Emergencies happen anywhere, anytime, and sometimes physicians find themselves in situations in which they are the only ones who can help. Is There a Doctor in the House? is a new Medscape series telling these stories.
Dr Govani: We were lucky. In 2021, the NFL had chosen some healthcare workers to go to the Super Bowl. We’re Rams season ticket holders, and we were chosen. We had an amazing time. About 30 minutes into our flight home, I was about to go to sleep when there was an overhead page saying they needed a doctor. I looked at Salima and said, “I’ll go.”
Drs Gobani and Thovani at the big game before their fateful flight.
Dr Thobani: The funny thing is, this is not uncommon. Rahim has been called eight times to help people when we’re flying. It’s usually something like anxiety, or they’re just not feeling well, something that’s really not life threatening.
Dr Govani: I told the flight attendant I was an ER doctor. She told me there was this 60-year-old woman feeling short of breath. She has asthma and only speaks Spanish. I said, “Whoa, one second. My wife is an asthma and allergy specialist and speaks fluent Spanish.”
Dr Rahim Govani
Dr Thobani: The woman was in distress, having a lot of difficulty breathing. But she had a very convincing story that she had asthma. I asked her where her medications were. Her husband took out her medicine bag with all of her inhalers. All asthmatics usually carry their rescue inhaler, which is albuterol, and she had that on her. We thought we’d try that, because it works pretty quickly. If you have asthma, within 15 to 20 minutes you’re going to start to feel better.
Dr Salima Thobani
In the meantime, the airplane had a little emergency bag, and we opened it up. There was this plastic stethoscope, and when I grabbed it, one of the earbuds flew off. So, I have one earbud in, and I’m trying to listen to her. I’m not hearing the breath sounds very well on one side. That’s when I thought, Okay, something else is going on here.
Dr Govani: We found out she’d developed pneumonia while visiting her family and had been in the hospital for a week. Now we’re going to have to start asking more difficult questions, like, “Do you have COVID?” We were in the middle of a row with people in front of us, people behind us. Everybody got really quiet. She didn’t have COVID, thank God. She said she’d been tested twice.
Then she said she now had chest pain, and Salima said, “This is not asthma.” I thought, Oh no, this is a heart problem. They had nitroglycerin on the plane, and we gave her some. They had a blood pressure cuff, but not a normal one. It was a wrist unit, which isn’t as accurate. Her BP was a little bit elevated, 140 over 90. Her heart rate was 106.
Dr Thobani: We really needed to make sure she was oxygenating. The airplane kit had a pulse ox, but it didn’t have a battery in it. Because of COVID, Rahim had randomly decided to throw a pulse ox in his backpack. He remembered that, so we used it. At least we knew she was oxygenating at 97% or 98% the entire time we were treating her.
We were in survival mode. Normally in a hospital setting we have an x-ray, we have labs, we have so many things at our fingertips. We also had another friend with us, Dr Nilesh Vora, an oncologist. So it was the three of us in this little aisle. This was the first time we had worked together, but we were a team.
Dr Govani: All of a sudden, the woman says, “I feel dizzy.” I thought, Uh oh, she’s about to pass out. So, we lifted her legs up and put her head down. Her blood pressure dropped. We had an oxygen mask on her, and the tank ran out of air. We took it off her face, and she was breathing in gasps. I thought, Oh my God. They brought a second oxygen tank, and her chest pain started to get better. We kept asking her questions, because if she’s having a heart attack, we need to get down quickly.
We gave her another nitro. Her blood pressure dropped again. The flight attendant asked, “Are you guys okay? Can you do this for 4 more hours?” We all looked at each other, and I said, “Absolutely not.”
They put me on a phone with the pilot. I said, “This woman might be having a heart attack. She might have a pulmonary embolism. She might have a collapsed lung. She’s going to die on your plane if we don’t get down right away.” He asked if he needed to do a rapid descent. And I said, “No, but definitely get down as fast as possible.” So, he agreed that we could do an emergency landing. He said, “It’s going to be 30 minutes to get to Houston.” And I said, “That’s fine. Just get us there.”
As we started descending, we kept working on her, giving her more oxygen and comforting her. I had a needle in my pocket. I was ready. Because if she stopped breathing, I was going to have to put a needle in her chest in the middle of this flight. I really did not want to do that. Luckily, as we started to descend, her chest pain went from a 9 out of 10 to an 8 out of 10. And then we went down little bit lower, and it was a 7 out of 10. We finally landed, and EMS came on the plane. We said our goodbyes. We didn’t know what was going to happen.
We were delayed another 2 hours, then we flew home, getting in around 2:30 in the morning. As soon as we got in the car, I said, “Salima, we have to find out what happened here.”
Dr Thobani: We were so unsettled on that second flight home because we just knew this was something bad. We didn’t know if she was dead or alive. I Googled the nearest hospital to the airport. I called the operator, who connected me to an ER doctor. He said, “Oh yeah, she’s here. I’m going send you the x-ray, with her permission, because it’s a good thing she landed here. She would’ve coded on the plane.”
She had a tension pneumothorax. Not only had her lung collapsed, but there was so much pressure from air accumulating that her trachea and heart were being pushed over to the other side. It was one of those things where our jaws literally dropped. It’s something you read about or see in the movies. It was insane.
Dr Govani: What probably happened was the pneumonia made her lungs a lot more friable. One of her lungs popped, and it was slowly getting bigger and bigger. It wasn’t a tension pneumo in the airport, but by the time she got up there, it was slowly progressing. She got to the hospital just at the time where they were able take a picture of it. They put a chest tube in her, and she was there for an additional week. She wasn’t even allowed to fly back. Her family ended up driving there to bring her back.
You just think about all the different things that could have happened. If we weren’t there, or we didn’t say this, or if we didn’t do that in time, she would have passed away.
Dr Thobani: We still talk about it. We just happened to be the vehicle. It wasn’t her time, and we were meant to be there. This year, we had a little reunion. It was the first time seeing her, and she’s doing so well. She and her husband came over to our house. She is still very traumatized. She has a lot of PTSD from what happened. I mean, she was on death’s door, up in the air where there’s nothing that’s going to help you.
Dr Govani: She and her husband got choked up a little bit talking about how they got a second chance. They got more time with their children and their grandchildren. Sometimes when you’re working, you don’t get to see how you’ve affected someone’s life. It was amazing to see that we were really able to make a difference for this family. You hold your kids a little bit tighter and you just appreciate everything you have.
I thought going to the Super Bowl would be the highlight of the trip. But honestly, this was the highlight, that we were able to help save someone’s life. At that point, you feel like you won the Super Bowl.
More tips for doctors on how to provide in-flight assistance.
Salima Thobani, MD, is an asthma, allergy, and immunology physician at Kaiser Permanente, Southern California.
Rahim Govani, MD, is an emergency medicine physician at Kaiser Permanente, Southern California.
Are you a physician with a dramatic medical story outside the clinic? Medscape would love to consider your story for Is There a Doctor in the House? Please email your contact information and a short summary of your story to [email protected].
Read others in the series: A Plane Crash Interrupts a Doctor’s Vacation. .
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