Midway into the flight, she notices a flurry of activity in the first class section of the aircraft, with passengers forward of her seat craning to observe what is happening. Curious, but not too curious, she is reviewing her presentation on her laptop computer when she hears a flight attendant’s urgent request—“Is there a medical professional on the plane? Please ring the call button above you.” As she anticipates a ring from another professional pressing the attendant call button, she realizes that no one seems to be responding. Surely I am not the only physician or nurse on this plane, she thinks.
Explore This IssueJanuary 2016
Rather reluctantly, she presses the call button and identifies herself as a physician, and the attendant rushes to her seat with a relieved look on his face. “Thank God you are on the plane,” he gasps. “We have an emergency situation. Please come with me quickly.” Following the attendant up the aisle to the cockpit door, Dr. Billingsley sees the other flight attendants clustered around a person on the deck—the pilot! He is clutching his chest and upper abdomen and is in obvious distress. Noting that his color is ashen, his peripheral pulses diminished, and his breathing rapid and shallow, Dr. Billingsley quickly understands the gravity of the situation. The crewmembers are looking to her to care for the stricken pilot.
Clinical Scenario 3
Charles Baker, MD, and his family are participating in a church retreat on a rather remote ranch in West Texas. This retreat, the culminating event of a summer of spiritual renewal for the congregation, has been planned as a time for family outdoor activities and appreciation of the wonder of natural creation. So far, all expectations are being met, and the families are enjoying their shared experiences. Dr. Baker feels that this time away from his head and neck oncologic practice is going to be well worth it, as this is a rare opportunity for his family to be together, without iPads and the Internet to distract them.
The congregation’s early morning hike along the edge of a plateau to experience the rising sun is just outstanding. Suddenly, a scream is heard, followed by loud voices calling for Dr. Baker to come forward. Rushing to the area of the commotion, Dr. Baker sees what has happened: A boy has slipped off the edge of the trail and has fallen about 15 feet to a ledge below. His leg appears to be twisted, and he is screaming with pain. Urged by the boy’s parents, Dr. Baker climbs down to the ledge and examines the boy. He appears to be neurologically intact, with no obvious spinal injury, but he has a hematoma of the right thigh and a malrotation of the right leg. The boy responds to questions but is in obvious extreme pain. His mother beseeches Dr. Baker to “please take care of my boy.”