Anecdote: Is there a doctor on board?

Airplane from Bali to Doha: middle flight, I am as asleep as one can be on a loud plane. The speaker calls: “Ladies and gentlemen, if there is a medical doctor on board, please notify the nearest flight attendant. Once again, if there is a medical doctor on board, please notify the nearest flight attendant.”

I automatically stand up and go to where the stewardesses indicate, they ask for my license, I hand my German one. I am rushed to a seat to find a man in his 60’s, unresponsive, cold, almost blue, hardly breathing.

I check his pulse: is barely palpable, heart rate 55 (normal ~70) and at times feels irregular (bad sign). He has peed in his pants and the man sitting next to him says he had seizure-like movements after losing consciousness. I think “oh man”, I say to the stewardess “this could be grave”. The most common causes of such a state are: heart attack with on-going heart failure, stroke, epilepsy, vasovagal syncope, hypoglycemia, alcohol related. It is hard to know at first sight without the proper elements or being able to talk to the patient. I check his pupils: they are isocoric, reactive (a good sign, no brain damage yet).

An oxygen canister is produced by a stewardess. I put the mask on, after a few minutes the patient is able to say a few mumbling words. “Hello Sir., I’m a doctor, do you have chest pain? A heart condition? Are you under regular medication?” “No, I don’t have anything”, he says. “Diabetes, epilepsy?” “No”. “Is it the first time something like this happens to you?” “No, it has happened before” and faints again.

A Norwegian paramedic arrives and offers help. With another trained individual is easier to lie him on the floor. He wakes up, barely stands and can unsteadily walk. Between the girl and I , we help him lie down in the next airplane’s galley, before he feels like fainting again, oxygen mask still attached.

I put his legs up and ask for a stethoscope and a device to measure blood pressure (they do have it). Blood tension is low (100/60), between the airplane noise and his state is hard to hear the heartbeat, but it feels regular. He is reacting more, a bit warmer to the touch. He drank 3 Gin tonics and 1 glass of wine before the fall, they say. No water.

I give technical data to inform medics on land. They ask us to administer him 10 mg. of Diazepam. They surely think of a myocardium infarct. Info against it: the patient hasn’t had chest pain nor shortness of breath, no left arm pain, no jaw pain, practices sport 3 times per week, no heart history, athletic built, no xanthomas, has experienced similar episodes since childhood when standing for a long time and also 5 years ago on another flight. I think more of an extreme vasovagal response -never seen such a strong one though, that lasts for more than 15 minutes-, therefore I decide against the Diazepam, which is another nervous antidepressant (together with alcohol, they are not a good combination). I prefer to talk him into relaxation without a drug that might worsen his condition.

The Norwegian paramedic -great assistance to work with-, a girl in her thirties with scruffy hair dyed white, tattoos on her arms and a very friendly, grounded energy, agrees with me.

As soon as the patient can sit without fainting I ask him to drink a glass of water. Ten minutes later blood pressure is up to 120/80 (normal). He is still dizzy and weak. We stay on his side for the 2 hours of the rest of the flight.

I am asked to file a medical report and give my personal and professional info. I do. I ask the patient to drink more water and to rest lying down. He is slowly feeling better and better.

On a break from our constant monitoring, lovely punk-looking Scandinavian paramedic asks: “what is your specialty?” To save time I say: “Psychosomatics” and add: “I haven’t treated one of these in more than a year”. She smiles, nods and says, “but you are good”.  Something hard to get is appreciation from an experienced nurse, so I actually feel proud.

We land and a team of Qatari paramedics come into the airplane. They hook him up to an ECG monitor (electrocardiogram, to observe heart electrical activity). It seems to be all in order. He is recommended to stay on land, delay next flight to Paris. They are concerned it is too much for him and would like to do further diagnosis. Thankfully it was something manageable, and we acted well.

I’m told “thank you so much, we are lucky you were here, feel free to go to your next flight, doctor”  So I say goodbye to the patient, who profusely thanks me, and I’m on my way.

A stewardess carries my bags, she does not allow me to carry them myself. They have a guide take me through a door directly into my assigned departure area. I walk feeling a bit god-like until I arrive at the public resting room at Doha’s airport where there are around 50 reclining chairs, under strong neon lights.

It is crowded, women with hijabs who look like servants to the Qatari are lying on the floor with their kids and disheveled bags, one baby is crying on the back. I sleep on and off for a few hours with a mask, ear plugs, and my travel pillow, until the next flight to Berlin.

Next airplane seat space is small, I’m crammed together with a middle-aged German man, wearing sandals and socks, complaining about the taste/quality of the eggs in the breakfast tray.

I’m down from high land, from the “I-can-save-your-life” mode, another anonymous citizen traveling in tourist class, a regular human in transit.