Between the Devil and Deep Blue Sea | Saving a Life at 35,000 Feet

The fully loaded Boeing 767-400, with topped off fuel tanks and not a single empty seat, lumbered off the runway in Amsterdam bound for Chicago. My wife Joan and I, on our way back home after a Roman holiday, settled in with 250 other passengers, for what we expected to be an uneventful 9-hour-long flight.

About 3 hours into the trans-Atlantic crossing, the pilot announced, in a tone that did not convey the confident reassurance that one comes to expect from an airliner captain, “We have a medical emergency, if there is a medical doctor on board, please report to the back of the plane.” Joan looked at me, raised her eyebrows and then glanced back over her shoulder.

I quickly made my way to the back of the cabin to find a very pale, cold and clammy, middle-aged man in severe distress who looked as though he was about to lose consciousness. I had him lay down on the floor immediately, and found out that he was a Dutchman named Johan who felt somewhat unwell before boarding the plane.

As we ventured out across the wide ocean, he was now clutching his belly and complaining of “the worst pain in his life”. I quickly examined him, and though I just barely touched his abdomen, he writhed in agony pushing my hands away. His belly was as tight as a drum, and as I listened with a stethoscope, I heard no bowel sounds.  Johan had an “acute abdomen”, which is a potentially life-threatening emergency, often necessitating urgent surgery. Except we were thousands of miles away from the nearest hospital, and Johan was looking “shocky”, with a pulse of 110 and a blood pressure of only 70/40.  I placed an intravenous line and administered fluids, but had no other therapies with which to treat him; specifically the emergency medical kit contained no morphine or antibiotics. I did my best to comfort Johan, but both he and I understood the unspoken reality: we were “between the Devil and deep blue sea”.

I discussed our predicament with the captain over the phone, and he explained that we could circle back to Iceland or forge ahead to the northeastern Canada, but either option was about 3 hours away. I told him that wherever we land, we would need an ambulance waiting, and a nearby hospital. A moment later, we heard the engines roar to full-throttle as the plane’s nose tipped upward—climbing to a higher altitude that would allow for faster speeds. As we hurtled towards North America Johan soldiered on, patiently and silently enduring the ordeal, as I knelt on the galley floor next to him. Though the intravenous fluids had stabilized his blood pressure the bag was nearly empty now, his pain was worsening again and now he was also developing shaking chills. The thought occurred to me that maybe this was an example of Einstein’s Theory of Relativity: the faster we flew the slower time seemed to be moving.

After what felt like an eternity, we approached our destination: Goose Bay Airport—a remote airstrip surrounded on one side by the rocky Labrador coastline, and one the other three sides by hills densely forested with tall evergreens. Blustery winds from a ‘Nor’Easter’ were howling off the Altantic Ocean, and as we circled overhead, the Captain jettisoned fuel to drop some weight from the plane to make the landing safer. Goose Bay, an airport built during World War II was never designed to accommodate a fully loaded modern jumbo-jet airliner. In fact, the runway was about 30% shorter than what was usually required for a jet of this size. The plane pitched wildly as the captain fought the cross winds and finally broke through a very low cloud ceiling, setting the 767 down hard on the tarmac, and slammed on the brakes.

We offloaded Johan by stretcher into a 1960’s vintage model ambulance, and I gave report to a local paramedic who spoke in a strange thick Scottish-sounding dialect that was barely recognizable as English. I laid one hand on Johan’s shoulder, and with the other I gently squeezed his hand and told him that he was stable and that a physician was waiting for him just up the road at an emergency room. He looked up at me as his eyes welled up and said, “Thank you doctor.” I scampered up the stairs to the plane and stood there watching the ambulance pull away, bound for the little hospital in Happy Valley; I turned to notice that the sun was already setting—at about 4 in the afternoon. After the plane was refueled and de-iced, we sat at one end of the runway, waiting for what seemed to be a very long time. When we did take off I looked down and saw the runway disappear from under our wings just a few seconds after we were airborne; I was guessing that the captain’s blood pressure at that moment was at the other end of the spectrum from Johan’s—probably about 200/100.

I heard from Johan a few days ago—he had a large kidney stone blocking the flow from one kidney, resulting in so much pain and inflammation that it also caused a bowel obstruction. After a surgical procedure he was recovering well, and was expecting to be discharged from the hospital soon. The episode reminded me how grateful I am to be in a healing profession. The opportunity to make a positive difference for a person in trouble is by far the most rewarding part of my job. A person might make a living from what they get, but I believe you make a life by what you give.

In Good Health

James H O’Keefe, MD

Photo credit: BenjaminThompson

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