I was asleep, the plane dark as we flew over the Atlantic on our way from Johannesburg to São Paulo, when a familiar page came over the intercom: "Ladies and gentlemen, sorry to wake you. If there is a doctor on board, please hit your call button."
This wasn't the only time my sleep had been disturbed for a sick passenger. The first time was on a flight from Chennai to Frankfurt. I was still a medical resident and, as I slid out of my seat to help, I realized that I had no idea what medications, equipment, or assistance, if any, I would find. While relieved that it was nothing serious -- just a passenger who didn't feel well after mixing sedatives and alcohol -- I couldn't believe that no one else volunteered to help.
This time I was escorted to see a middle-aged obese Brazilian man. He was sweaty and dizzy, his shirt unbuttoned, his hands trembling. Another passenger helped translate. She told me that he was diabetic and had taken his medications that day. I checked his blood sugar with his glucometer and saw that it was normal. Then I checked his blood pressure -- no small challenge to do over the hum of the engines -- and was alarmed to find it very low. I nervously rechecked it, but it was again low, perhaps due to heart failure in the setting of a heart attack, or maybe a severe infection, or possibly internal bleeding. I went through the medical kit that the flight attendant had brought, gave him an aspirin and pulled out the IV kit. He needed fluids to support his blood pressure until we could land. Repeatedly I tried to place an IV in each arm and hand, growing more and more frustrated, but I simply couldn't locate a vein. At the hospital where I worked, I would have turned to a nurse for help -- any doctor will tell you that nurses are better at placing IVs -- but here I was alone. A flight attendant brought me hot towels to wrap around his arms to bring out his veins, but to no avail.