High stakes on a plane

I was sleeping on a flight and I am woken by a flight attendant asking a man in the opposite row “are you sure you’re OK?”

He was hyperventilating and complaining of chest pain. When the flight attendants started to bring out medical equipment from a locker, a curiosity spark lit up. I never experienced a medical emergency on a flight since graduating. I assisted a passenger on a train before, but never in the air.

I introduced myself, informed them I was training to become a surgeon and tried to get a brief history. I had no idea where to start. I asked, with little confidence, if there was any emergency kit? The crew proceeded to show me vials of adrenaline, an airway kit, an oxygen cylinder and plasters. The patient had low sats, so I went through my A to E in my head – thinking of my recent CCrISP -, putting on oxygen as we moved onto C and D, asking the cabin crew to be my “scribe” for the findings. A whirl of surgical differentials started spinning in my head when examining the abdomen. Could this be a pneumothorax, would he need a chest drain? Is this a perforation needing urgent intervention. Is this an episode of pancreatitis triggered by one too many in the bar pre-flight?

Now that the safety of an A to E assessment was done, I was stuck where to go next. All I had in front of me was a hypoxic man complaining of pain, nothing else was found on primary survey. I was stuck in the sky, completely blind. There would be no senior review, I needed to step up and make a decision. The man was not unwell enough that I could discuss the possibility of an emergency landing, but not well enough for me to ignore his problems.

I ended up speaking to the pilots, who asked if I thought the patient was stable enough to last an hour until we got to our destination. Even this simple question felt mammoth. I felt a weight of responsibility to the man, but also to the holidaymakers, anxious that this unwell man could mean a premature landing in a country no one anticipate going to. I made a judgement that the man was stable on oxygen, and we could wait until we landed. When we did land, a flurry of people extracted him away. Complete relief, a weight lifted, he could be reviewed by someone with more resources. I was gifted a couple of mini bottles of prosecco by the cabin crew. More reassuring was that I saw the man on the return flight, who reassured me that he was well, and nothing was found.

On reflection, there is little difference from this scenario and being a surgeon on-call. You’re often blind, sometimes with only the luxury of observations to supplement your clinical reasoning. I was very relived nothing more serious happened in the sky. Was it worth the mini prosecco? 100%.