Part 2 Is there a doctor on the plane?

It has too busy with travel and treatment and lectures and the Stanley Cup Finals (GO KINGS GO) to blog. I should be able to catch up more with lots of good news about me and ibrutinib from rainy Orlando real soon


But first when I last left you, I was walking to the back of the plane to see who needed medical attention.


To see if I could help?


To see if was putting myself at risk/


What I found in the last  row was a man in his early 50s acutely short of breath with an oxygen mask on, very afraid for his life.


Less than a minute after arrived, t was being asked should we divert  the plane to Las Vegas. (What power. I should have said that Hawaii was a better choice).


I took a brief medical history. Turns out my patient suffered from chronic inflammatory demyelinating polyneuropathy (CIDP). I had had one patient with that rare disorder years ago. It is a bit like MS in that the sufferers develop an auto-immunity against their own myelin sheaths so the nerves, especially the motor nerves getting weaker and weaker. If CIDP involves the respiratory muscles, life threatening shortness of breath is a rare but real possibility. Pneumonia can also occurs with a decrease cough reflex.


He denied chest pain. No calf swelling or tenderness. No cough or fever. No new new meds or foods. No history of asthma or severe allergic reactions. No other major medical issues.


I used the emergency stethoscope that the steward provided. I could hear no air moving in and out. A very very bad sign. Then I listen to the heart. Again I heard nothing. But my patient had a normal pulse.  And he was not turning blue or had any altered mentation. In fact there was none of the classic signs of respiratory distress- nasal flaring, using accessory muscles, tracheal tugging. Maybe the CIDP was obscuring them? I retrieved my own stethoscope from my seat. Still nothing. Then I listen to my own heart. Nothing. The problem of course was the volume of the ambient noise, not that my patient had no air entry into the lungs and that his heart had ceased beating. I didn't asked if they could turn the engines off for a few minutes so I could listen in the quiet, but the thought did cross my mind for a moment.


He had an infusion of IVIG the day before and was worried about the effect of flying so soon afterward. Now I have great personal familiarity with flying right after IVIG. I have done it dozens of time without a blink or blip. I plan my long foreign trips around my IVIG and try to get it just before I leave for  exotic lands. He was very reassured by this.
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We chatted more. He was able to talk without gasping or halting. He was felling better, less air hungry. We walked up to first class. His gait was weak and his hands shaky. CPID has devastated his muscles.


No need to divert the plane.


We talked about his family, my leukemia, his treatment. The oxygen mask came off. He was smiling, relaxed, feeling OK again. I gave him my contact information.


His panic attack was over. I still had the paramedics meet the plane and take over his care. After all I had yet to really auscultate his lungs. I could have missed a pulmonary embolism or a cardiac issue or....


That afternoon back home at last, I got a call from a dear friend, a fellow family doctor with CLL living in Canada just admitted to the neuro-ICU with chronic inflammatory demyelinating polyneuropathy. Was it related to the weird immune system us CLLers share? Was it totally unrelated? Seeing as no-one knows the cause of CIDP, it is anyone'e guess.


What are the odds? Two cases of an exceedingly rare disorder on the same day. 


Synchroncity? Where is Dr. Jung when I need him?


I had done my doctorly thing. It ended well. I could talk to my Canadian friend with some fresh knowledge of CIDP from the research I did after I landed.


The steward asked for my frequent flier number as I was leaving the plane. Maybe I will even get some miles out of just doing what I do.


One last puzzle piece. When I got down to baggage claim, another doctor who was on our flight walked up to me too thank me for jumping in. He was being treated for cancer and didn't want to take the risk of offering to help due to his lowered immunity. 


Don't be judgmental.


We all make decisions. If the patient that I had found at the back of the plane had not had a panic attack on top of a rare neuromuscular disorder, but was suffering from a much more common condition such as severe asthmatic bronchitis, putting anyone such as me or the more reluctant doctor at grave danger and with little to offer in the way of help, his decision would have been the correct one, not mine.


It is good to be lucky.


I promise more lucky news soon from my ibrutinib trial at OSU.

Having cancer gives you a whole new perspective: A medical emergency on the flight home and a friend with a new possible complication of CLL: Chronic inflammatory demyelinating polyneuropathy (CIDP)

I last posted from the gate at O'Hare about how tired I was on my trip home from Columbus.

Soon after that is when it started getting interesting.

I managed to stay awake long enough to board the plane, but was soon I was sleeping, wearing my N95 mask, feeling lucky and comfortable with the extra leg room in my exit row window seat with the rare joy of no-one's elbow in the middle seat next to me, when the call went out: Is there a doctor on the plane?

There was no choice. There was no decision to be made. There was only one course of action: to try to help.

A medical degree is not disposable and can't be shed like a worn out shirt.

A call for help demands a response. After all, a complete stranger from halfway around the world,  a Talmudic scholar had tried to save my life by donating his stem cells for my transplant.

I am no Talmudic scholar, so I beg any one reading this more familiar with the backbone of ethical actions for an observant Jew to add their commentaries and correctives, but here is my take.

The Talmud is clear about one's obligations. You must help, but only when it is possible to help. You do not need to risk you life to try to save someone beyond saving. And you are not asked to put yourself in immediate danger to save another.  Inconvenience, cost, and loss of time or money are not imminent dangers and are therefore not acceptable excuses. You may need to pay a price for doing the right thing. So be it. Risk to your own health and well being however is a different story. It is a legitimate and ethical and just plain sensible not to jump into the raging river to save a drowning man, especially if you can't swim.

Neither of these two caveats were clear to me when I heard the call.

After all, anyone with CLL has compromised immunity from the get-go. Was the person I was being asked to help contagious?  Was he or she coughing or bleeding or oozing? Was I putting myself at risk? The efficacy of the mask in protecting against infection is suspect at best when the mask is brand new. This one was making a return flight on my nose and mouth. Did they even have latex gloves to protect a good Samaritan doctor?

As to the first question, I wondered as I headed to the back of he plane: Could I do anything to help on a noisy crowded plane with very limited equipment and no real therapies to offer? I had worked my last ER shift over 30 years ago. Not much that I could treat on a plane. I carried a bottle for ASA to help in case of a heart attack. Did they have a epi-pen for a severe allergic reaction or asthma? I didn't. Did they have pressure dressing for bleeding? Not me. Did they have oxygen for all of these? What if it was a GI or GU or an OB/GYN emergency? Premature labor? Any one of those would be a challenge in economy seating at 30,000 feet.

I needed to find out.

I walked to the back of the plane where the patient waited.

TO BE CONTINUED.