Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

An embolus in one but trauma in many at 30,000 feet

Melissa Stone
Conditions
February 2, 2014
Share
Tweet
Share

A middle-aged obese female with a past medical history of diabetes and congestive heart failure is in cardiac arrest after several hours of immobility on an airplane. What is the cause of her condition?

If this were a USMLE exam, my thoughts would race to Virchow’s triad: stasis, endothelial injury, hypercoagulability. But this wasn’t an exam. This was a few rows behind me on an airplane.

I sat only two rows behind her on the plane for a few hours. I barely noticed her and at the time, I wouldn’t have been able to pick her face out of a line-up. Yet, two hours into my flight, I was awoken by a woman’s scream and a frantic announcement over the speaker, “Are there any doctors, nurses, or any medical personnel on this flight? Please come to the rear plane immediately.” A woman had collapsed and was now unconscious in the back of the aircraft.

Being on a plane headed to a national medical conference, about twelve physicians and nurses, more than could actually fit in the back of the plane, suddenly rushed through the aisle.

For the next thirty minutes, I watched flight attendants run up and down the aisles, yelling, “I just checked my notes and she had two vodka drinks. I can’t find a coat hanger; does anyone have a coat hanger? I just found some medications in her purse, and she’s a diabetic! Does anyone have any other medications?”

She was given intravenous medications while physicians performed chest compressions. She was vomiting and they kept losing her pulse.

Children were shrieking; a flight attendant sobbed in the aisle; and several women reached for their bags to take pills themselves. The captain announced we were making an emergency landing in New Mexico in twelve minutes.

Sweat was pouring down one physician’s face as he pounded the woman’s chest and blew air into her mouth. Throughout our rough landing, the physician did not sit in his seat and buckle his seat belt — he continued on. Several minutes later, EMS boarded, and so did fire safety, the police, and crime scene investigation. The line of people on board the plane extended down the aisle, halfway down the entire plane on both sides.

The patient was immediately intubated and given more epinephrine. Vomit was suctioned from her mouth and nose. Her body was moved further down the aisle, away from the back of the plane to make more room for EMS. Whereas only a few people in the back of the plane could see her before, her limp body and intubation were now visible to half of the plane.

Twenty minutes later, her obese, bruised, totally naked body was brought off the plane. I’ll never forget her lifeless face and the difficulty with which EMS performed this task. A plastic sled wouldn’t fit in the aisle and there were no stairs to accommodate opening the back door of the aircraft. EMS had no other option. Over a hundred people, including very young children, saw her dragged off the plane in a scene resembling a lion struggling to drag his destroyed prey through the grass.

Fire safety removed the equipment from the plane, while a hazmat team cleaned her vomit from the floor. Police talked to the flight attendants, physicians, and passengers to piece together what happened during this woman’s last few hours. Crime scene took pictures of the aisle, her seat, and back of the plane. The flight attendants re-boarded the plane and went up and down the aisles talking to passengers saying, “She passed. Let’s all say a prayer for the poor woman.” The attending physician later told me she died in flight but EMS called the time of death on solid ground.

When I reached solid ground, it was difficult for me to digest what I had endured alongside every other passenger on the flight. A poor woman was happily sitting and drinking on her flight to the west coast only a few hours before a thrombus dislodged from the deep vein of her leg, propelling up through the vena cava and into the right ventricle, blocking blood flow to her legs. At least, that is what we think happened and true closure will never come.

Even with a plane staffed with more physicians than the average emergency room, when her heart stopped beating, her lungs stopped breathing, and her brain lacked the substance needed to survive, there was little anyone at 30,000 feet could do to heal this poor woman. In retrospect, maybe more could have been done to heal everyone else on that plane. On this flight, there was an embolus in one but trauma in many.

ADVERTISEMENT

Melissa Stone is a medical student.  A case report discussing this event was published in the Journal of Travel Medicine.

Prev

Death of the physician progress note

February 2, 2014 Kevin 23
…
Next

The generational shift in the learning styles of medical students

February 2, 2014 Kevin 5
…

Tagged as: Emergency Medicine, Pulmonology

Post navigation

< Previous Post
Death of the physician progress note
Next Post >
The generational shift in the learning styles of medical students

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More in Conditions

  • Financing cancer or fighting it: the real cost of tobacco

    Dr. Bhavin P. Vadodariya
  • 5 cancer myths that could delay your diagnosis or treatment

    Joseph Alvarnas, MD
  • When bleeding disorders meet IVF: Navigating von Willebrand disease in fertility treatment

    Oluyemisi Famuyiwa, MD
  • What one diagnosis can change: the movement to make dining safer

    Lianne Mandelbaum, PT
  • How kindness in disguise is holding women back in academic medicine

    Sylk Sotto, EdD, MPS, MBA
  • Measles is back: Why vaccination is more vital than ever

    American College of Physicians
  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How functional precision oncology is revolutionizing cancer treatment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why physician voices matter in the fight against anti-LGBTQ+ laws

      BJ Ferguson | Policy
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • How functional precision oncology is revolutionizing cancer treatment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • When a doctor becomes the narrator of a patient’s final chapter

      Ryan McCarthy, MD | Physician
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • Navigating fair market value as an independent or locum tenens physician [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How functional precision oncology is revolutionizing cancer treatment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why physician voices matter in the fight against anti-LGBTQ+ laws

      BJ Ferguson | Policy
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • How functional precision oncology is revolutionizing cancer treatment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • When a doctor becomes the narrator of a patient’s final chapter

      Ryan McCarthy, MD | Physician
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • Navigating fair market value as an independent or locum tenens physician [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

An embolus in one but trauma in many at 30,000 feet
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...