Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Thursday, August 31, 2006
    "Are There Any Medical Personnel on Board?"

    ... is a question you never really want to hear on a plane. But like a good internist I hit the call button and identified myself to the flight attendant. She walked me to the back of the plane, where I was confronted by an eleven-year-old boy in the throes of a grand mal seizure.

    Here's a dirty little secret. Seizures aren't that scary. Spectacular, yes, but not scary... if you've seen them before. Basically you protect the person's head and airway as best you can and wait for the seizure to end. By the time I got back there, there was an EMT (paramedic) who was restraining the boy and lifting him onto the row of seats. I busied myself trying to get a history from the parents, who were understandably very upset. Briefly, there was nothing wrong with him.
    • Personal or family history of seizure? No.
    • Fever, stiff neck, rash? No.
    • Head trauma? No.
    • Diabetes, medications, allergies? No. None.
    • What did you do yesterday? "We went touring," they said. (This was a Los Angeles-to-Toronto flight.) "We saw some friends, had lunch."
    • Were the friends sick? No.
    By this time the seizure activity had stopped but the child was still not really responsive (they call this state "post-ictal" and it's normal after a seizure). Someone handed me a bottle of oxygen and a mask, which I passed to the EMT, and then the airplane medical kit, then asked me my favorite question of the entire experience: "Do you need the defibrillator?" NO. God, no. The flight staff called a doctor who worked for the airline, who reviewed things with me and the EMT. He suggested that we start an IV line in case the child seized again, so that we could give him Valium. This question did not occur to me at the time, but I have no idea how much Valium you would give an eleven-year-old kid. Fortunately, it did not come to that as he remained stable. I discussed things with the EMT, who had basically taken charge, and we decided not to start the IV unless he seized again. This was fine with me. I haven't started an IV in years, and the prospect of trying to do so on a plane at 30,000 feet was not one which made me feel confident.

    The flight proceeded to Toronto without further incident. As soon as we landed, the boy and his parents were taken off straight to an ambulance.

    I've never before been a passenger on a plane where there was a medical emergency, although I used to work in a medical clinic at San Francisco International Airport and was frequently called out to arriving planes where there'd been an emergency on board. It's a bit different when you're actually on the plane.

    I'm writing this from a public library in Stratford, Ontario, so will have to sign off as my time is about to run out. More later.

    Saturday, August 05, 2006
    You're On Notice

    Thank you, Stephen Colbert: