Not Retired

It seems that I am following Paul Levy, who is Not Running a Hospital.  In sharing his spirit, I am Not Retired.

My flight from Denver to Washington Dulles was late to depart due to thunderstorms.  We left at 10:30 pm and I tried to sleep, but was sufficiently alert to hear the page at approximately 2 am: “Any medical personnel on board?”   The flight attendant escorted me to first class where a passenger had what she thought was a seizure.  And she was probably right – only it was due to sudden cardiac death.  No pulse, no breathing, unconscious.  Male, perhaps 45 yo, looked fit, no companion.

The flight crew assisted me in lifting him into the aisle.  Because of their training, by the time that I started CPR, one of the attendants had the AED out and started handing me the pads for placement.  V.Fib.  We shocked once and got a rhythm.  He started to breathe and the oxygen tank was right there.  He had a rhythm, he had a strong pulse, he was breathing.  I said: “This is good.”

I tried to get a BP, but the sphygmomanometer was broken.  We got another emergency kit and it had a cuff that worked – BP ~115 systolic.  I admit that I struggled to get accurate BP recordings because my ears felt like I was 12 ft underwater from the altitude change (and probably a need to see an audiologist).  We sorted through the medical kits and I finally found the NS under the neatly packed top layer of drugs.  Found the tubing, tried to maintain sterile technique, and got a decent IV in his forearm while fighting postural movements of his upper extremities.  Then came VF arrest #2 and #3.  Shock, shock, back to NSR.  I was able to push lidocaine 100mg IV.

While scrounging around the medical kits, I found an endotracheal tube.  To me great relief, he kept breathing on his own and had good color.  I hadn’t intubated anyone in 40 years.  Meanwhile, the pilot was diverting us to Louisville where the EMS team met us.  You know how tight the aisles are.  We managed to get him onto a back-board, but then had to tilt him to nearly 90 degrees to turn the corner.  He was on his way to the hospital and after refueling, we were on our way to Dulles.

I got applause and handshakes as I returned to my seat.  How strange!  After our 4 days together, I could only think that “it’s about the patient, not about me.”  I was particularly aware of the calm and effective work of the flight attendants on our team.

In Louisville, we needed new fuel and a new flight plan.  So, with the extra time I asked to gather all the attendants and debrief.    What went well?  1) We successfully resuscitated a passenger with SCD at 30,000 feet.  2) An AED was mission critical and the staff was trained in its use.  3) Our treatment lasted about 45 minutes; we were calm; we explained what we were doing among the team; no one panicked including the other passengers.  4) EMS personnel were at the door upon the Captain’s diversion.

What didn’t go well?  1) the first BP cuff malfunctioned.  2) I struggled with obtaining accurate BPs.  3) I was slow to get what I needed out of the medical kits; the IV bag, couldn’t find a tourniquet  4) The patient had not regained consciousness upon departure, but groans were evident.

How can we improve?  1) preventive maintenance (PM) on medical equipment.  2) I suggest a digital BP cuff that reads the result without my impaired use of the stethoscope.  3) We should ask nearby passengers to vacate their seats so that we might spread out the medical equipment and drugs.  4) have EMS use an entrance that avoids tight turns, if possible.

We become physicians to heal the sick, relieve suffering, comfort those in need, and occasionally we may save a life.  I do not know the outcome for this gentleman.  I am worried; yet, I am hopeful.  I strive to role-model humility.  Yet, transparency reveals that I am proud to be a physician and proud of our team of strangers at 30,000 feet.

 

7 Responses to Not Retired

  • This is such an incredible story! I feel so blessed to say I got to spend a few days with you. What an amazing physician you are!

  • Dr. Leonard! Your story is so inspiring! Thank you for sharing this with all of us! It makes me proud to be training to be in healthcare. I love that you debriefed the team on the good, the bad, and the ugly so that all of you may respond with even higher quality next time around. I hope your patient has a good outcome. It sounds like he was very fortunate to have a well-oiled team, with you at the helm.

  • I knew the first day I met roger that he was special. Not only a well trained cardiologist, but a true patient centered compassionate physician. Exactly what we need more of. From the day you enter the field of healthcare be it nurse, doctor, pharmacist or more we truly never retire. I like to think it will always be in our blood and more importantly in our hearts. The time in Telluride was priceless and this sums up exactly what we as faculty tried to impart to students. Open communication, honesty and transperancy . Kudos Roger. So proud to consider you one of my friends.

  • Roger,

    You were already a hero for me on the ground when you and Sam “escorted” me back down the mountain from the waterfall.

    This is an excellent example of what John Nance was referring to in how to quickly spread the word on safety improvements by sharing our stories so that others can learn.
    We’re so fortunate that you are “Not Retired”!
    Jan Boller

  • Roger, what great thinking to debrief!! I too have assisted several times on airplanes and never once thought to debrief!! That is how we improve, reflecting on what happened and analyzing how to improve. it is a joy to work with you.

  • Dr. Leonard,

    What miraculous timing to have this experience. Your story and my time at Telluride has inspired me in many ways. I have never felt so clear in my life about choosing this profession and the way that I intend to practice it in the future. The sense of community and humility that I saw at Telluride will forever serve as a reminder when I am struggling to change the culture of medicine around me.

  • Great job Dr Leonard. And glad to hear the patient is doing well. Feel free to congratulate your self as you have congratulated the staff.

    It reminds me of a time that you helped me put in an emergency pacer maker in the ER during a snow storm that crippled the area.

    Miss you at the hospital,

    R Larkin, MD

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