Post 46 On flight medical emergency

It’s been an idyllic holiday. For the last fortnight, my wife and I have escaped the British winter and cruised around the Caribbean on a luxury liner. We’ve visited ten different islands; St Kitts, St Lucia, Dominica, and Martinique amongst them and, as sit here on an Airbus 330 on the flight home, the long journey eased by the glass of Sauvignon Blanc I have in my hand, it’s pleasant to reminisce about those green islands, blue skies, and warm seas. We’re both determined to return and savour it all again at some stage in the future.

Oops, hang on a minute! Here comes the air hostess again with a second glass of wine. I mustn’t miss that! ‘That’s lovely, thanks very much.’

Of course, everyone knows the food onboard cruise ships is superb and there’s so much of it!  I confess we tried to be disciplined and not eat too much, but we’ve both managed to put on a pound or two. Those five course evening meals were superb.

 On our table, there was a retired army general from Holland and his wife. I didn’t know that Holland was a member of NATO until he told us about his involvement in joint exercises with our military.  His wife was a quiet little mouse who was difficult to engage in conversation, but they both spoke beautiful English; well, the continentals always do, don’t they? 

The other couple came from Hereford, an accountant called Frank Purvis, and his wife, Mavis; both were pleasant enough, though Mavis was a bit intense and clingy. I thought she pried into our private life rather too much; my wife said she was just nosey! As it happens, they’re on the same flight as us now, sitting a few rows behind.

 When I’m on holiday, I don’t like folk to know I’m a doctor. I don’t have ‘Doctor’ recorded on my driving licence or passport, and I don’t go advertising the fact when in the company of strangers. If your medical background slips out, it seems the whole world and his dog feel entitled to a free opinion on their various illnesses.  Fortunately, I’m usually able to tell them that my knowledge of their various problems could be written on the back of a postcard; you see I’m a retired psychiatrist, and when they learn that, they usually shut up. There shouldn’t be a stigma about mental health, though unfortunately there still is, and people rarely admit to being sufferers.

 I’ve eaten my meal, it was only a small portion but quite tasty. I’ve had a coffee and finished that second glass of wine. The lights are low. I’ve a mask over my eyes, and I’m searching for sleep when I hear an announcement over the tannoy, muted by the plugs I’m wearing in my ears. ‘If there is a doctor on board, will they please make themselves known to a member of the cabin crew?’

 I groan and sink further into my seat. It’s the one thing I dread when travelling.

 There are nearly three hundred people on the plane; surely, I’m not the only doctor on board.  I’ll close my eyes, pretend to be asleep, waiting and hoping that someone else will answer the call.

Then I hear a voice behind me calling for the steward, and surreptitiously I look over my shoulder. Mrs Purvis, busybody that she is, is talking to the steward and pointing in my direction. Privately, I curse her.

The steward is speaking to me now. ‘I wonder if I can have a word with you. I understand that you’re a doctor. I’m afraid we have a passenger who requires urgent medical assistance. Perhaps you could follow me?’

 He doesn’t offer me any choice, I note, though I guess he’s right – I don’t really have any choice!

  He leads me towards the front of the plane, past the toilets, through the forward section, then on towards the front exit doors.  All eyes are upon me as I trail behind the steward. We go behind the screen to the area where the cabin crew prepare the meals. I am amazed how cramped it is.

 Lying on the floor is an elderly man. He is semiconscious.

 My heart sinks. I haven’t a clue where to begin.

 ‘Look,’ I say desperately, ‘I’m just not qualified to deal with this. I was a psychiatrist, but I’ve been retired for more than ten years.’

 ‘But it seems you’re the only doctor on board,’ the steward says, ‘and obviously that makes you better qualified than we are.’

 I remember that I no longer hold any indemnity against claims of medical negligence, but vaguely recall reading somewhere that Good Samaritan acts usually escape litigation.

 ‘We have a defibrillator on board,’ the steward continues,’ ‘I’ll go and get it.’

 I look again at the man on the floor. Clearly, I have no choice but to see what I can do, despite the fact that its 50 years since I last practised any physical medicine.

 Although semiconscious, he has a reasonable colour.  I kneel at his side and feel for his pulse. At least I know how to do that! To give myself some thinking time, I measure it over thirty seconds, but even then, I can’t think what to do next.

The steward returns with the defibrillator and takes it out of its case. I’ve never seen one before!  It strikes me the steward will have had some first-aid training;  if we have to use it, perhaps he will know how it works because I certainly don’t!

 ‘Hopefully we’re not going to need that,’ I say out loud, though mainly I suspect for my own reassurance.

 I feel the panic rising in my chest, and my mind becomes a blur. I’m conscious of the steward standing over me, expecting me to be competent and professional when I know that any boy scout with his first-aid badge would have a better idea of what to do.

 Now the man on the floor is attempting to speak, and I try to make out what he’s saying. One word is clear enough to understand........‘diabetic’.

 My God, I think; what the hell do I remember about diabetes. Finally, one constructive thought penetrates my befuddled mind. If he’s diabetic, he’ll be travelling with some tablets or insulin.

 ‘Is he travelling alone?’ I ask.

 ‘Yes, he is.’

 ‘Does he have a bag or any hand-luggage with him? Perhaps there will be something there that may help us.’

 He returns with the man’s case, and we rifle through it.  Sure enough, there’s a supply of insulin, and a collection of needles and syringes.

 So, he is indeed diabetic. But now I’m more concerned, and even more aware of my own inadequacies than before. Is his present condition due to his diabetes, or is diabetes just a red herring and he’s actually suffering from some unrelated problem, possible a heart attack?  And if this is a diabetic coma, is this due to a low blood sugar or a high one?

 I honestly haven’t a clue how to distinguish high from low, and if I assume it’s a high blood sugar, give him a shot of insulin and it turns out he’s got a low blood sugar, I shall probably kill him. And the steward is still standing over me, observing my every move, expecting me to know what to do. 

 A stewardess arrives and piles more pressure on me.

 ‘The captain urgently needs your assessment of the situation,’ she says. ‘We’re mid-Atlantic, and he has to decide whether to continue to London or divert to Tenerife.’ As if I haven’t already got enough on my plate!

 ‘Well, to tell you the truth,’  I start to admit, ‘I really don’t........’  and then the most marvellous thing happens.

The screen is pulled back and a tall good-looking man of about forty comes through.

‘I hear you have a bit of medical problem,’ he says, his voice oozing confidence. ‘I

would have come sooner, but I was asleep.’

‘Are you a doctor?’  I ask, praying that he is.

 ‘Yes,’ he says, ‘indeed I’m a consultant in Emergency Medicine,’ he adds and mentions one of the largest and most prestigious hospitals in London.

‘Thank God, I’m so relieved to meet you,’ I reply.  ‘I’m sure you’ll be somewhat better qualified to deal with this problem than this elderly retired psychiatrist.’

 Hugely relieved, I return to my seat.

 Mrs Purvis immediately rushes to speak with me. ‘What was the problem?  It must be so exciting for you; so wonderful that you’re able to help in an emergency like this. What a tale I shall have to tell my friends when I get home! Is the patient all right?’

 ‘Yes,’ I say, as cool as you like. ‘It was really no problem at all; everything’s now safely under control so, if you will excuse me, it’s time for me to get back to sleep.’

Thought for the day

Any man who goes to a psychiatrist should have his head examined.                                                                                                                                                                                                                                             Sam Goldwyn 1882 -  1974