Mid-air consulting… Aussie GP style

It’s an early morning flight. You’re tired, grumpy and regretting not grabbing a coffee before boarding. The seatbelt sign is turned off and the mouth of the person sitting next to you is turned on.

She starts yapping away, trying to engage you in small talk. Not wanting to appear rude, you reply, all the while wishing she would just shut up. The situation turns from grim to dire as she moves from the trivial to the personal.

I was en route to present at an international medical humanities conference in the US, and, I have to confess, I was that annoying talker. Why? I noticed a mole I didn’t like on my fellow passenger’s forearm.

Now, I’m certainly not in the habit of giving strangers unsolicited medical advice, but I was sitting there confronted by this highly suspicious naevus, my fingers itching for a dermatoscope, and just couldn’t stay silent. The young American told me that it had been looked at “a couple of years ago” but admitted that he’d noticed recent change. He hadn’t been concerned about it before boarding, but I made darn sure he was before disembarking. I gave him my business card (to demonstrate that I did indeed have a medical degree), and two weeks later received a very grateful email. The lesion turned out to be an invasive melanoma with a Breslow thickness of 1.3mm

On the very next leg of my journey, I again had cause to advertise my profession. Regular readers may recall that the last time I heard “Is there a doctor on board?”, I slid down in my seat and waited for someone else to respond. This time I attempted to redeem myself by volunteering immediately when the call came over the PA system. Two minutes later, faced with an unconscious young woman, my good-deed buzz was replaced by alarm bells chiming “panic”.

According to the nearby passengers, she had been acting “weirdly” before “passing out”. I wondered if this inappropriate behaviour included asking strangers about their moles. She became responsive after some oxygen, but was confused. Later, she started complaining of severe chest, abdominal and back pain. To cut a long story short, the combination of hypoxia, methamphetamine and dehydration had precipitated a sickle cell crisis. The next three hours were not much fun for either of us.

Half an hour in, the drinks trolley came around. Unlike on many of our Australian carriers, a free beverage is offered by this American airline, although the tiny pretzel packets have been banished along with the term “air hostess”. With my patient stable at the time, I requested a tomato juice. The attendant opened a can and half-filled a tiny cup. When I politely requested the remainder of the can as well, he looked at me as if I’d asked for pretzels and called him an air hostess.

“Passengers are only eligible for one free drink,” he pronounced.tomato juice on a plane

“I only want one — a can of tomato juice.”

“But that’s two serves.”

“Hey, I’m saving a life here. Surely that’s worth the extra half can.”

“We are not allowed to give any kind of gratuity to doctors who volunteer their time to assist in an emergency.”

While I appreciate that this situation presents a legal quagmire, the fact is that in the US, this crazy country, I’m expected to tip a waiter in a bar for pouring me a glass of tomato juice, but I can’t even get an extra half-can of unpoured stuff for delivering three hours of after-hours emergency care. I know I’m from Down Under, but it all seems a bit upside down to me.

First published in Australian Doctor on 17th May, 2012 On Unsolicited Advice


Is there a doctor on board?

Qantas plane“Is there a doctor on board?” I used to wish a call like this would go out while I was flying. I had this romantic idea of saving the day, being showered with praise and upgrades, the cabin bursting into spontaneous applause; joining the medical equivalent of the mile-high club.

On a return trip from Canada, my dream was put to the test: LA to Brisbane, 13 hours of economy-class hell, barely a spare seat on the plane and surrounded by more energy reserves than needed to sustain an African village for a year. Yep, morbidly obese Americans — in front, beside and behind me.

The three seated behind me took the cake (actually I suspect they’d taken many a cake in their time). Dad was as loud as he was wide, and his demands and complaints kept the poor flight attendants on their toes.

“I’ve heard this called ‘cattle class’, but I own a big ranch in Texas and, let me tell ya, my cows have more room when they travel than we do here.”

I wanted to point out that most humans were smaller than bovines, and require less room, but I resisted.

“My wife is pregnant and these here cramped conditions are dangerous for the baby. Never flown ‘coach’ before.”

Why did he start doing so now — on a long-haul, trans-Pacific flight with a pregnant wife and, more importantly, me in the next row?

“But now that I’ve been jammed into this damn midget seat, I intend to take up the matter with the airlines — and my lawyer! It shouldn’t be legal!”

Mom’s mouth was mostly occupied with chewing, but in between mouthfuls she let forth a lungful or two. Their four-year-old butterball rhythmically kicked the back of my seat but I didn’t feel I should admonish him — after all, he was exercising!

In the end, I could take no more. I can count the number of times I’ve ever taken a sedative on one hand, but these were desperate times, and a Stillnox allowed me to sleep.

The word ‘doctor’ penetrated my groggy haze.

“She’s got a lotta pain in her belly. We need a doctor — now! It could be the baby! I told you these tiny seats were dangerous!”

Soon enough, the call for medical assistance came over the PA.

“How pregnant?” I wondered. It was impossible to tell from her body habitus — as in the song from Oklahoma, she was “as round above as she was round below”. I had visions of trying to deliver the premmie baby of an obese, litigious American on a crowded plane and half-asleep, I decided discretion would be the better part of valour. I lay in wait, fervently hoping I’d be beaten to the punch.

Luckily, three altruistic medicos swooped in as I watched from my seat. The ophthalmologist and psychiatrist from business class weren’t particularly useful, but the third-year resident from the rear of the plane was marvellous. How he examined her in the space confines I have no idea, but efficiently and professionally he was able to reassure her that her burning epigastric pain was unrelated to her seven-week pregnancy. An antacid was produced from somewhere and the pain settled rapidly.

He was proclaimed a hero and upgraded to business class for the remaining nine hours of the flight. Meanwhile, now wide awake, I was left in the company of my still-whining neighbours, to pay the penance for my inaction.

First published in Australian Doctor 31st March, 2011: On Airline Anguish