麻豆传媒

You may have read recently about the death of a 25-year-old nurse who suffered a pulmonary embolism during a flight. After she passed out in the bathroom, a physician who was also a passenger on the flight pleaded unsuccessfully with the pilot to divert the plane. The nurse suffered anoxic encephalopathy and died several days later.

Reading about this tragic incident stirred my memories of being the "doctor on the plane." I have played this role on several occasions, and two of my experiences are worth recollecting. Both occurred in the 1980s, when I was a front-line cardiologist facing cardiac emergencies on a daily basis.

First, the really terrific story.

I had just landed in Oslo after a transatlantic flight and was waiting in baggage claim. A middle-aged man collapsed in front of me, pulseless. I and another passenger promptly started cardiopulmonary resuscitation. Within two minutes, airport emergency personnel delivered an ECG/defibrillator and a kit brimming with syringes and ampules of cardiac medications, which (although written in Norwegian) were easily understood. While my colleague maintained ventilation, I delivered five shocks and two intracardiac injections of epinephrine and managed to achieve sinus rhythm and a pulse. The patient was rapidly moved to a nearby hospital and awoke later that evening without neurological deficits. I received flowers from SAS Airlines at my hotel room.

Now the not-so-terrific story.

I was traveling from New York to Los Angeles on a U.S. carrier, when an elderly man experienced severe chest pain. Three physicians identified themselves: two were middle-aged and professional-looking and included a psychiatrist and a gastroenterologist. I was in my early 30s, wearing casual clothes. After I identified myself as a cardiologist, the other physicians happily returned to their seats.

The patient was French, had a long history of coronary artery disease, and was taking a long list of medications, including many that were not available in the U.S. He clutched his chest, was diaphoretic, and looked awful. He carried nitroglycerin, but multiple doses failed to relieve the pain.

I asked the flight attendants for medical supplies and was shocked when they handed me a first-aid kit that contained only bandages and gauze pads. It was the 1980s, so there was portable oxygen -- but no defibrillator, no medications of any kind, and no blood pressure cuff or stethoscope. I was not carrying my own medical equipment.

I believed the patient was suffering an acute myocardial infarction and required immediate medical attention. I said that to the flight attendants, and the pilot came out to talk to me. I told him that we needed to land as soon as possible.

We were at the midpoint of our flight, nearly 3 hours away from Los Angeles. The pilot explained that the flight was already late, and he needed to get to L.A. quickly. I explained that this was a medical emergency. He said that he could land the plane in 20-30 minutes but would prefer not to.

The pilot's main question to me: Are you telling me that this patient will definitely die in the next 3 hours if I do not divert the plane?

I responded: That isn't the right question. I do not know what will happen in the next 3 hours. He might die; he might survive. Regardless, he needs immediate medical attention.

Then I made the most persuasive argument I could: Based on a great deal of professional experience, I am telling you that you need to divert this plane. You would agree with me if this man were your father.

I really thought my argument would be compelling, but I was wrong. I think the pilot looked at my youth and casual clothes and discounted what I had said. Or perhaps the pilot was not particularly fond of his own father.

The pilot's response: We are going on to L.A. Do the best you can.

I spent the remainder of the flight next to the patient, continually monitoring his pulse. I did so for both his reassurance and my own. If he had experienced an arrhythmia, I would have had no way to treat it.

I told the flight attendants to make sure that there would be emergency personnel waiting for us when we landed. The flight attendants asked the other passengers to remain in their seats so that the man could be taken off the flight before anyone else deplaned.

But when the plane arrived at the gate, the passengers rushed to the exit and prevented the emergency medical personnel from reaching the patient. The flight attendants did not intervene, and the man had to wait another 10 minutes before the paramedics were able to take him off the plane. I remained behind to complete the paperwork.

Did the pilot make the right decision to maintain his flight plan? I do not know. I never learned if the man survived or died.

Interestingly, when the pilot left the plane, I was still on board, but he never asked me about the man. And even though I kept looking at him to make eye contact, he never even glanced in my direction.

These two incidents occurred 30 years ago, and emergency medical care on long-haul flights has undergone major changes. Medical kits are far better equipped, and I think that pilots opt to divert flights more frequently. At the same time, I sense that some of my colleagues are less likely to identify themselves as physicians when there is a passenger in need. Some are worried about liability or other complexities, and others believe that there is little they can do.

So my advice to passengers has remained the same: Don't get sick on a flight. And if you do, pray that you will encounter people with compassion and the willingness to get involved and make tough decisions.

Medical miracles are rare at 30,000 feet. Your consolation: if you believe in prayer, you are a little closer to heaven.

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