The most stressful two minutes in my life aren't the two minutes I have to wait for the nurses to draw up an emergency intramuscular injection for my psychotic patient who is raging high on drugs and willing to take out the nearest person standing between him and his chosen manifest destiny. No, in those two minutes, I'm surrounded by trained nurses and sheriffs with tasers and hard restraints.
So those minutes are bliss compared to this.
I think every psychiatrist dreads it. And yet, it seems to happen to me more than any other physician I know. On my most recent plane trip home from Europe, I was in the midst of breathing deeply to avoid thinking about turbulence and birds flying into engines and having to land emergently on the Hudson River, when a girl started frantically screaming that her mother had stopped breathing. Oh crap. Flight attendants rushed down the aisle, and then inevitably, the flight attendant leader's voice came on overhead to calmly ask, "If there are any medical personal aboard, please make yourself known to our crew by pressing your call light."
I didn't press my call light. Instead, I held my bated breath for someone else to press their call light. Surely, there was an emergency medicine doctor or an internist or a trauma surgeon on board. Surely, there was someone with more CPR experience than me.
Instead, all I got was silence.
Shit.
And then, a woman stood up and made her way towards the commotion. "I'm a retired nurse," she told the crew.
I exhaled.
But I kept one ear open, because I was fully aware that I was shirking my physician duties, and oh man, was this going against every oath that I had taken upon graduating from medical school?
What I heard was not pleasant:
NURSE
Oh shoot.
FLIGHT ATTENDANT
What?
NURSE
I can't feel her pulse.
HYSTERICAL DAUGHTER
MY MOM HAS NO PULSE???!?!?!?
NURSE
No...well...I just can't feel it. Maybe?
HYSTERICAL DAUGHTER
IS MY MOM DEAD?!?!?!!?!?
FLIGHT ATTENDANT
No, she's fine. Miss, you need to stop yelling. You're being hysterical. And that's not going to bring your mom back.
HYSTERICAL DAUGHTER
[bursts into further wailing]
Fabulous. I craned my head to look at the mom five rows back. I could see her chest rise and fall, so clearly she was breathing; she was pink, and she most definitely wasn't dead. A flight attendant was walking by me, so I tugged on his arm. "Hey, I'm a psychiatrist, do you need my help?" He brushed me off, "No, we have a retired nurse."
I had just been absolved of any duties.
And then I realized that the flight attendant probably didn't realize that I was a doctor. Didn't realize that a psychiatrist is a real full-fledged MD. And the nurse was making the daughter even more freaked out. So I unbuckled myself, despite the seat belt warning sign, and made my way towards the patient. Everything was in chaos. The patient had a mask on her face, but the oxygen wasn't connected. The nurse had her hand pressed up against the patient's carotid, pressed so tightly that her own fingers had lost blood flow. And the daughter kept shaking her mother, loudly instructing her to "wake up!"
I went into doctor mode and tried to not think about my own insecurities and turbulence anxieties as the plane dropped and weaved in the air. "Hello ma'am, I'm Dr. Wu, and I'm going to take care of you okay?" She nodded at me and squeezed my hand as I held hers and checked for her pulse. "Do you take any meds?" Her daughter hysterically started crying again, loudly saying, "No, my mom is completely healthy! She doesn't take anything!!" But the mom squeezed my hand again and looked at me. I pulled her mask away so that she could answer me. "Cymbalta and Wellbutrin," she whispered faintly to me.
Slam dunk. This was one of mine.
Feeling slightly more reassured that I could handle her emergency, which was seeming more and more like a panic attack, I smiled at her. "Is that for depression or anxiety?"
"Anxiety."
Yes. Definitely one of mine.
I sent a flight attendant to get me some ginger ale, and sat down on the aisle and worked through some breathing exercises and guided imagery. When the flight attendant returned, I prayed to the placebo gods, and gave it to the mom, telling her "Ginger ale is perfect for nausea, and you know what? You're probably a little dehydrated, so this will help with that too." The placebo effect worked, as she took a sip and immediately smiled, saying, "Oh I do feel much better now."
She took off her oxygen mask and I made my way back to my seat.
Just as I was starting to drift back off into my jet-lagged sleep, the flight attendant came by with paperwork for me to fill out. So, instead of resting, I filled out all the random documents that needed to be signed. And realizing that my name was now connected to this patient, I felt compelled to turn around to look at her every fifteen minutes, to make sure that she was still alive and breathing.
So much for the Good Samaritan rule.
The icing on the cake? My seat neighbor, upon seeing that I wasn't going to sleep anymore, immediately launched into all of her own sleep and bowel movement problems, and didn't stop talking for the remaining five hours of our flight.
