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race as I wondered if there was a doctor or nurse who could help me . A crew member handed me the unopened emergency first-aid kit . I had never seen one before . I opened it and there before me was a stethoscope , a blood pressure cuff and sphygmomanometer . A checklist enumerated a list of drugs were available . I felt for his radial pulse , I thought I felt something but could not be sure . Perhaps I was feeling the pulsations of my own blood surging in my fingertips which were now in a heightened state of alertness . I reached for the brachial artery and the carotid . I felt a definite pulse but it was fast and thready . His heart rate was 120 beats per minute and perhaps faster . I touched his abdomen . He immediately held his breath . Guarding , hard-board rigidity , rebound tenderness ! Acute abdomen ! All very well but what in the world was an ear nose and throat doctor to do with a hot belly ? Years of hard surgical training helped me make the diagnosis even in this high pressure situation .
By now four or five of flight attendants stood by , wanting to help but not really knowing what to do . A young doctor from Florida made his way back from the first class section . He was mourning the loss of his own brother in the Philippines and had decided on this trip at the last minute .
“ I am a cardiologist and am happy to help but I have not started an IV in years ,” he declared .
“ Would you mind spiking the bags of IV fluid , cut strips of tape , and help if I needed it ?” I asked . Despite his own personal grief , he was eager to help .
A hot abdomen , veins collapsed , tachycardia , diaphoretic , a patient in shock on a noisy airplane ; where was the phlebotomist when one was most needed ? What was his blood pressure ? I wrapped the cuff around his arm and listened through the stethoscope for the lub-a-dub on his brachial artery , as I slowly deflated the cuff . I could hear nothing over the sound of the engine . I tapped on the
18 LOUISVILLE MEDICINE
Dr . Gadre assists a fellow passenger on his transpacific flight from Detroit to
Nagazaki , Japan . diaphragm and re-inflated the cuff and gave it one more go . The needle seemed to oscillate but still no knocks . ( I soon realized that a stethoscope is useless to measure blood pressure on a moving jet aircraft .) All one can hear is the sound of the engines . In my view , airlines ought to substitute these old dial aneroid instruments with modern electronic devices ). I recollected the palpatory method they taught us in physiology class at medical school . I inflated the cuff again and let it down slowly as one more cry of pain emanated from his parched cracked lips . Systolic blood pressure was 80mm of Hg ! He attempted to say something , which was incoherent to me . The only word I understood was “ Tokyo ” as he now seemed to lapse in and out of consciousness . His young traveling companion began to sob quietly .
I left the cuff inflated and reached for the 20 gauge angiocath . Mr . MB , the chief flight attendant , was calm and kind , and helped as best as he could . He held the flashlight as I palpated the slowly filling vein in the man ’ s wrist . A flash of dark red blood presented in the hub of the needle . I advanced the cannula smoothly into the vein . I only prayed that I did not mess up the vein stick as I may not have another chance . My cardiologist friend had expertly primed the intravenous tubing as I hooked a 500 ml bag of normal saline into the waiting angiocath . It flowed freely . I asked the attendant to open the spigot as I secured the angiocath to the cold clammy skin . Not knowing what to do , she shut it off . My legs were now cramping from the alternate kneeling and squatting positions I had to assume to get the job done . I came to my feet feeling light headed . I saw another human being in a desperate condition on the floor . He was alive but sinking fast . I had to get his blood pressure up . I squeezed the bag that someone had now secured to a coat hook , as the first 500 ml of life giving normal saline rapidly entered his veins .
By now the captain joined the crew and asked me for some details . I told him all I knew , as he took down notes .
“ How much longer , and are we over US or Canadian airspace ?” I asked .
“ More than 10 hours to go , do you think he can make it for that long ?” he asked , his forehead wrinkled with inquiring worry .
“ The risk is too great ,” I told him . “ Its best to get him to a hospital .”
He called out the parameters that I had given him , which included only pulse , systolic blood pressure and respiratory rate . He walked toward the cockpit to inform Delta Airlines headquarters in Atlanta and to obtain advice from the Mayo Clinic . I hooked up a second bag of normal saline and squeezed it in , and with two empty bags down and nothing else to do , I hung the third bag . I wondered what