(now, I don't know why but I'm going to try to build up the situation as though you don't know what this post is going to be about from looking at the title)
So, the other day I was on a plane back home because I finally finished exams and I was free (FREE!). I'm pretty used to being on planes so nothing was out of the ordinary. They'd served our dinner, and everything was peachy. I was watching Avatar, and I think they were only just past the part where Aywa (or whatever her name is) just decided to take a side in the battle in the skies, when, all of a sudden...the screen cut and a message was displayed saying there was a cabin announcement. In short order, my worst nightmare came true...
"If there are any medically trained passengers, please immediately make yourself known to staff by pressing your call bell".
The blood I felt immediately drain from my face, and my heart stopped. I wasn't ready for this! In a split second my mind had a furious battle where numerous arguments fought: first and foremost, I was afraid that I would be the only medically trained person on the plane, and that if I made myself known I would suddenly have a life on my hands. Within that though, I knew that despite being just a first year medical student I still perhaps knew more than the average joe blog and so I knew I should take the call. Still, I was afraid of having the life on my hands. Secondly, to be honest I wanted to be a part of it. Not because I was nosy, but because it was exciting and perhaps a chance to use some of the knowledge I've gained so far. Thirdly, as I saw another person press their call bell I had to think about whether my limited knowledge would be of any assistance at all, and whether I would just be in the way. Fourthly, I did consciously put my stethoscope in my carry on luggage just in the remote chance that something happened in the air because I've heard horror stories of airline medical kits not even having stethoscopes and I want to be prepared. So, all of this went through my mind in about a split second. I wasn't ready, but my mind went blank and I just knew what I should do: I pressed the call bell.
Within less than a second a hostess came to me but I was already getting out of my seat -- I didn't know what the issue was and if it was serious then time may have been against any attempt to save the person. Once I decided to help, I was committed. I felt sheepish being escorted to the rear of the plane, feeling way out of my depth and wondering just what the hell I'd just gotten myself into. If I couldn't help this passenger, what would I do? The people around might be looking to me as the person to save the passenger, and if I didn't know what was happening to them or if I didn't know what to do, what would I do?? I was freaking out, but trying to stay calm at least to assess the situation.
Making my way to the rear of the plane, I noticed that there were barely any passengers around and I wasn't sure if they'd cleared the area but it was really good. When I arrived there was already a guy in a tshirt talking to the man who had an oxygen mask on, and there were probably 5 or 6 air hosts/esses around. The guy in the tshirt I quickly realised was an experienced medical person, which made me instantly relieved -- I felt like he had saved me, as much as he was saving the passenger. I soon learnt he was a trainee surgeon from a victorian hospital. He was doing a history of the guy, while the air hostesses got out what seemed like every piece of medical equipment and materials the plane had. The guy was diaphoretic, tachypnoeic, had rigors, tremors, fever, headache, had vomited profusely and had a large quantity of diarrhoea over the whole duration of the flight, had chest pain, numbness around the mouth (we decided probably from hypocapnia secondary to the tachypnoea), and he felt very nauseous. He had lost consciousness while trying to tell a hostess that he was feeling ill, and he convulsed while unconscious. While the nausea, diaphoresis and chest pain initially had me wanting to rule out MI, the surgeon said quite rightly that at the patient's age it was highly unlikely, and so with the fever he was more inclined to go straight to a bacterial cause -- sepsis, secondary to a gastroenteritis.
Basically, we found that almost everything the aeroplane had was for acute life threatening non infectious conditions like an MI. In the absence of IV antibiotics (or even oral antibiotics), our options were severely limited. Basically, we could only give symptomatic treatment and hope that the diarrhoea and vomiting had reduced the infectious load enough that he would make it to our destination. We gave him an aspirin for the chest pain, and we were going to give him some fluids that they had (hartmann's solution) but the cannula didn't connect with the tube from the IV bag for some reason, so we just had to be content that we had secured a peripheral line for the ambulances who were going to meet us when we touched down.
The man's condition was pretty serious. His temperature was very high, but he perceived his temperature to be varying wildly -- one minute he would be sweating profusely, the next he would be shaking with extreme shivers. The sepsis appeared to be quite bad. We had him on 4L O2 and he said that was the only thing stopping him from vomiting. His condition become the worst we saw just before we landed, but he still didn't vomit again after we saw to him.
As for what I did myself, it wasn't all that much. I of course offered my stethoscope and it was gratefully received so the surgeon could listen to the breath sounds. I also liaised a lot with the aeroplane staff, telling them what we needed and what was happening now. I also talked a lot with the surgeon, giving him equipment and talking to him about what he was doing and thinking, what I was thinking, etc. I really wanted to get in there and have a listen to his chest as well, but there wasn't enough space and I didn't want to speak up because I was just a medical student after all...
Anyway, when it was apparent to us that he was perhaps at least stable, I talked more casually with the surgeon. We got friendly, and he said that he'd give me his number and when I'm back in melbourne I should give him a call and maybe he could give me some experience in his hospital -- including theatre! I'm sure he didn't mean that though so I'm staying realistic, but I'd still love to even just get to be friends with him.
The staff of the plane thanked us so much after the paramedics came on board and we started packing up. They were thrilled with us, even the captain came down and shook our hands. One of the main staff people gave us each a bottle of wine, and they took our details and the captain said he'd see what he could do...he meant about getting free tickets I think!! Incredible.
All in all, that was an incredible experience and I am very glad that I decided to stand up and offer what little I could. I couldn't believe that it was actually happening and I still can't in a way, but it taught me several things but most importantly, it gave me my first taste of a situation where not only are tensions running high, but I am also required to be able to think critically and draw upon my knowledge. So exciting.
Until the next time,