"If there is a doctor on board, would you please contact the cabin staff". I owned up and found myself taking the pulse of a large American lady called Valerie. She was sweaty and dizzy four hours into a cross pacific flight. The other volunteer was a retired psychiatrist from Melbourne who was a great moral support.
There had been no chest pain or shortness of breath. My aero-patient was on lipid lowering agents (Zocor) but had no cardiac history. There were no recent operations and she had no symptoms related to the gastrointestinal tract. She was a non-smoker. Although normally a teetotaller, Valerie did have a glass of Australian wine with a meal an hour earlier.
She was pale as a ghost. It was impossible to hear the heart or the brachial artery in the air, despite the Qantas aircraft being equipped with an excellent medical kit including stethoscope and sphygmomanometer. The constant drone of the engines is all that could be heard. In her propped up position, Valerie's blood pressure was under 100 systolic and the pulse 110 per minute and quite thready. She was in a lather of perspiration to the point that it was dripping off her. She was conscious but drowsy when I got to her.
After some generous fellow travellers gave up their seats, she was able to lie down for a while. With the addition of some piped oxygen, the blood pressure rose to 150 systolic with a stronger and more regular pulse at around 70.
On closer questioning, the poor woman had taken a motion sickness tablet before leaving Ohio that morning and, feeling quite queasy on reaching Los Angeles, took another before the long flight to Australia. Perhaps this led to the drop in blood pressure and her 'attempted faint'. With the lack of room in economy class it is physically impossible to faint, so the poor soul was drifting in and out of consciousness until we arranged some oxygen and the opportunity to lie horizontal (if only we had been in first class!).
I was summoned to the flight deck. Did we need to put down in Hawaii or could we proceed straight to Oz without danger to the lady's condition? The crew related some cases where airlines had been sued for not taking the appropriate action. My credentials were sought. Working in casualty for ten years sounds like a cruel and unusual punishment ... but it impressed our captain. There were no signs of cardiac instability and a general check-up could wait until morning.
Even if a traveller does have a myocardial infarct, there are all the necessities of a mini-intensive care ward on board Qantas. Intravenous drips, anti-arrhythmic drugs and even a portable defibrillator with ECG monitor. I was told that Qantas plans to introduce a cardiograph transmission service so that a cardiologist on the ground could be asked for an urgent opinion within minutes.
With a lot of time to kill (like 14 hours), the pilot engaged in some chit chat. I was engrossed in the cloud formations over the Pacific Ocean. We had to skirt around several massive mushrooms during the 40 minutes I was there. All the time, he was engrossed in telling me all about how doctors mostly know nothing about alcoholics and addiction. I was therefore not alone in my ignorance. 'The 12 step programs were confused with the 12 traditions of Alcoholics Anonymous which most doctors also misunderstood', I was told.
The pilot and his wife had been in the US for three weeks during which they visited the grave of 'Doctor Bob', co-founder of Alcoholics Anonymous. I was told further that there was no need to be Christian or even god-fearing. Moslems, Jews and even Atheists can partake fully in 'the fellowship'. I was getting very uneasy by this stage, but disengaging without offending could be difficult. I decided to invoke my patient's condition and excused myself, having already pronounced we should fly on direct to Australia.
I was thanked for my assistance and offered my choice of the duty free cart. I took a French neck tie and returned to my economy seat way below. The patient was fine. She had resumed her seat and the fluids, oxygen and passage of time had worked wonders.
The head steward explained that to touch down in Honolulu would have cost $90,000 in fuel alone, not to mention the delays, landing fees, missed connections etcetera. 'The designer neck tie is a little nothing in comparison', he said.
There was a cute sequel to my story. Next morning, I went into my favourite haunt in Victoria Street, near St Vincent's Hospital for a real coffee, a species hard to find in America. The waitress welcomed me back and offered a strong brew for my jet lag. While waiting, a large woman with an American accent walked in ... and ... yes, it was my patient, Valerie! She was speechless at first, but walked up to the waitress and told her that I was the 'most wonderful man in the whole wide world'. It was not a complete coincidence as I had advised her to attend St Vincent's Hospital for a check up on arrival. It made Oz seem like a 'small town' place indeed ... but it was nice to get some reliable follow up without doing exhaustive research!
