Kyle grabbed his stethoscope once again—somehow it hadn’t fallen off while we had been moving the man—and listened to his heart and his breathing once again. He asked for pillows, blankets, anything he could get to raise the man’s feet some more; almost immediately the things appeared, and he got them arranged as he wanted.
“Do you have any meds of any sort on board?” Kyle asked.
“We’re a long-haul flight, so we’ve got a full medical kit.” He didn’t even have to ask; she simply moved to grab the kit and open it for him.
Kyle had been totally focused on diagnosing and caring for his patient to that point. Suddenly he looked up and asked, “Where’s his wife?”
A very upset-looking woman was standing just a few feet away from him. “I’m here.”
“Do you know if he’s taking any medications of any sort?”
“Yes, but I don’t remember them right now.”
“Did he carry them on board with him?”
“Yes.”
“Get them for me,” he ordered. “I need to know what he’s taking so I don’t give him something that will interact badly with anything he’s already on.”
A flight attendant and the woman moved quickly back down the aisle to find the man’s bag. In a few minutes, they were back. Kyle opened the bag and checked the meds. “Is this everything?” he asked.
“Yes.”
“No others?”
“No. This is what he takes.”
“Okay.”
Kyle opened a small container, broke the seal, shook it, and sprayed something into the man’s mouth under his tongue.
“What’s that?” I asked.
“A nitrolingual spray. Do you remember hearing anyone ever talk about taking a nitro tablet when they’re having chest pain?”
“Yeah, I do.”
“It’s something like that. It’s called a nitrate, and it helps the heart to work more efficiently. It makes the veins and arteries relax and widen so that blood can flow with less resistance. That means that the heart doesn’t have to work as hard to pump blood around the body. It also means that there is less blood coming back to the heart with each beat so it has less blood to pump back out. And you can see how all of these things together are good things.”
The man’s wife was getting a little agitated. “What’s wrong with him? Do you know what you’re doing?”
This was something I could deal with so Kyle could stay focused. “You got extremely lucky today, ma’am. He’s an emergency physician in one of the busiest ERs in New York. He knows his stuff really well. If anything bad like this had to happen, thank goodness it happened when someone was here who has dealt with this before.”
“But he’s so young,” she complained.
“That’s the best. He hasn’t had years to forget everything he learned in medical school and residency. And he’s an emergency physician trained to deal with a wide variety of health matters.”
The earlier bumpy air chose that moment to recur. The flight attendant got the ill man’s wife into a jump seat just around the corner since she wouldn’t return to her own seat way in the back of the plane. Really, who would? Kyle took my seat, so I also sat on another jump seat just around the corner—fortunately there were some extras.
Remembering something, I shouted around the corner, “Kyle! Put your seat belt on! Do it! Now!” I suspected that Kyle would have been totally focused on his patient and wouldn’t have paid attention to his safety, so I wanted to be sure he, too, was strapped in so that he wouldn’t go flying if we hit some air pockets. The rough air continued for a few minutes with a couple of really big bumps.
When it was safe to get back up, I returned to Kyle’s side and checked on how things were going. “Need anything, babe?”
“No. We’re okay for the moment.” The man was somewhat conscious but seemed to be sluggish. “How much longer?”
“I’ll find out.” A flight attendant called the captain. Procedures for the cockpit door to be opened in flight were rigid since 9/11, so it took a bit of juggling to get the beverage cart in place to block access to the flight deck so that the captain could come back to personally assess the situation. One brief exchange with him earlier had assured him that Kyle knew what he was doing, but still he wanted to know personally how everything was proceeding because he needed to update air traffic control and emergency workers on the ground.
“The computer tells us we’ll be landing in forty-three minutes,” the pilot reported to Kyle.
Kyle gave no commentary but nodded in acknowledgement. “Can you have an ambulance waiting when we land?”
“Already done. And I’ve asked for a straight-in approach because of an in-flight medical emergency. If this had happened over land, we’d have had lots of options for quicker landings, but out here there’s just nothing between the mainland and the Hawaiian Islands except water.” The pilot returned to the cockpit to get ready for landing.
Somehow in the midst of everything, the flight attendants had managed to serve a snack and drinks to everyone else on the plane—I wasn’t sure when that had happened, since my focus had been on Kyle and his had been on the patient. I’m not even sure I would have noticed that we were starting our initial descent into Honolulu if a flight attendant hadn’t announced the news.
The earlier hours seemed to have flown past, but Kyle later told me that the last thirty minutes seemed to tick by remarkably slowly. Every minute or two, when he looked at his watch, he was convinced that we should be landing, but every time only another minute or two had elapsed.
This was certainly not the way I had wanted Kyle’s first arrival in Hawaii to be. I had wanted Kyle to be able to sit and watch out the window as the first island came into sight. I had wanted Kyle to practically bounce up and down with
