Crisis in the Air

George Dunea, MD

Even the most experienced doctor might admit, if pressed, to at least a twinge of anxiety, or even a slight feeling of helplessness, when called to minister to a patient with preciously little else but his hands to rely on. Even up in an airplane, where many calls for doctors take place nowadays, the availability of a tank of oxygen, a defibrillator, and a few irrelevant drugs would hardly serve to assuage his feelings.

And so it came about, sometime in the sixth month of the era of yellow and orange alerts, that a call for help came over the loudspeaker system. We were at 35,000 feet, and I had just settled to watch the exploits of a policeman who never fails to solve a case, difficult as this may appear to us ordinary muggles.

What the outcome of that particular investigation was I shall never know. I stood up, squeezed myself past the corpulent lady in the aisle seat who was avidly ingesting her frugal meal, and began to wend my way towards the front of the cabin. I was met there with evident relief, but also detected a glimmer of hesitation in the eyes of the stewardess. For in these anxious days the pilot’s cabin is his fortified castle, not to be entered in vain. Yet in no time and with no further ado I was ushered into the inner sanctum of this Airbus 320.

There I found blood everywhere: blood on the floor, blood stained napkins strewn all over the cabin, even drops of blood on those impressive dials and levers that I had no time to admire. For there was the captain, scrunched up in his seat, blood streaming out of his nose, he leaning forward and spitting mouthfuls of blood into a paper bag, the stewardesses meanwhile rushing about and bringing more napkins.

I felt reassured, thinking this would be easy to treat with firm pressure, as long as one resists the temptation to constantly look if the bleeding has stopped. I used napkins, then my bare thumbs, compressing both nostrils for twenty minutes at a time. Soon my hands were dripping blood, and he reassuringly volunteered that he had recently been tested for AIDS. All this time the Airbus continued its journey through the skies, seemingly automatically, but under the watchful eye of the co-pilot.

After about an hour there were still no signs of the bleeding stopping, and I could not even see where it was coming from. It was now decided to seek advice from the ground, and the co-pilot made contact with a doctor, who however had nothing to suggest. So the captain, still spitting and spluttering blood, decided to divert the plane, though sadly wondering “what is going to happen to all these poor people”. They again made contact with controls on the ground, and preparations were made for an emergency landing.

I was only half strapped into the accessory jump chair because one of the buckles would not engage, and they were both too busy to help. The co-pilot did most of the maneuvering, with the pilot giving instructions and occasionally pulling down a lever while I was desperately holding on to his nose, trying to keep my fingers out of his field of vision. “Can you see, can you see?” I asked several time, as I seemed to obstruct his view. But the computers did most of the seeing, and soon the lights of a big city appeared on the black horizon.

Seen from the cockpit the view was spectacular, unforgettable, panoramic. In front of the cabin a huge sickle shaped moon, from side to side brilliant city lights flickering in a huge semicircle. Then the airport lights came into view, and we landed on an illuminated runway. As the airplane came to a halt the bleeding also stopped.
Now a woman paramedic boarded the plane and aggressively took over. She applied a cuff to the captain’s arm and took the blood pressure, then began to question him. “Do you take any medicines”, she asked. “Only one aspirin a day”, he replied.

She then walked him to the gangway just outside the plane, sat him on the floor, produced a massive syringe out of her bag, and instilled epinephrine up each nostril. Then she clamped a tusk like clip on his nose and began to write her report. The captain, now bearing a remote resemblance to a rhinoceros, sat on the floor for some five minutes, then got up, straightened up his jacket, and returned to the cockpit.

Meanwhile someone had shoved a $100 gift certificate in my back pocket. Then the stewardess gave me two bottles of Sprite to rinse my bloody hands, the water having been turned on during the landing. Soon we took off again, and as I returned to my seat I was met by the curious eyes of the passengers, who had been largely unawares of the drama that had just taken place.

Back in my seat the movie was over. A happy ending, no doubt. Yet I felt defeated, wishing I could have stopped the bleeding by applying a packing or inserting a catheter, as is done in emergency rooms. On further analysis, I questioned the wisdom or safety of injecting epinephrine, especially as the bleeding had already stopped. I also wondered about the cost benefit ratio of pilots taking aspirin for primary prevention, especially considering that in this instance an aspirin a day nearly kept this Airbus away!

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George Dunea MD, FACP, FRCP, FASN is the President and CEO of the Hektoen Institute of Medicine.   He is also a Professor of Medicine at University of Illinois at Chicago and the Medical Director of Chicago Dialysis Center and
Founding Chairman Emeritus, Division of Nephrology, Stroger Hospital of Cook County.