Saturday, June 2, 2012

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.


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Anonymous STEW (WORCESTER) UK said...

Hi Brian
Blog is fantastic , just finishing nurse training in uk ,diagnosed Aug 11 (Watch and Wait) was going to give it up but decided the hell with cll and carry on with training . Good Luck with this treatment sounds encouraging and exciting time in the cll battle . Keep up the blogging, really makes a difference( i know a cliche but true) to others getting insights

June 2, 2012 at 4:30 AM  
Anonymous Anonymous said...

Dr. Koffman, I have been reading your blogs almost from the beginning. The blogs are not only educational, but your sharing of thoughts and insights into so many aspects of life are priceless, generous and very appreciated.
I am looking forward to many more of your blogs. Even though it takes time out of your schedule, please keep blogging. Gisela (Connelly)

June 2, 2012 at 1:57 PM  
Anonymous Anonymous said...

Wow high drama - looking forward to hearing more. More than once I've sat on a plane and thanked my lucky stars that you never hear "is there a journalist on the plane?" Stay well, Deborah

June 2, 2012 at 4:36 PM  
Anonymous said...

Hey, that's not be continued.........UGH........

Only one word for you my friend and DR.


June 3, 2012 at 12:18 PM  
Blogger Darlene said...

So happy I found your blog. You have a way of communicating that is eloquent and educational. I will be anxiously awaiting the rest of the story!

June 3, 2012 at 7:15 PM  

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