On airborn emergencies...

So... My flight took an eventful and unexpected turn... And I'm going to put some things here for really one reason only. Please remember, it is far more important that you are safe and healthy than on time this holiday season.

I was flying trans-atlantic on a 767 with a major airline. I was sitting in coach (near the back) because long gone are the days that doctors can afford to fly 1st class (if you think I'm kidding, I will explain a thing). Prior to take off, a gentleman had (what seems like) a pre-syncopal episode. He was attended by a doctor sitting across the aisle, and seemed ok for flight. 30 minutes into the air, he got worse. The doctor who had attended him previously asked for another set of hands. That's when I stood up to help.

Aside: standing up on a flight to say that you can help is terrifying. I don't like to do it. It's scary. You have very little to no equipment (none of which you're particularly familiar with) or help. And, to put it bluntly, adults of any kind are not my specialty.

Now, that gentleman was ok... He probably (and his family probably) should have had the sense to not fly before we pushed back from the gate. But if the person says they're ok, a doctor cannot really force them off the flight. And, in defense of the first doctor (a chiropractor), I didn't see him at the first event. I may have made the same decision. Now... he was fairly easily managed. And I was comfortable not turning back to Dublin. I treated him, and returned to my seat with the thought that I'd check on him every hour (much to the dismay of my poor seat neighbor who really wanted to sleep - I am so sorry! I should have suggested you take the window...).

2.5 hours later... Things changed. Another passenger had what looked to be a seizure and collapse. Now, my college (God bless them) trained us well. I worked in adult medicine as part of my qualifications and intern. To make a call over the ocean with a manual sphig, a stethoscope, and your own clinical judgement is not easy or a happy matter. But I have to say, I know a clinical stroke when I see one. And that's when I had to make a decision, as the only qualified doctor, on a 767, over the atlantic, whether or not to divert the plane. And yes, I did.

The 2 hour delay plus repeat customs and passport control when we landed was a horrible inconvenience for both the passengers and the airline. For that, I am sorry. When they build isolation CT suites on all 767s with interventional capabilities, I will never have to do that again. For the passengers that missed connections, that had to reschedule events, that had to stay in NYC overnight, I am sorry. No one wants to start their holiday that way. It's crap. I've had it happen myself. And I particularly apologise to those of you with small children. They were so good! And you were so patient. To the flight attendants that took the flack for the delay before we touched ground, I am sorry. You too are front line staff. I know that pain. But you were all so calm and composed, and for that, I am eternally grateful. I was also grateful for the business class seat for the last 3 hours of the flight to NYC, not for the leg room particularly (I'm kinda short), but it gave me a quiet space to freak out in private. [Yes, freak out. As I mentioned before, I don't treat adults... I'm a paediatrician... I haven't had an adult patient in 4 years. But I did work in geriatrics for 3 months (I know that sounds short, but I have working experience in a number of small subspecialties) and my focus is emergency medicine.]

But let me be clear. I am not sorry for diverting the plane. That passenger needed hospital care on a time limited basis. I would do it again. And I would do it for another passenger if necessary. And I'm sure the airlines support this practice, because you cannot get repeat business if your passengers die (That's blunt and tasteless and they care about their passengers beyond revenue, but it's also kinda true). Furthermore, I have one thing to say to the "super important business man" who complained for the remainder of the flight and through customs and through passport control and through rebooking your flight and who suggested that "we" (I use the royal we to encompass all of the people looking out for the well being of the passenger) made the wrong decision--whatever it is that you do for your living... you are alive. And I doubt your career calls on you to perform outside of your expertise, in front of terrified and captive people, when you are supposed to be on holiday! (Yes... that's right... when's the last time you had a business emergency on a flight where they came over the PA and asked for a CEO volunteer?) If it had been you... If you were unconscious on the ground, seizing, vomiting... I would have diverted that plane for you... And you'd (hopefully) still be alive as well.
Now... I'm going to try to put this 25hrs of travel behind me... Sleep (since I am now essentially post-call)... And spend some quality time with my family.