Two Codes

by carlocmd

six and a half hours into a ten hour plane ride, the stewardess came over the public address system, “is there a doctor on the plane?”

we were a big group, so several of our friends came over to where we sat, telling us of a commotion in first class. “it might be a stroke,” one said. and with those five words, the sleep evaporated from my mind, and we went to work.

there was a 72 year-old lady in the aisle. they had to remove the restroom door to get her. while another passenger, an emergency room nurse, asked for and placed the AED device, i did a quick medical review with her husband.

just hypertensive, he says. she took her medicines today. she visited her cardiologist a few days before the flight and there were no medical issues. i think she may have an irregular heart beat, he continued. we were on our way to visit our son, a nurse, he said.

no pulse, no breathing, the ER nurse said, and a flat line on the AED.

then we better start CPR, i said.

there were no curtains. according to FAA rules, there should be no place to hide on a plane. so the first class passengers witnessed everything.

in that small cramped space, we took turns ambubagging and doing chest compressions. we struggled with the IV line as we had to describe each medical equipment we needed to the stewardesses. unlike a code run in our hospital where you take for granted the quick, calculating, and efficient movement of the medical team (yes, my dear residents, your consultants are proud of you).

after a turn at chest compressions, i went to the husband to describe the deteriorating and desperate situation. after a few minutes without oxygen, the brain starves. we were not getting a heartbeat, she had not responded to three doses of epinephrine (there was no 4th vial on the plane), and her pupils were fixed and dilated. these were all signs of a very poor outcome.

do everything, he said. so we prayed and continued. i prayed that our hands, our minds, and our hearts be guided according to His will. we later learned that they were Methodists. but in the busy details of a running a code, this little information did not seem to matter much.

a few minutes later, we gently told the husband that our interventions had become futile.

this is the end, he said, she’s really dead. there was a silence in that space, miles above the ocean.

quietly, we removed our devices, cleaned up the mess, washed her hair and clothes of the vomitus she brought up during resuscitation. we placed her in a first class seat. we reminded the stewardesses that it might be a good idea for the husband to get in touch with their son to make the necessary preparations.

apparently, we cannot pronounce a death on a plane in flight. the authorities would consider the plane a crime scene with the other passengers as witnesses. no one would be allowed off the plane. after landing, over the PA, they announced that they had an unconscious patient, and if everyone would please wait a moment for the medics to come aboard and check her out.

we passed by the husband on a wheel chair outside. he was in obvious shock. we spoke with the medical team on the ground, making sure they care for the husband as well. then we went our separate ways.

this incident stayed with us over the next two days. what if this happened to a family member? did we do enough? what happened afterwards?

on our plane ride back home, by coincidence, we again saw the husband on the flight. he was now with his son, and they were bringing her back home. they were ok, he said, and thank you. they spoke of the things that happened after the flight, which gave closure to the story in our minds.

they spoke of how small the world was, of mutual acquaintances, and of the kindness of strangers. the other doctor who helped was a distant relation, he said. we are thankful for the care you have given my wife during this time, he said. there were tears in our eyes as he took my hands in his.

with his thanks, the troubles that invaded our hearts lifted. we were finally able to find our peace, our joy.

they spoke of a stranger who accompanied them throughout their ordeal after the flight, facilitating the paperwork needed, and getting things done. this was a person they knew nothing about, who responded to a plea from a call back home, and who did extraordinary things while allowing the family to grieve.

they spoke of finally going home.

three hours into the flight, the stewardess again asked, “is there a doctor on the plane?”

i sighed again and went to work.

it was a 50 year old lady, hypertensive, who drank a few glasses of red wine. she stood up to go to the restroom, got dizzy, and fell to the floor. her blood pressure was 60 palpatory. it was probably a vasovagal reaction to the alcohol. when we lifted her legs, her mind cleared. she didn’t make it to the restroom.

went back to my seat, wanting very much to go home.

p.s. the same stewardess who assisted during the first code was also on the flight home. with a wink and a smile, she gave two video monitors to enjoy during rest the flight.