"I'm not a doctor. I'm an ophthalmologist"

Forced to respond to an in-flight emergency, the author rediscovers his true medical identity.

By Andrew G. Lee, MD
Ophthalmologist/Iowa City, IA

I'm an ophthalmologist, a neuro-ophthalmologist, to be exact. Every day I see patients who have one question: "What's wrong with my eyes?" Rarely does it occur to me that I'm anything other than an eye specialist. All that changed recently aboard a plane en route to Minnesota from Houston.

I was flying back from a medical meeting. The plane was full, and I'd been fortunate to get the only remaining standby seat. Settling into the last row, I was soon half asleep. Suddenly, I was awakened by the call all traveling doctors secretly dread: "If there's a doctor on board, please ring your flight-attendant call button."

The message threw me into an instant identity crisis. "Doctor?" I thought to myself. "I'm an ophthalmologist, for God's sake. Can I possibly be the only physician on this flight?" Ignoring the call button but feeling apprehensive, I made my way up to the front of the cabin.

To my relief, there was already someone I took to be a doctor hovering over the infant patient. My relief was short-lived. "What kind of doctor are you?" the man asked nervously.

"I'm an ophthalmologist," I replied, equally nervous.

"Great. I'm an orthopedic surgeon. Please tell me you take care of kids."

I ignored the entreaty, and asked, "What do we have?"

Even at 30,000 feet, his response was classic doctor talk: "Six-month-old with some kind of cardiac valvular disease on his way to Minnesota for heart surgery. Recent cough, on some medication labeled in Spanish. No records, no other history. The mother speaks Spanish only. The kid was fine when he got on board, but apneic and cyanotic when I got here. I think he's breathing now, though."

We struggled to fit the adult-sized oxygen mask over the infant's tiny face. The child began breathing spontaneously, but his respirations were rapid and labored. He was tachycardic, and clearly in distress.

The orthopedist and I rummaged through the in-flight first aid kit, tossing aside useless items like the adult blood-pressure cuff, the automatic defibrillator ("Not recommended for use under age 8"), and bandages in a variety of shapes and sizes. But the kit also included a stethoscope.

As I placed the scope on the infant's tiny chest, I could hear his rapid heartbeat over the roar of the engines. Despite the tachycardia and a few audible wheezes, his heartbeat seemed regular. The child was less cyanotic, had no radial pulse, and his extremities were cool. Still, his trunk and head were burning up.

"Hey, I know a pediatric cardiologist," the orthopedist said excitedly. "I'll call him on the in-flight phone."

The air consult proved reassuring. The cardiologist told us to administer a few breaths and chest compressions if the infant's heart rate and respirations started to decompensate. Desperately, I tried to recall the CPR protocols for infants. Why hadn't I signed up for that refresher course when I had the chance? I promised myself I'd do just that if we made it through this ordeal.

Then it came back to me. Airway, breathing, circulation. That's it! The infant's airway looked clear, he was breathing, and his little heart was pumping away.

What's next? Should we do more? In a flash, the infant's eyes rolled back, and he appeared to be having a seizure, although his breathing was unchanged. As an ophthalmologist, I did the only thing that came naturally: I checked his pupils. They were equal and reactive. The seizure-like activity had stopped.

As I looked over my shoulder, the flight attendant appeared, looking agitated. "The pilot wants to know if we should make an emergency landing," she said. As if on cue, the orthopedist and I nodded our heads and said in unison, "Yes, as quickly as possible."

Turning back to our patient, we were encouraged that he was still hanging in there. The oxygen, now on full blast, was helping him to breathe. We were on our third canister. There was nothing we could do but relay his vital signs to the ground—and offer words of hope. "Just a few more minutes, kid. Stay with us. Don't poop out on us. Breathe!"

The plane touched down in Tulsa. As the front hatch opened, I rushed off the plane with the infant in my arms. I relayed his history to the EMTs on the run. As I did, I saw the anxious look on his mother's face—a look that needed no translation. She thanked the orthopedist and me and was gone. The infant was alive, and we'd made it through, too.

Exhausted, we reboarded the plane. The passengers burst into applause. I made my way up the long aisle and returned to my seat.

At least for today, I'm a doctor first, and an ophthalmologist second.

 

Andrew Lee. "I’m not a doctor. I’m an ophthalmologist". Medical Economics 2002;3:47.