The patient: “Amy,” a woman in her late 50’s and fellow traveler on a recent flight from Seattle to Phoenix.
Why she came to see me: Amydeveloped sudden chest pains and asked flight attendants to call for a physician, hoping one was on-board. I answered the call. (M*A*S*H fans might be interested to know that I was fittingly wearing a “Hawkeye Pierce” Hawaiian-print shirt at the time!)
I’ve always held that physicians should attempt to aid human suffering regardless of circumstances. Midair or mid-ocean medical care becomes a bit tricky—you serve at the pleasure of the captain, perhaps within the jurisdiction of the “flag of the craft.” Most airlines have a crisis management center staffed with ground-based medical personnel who can advise flight crew as to care necessary for passengers experiencing issues but having someone onboard who can at least provide an initial diagnoses is always preferred.
How I evaluated her: I was brought to the rear of the plane where Amy was seated, looking concerned with one hand over her chest. She had no history of heart issues and the sudden chest pain began shortly after she had finished the sandwich she packed for herself and the plane had changed altitude. I was provided a stethoscope and blood pressure cuff and found no heart-related symptoms other than the mid-chest pressure.
How I addressed her problem: I told her that a surprising number of ambulance calls for people experiencing what they think are heart problems are actually due to swallowing air while eating too quickly. This can cause the stomach to press up against the diaphragm, tilting the heart and producing a feeling of tightness in the chest.
I asked the flight attendant to provide Amy with a glass of sparkling water and had her drink the entire glass in one shot, which prompted her to produce a very large burp! Within a few minutes the color returned to her face, a smile emerged and she pronounced herself “cured.”
The patient’s progress: I spoke to the captain on the intercom to relay the outcome and we proceeded to our destination without needing to be diverted to a nearby airport. I told Amy that airline policy was to offer her immediate assistance once on the ground, including ambulance transport to a local hospital, but that if she continued to feel fine she might choose just to check in with her regular physician. Three weeks later, I received a letter from the airline’s customer service thanking me for my inflight care and letting me know that Amy had contacted them and said she continued to be fine.