practically to me. I felt for a carotid pulse and found one. Pushing the man’s inert form back to get the lay of the land, I asked his seatmate for details.
In broken English the young guy explained that the man was indeed from Portugal, but that was all he knew about him. He didn’t even know his name. He said the man’s wife had been sitting on the other side.
The big guy had experienced some kind of episode. At its onset, the guy’s bride leapt up and locked herself in the lavatory. The flight attendants were trying unsuccessfully to coax her out. With the assistance of the female Limey med student and the Spanish ambulance crewman, we got the man’s massive form wrestled out into the aisle. Of course, everybody on the airplane was looking on with rapt attention.
The Art of Medicine
I’ll let you in on a little secret. I’m a two-hymnal man. That’s really what sets me apart from my peers, medical-wise. Most physicians, when confronted with some little old lady who suffers the vapors during a particularly enthusiastic church service, will support her head with but a single hymnal while waiting for the ambulance to arrive. I typically employ them in pairs. I feel this provides some slight modicum of enhanced comfort over the traditional one. However, without any proper tools, speaking in soft dulcet tones and holding her hand is really about all you can do outside of a proper facility. I’m naturally pretty decent at CPR and the Heimlich, but those applications are actually pretty rare.
We’ve all seen the movies. Old Tex gets gut shot. If only they can get him to the local medical practitioner he’ll pull through. That is pure unfiltered fantasy. Suffer some serious medical event at 40,000 feet that can’t be addressed by your typical Boy Scout, and you’re just gonna die.
Diagnostics
I’ve delivered 60 babies, put in chest tubes, managed more than my share of gunshot wounds, and have done a couple of ventriculostomies—that’s where you drill a hole in somebody’s skull to address a brain bleed. This dude didn’t need any of that. He was just inexplicably unconscious. The only person in the airplane who could offer any practical insights had barricaded herself in the bathroom.
Blood pressure was low-ish but respectable. Pulse was a bit tachy but nothing insane. Respirations were stable for the moment. We scared up a glucometer and found that his sugar was fine.
Portuguese airliners have a pretty decent first aid kit, and my EMT buddy had his aid bag. We hooked him up to everything we had, but nothing was terribly enlightening. However, at least he was alive. I didn’t relish the idea of thumping on the chest of a cooling corpse with 300 multinational passengers hinging on every heave.
Learned Helplessness
Eventually, the flight crew persuaded the man’s hysterical spouse out of the lavatory, but she was too agitated to speak coherently. Not that it mattered. I think I mentioned, I don’t speak Portuguese.
I duly reported to the captain that I had no idea what the man’s problem was, but that he would likely fare better on the ground. That bit of information earned us a straight-in to Gatwick. When the pilot veered off the active runway heading for the terminal, I swear that big plane was on two wheels.
After all the chaos getting into the terminal, the flight crew still inexplicably deplaned all of the passengers before allowing the ambulance crew to board and tend to the man. They asked me what was wrong with him, and I said I hadn’t the foggiest. At least they spoke English. The British EMTs subsequently wheeled him off without fanfare.
I made my way back to my seat in the now-deserted airplane and retrieved both my wife and my stuff. The Portuguese flight crew nodded as I left with the obligatory “B-bye,” characteristic of stewardesses the world over. My wife and I subsequently had a delightful time in the British Isles. Next time, however, I might just remain in my seat and claim to be a plumber.
