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Is There a Doctor on the Plane?! (Again)

— How my YouTubing saved a life

MedpageToday

Following is a transcript of the video:

There's a meme that's been going around that goes along the lines of a flight attendant asking if there's a doctor on board, and then dad nudging the person and saying, "That should have been you," and general hilarity ensuing as each person fills in their professions' relevant details in a self-deprecating way. As far as I can tell, it started with "The Dad" social media account where the profession at the butt of the joke was YouTuber. Of course, loads of people tagged me in it because I'm a doctor that gets involved with medical emergencies on planes more than really seems reasonable, and I'm also a YouTuber, but I've got a story where I can honestly say that being a YouTuber probably saved a life.

As usual, I'm very sorry I couldn't get this out any quicker. I'm struggling with time at the moment. The meme is probably long dead at this point. The reason I've got this association, I guess, with the planes now is due to a video I made earlier this year where I shared a story about a medical emergency on a plane where I got involved. I started that video by saying that despite the fact that emergencies happen on fewer than 1 in 600 flights, and I've had to help out three times suggests that I or perhaps more accurately my fellow passengers are cursed by some sort of malevolent spirit eager to do them harm. I guess I was born near an Indian burial ground. Oh, no, not that kind of Indian. I joked that you probably shouldn't fly anywhere with me.

Well, it happened again, twice, on the same flight. As with that previous story, I was on my way to India, but this time I had my wife and two young kids with me. We boarded, already near our wits' end due to an hour's argument to sort out Air India's wise decision to seat our 3-year-old 14 rows away from us. Anyway, we got on the plane. We were happy to see a friend of ours sitting a few rows behind us. He was on his way to a wedding. We had a brief chat, took our seats, and we were off. Now, the U.N. Convention Against Torture lists flying with a baby and a toddler just above waterboarding. After a few hours of struggling to feed, placate, entertain, and change them, I was more than ready for my customary double whiskey when the now rather familiar call went out, "Is anyone a doctor?"

I experienced a strange range of emotions within the space of a split second, joy at not having to deal with those kids anymore, guilt that I had just felt joy when a person is in trouble, excitement, the same kind of adrenaline rush that you get at work when the cardiac arrest alarm goes off, rage that I haven't actually started my whiskey yet, calculation, and yes, I'm treating that as an emotion when I tried to figure out if I drank the whiskey now before getting up would it actually affect my doctoring ability, and then horror took over when I realized I'll be leaving my wife alone with both kids.

I turned to her and could read in her face an expression as clear as day that said, "I know you have to go, but it's at times like this I wish I'd married that investment banker that took a shine to me at university." I got up to identify myself as a doctor, and then I ruined my friend's flight by grabbing him and informing him that he's now responsible for my firstborn son. I was taken to a lady towards the back of the plane in severe distress. She was howling in pain. She was clutching her chest. She really didn't look well at all, but I guess as a cardiologist I figured at least, hey, this is familiar territory, but more than that, I actually felt prepared. I'd made that previous video only a few months earlier. I'd read pretty much everything there is to read about airborne medical emergencies. YouTube had honestly made me ready.

Once again, I was so relieved to have company in the form of another doctor. I can't tell you how useful it is to have someone to bounce ideas off in situations like this. The woman vomited several times. She couldn't answer any of our questions as she was breathing so hard. We tried to examine her but couldn't hear anything in her chest due to the stethoscope being the usual Christmas cracker $1.00 garbage, and the engines being so loud, plus she was still shrieking in pain. She really looked like she was in trouble. I checked her pulse and her blood pressure, and actually, they were normal. I turned to the cabin crew who was with me who was pretty young and looking a bit panicked, and I said, "This looks like a heart attack, and unless we can settle her down, I'm afraid my recommendation would be that we're going to have to land. Please inform the captain and radio the ground staff to update them and ask advice."

I could tell the crew were worried and tried to be as clear and as calm as possible, and I reiterate that I only knew all of this, what to say, because of my YouTube research, in real contrast to when I have done it in the past and I was far more clueless. I knew exactly what kit to ask for and what they were likely to have. Then fairly suddenly, she started stabilizing. The breathing slowed, her eyes opened, her hands relaxed, we were able to get a bit of history.

During this first period of stability, I learned that my fellow sky doctor was a chap called Pankaj, a brain surgeon from Jaipur in India. When chatting to him later on, he told me that he'd worked in the U.K. for quite a while before returning home to head up his department as a highly specialized neurosurgeon. He had previously treated a young man on an airplane who had had a full-blown cardiac arrest, so I guess we're kind of like the Sankara stones -- when you bring us close together, cosmic forces of bad luck are released.

I can't divulge much about the medical details without risking breaching confidentiality, but suffice to say, we narrowed the problem down to one of two things: an asthma attack or a heart attack, and they're not that similar, but it really wasn't typical for either. Another wave of symptoms came on, and we quickly gave her an inhaler, which had been donated by one of the cabin crew, a nitrate tablet, which relieves the pain of a heart attack, and some general pain relief, and again, things settled down. By this point, my suspicion of it being a heart attack was falling quite rapidly, and asthma seemed much more likely. She had a background of quite significant asthma, but to be honest, it really wasn't that clear, and as I said, it wasn't typical for either asthma nor a heart attack.

We could now hear some breath sounds, suggesting that perhaps the reason the chest was quiet earlier on was the dreaded complication of asthma called a silent chest caused by the fact that the airways are so clamped shut that no air can get in. So now hearing breath sounds meant she'd either responded to the inhaler or her slowing her breathing had just made it easier for us to hear. She seemed a lot better and I didn't think there was any reason to divert the plane now, but you keep second-guessing yourself. I said to Pankaj, "If only I had an activator." No, I didn't say that. I said, "If only there was some way I could reassure myself that this isn't a heart attack, I'd feel a lot more comfortable." He replied, "It's a shame you can't do an ECG, huh." Then I said, "You know what? I've actually got an ECG machine in my bag."

A company called AliveCor had recently brought out a six-lead ECG device that Bluetooths to your phone and can record a heart tracing. Unlike the Apple Watch or more basic similar devices which only give one lead, which is useful for looking at your heart rhythm but useless in something like a heart attack, this gives six leads. Now, hospital ECG gives 12, so this isn't perfect, but it's more than six times more useful than one. Now solely due to my YouTubery, I guess I've popped up on some medical marketing people's radars and AliveCor got in touch to send me the device to test out. Now they didn't explicitly ask for me to put it in the video. Perhaps I am wrong to infer that that's what they wanted, and to be honest, I wasn't feeling very comfortable putting it in a video without looking like I'm a sellout. I'm not a review channel after all, so I put it in my backpack thinking, "I'll look at it at work and try and figure out some other way to use it," and then I just completely forgot about it for a week.

Now, I don't know what model of serendipity you subscribe to, but somehow my forgetfulness had conspired to give me exactly what I needed at that moment in time. I think Pankaj thought I was joking until I returned with this little gizmo. Now he'd never seen anything like it, so was a bit blown away and asked if all British cardiologists carry this around. I said, "Yeah, of course." I connected it up and presto, this is what I recorded or at least one part of one of the traces. Pankaj said he'd be unable to interpret these complicated squiggly lines having not done any cardiology for years, and I said, "Dude, it's not brain surgery," and yes, I actually did say that. I mean when would I ever get a chance with a setup as good as that to use that line? I had to take my opportunity.

Now there are lots of devices including the Apple Watch that give a one-lead ECG, meaning that there's one view of the heart. Now you get that with two contacts like the two that you get on this device and that creates a circuit. That gives you that one view. But by adding a third contact on the back here, you then get three different views. With a clever calculation, you can then use something called an augmented lead to get an additional three views or angles. You've now got six different ways of looking at what's going in the heart.

An ECG can diagnose a heart attack, but you can't exclude a heart attack with an ECG, so that's not what I was trying to do. But the fact that it was normal was at least one extra data point in our decision-making. I didn't have to reach a definitive diagnosis. I just had to decide if she needed super-urgent treatment. Again, I don't want to share too much, but thankfully she remained well and pain-free after the treatment we gave. By this point, there wasn't a great deal of time to go in the flight anyway. There was enough time for a young man to collapse at the back of the plane. Pankaj and I were called into action again, and before I could whip out the ECG, he was awake and chatting, and this was a classic faint after a long flight. Nothing to do, but it gave Pankaj and I a chance to chat properly, exchange details, and invite each other to our respective hospitals, or perhaps, we should actually meet outside the hospital grounds just in case the Sankara effect kicks in again.

I'd also like to say a huge thank you to the amazing Air India crew who were exemplary, except for the fact I never got another whisky. Unlike my experience in that previous video on an airline that has now gone bust, which was a total shambles, it was great to have a competent and supportive staff. There were some senior supervisors and very young cabin crew who really did their best. One of the guys, Paul, his mum had died the day before. He hadn't even been home yet. He was on his way home and working, and he was still doing his best to help out. They were as good as their airline is terrible. Air India actually said they'd get in touch with me afterward. I don't know why, but they never did. In fact, they haven't even replied to a complaint from earlier in the year about something entirely unrelated, although they did try to seat my son away from us, again, on our connecting flight. Great job Air India. Sorry, rant over.

This video is not sponsored by AliveCor in any way. Please do not consider this an endorsement of their products because funnily enough doing ECGs at 30,000 feet is not the reason they suggest you buy their device. Now I'm not flying anywhere for a little while, but just in case, from now on I'm going to tweet all my future bookings so that you can ensure you're not on the same flight. As one commenter said, "I can now brag that I've joined the mile-high club, and by that, I mean the club of people who have performed a six-lead ECG on a plane," which I presume is considerably more exclusive than the other one.

, is an interventional cardiologist, internal medicine doctor, and university researcher who makes science videos and bad jokes. Offbeat topics you won't find elsewhere, enriched with a government-mandated dose of humor. Trained in Cambridge; now PhD-ing in London.