Friday, March 27, 2009

Yankees, Towels, and Surgeons on Planes

There is nothing harder than returning to work after a nice vacation. Somehow, I've managed to function adequately for the past couple of days since leaving the warm beaches of Costa Rica.

The last day at Paradisus was at once the worst and the best. We went to a little place called "Monkey Park" in the morning, hoping to feed some more Capuchins. Sadly, the descriptions were a little off, and "Monkey Park" turned out to be a sort of small zoo, with a few animals in cages. Still, this is a place of animal rescue, where some of the baby critters abandoned in the wild are saved and rehabilitated, so our visit did support a good cause.

Back at the hotel, we had the joyous experience of trying to find a lounge-chair by the pool. It seems there is a Yankee trick of going to the pool at 7AM, and placing your beach-towel on a chair. Magically, the spot becomes YOURS for the rest of the day, even if your gluteus maximus never graces the chair and the towel again. Heaven forbid someone should even move it slightly (we did and the Yankees came running, bellowing about THEIR chairs!) People, this is disgusting, piggish behaviour, and it is no wonder Americans aren't well-liked. Don't blame Bush for our bad reputation!

Fortunately, this chair-fight prompted a move to a quieter section by pool (the Paradisus pool is supposedly the largest in Central America), where we met a wonderful family from Iraq, now living in Canada. The mom was a physician, the dad a computer specialist. They told us some nasty tales of Saddam's Iraq, stuff you won't hear on the news. Did you know that last names were banned? Saddam's new world order required that one take the first name of his father and grandfather as his "last name", dumping traditional family names. Had you heard that Uday and Qusay Hussein made a regular practice of going to clubs to select the women they would rape that day? A few lucky women were able to escape out of the back doors. And there was more that we never hear from the mainstream media. As for Canadian health-care, well. . . Our new friends were absolutely incredulous that we in the States wanted to copy their system. "It doesn't work!" The wait for an MRI is over 6 months, unless you have a spare $900C and can get to a big city such as Montreal, where there are a (very) few private outlets. There were numerous other examples. This isn't the way to go, but no one will believe it until it's too late.

Flying home the next day turned out to be a bit more of an adventure than I had anticipated. I had already seen the movie, so I was watching something old on my iPhone, blissfully oblivious to my sourroundings. About 45 minutes into the flight, there came the call we physicians, especially radiologists, all dread: "Is there a doctor, nurse, or P.A. on board? We have a medical emergency. . ." Hoping for the best, I pressed the call button to identify myself, and I was taken to the back of the aircraft. (Mrs. Dalai had to help me get untangled from my headphones.) Fortunately, another physician, a family practitioner, was right behind me, so I wasn't totally on my own. We found one of the flight-attendants writhing in pain in the aft-most row, and we began working with what we had available.

The in-flight medical kits are well-stocked for heart-attack victims, with drugs and devices up to and including an automatic defibrilator. There were drugs for colds, too, but there was nothing in there for nausea or pain. I guess keeping morphine in the kits would attract the wrong kind of patient. Anyway, the FP and I could do little but take vitals, listen for bowel sounds, provide moral support, and just stand around looking stupid, and wishing we had a CT scanner available. (Even a pocket ultrasound would have been nice.) The crew gave us the option to divert the plane to Miami if we thought getting the patient to the hospital an hour sooner would make a difference. But since she had a soft abdomen and no fever (although we could detect no bowel sounds over the noise of the engines) we concluded her malady was probably not life-threatening. All the while, the crew had been in touch with a ground-based physician (or nurse or P.A.?) contracted by the airline to deal with this sort of thing when no docs come forward. The service independently came to the same conclusion, which probably made the folks in Flight Operations breath a sigh of relief.

Now, here's the punch-line. After we, the radiologist and the FP, had been ministering to the poor girl for an hour, a well-dressed fellow sauntered back from First-Class, identified himself as a surgeon, and had a quick look. He got the history that she had had some sort of viral enteritis a year ago, and he was convinced that she had it again. He then told the other flight-attendants that the FP and I had it under control, and went back up to First. The FP and I looked at each other and said pretty much simultaneously, "Surgeons!"

We made it to Atlanta with no other mishaps, and the victim was able to walk off the plane to the ambulance. I don't yet know how she is doing, but hopefully she will be back on duty very soon.

In 46 years of flying (I took my first plane-ride at age 4), this is only the second time I have heard (and heeded) the call. Maybe riding up there closer to Heaven helps out some. An on-board CT would have been nice, though. Maybe if lighter-than-air travel ever comes back in vogue, that might be possible. This being a PACS blog, it occurs to me that a small ultrasound unit could be included in the spartan medical kit. Even if there is no one on board who can interpret the images, they could easily be transmitted ground-side to someone who knows what they are doing. We have night-hawks, why not Sky-Hawks? I think I'll look into it.


Anonymous said...

Great work Dr. Dalai. Way to come to the rescue!

In my limited years practicing medicine I too have been called to duty on a flight. I think the radiology training in contrast reactions does help as I had to deal with a very anxious lady who had a vasovagal reaction on the plane. I too got that cringe in my stomach when the flight attendant made the call overhead for a doctor.

Anonymous said...

PACS Monkey?