The delivery of medicine is unique, healing can occur almost under any conditions and at any latitude and altitude.

I have to confess that we health professionals have many responses to stress including shouting, crying and most frequently sarcasm, it attenuates the emotional pain and trauma of the unfortunate tragedy of human kind.

I am a frequent air traveler, I have logged over 1.5 million miles on United Airlines alone (that’s 2 1/2 round trips from the earth to the moon). When I was a child if someone would have told me that I would have traveled the world, I would have told them, ” I believe that about as much as butt ugly Chelsea Clinton reproducing”!! In all my travels I have been surprised by how many times I have delivered health care at 30,000 feet.  I have to reveal a conflict of interest in this passage because I have family that has worked as a flight attendant but also another family member whom retired as a pilot from the airlines industry.  I hold an exquist sensitivity to the airlines industry having family members in the business.  Since I was a teenager I heard so much about the travel industry and while in college I even obtained my pilots license.  This exposure has heightened my awareness of not only how difficult the airlines industry is, but also how hard pilots and flight attendants work, yet get little of the appreciation of what they do in the skies to keep us safe.  I am so aware of this that very early in my travel career, I always looked the captain, flight attendants, etc, in the eye and thanked them, ALWAYS! regardless of how little the gesture of kindness. I frequently would tell them  I know you are busy, whenever you find some extra time, just to minimize my burden as a passenger to their very stressful and under appreciated careers.

While on a recent trip from a medical convention, I had the opportunity to be called to use my powers for good rather than for evil (see Spider-Man).  Not yet quite at 30,000 feet I was just getting comfortable as my movie, Zero Dark Thirty was beginning to get interesting.  A movie that chronicles the capture and killing of the planets most wanted terrorist.  The proverbial announcement came over the intercom, “If there is a medical personnel, can you please ring your call button?” I remember thinking, here we go again…. I immediately went back to my medical training days of the term, “slow code”. This was a common term used in my medical training regarding the situation of being a called to a code red.  Residents in training when paged to a situation for a code red would walk very slowly in hopes that the patient would not survive by the time they arrived (This is no longer practiced and considered unethical and could lead to termination of your training by an ethics board). I of course worked under the fear of losing my job so I always ran to code red’s, I have to admit I crawled to code “Browns” (when patients crapped on themselves)

I arrived in the back of the plane and said patient was sweating, I checked for a pulse and it was thready, to a trained cardiologist, this usually implies a blood pressure of a minimum of 80. When you are starting with that as a blood pressure, it usually is a bad sign, things usually get worse before they get better.  The flight attendant helped me obtain history from the matriarch as her husband had just slumped over in his chair toward her and briefly lost consciousness.  I was able to find a blood pressure kit and it was slightly better.

While the attendant obtained history and translated from English to Spanish I was examining him and trying to talk to the family. I informed them that based on what we know , he probably should see a doctor in houston prior to continuation to Panama.  Meanwhile the staff was able to find the first aid medical kit and a heart monitor, while putting the monitor on our patient, another doctor joined my for assistance.  while trying to focus on our patient I was overcome by anger and fear, you see I do not really have any fears, no fear of heights, blood, speaking in public, however my greatest fear is seeing women with red lipstick on their teeth.  Yes, you read right, red lipstick on women’s teeth just creeps the shit out of me.!!!!!! I believe I can trace this back to my childhood, I saw ,”who’s afraid of baby Jane”/  A movie staring Betty Davis as the evil sister, whom is bat crazy, Like hanging from a tree upside down kind of crazy and terrorizes her sister. There is a scene in the movie where she has tons of make-up and the camera is a tight shot on her face and she has lipstick on her teeth!!!!!!!!! I still can’t get that scene out of my head, so when I see women with red lipstick on their teeth, I am like a cat on its hind legs.

So the saga continues, I now have a monitor on his chest and sure enough he has an abnormal heart rhythm.  The diagnosis is clear, his heart pauses for approximately three seconds. The Matriarch of the family now tells the attendant that they don’t have insurance. I guess even in panama they understand how expensive health care in the US can be, Knowing full well in the us a Tylenol in the emergency center requires a platinum American Express, when you absolutely cannot leave home without it!!! The flight attendant told me the issue and I quickly responded, oh,…..nothing to worry about, the US gives everything away for free, including health care! The flight attendant was about as uncomfortable as Adrian Peterson from the Minnesota vikings at a day care center.  Maintaining her professionalism, she turned around and told the matriarch, the doctor insist you must be transported to the emergency center! You have to love the professionalism of flight attendants. .Things began to stablize, I drew up atropine into a syringe ( an agent used to accelerate the heart rate) as a precaution, in case his heart tried to stop again.

The flight attendant asked me if I wanted anything to drink? I told her scotch, make that a double, shaken not stirred!! She looked at me so confused with that “deer in the headlights ” look, (no disrespect to deers).  I had to whisper, “I’m just messin with you, the sarcasm helps to take the stress off this medical situation”.

By now I had my assistant place an IV and he was resting comfortably in the seat, we will be landing soon so I sit behind him, watching the monitor, looking out the window on our descent and holding a syringe of atropine in one hand, the flight attendant was somewhat annoyed with me, because my seat belt was not, “low and tight across my lap”!!!!!!!

So as I walk off the plane behind the ambulance crew, I am handed a brown bag, a token of the attendant’s appreciation???????