The Patient Was…

The patient was a 70-something-year-old male who developed severe chest pain, shortness of breath, and nausea on an intercontinental flight from Paris to New York. The flight was completely filled, but I was the only person who responded to the crews’ call for medical assistance.

The patient was in obvious distress as I approached his seat. His wife, seated next to him, quickly supplied a brief medical history that included known heart disease and diabetes, both under medical treatment. He had taken his usual medications before the flight, but she did not know the names or dosages of the drugs.

There was no place in the aircraft to move him for better access to examination or treatment, but we could extend his legs slightly into the small space in front of his bulkhead seat, and allow him to lean back slightly by reclining the seatback.

He was wearing a heavy woolen suit, including a vest. He also had on a felt fedora-type hat, and under his shirt he had on tzitzit, a pullover garment worn by orthodox Jewish men. He did not want his body to be exposed to other people around him, which made any type of examination difficult. His wife tried to convince him to let me try to help him, but he remained resistant.

I was certain that he was suffering from cardiac ischemia, a lack of sufficient oxygen-carrying blood to supply his heart muscle. The overwhelming most common cause of cardiac ischemia is blockage of one or more coronary arteries, the blood vessels carrying oxygenated blood to the pumping heart. The ultimate outcome of ischemia can be an actual heart attack, death of heart muscle.

The medical equipment on the airplane was rudimentary, at best, and with an essentially uncooperative patient, it was futile to try to do much. I told the flight attendants that the patient was in serious condition, and that the flight should be diverted, if possible, to the nearest location where a jumbo jet could land and the patient could receive appropriate care.

The purser took me to the flight deck to speak to the captain, who looked surprisingly youthful, even younger than the first officer (co-pilot). To my surprise, there was a third person in the cockpit who said he was a navigator. The crew was French, the flight being on a French carrier, but they spoke to me in accented English. I explained about the patient, and the captain immediately said he did not want to divert the flight.

I know that flight diversion is not a simple business. There are many considerations, including economic, geopolitical, social, and environmental ones. But a medical emergency is clearly a legitimate reason to divert, and the situation aboard this flight qualified, in my view, without question.

I protested when the captain indicated that he did not want to divert. He offered to put me in contact with medical personnel on the ground who could “advise me” on how to proceed with the patient. I explained that the medical situation was clear, that “advice” from someone who did not see the patient or know his status would not be helpful, and that there was a significant risk of the patient dying.

The captain then said he would go and see the patient himself. I didn’t understand what that would accomplish, but said nothing. We went to see the patient, who looked as he had before. The captain stood there silently for a moment, then turned to go back to the flight deck, me following.

Once back in the cockpit, the pilot reiterated his reluctance to divert the flight. There is no suitable place, he said. Now, I had flown this route before, and had even been on a flight that was diverted to the large US Air Force base in Goose Bay, Labrador. And I knew that we were now in the air between Greenland and Labrador.

I said I knew that Goose Bay was not too far, and they could accommodate a jumbo jet. This prompted some joking from the navigator about “goose” and “foie gras,” which infuriated me but I didn’t react. The captain said there were only three places he could land in the United States: Montreal, Boston and New York, and that he intended to fly to our original destination

 I decided not to point out that Montreal was not in the United States, that Goose Bay was still a viable alternative, that the airport at Bangor, Maine could accommodate a large jet, and that Bangor had a first-rate medical center where the Chief of Cardiology was a former colleague of mine.

As the flight continued, the patient’s condition fortunately stabilized without significant intervention. We landed in New York and were met by an ambulance and an advanced medical team.

The experience was bittersweet for me. The interactions on the flight deck were exasperating. But the patient survived the trip, which was obviously the best outcome. And the icing on the cake, so to speak, was the magnum of champagne that the purser presented to me as I deplaned. Viva la France!