OPINION
DOCTORS' Lounge
(continued from page 27)
to her chest by putting his head down onto
it, which made her blush. She looked as
though she would live.
We thought it was reflux (coffee/no
food/hungover) but of course there were
considerations of pulmonary embolus, and
so the captain (who spoke only to Goetz)
landed us at Heathrow, where a gruff am-
bulance man came in, and spoke only to
Goetz. I was female chopped liver, so I sat
down and read my book. We never did hear
how she was.
In practice, each airline has ground-sup-
port medical consultants and they primarily
help the captain make the call. What we can
do, up in the air, is use an app.
It’s called AirRx and is a collaborative ef-
fort, the brainchild of Dr. Raymond Bertino,
an interventional radiologist and Clinical
Professor of Radiology and Surgery at the
University of Illinois College of Medicine.
He and five other doctors, including ER
docs and aerospace docs, invented this and
– brilliantly – it’s designed to work when
your phone/device is in Airplane Mode.
The authors advise: review the app every
time on the plane, when the crew is remind-
ing you about the exits and the flotation
devices. Know always that the cabin is a
relatively hypoxic environment, especially
for valley-dwellers like us, since its oxy-
genation is equivalent to high-altitude, not
the banks of the Ohio. If we are unused to
breathing at altitudes between 6,000 and
8,000 feet and we are stricken, giving us two
liters per minute is not enough - we need
four. Remember that cabin pressurization
will result in worsening of a pneumothorax
or an air-filled bowel obstruction. One thing we should not do, if flying be-
yond the continental US, is to make a formal
pronunciation of death. Apparently, that
opens up a legal can of worms that we do
not want to be involved in. However, when
I read this, I wondered how any doctor can
say, “He looks sort of dead.” I think perhaps
that might mean refusing to give an exact
time and an exact reason.
We should immediately tell the crew our
qualifications, either take charge or help a
person who is more qualified, ask for the
emergency kit, and get one crew member to
be our helper and go-between. We should
tell the patient and the crew exactly and
relatively rapidly what we think is wrong. In this day and age, the prospect of con-
tagious infectious disease is a nightmarish
one for all involved. We are cautioned to ask
immediately for the universal precautions
kit for ourselves and personnel involved
and mask the patient if feasible. We should
immediately inform the captain. If it looks
bad, we should ask for patients to be moved
back/away if that is at all possible. We should
avoid, I would add, any note of hysteria.
We should position the patient correctly
either up or down as needed, and using the
information in the 23 scenarios outlined,
choose the equipment and medicines we
need. For instance: for a breathing problem,
this app reminds you how to take a history,
how to do a focused exam, warns you of the
signs of severe distress, and when to proceed
to the cardiac/respiratory arrest scenario. It
gives precise advice for which medicines.
The app has concise listings for the usual
availability of medicine and equipment on
various airlines according to the regulations
of each country.
The AirRx app is most interesting read-
ing, the psychiatric part in particular, and
the obstetric part, which I hope to read as a
bystander only and never a participant. But
if I drew that short straw, I would read the
app, take deep breaths, take my own pulse
first, help that mother, and pray.
Dr. Barry practices Internal Medicine with
Norton Community Medical Associates-Bar-
ret. She is a clinical associate professor at the
University of Louisville School of Medicine,
Department of Medicine.
LAMENTATIONS OF THE Retired Physician
John Lloyd, MD
I
often ponder (more often since my
retirement) a quote attributed to the
ancient Roman poet Virgil: “Optima
dies…prima fugit” (the best days are
the first to flee). When physicians of
my generation discuss the current practice
of medicine, they often arrive at a similar
conclusion (although not as eloquent as
Virgil), i.e. “The best days have flown.” I’m
sure this is not a new or original revelation.
28
LOUISVILLE MEDICINE
Every generation of physicians, no doubt,
feel that their own generation has been the
“golden age” of medicine. But nonetheless,
there have been recent seemingly rapid
and unsettling changes that dominate the
conversation of older physicians who have
continued the practice of medicine or who
have recently retired: 1) loss of indepen-
dence, 2) enslavement by computers, 3) be-
ing shackled by insurance companies and
governing bodies, 4) the increasing expec-
tation for perfect treatment outcomes, (i.e.
less than a perfect outcome appears to be
unacceptable in today’s world), and 5) the
dilemma resulting from expectations for the
practitioner to deliver “state of the art” and
evidence-based care with a minimal use of
resources and in a minimal amount of time.
As a result, whether real or imagined, some
older physicians have concluded that it may