by Lizbeth M. Dalaza, D.O.Volume 58, Number 7
At 10:30 a.m., I boarded American Airlines Flight 1442, a connecting flight from Chicago to Tampa, Florida. Everything was routine. I sat down and got comfortable in 19A, stuffing my huge laptop bag under the seat. Then a fourth-year, I had finished an emergency medicine rotation at a level 1 trauma center in Michigan the day before and was now ready for my usual three-hour airplane nap.
Two hours into my slumber, the flight attendant declared a medical emergency and asked for the help of a doctor, nurse or EMS personnel. I stood up and quickly realized that I was it. No one else on board was even remotely associated with medicine.
In Michigan, I’d seen knife and gunshot wounds and attempted suicides, not to mention car accident victims and heart attacks—even a guy who had swallowed part of a coat hanger. Here, I was scared, and I had no attending to back me up.
I rushed back six rows not knowing what to expect but hoping to God I could help. I found a woman, about 70 years old, slumped over toward the window, cold and clammy to the touch and obviously lethargic. The woman next to her said she “passed out.”
Airway. Breathing. Circulation. I could hear her breathing. No use of accessory muscles. No nasal flaring, but deep inspirations. Not cyanotic, but pale—very pale. She could speak a little but complained of weakness in her arms. She was in and out of consciousness, sometimes answering questions, sometimes not. She de-nied chest pain, shortness of breath, and only complained of being “weak.” Despite that, I put a mask on her and connected it to the oxygen tank. I had no idea what her pulse oximetry was. She felt better after the oxy-gen but remained nauseous and grew increasingly weaker.
Immediately, I thought of transient ischemic attack or a full-on stroke. She could be stroking out—period. Her syncopal episode could be due to cardiac arrhythmia or bradycardia. With only a history of restless leg syndrome reported by the patient, this could be due to anything. Electrolyte imbalance, hypoglycemia, brain tumor. The list of possibilities went on.
If she were in the ER, she would get basic labs, EKG, CT of the head, cardiac enzymes, the works. “Do you need aspirin?” the flight attendant asked me.
“We need to land!” I replied. “Please tell the pilot, now.”
Flight 1442 spent another 15 minutes in the air before making an emergency landing in Atlanta’s Hartsfield-Jackson International Airport. During the entire time, I was talking to this lady and holding her right wrist, monitoring her pulse. If she was talking, she was alive. Her pulse was weak and thready, but she was breathing. EMS filed aboard, took her out of the plane on a stretcher and into the ambulance as I told them the story. Thirty minutes later, the plane was airborne again, headed toward Tampa minus my 70-ish-year-old patient.
I never expected this. Who does? Emergency medical landings are what I had seen on CNN, definitely not on any of my plane flights. The flight attendants took my name, address and phone number.
It was the grand finale—maybe the final test—one day after ending my emergency medicine rotation.
Dr. Lizbeth Marie Dalaza recently graduated from the University of New England College of Osteopathic Medicine. The flight number has been changed for privacy purposes.