Today, I was flying back from a residency interview at UCSD. I’m a 4th year medical student, and that’s what we do. Interview. Or so it seems.
The flight, a packed 737-900 (Continental says it holds 167), left at 11:40 AM on time. I get out my book and my iPod and am enjoying the sit down after a long security line and two days of interviews when the dreaded announcement is made:
“If there is a doctor on board, could he or she please see the flight crew in the rear galley.”
Yoink. It has happened once before to me, between Tokyo and Seattle, and it was a dehydrated guy who keeled over in the aisle as his blood was pooled in his legs after sitting for 4 hours and was fine after a little lie down and a glass of OJ. That time, there was an FP, 3 nurses, and several other medical professionals on board (including a midwife), so I, as a second year medical student, didn’t feel bad about going right back to my seat.
I know a little more now, but by no means can I handle an emergency. Giving drugs would be a disaster (medicolegally), even though I probably have an idea of what to give. But I obviously offer to help – I’m slightly better than nothing. So I take off the iPod and go to the back.
Well, this time, it is a veteran EMT and me, that’s it. 3 rows in front of me, a woman is feeling sick. The EMT starts evaluating her, I start getting a history from the husband. 49 years old, hypertensive on lisinopril, amlodipine, K-dur, and simvastatin. Last year had a stroke with some left sided weakness and numbness but has now resolved. Now feels nauseous and lethargic, husband says she has had 3 episodes similar to this since, the last of which (2 weeks ago, on a plane), resolved by itself in about 20 minutes. Other episodes resulted in ER visits for which she was treated and released. Husband is a poor historian (I don’t blame him in the circumstance) and thinks that the K-dur was started after one visit. She takes her meds, but it sounds like she is casual about the K-dur, and didn’t take it this morning. The flight attendants get out an oxygen bottle and contact ground Medlink.
She is pretty zonked. She’s kind of responsive, lethargic but oriented. I ask for a penlight and a tongue depressor and the attendants get the advanced first aid kit. I peek inside to see ACLS gear, an AED, epi and atropine, a laryngeal mask airway, bite guards, an ambu bag, and I hope it doesn’t come to that… EMT gets a reasonable BP and a pulse, which we follow every few minutes. Besides a little stint into tachycardia, it is pretty stable. Pulse regular, pupils equal round and reactive. Heart sounds are normal, she moving pretty good air and has no lung history. No belly pain at least that she winces or guards at. I’m worried about 1) another stroke 2) electrolyte abnormalities because she is having some arm fasciculations (low K from missing the K-dur or low Ca although there ain’t reason – she didn’t have Chvostek or Trosseau’s signs either, she wasn’t diabetic so I wasn’t so worred about glucose) 3) some kind of weird panic given the history of this on her last plane ride. The EMT, a really nice guy, gives her some sugar under the tongue and a few sips of orange juice. The flight attendants also cancel meal and beverage service.
Over the next half-hour, she perks up, but only a bit. We watch. I sit down next to her and start talking to her and continuing an exam. She is now able to answer questions and follow tasks, so I start a little neuro exam. Strength is 2/5 on the left and 5/5 on the right. She still has fasciculations with movement on the left. She complains of numbness and some burning leg pain on the left, nothing on the right. Sensation is grossly down on the left. DTRs are 2+ on the right and nothing on the left, as well as I can assess in an airline seat. Pretty much textbook, especially with a previous history of a stroke. What next year, as a bastard intern, I’m going to be calling “a diagnosis that even a medical student can make.”
Flight attendant comes over and asks what the status is. I tell her to tell the ground people that she is numb and weak on the left and has a previous history of CVA. 5 minutes later she tells me “We are diverting to El Paso.”
We begin a fairly hasty descent. I sit next to her and keep her talking, watching her mental status. I wonder about aspirin or anything else that I should be doing for suspected CVA or TIA, and I decide that it is best not to do anything as a fourth year medical student. 15 minutes later, we land at El Paso. The EMTs come on and the EMT and I check out to them and help them load her in an aisle chair. They wheel her off, husband in tow, and in a few minutes, we see the ambulance speed off.
Of course, then they have to unload the couple’s bags. They have to file FAA paperwork. And so forth. So we sit for another hour or so, and then get back up. An hour and a half later, we arrive in Houston. Not many happy voices on the plane that day, although I got only a few comments about it (sarcastic but a little too edgy-to-be-completely sarcastic “Well we can always blame that guy for missing our plane.”)Of course, I’m sure this was absolute hell for Continental, who have to reroute 100+ passengers. Elapsed time of trip, 5 and a half hours. Initial prediction, 2 hours and 41 minutes.
Luckily, I stay in Houston, so all I missed was dinner. My thoughts are with those who were temporarily stranded in the marvelous fantasy candyland that we call George H. W. Bush Houston Intercontinental Airport. I hope you get to your families and holidays expediently. And of course my thoughts and wishes for a speedy recovery are with Mrs. X and her husband, now probably in an El Paso hospital, who will have a much more miserable Christmas than any one else on that plane.
