“Is there a doctor on the plane?”
Seven otherwise innocuous words, striking fear into the heart of every physician. Like “Quick, can you bring me a whole bunch of paper towels” and “Omigod, where’s the plunger,” the implication was obvious. Some phrases just herald disaster. When you thought about it, it was surprising there weren’t more medical disasters on planes; certainly it was surprising there weren’t more psychological ones. Sealing yourself in an aluminum tube and zooming up to the outer reaches of the troposphere and the lower reaches of the stratosphere, sailing through the jet stream at speeds of six hundred miles per hour, where the temperature might be -60 degrees Fahrenheit and the windchill might be -120 degrees Fahrenheit—well, that was not natural.
As the call for a doctor went out again, Georgia allowed herself a few furtive glances around in case a random ER doc was about to spring to the rescue. She was a passionate believer in helping your fellow man—or woman, as the case might be—but she had to admit, chances were slim this would be an issue related to her specialty. How many people had a urologic emergency on an airplane?
“Here!” yelled the woman next to her, a bleached blond twenty-something-year-old in a bedazzled T-shirt, waving her arms energetically. “Right here.”
Georgia turned to her in surprise. A few seconds later, the flight attendant appeared at the end of the row, regarding the woman with a similarly dubious look. “You’re a doctor?”
“I’m a dancer.”
“Thank you,” said the flight attendant, baffled, “but we’re looking for a doctor.”
“She’s a doctor,” said the woman, triumphantly pointing to Georgia’s carry-on bag. The flight attendant’s eyes followed the woman’s finger, landing on the bag, where Georgia Brown, M.D. was stitched at the top. The flight attendant pivoted, her eyes drifting from Georgia’s high ponytail to her giant rhinestone hoops to her clothing: a threadbare green T-shirt, emblazoned with the words Foosball Wizard; a maroon smoking jacket; flared orange pants; and a pair of Lucite-heeled sandals. The flight attendant consulted a list in her hand. “Any chance you have your medical license with you, ah, Dr. Brown?”
“No one carries their medical license around,” said Georgia.
“What seems to be the problem here?” A wiry older gentleman made his way up the aisle, all irascible eyes and ferocious hair and stubble: Gregory House, personified.
The flight attendant relaxed. “Are you a doctor?”
“I am Dr. Magnus Doellman,” said Gregory House.
“Oh thank goodness, we have a situa—”
“I am a herbologist. But I volunteer frequently at the hospital.”
The flight attendant faltered, torn between two evils. By now, the people in the rows of adjacent seats had awakened and were eying the spectacle, turning around in their seats. A scrawny guy in a beanie raised his hand. “I’m a herbologist too,” he said, prompting his friends to collapse in helpless guffaws. Dr. Doellman glowered.
The flight attendant eyed Georgia again. “What kind of doctor are you?”
“A urologist,” she said emphatically; the flight attendant needed to know what she was getting here.
Apparently urology trumped herbology in this particular emergency, because the attendant nodded. “Okay,” she said. “Please come this way.”
* * *
—
They walked past two dozen rows of people glued to their electronic devices until they reached the rear galley, where the sprawling form of a man filled the floor. Someone had laid him out perpendicular to the aisle, his head in the kitchen area and his large feet, shod in a polished pair of wingtips, near the jump seats. With one look, Georgia knew: this was bad. In medical training, the first thing they taught you was to answer one question: Sick or Not Sick? Not Sick covered a lot of territory, from legitimate but non-emergent medical needs to a whole bunch of asinine things for which people routinely showed up in hospital ERs. In med school, she’d seen—they’d all seen—people for dumb complaints all the time: zits, paper cuts, emergent requests for liposuction.
On the other hand, you had the Sick People. These were the MIs, the septic patients, the ones with blood vessels full of clots or lungs full of fluid or kidneys full of toxins, hovering at the precipice dividing the living from the dead. From an academic standpoint they were interesting, but they also held a peculiar disastrous power: they possessed the potential to take you with them, metaphorically speaking, if you made a mistake. And sometimes they took you with them, literally speaking, as in the case of certain neurotoxins and infectious diseases.
It was apparent to even an untrained eye that this man belonged in the Sick category. Georgia stretched a hand toward him and he stared at her with the vacant panic of a mole, beads of perspiration dotting his flushed forehead.
Aside from his sudden impairment, he looked healthy, as far as she could tell. She gripped his shoulders and leaned her ear against his chest: his heart rate hovered in the 160s, way too fast; his breathing sounded shallow, but without sounds indicative of pneumonia or asthma. Examination of his abdomen revealed no bowel sounds; also no distention or apparent tenderness. Enormous black orbs swallowed his irises, so she couldn’t discern his eye color; peering into his mouth, she observed a dry, caked tongue, without any swelling or redness in the back of his throat.
The flight attendants offered a brief rundown: he’d seemed flushed but fine as he boarded, but he’d begun to look a little strange as the flight took off, becoming heated and restless as the miles piled up. The attendants had proceeded cautiously; he hadn’t been rude or disruptive, but they had all seen plenty of personality disorders manifest themselves mid-flight. As the flight progressed, though, it became clear this was not an intercontinental freakout brought on by alcohol or anxiety; by the time they’d cleared the landmass of Greenland he was confused, followed by outright hallucinations and a brief, terrifying seizure. Following their in-flight protocols for medical emergencies, the attendants had contacted a physician on the ground, who’d directed them to obtain vital signs and enlist the help of any doctor who happened to be on board.
The man let out a feverish yelp as a flight attendant dabbed his head with a wet, rolled washcloth held by silver tongs. Frantic, he clawed at the skin beneath his eyes, flopping like a banked salmon, his nails digging into the soft tissue of his face.
Georgia forced herself to think, sequentially and logically, through a differential diagnosis as the flight attendants strained to hold the man down. One possibility seemed more and more likely here. Otherwise healthy male, with sudden agitation and mental status changes? Not sepsis: the attendants reported his blood pressure as high, not low. No reported history of head trauma. Even though he looked red and had scratch marks on his arms, there were no other signs to indicate anaphylaxis, ruling out an allergic reaction.