Is there a doctor on board?

I was on my way home from an international conference, having introduced the concept of hospital medicine to the Lower Slobovian Medical Society. I was flying out of OMG to MSP, a direct flight of 16 hours. I'd used my miles to upgrade to first class. The seat folded down to a flat surface and I asked for two extra blankets. SlobAir has excellent food and some really offbeat movies. I could not believe they had “King of Hearts,” “M*A*S*H,” and “One Flew Over the Cuckoo's Nest” on their system.

I had just finished watching my first movie and was contemplating a gin and tonic when I heard the words you never want to hear on a plane, especially over the middle of an ocean: “Is there a doctor on board?” I looked around the rest of first class. I had met one doctor from some place in Boston, in the lounge before the flight, but I'd seen him take two Ambien and wash it down with a fistful of small bottles of Scotch. He would be useless even if he were conscious.

I sighed and pushed my call button. There was a young man four rows behind me who was unresponsive and sweaty. His pulse was up slightly. I looked in his carry-on bag and saw some bottles of medication and a glucometer. I had the flight attendant bring me four bags of sugar, which we poured into his mouth. He slowly woke up. Soon he was looking better. He had not ordered any food on the flight. I gave him my dinner. I hoped he appreciated it.

Back in my seat I once again contemplated the medicinal value of a gin and tonic. We hit some chop. Soon we were bouncing along like a bus on a potholed road. The captain announced something in Slobovian, and then the ride really began. We dropped 500 feet. Lightning flashed outside the window. People screamed, the overhead racks bounced open, and luggage flew through the cabin. Just as suddenly it was over. I heard the sounds of terror and pain in the rows behind me.

I knew flight emergencies were rare, something like 1 in 600 flights. I also knew I would have liability coverage, assuming I did not do something grossly incompetent. That was a significant assumption, but thankfully, I had still not had a drink.

I walked toward the back of the plane. The first thing I saw was a young woman holding her forearm at an impossible angle. She moaned pitifully. I asked for the medical kit. It contained two aspirin, a roll of surgical tape, epinephrine 1:1000, Tylenol, a stethoscope with no ear pieces, a blood pressure cuff, a bag-valve mask, a scalpel, some needles, and thread. I grabbed the tape and a meal tray from the first class galley, which I bent in half. It seemed long and narrow enough. I pulled her hand forward to straighten her forearm and she screamed. I laid her arm in the folded tray like a splint and taped it in place. I could feel her radial pulse, so I knew she would be OK.

Then the full extent of damage done by the turbulence became apparent. There were gashed foreheads and a dislocated shoulder. One man was holding his chest, sweating with a racing pulse. This looked like an MI or a PE. Not much I could do, except lay him down and provide two aspirins and some oxygen. I called out to the passengers, most of whom spoke no English, asking if anyone carried nitroglycerin for chest pain. One man handed up the little brown bottle. I gave the patient three over the next few minutes, and he settled down. I asked if there was a way to land early, but the captain wanted to stay on course.

I heard a scream from the back. A tall young man was lurching forward holding his chest and gasping. The stethoscope was useless, so I rolled an in-flight magazine into a tube and used it as a primitive scope. No breath sounds on one side, broken ribs, trachea deviated; this looked like a pneumothorax. I asked the flight attendant to see if anyone had some tubing. One old man had an extra straight catheter from the set he used for his overlarge prostate. Another passenger offered up some oxycodone, which I had the patient swallow with a large gulp of whiskey. I grabbed a bottle of water from the galley and the rest of the tape and the scalpel. I used whiskey to sterilize the scalpel and catheter. I laid the man in the aisle. I grabbed the scalpel and proceeded. I ran the tubing though the bottle of water with another hole for air venting and taped it in place. Air bubbled out. His breathing stabilized.

I sewed some skin, applied some pressure, and popped a shoulder into place. Everyone seemed to be settled down—except me. I was exhausted. I was glad to have had the skills to help these people but I also felt tired and slightly annoyed. It would have been great to have another health professional on the flight. The flight attendant thanked me and handed me a big bowl of mixed nuts, which I hungrily wolfed down. The plane was diverting for an urgent landing. I was relieved.

I swallowed another handful of nuts. Suddenly I began to choke. I stood up in the aisle with my hand to my throat. I had a cashew lodged in my trachea. The man I had treated for hypoglycemia jumped up, ran over, wrapped his arms around me, and gave me a big squeeze. We both watched the cashew become airborne and land in the hair of the sleeping physician from Boston. We left it there.

SlobAir gave me 5,000 free miles. Somehow I doubted I would ever use them.