Cabin Pressure: Lessons From A Lost, Scared Medical Student
Guest contributor Darin Williams, MD discusses how an extraordinary travel experience taught him an important lesson about what it means to be a doctor.
As a medical student I always found safety in turning to my resident when I didn’t know the answer, “He or she is a doctor. They’ll know what to do.” I couldn’t wait to be a resident so I would finally have all the answers myself. Here I am—a resident, a doctor, and I find myself just as lost at times as I was when I was a student. Last week, after a particularly busy day with some very sick, complicated patients, I remembered something that happened to me as a medical student and the lesson that that experience brought with it:
The Airbus A319 can hold 124 passengers at maximum capacity. Apparently 123 other people were as eager as I was to return home from Las Vegas. I was absolutely exhausted after a weekend with college friends. I plugged my ears with my soft pink earplugs—the same earplugs I had used 4 days earlier to drown the sound of a sneezing classmate during an endocrine test, and before the plane took off I was sound asleep in the back..
I’m not sure how long I was asleep– long enough for my contacts to dry out—before I got a nudge on my left shoulder, “Hey, I think they just called you,” my friend pointed up. I sat puzzled. I thought maybe I had won a contest in which I was an unaware participant.
The speaker dinged, “Is there a doctor on the plane?”
“Not one back here,” I thought to myself. I wondered who would get up. I wondered about the man or woman I would envy and admire, my typical thoughts when seeing doctors spring into action. I wondered why no one got up.
“Please, is there a doctor on the plane? Please come to the front,” the ominous bell sent a chill through my body. Maybe this was something I could assist with. Maybe the pilots were having a debate about the mode of inheritance of Fragile X syndrome—I could certainly help them with that. I knew that wasn’t the case, but could a second year medical student possibly do more good than harm? I was about to find out.
I was certain to let the flight attendants know that I was JUST a medical student, but I would see what I could do. I assumed I was going to see a patient with dyspnea and chest pain, maybe “a pulmonary embolism after a long plane ride.” I have seen so many of those in textbooks that this HAD to be what it was. When I got to the front of the plane I saw a young woman who had a surgical mask draped over one ear. She was awake, moaning, and vomiting into a bag. I tried to elicit a history without getting much information between heaves. She was in a great deal of discomfort, was freezing and had cyanotic fingers. I felt for peripheral pulses and couldn’t get anything. I got a carotid pulse and she was slightly tachycardic.
I laid the young woman down, covered her with blankets, and got an oxygen tank to help her breathe between heaves. I began going through the motions. She’s breathing. That’s good. We tried to take a blood pressure. I don’t know if it was the nerves, the less than sub-par stethoscope or the fact that the cabin sits around 86db, but I thought I got a systole of 110, no diastole. I began writing all the vitals down. At least this way I could monitor her progress.
She began talking. She suffered from Atypical Hemolytic Uremic Syndrome, and she had a kidney transplant two years ago. She was on Prograf and Prednisone. I remembered HUS from renal. Buzz words began popping into my head, “HUS…E. Coli…Low platelets…did she say atypical?” I was lost, and I was scared. I wished I were a real doctor.
The flight attendant was now relaying messages between me, the pilot, and the ground crew.
“The pilot wants to know if we should land,” the flight attendant eagerly looked at me as she held the phone to her chest. This was the single scariest moment of my life. Behind me 121 people, zero doctors, sat fixated on me as I knelt beside this woman on the floor of the plane.
“I can’t make that call,” I quivered, hoping that the roar of the two V2500 turbofan engines drowned out the sound of fear in my voice, “but her vitals are remaining stable, her fingers are no longer blue, and she says she feels a little better.” We decided to stay in the air for the final 30 minutes of our flight.
Keeping an eye on her vitals we held her hair back and put a hand on her shoulder as she vomited in between sips of water. I think that was the best thing we could have done for her: letting her know she wasn’t alone.
The flight ended and we rushed her off in a wheelchair while briefing the paramedics. She was taken to the hospital. I sat down for a minute to breathe. The pilot came up to me and thanked me and gave me a flight voucher for future travel. Thanked me for what? I was a human heart monitor who was quite possibly more scared than the sick woman alone on an airplane.
Now I am a real doctor, and I find myself at times not feeling much different than a scared 2nd year medical student alone on a plane. I know that I have more experience, more knowledge now than I did– I’m not doubting that. With that knowledge and experience comes a increased responsibility, and increased desire to have the right answers. Luckily in residency there are plenty of people there to help me who do have the right answers, and they’re never too far away. When I need to rely on other residents or attendings for guidance I can remember the lesson I learned on the plane that day:
Although I may not have all of the answers, and I may feel lost and scared at times, being a presence, a shoulder to lean on, is sometimes the best thing you can do for your patients.
Darin Williams, MD is an Emergency Medicine resident working in his hometown of Atlanta, GA.