There was an OpMed article on Doximity (https://www.doximity.com/newsfeed/1946e8dd-eddc-4eb4-aad6-46fe59c86da5/public) which reports that 69% of 58,000 physicians surveyed said they would provide emergency care. That number is depressingly low at first view but can be answered by asking how many of us are ATLS, ACLS, or BLS certified? A quick search fails to give a result, although various pro CPR groups have on their websites that all caregivers should be trained in BLS. The darker question is how often do fully trained and certified physicians choose to withhold care and hide their identities?
I can give you a quick answer. Most doctors will sit on their hands when the PA announces “is there a doctor on the plane?” hoping that someone else will raise their hand. Back when I was a second year surgical resident, I took a vacation with my wife to London and Paris. On the flight, over the Atlantic, the cabin crew asked for any medical assistance. Before I had a chance to contemplate the question my wife jumped up and pointed at me and shouted “He’s a Doctor!”
I was in shorts and hoodie, with a baseball cap. Back then in my late twenties, I looked about 15 years old. The British Airways stewardess looked at me dubiously, then looked around behind me to see if any other hands were raised. <sound of crickets>
She escorted me up the stairs to first class and in one of the giant chair-and-a-half recliners was a pale fellow in a nice suit, diaphoretic, dyspneic, and maybe a little drunk. He couldn’t speak well but was awake and maintaining his airway. His radial pulse was thready and weak. I pressed the button that fully reclined him into a bed, not a little jealous.
“Are you having chest pain?” <head shake>
“Do you have pain anywhere?” <head shake>
“Are you diabetic?” <¯\_(ツ)_/¯>
Cold, clammy, dehydrated, drunk -hypoglycemia was my diagnosis. I asked the stewardess if they had any tubing, a funnel, and orange juice -because that is how you deliver sugar to someone who can’t protect their airway. I was an enthusiastic PGY2 and the orange juice enema was one I was eager to roll out. She looked at me funny and handed me a large black leather suitcase -the kind you see sniper rifles disassembled and packed. In it was a pretty thorough crash cart with defibrillator, airways, Mac blades and handles, bag mask, IV’s, bags of saline, and boxed syringes of code meds including D50. Oxygen was available. It was British Airways first class after all.
I looked around and saw no great place to hang an IV, so I grabbed the D50, horse needle and all, and found his cephalic vein and injected the whole vial. The change was instantaneous -the eyes which were spinning beachballs, stopped wobbling and focused. All that was missing was that Apple Macintosh “bongggg” sound. I gave the fellow a gauze and instructed the stewardess to give him orange juice spiked with sugar.
“Shall we land?” asked the stewardess. The neighboring passengers, all dressed as if for a fancy cocktail party, looked at me with eyes that said, “We really need to get to London.”
“Where are we?” I asked.
“Over Reykjavik. The captain needs to know now.”
I look at my patient, and he had unreclined himself in his fancy leather loveseat, and shook his head. “Thanks. I’ve got to get to London for a meeting.” He was going to be fine. I recommended he see someone for his diabetes (which he confessed to neglecting), and I walked downstairs and back to my seat in steerage.
A older couple (I’m sure they were middle-aged like I am now) was next to us and the lady smiled, and the man leaned over and asked, “how did it go?”
“Hypoglycemia. Are you a doctor?” I says.
“Why yes, a cardiologist. We’re going to London for a conference!” he chirped. I think he caught that I was giving him an accusing look, and added, “you’re wife volunteered you so well, so enthusiastically, I figured you had it well in hand. Good job.”
I sat down and my wife immediately asked, “did you ask them to upgrade us?”
“No.” That is the advantage of a wife when she isn’t volunteering you for missions, she’s looking out for your interests. I was going to make some grand statement of my purpose in life, but was interrupted. The stewardess came up with a brown bag full of tiny bottles of liquors, spirits, and whiskeys, which made me very happy, but my wife just rolled her eyes.
“You would have been happy with a cookie,” she hissed. “Why didn’t you ask for an upgrade? What’s wrong with these people?” And I thought the same, for a different reason. Seated all around me were likely cardiologists headed to London for that conference. Just counting bald heads, there were at least twenty.
Now, nearly thirty years on, I don’t blame those fine folk for not being quick on the draw. I am sure one of them would have stood up eventually, but the last thing you want to do on vacation is work, and what I did upstairs in first class was not much different from the work I was doing every other night on call (this was 1995).
Now, in the middle of my career, there isn’t much that gets my blood running, so I empathize with the festive, sanguine attitudes of the many physicians probably on the plane with me, headed for a nice holiday and conference in London. Some happy fellow jumps up and takes care of the problem, so no need.
Also, I’m not shy in crowds or stressful situations. Everyone in first class was watching me get venipuncture with the D50 syringe and the horse needle which was easy because the fellow was so thin. At that point in my life, screaming HIV positive crack addicts fighting you while getting central lines and spinal taps were the norm. I suppose I couldn’t fault someone more bookish and scholarly for not standing up right away. I assume 69% would have.
I’ve been called about a half dozen other times on planes. It used to be my wife volunteering me, but over the years, even she has taken on a bit of a glazed attitude. The last one a few years ago was a poor fellow whose wedding ring was causing an ischemic finger, made worse by traumatic attempts at removing the ring. Soap and rubber bands fixed him. It barely elicited an eye roll from the spouse who did not volunteer me that time. It was one of those cheap airlines in the American Southwest and I got nary a thanks.
I have never contemplated the medical malpractice ramifications of rescuing someone, saving a life. I assume something like sea-law prevails up in the air, where the captain can marry folks and push them off gang planks, where decency, need, and common sense prevails over tort law. Unfortunately, I have never seen another black suitcase since that first time on British Airways, and the pre-9/11 days of carrying a pocket knife are long gone, making emergency surgeries and fashioning of MacGyvered medical devices impossible. The idea of embarking on supporting the life of someone when the last time you ran a code was in medical school may be too much to ask someone, and doing the wrong thing may be worse than doing the right thing badly.
Did you know you can fix a tension pneumothorax with a pen, a rubber band, and a condom, with the appropriate knife and fortitude, and maybe a tiny bottle of vodka.
But isn’t that why we went into medicine? To save a life is to save the world, the Talmud tells us, and we can be heroes, if just for one day.