I was about to make the same point that QtheM just made–it’s obviously important to know what to do in an emergent medical situation, but it’s just about as important to take control and exude confidence. I taught my interns that the difference between a good code and a bad code was often made when the doctor walked into the room; if he walks in like he owns the place and talks like he’s taking control, then it goes well. As an intern, this often means showing far more confidence than you actually have, and that’s OK, as long as you don’t start believing your own hype.
A friend of mine had to help someone out on a plane (who appeared to be having a panic attack), and she got a nice gift basket from the airline. Someone else told me a story of how her transatlantic flight was diverted because a guy coded and died in first class despite the best efforts of two paramedics on board. After they unloaded him (and his wife) in Godforsaken, Canada, they rewarded the paramedics with the two newly-empty First Class seats.
I was the grateful recipient of in-flight medical care once, flying first class from Atlanta to L.A. Short version: Asked for hot fudge, flight attendant also put nuts on it, I thought they were peanuts, I swell up like a strawberry. The flight attendant first tried giving me Benadryl, but it only got worse, so they asked for a doctor. They broke out the first aid kit, but he broke the needle trying to get the epinephrine out of the bottle, so they had to get the other kit and ask for a nurse. Luckily, an ER nurse responded, and after epinephrine in my arm and steroids in my butt - I got to moon first class! - I was much better, and they told me to just see the doctor when I got to Hawaii. I was also strongly - and rightfully - scolded for not having an Epi-Pen, but in my defense I hadn’t had an attack in at least 5 years.
While I thanked the doctor and the nurse then, I’d like to thank all the doctors who respond to in-flight emergencies, risking annoyed passengers (and embarassed patients) to serve those in need.
Let me also say that one of the hardest things you can do as a doc is to make a call that creates a pain in the ass for a lot of people. It might be tying up an ER bed when there are no admission beds and you don’t feel right sending a marginal patient home, waking up a specialist in the middle of the night because you can’t be sure about something, or diverting a plane, it happens all the time. I guess it gets a little easier, but that’s not to say it gets easy.
If nothing else, you’ll have a great story for your next residency interview. (Are you doing IM?)
As for the OP? This is going to be slightly impolite, ok?
Fuck the passengers who dared to whine. Fuck the passengers who thought about bitching to you and held off. Ok?
As a retired EMT and first-responder the morning of Sept. 11th, 2001 in lower Manhattan I am here to tell you that you followed exactly the proper instincts, and it sounds as though you divided responsibilities appropriately with the EMT who dove in with you to help out. You assessed, kept an eye out for a more seriously emerging situation and informed the flight crew of her status.
You didn’t make 100+ people miss their flights. You are a medically trained person who assisted in the evaluation and early field treatment of someone who was ( likely ) enduring a neurological event. You did what you were supposed to do.
For those who bitched, we get to silently turn the tables. It’s your wife/husband/mom/dad/son/daughter/partner who is in trouble at 37,000 feet. You ring for help and they announce a need for a Dr or medically trained person on board.
And nobody answers up. You, my pissy friend, would be in a world of trouble if nobody answered up who had some training.
I congratulate you on handling it properly, and I hope the gal made out okay. As far as the anti-coagulants you debated, that’s a darned good idea IMHO. ( Qadgop? Help here? ) If it were me, and she was able to swallow, I’d pop 80 mg of aspirin into her and not think twice about it. I’d mark the time of dosing and dosage of course.
toonie, with acute stroke symptoms, I’m not sure I’d add aspirin without the benefit of a CT scan to know whether it’s a hemorrhagic stroke or not. If it is hemorrhagic, you run the risk of making the bleeding worse, and extending the stroke. Those platelets are permanently rendered less sticky by adding Aspirin, remember.
Granted, most strokes are thrombotic (2/3 vs 1/3, I think) and ASA might help there. Even so, the principle of Primum Non Nocere (first do no harm) would lead me to just want to stabilize and divert ASAP.
Now for a suspected MI, ASA would of course be right on.
Continental has my name and my address. Maybe I’ll get something (besides the whole can of Diet Coke during the eventual beverage service), but I won’t count on it.
The example of aspirin was just because I was scrounging around in my head to think of anything to give in the event of a stroke, and of course I held off because of hemorrhagic strokes. But I was trying to remember the literature…
Again, thanks for the words of encouragement and the constructive criticism. As a fourth year med student (who has less experience than most third years, due to a loooong hiatus), I know I didn’t handle the situation perfectly and I could not have been expected to. That’s the reason I posted (besides it making an interesting story).
DoctorJ – I am categorical versus PSTP short-track internal medicine right now. I have 2 interviews left, having done 9 already. All of the big-gun schools were done during early December, with U Chicago and Wash U coming up in January. So it will make a fun story, but the Northeast/Baltimore/California stretch is in the past.
The issue of confidence is a big deal with me now. As of now, I have little. Some programs stress autonomy (namely Hopkins, Southwestern, and Baylor of the ones I have looked on), and that is very tempting as responsibility is thrust upon me from very early on. Some programs, though, I feel lean way too much on the autonomy side – at Hopkins, from the third month on, junior and senior residents don’t take call with interns. Critical care fellows need intern co-signs on their orders in the ICU (stressing that it is the intern’s patient). On one hand, it is very tempting to know you will at least be marginally competent within three months of starting (especially if I short track). On the other, I don’t want to mess up and kill someone. The other programs, which seem to train equally fine physicians, seem to be more laid back or more academic (in reality, all interns everywhere work as close to 80 hours a week every week). This is not the model I’m used to (coming from Baylor), but it has a whole other set of temptations associated. This is what I’m deciding between when making up my rank list…
Let me just qualify one of my last statements, in the slim chance that someone from Hopkins with an influence on their rank list is reading here:
Hopkins, from an outside perspective, seems to be way over on one extreme of the autonomy scale. This doesn’t mean that a) I don’t like the program b) they don’t train fantastic physicians c) I don’t want to go there. It is just I’m a bit (rightly) afraid of that much responsibility that quickly. They must be doing something right, though, cause the interns (and the house staff, and the attendings, and apparently the patients) love the system and would never change it. It is not an issue about duty hours, it is an issue about having to start an IJ or subclavian line and intubate someone unsupervised in September of my intern year. It is still among my top, top choices.
The worst flight I’ve ever been on as the transpacific one where I had a migraine and the 96-year-old man behind me tried to die. A group of 30-or-so family members was traveling from Southern India to Eastern Canada - a several day journey. This fellow was the patriarch of the family. I got to hear all of this since I had a front row seat to all the conversations. This gentleman started a nasty rattle and whoop about 15 minutes after take-off. An RN from the front of the plane came to look in on him after a general call for medical personnel was made. The family had a conference and told the flight attendant that he was 96 and if he died, he’d had a nice long life. So, they put a blanket over his head, and someone checked on him every half hour or so to see if he was still alive. At least when he was rattling, I knew he was alive. He got really silent about an hour before landing - I think we all thought he had died. As we decended, he started making noise again, and was alive when they wheeled him off the plane in North America.
One thing to remember about Hopkins. The med students can be annoying as hell. Brilliant, but annoying. Some will try to out-intern the intern. But they can be good to have covering your back in a pinch.
At least that’s how I remember it, as a student there on the wards circa 81-83.
I also think their “learn by doing” approach is pretty good. Just make sure you have your scrub cuffs tucked into your socks, is all.
And I believe I have no pull whatsoever at the Hop these days. Sorry.
