pathology he might have. Did he have a ruptured diverticulum or
appendix, aortic dissection, pancreatitis, volvulus, intussusception
or worse a dead bowel? It seemed almost forever until the captain
walked back and informed me that he had been cleared to land in
Anchorage, Alaska.
“How much longer?’ I asked, as I knelt down and checked the
blood pressure again. Systolic in the 90s! We were making progress.
“An hour, hour and a half, and the EMTs and ambulance will be
waiting," he replied.
Fourth and last bag in: I was done. Two liters of normal saline
was all I had, and now it was gone. It was a very long hour and a
half, and I was beginning to feel helpless. There was not much else
I could do other than to monitor the patient. No more IV fluids. I
looked at the emergency kit checklist. Yes there was atropine, and
epinephrine, in case his blood pressure started to drop again. I was
handed some forms to fill out. There was nothing else to do other
than monitor his vital parameters.
His glassy eyes now slowly seemed to get out of their haze as he
focused on me. I tried to make eye contact and ask him how he felt.
He did not smile. He was stoic. I inflated the cuff again. Systolic
blood pressure was now at 100 mm of Hg. I informed him that
help was close at hand and that we would be landing soon. That
seemed to upset him as he sat up and rested his back on the side
of the galley wall. He then insisted on going to the lavatory as the
plane touched down! He appeared to be more coherent now. His
companion began to cry and asked that he not be taken off the plane.
He then said, “No! No! No! I go Tokyo!” He was a big man, more
alert now despite the pain. He sat on the commode with his trousers
still on, and placed both arms through the kind of metal pipes that
one holds on to during turbulence. His hands locked around the
handles as he willfully refused to leave. We landed, and the EMTs
and our captain tried to reason with him. Then they gave him little
option. He glared at me angrily. I moved away. The police pried his
hands open and they carried him out in a waiting wheelchair. His
sobbing travelling companion walked off too.
As I slumped in my seat, a flight attendant walked up to me and
told me that as a mark of appreciation I was invited to sit in business
class. As a bonus, she handed me a cash voucher for an upcoming
flight. I could not sleep. I have wondered many times, what was his
final diagnosis? Was I correct, or was I wrong? Had he made it out
of the hospital alive? Had they operated on him? What had they
found? I will likely never know.
Arun Gadre, MD, FACS, is the Heuser Hearing Institute Professor of
Otology and Herotology, Director of Otology, Neurotology and Skull
Base Surgery, and Associate Professor of Otolaryngology-Head and
Neck Surgery at the University of Louisville.
AUGUST 2016
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