I guess this was partly based in my experience of using my First Aid training the day after I flunked my St John's Ambulance assessment back at school. A man had an epileptic fit on the bus and so I had to "help" out. Well I did what I could and he didn't die so that equals sucess right?!
In actual fact, the fear that I would soon be a doctor meant I that had started to carry my mini-Oxford Handbook of Clinical Medicine around with me wherever I went... in my carry-on bag on planes, if I went home on the train for the weekend, that sort of thing. And indeed, when Lucy and I flew to Tokyo about two weeks ago, and she spied this little book of knowledge in my bag and wondered why I'd brought it. "Because..." I replied, "... I know one day I'll need it."
Little did I suspect that day would come just 10 days later, on our return flight from Tokyo into Heathrow.
The long journey home...
Lucy and I had made our way to Narita Airport from a great hostel having experienced a 30-second earthquake the night before. We were kinda sad to be leaving Japan, as we'd had a great time. We did all the usual stuff at the airport and boarded the plane in good time. Before take-off, we got moved to emergency exit seats (which some long-legged saps had paid £75 for the privilege of!) as the economy section was more than half-empty. How lucky we felt, and almost excited at the prospect of being allowed to yell "Unfasten your seat belts and get out!" (seriously) should evacuation be necessary.We took off and enjoyed our meals and movies from seats sprawled across the cabin, amused that we had far more space than those in Premium Economy in front of us.
Midway through my film, Juno, however, the audio stopped to signal a cabin-wide announcement:
"If there is anyone with medical training aboard, please could they make themselves known to the cabin crew, who will be making their way through the cabin"
My heart, at this point, was in my mouth, and my chin was at the floor, as Lucy turned around in her seat, and simply took my outstretched hand in comfort.
"What are you going to do?" she asked, mindful that about 4 hours previously I had said one reason not to have "Dr" on my credit cards was so that I could hide in such a situation.
The answer, however, came quickly, as two of the Japanese crew in their red jackets swished through the curtain.
"Hi." I gulped.
"Are you a doctor?" asked the stewardess, perhaps wondering if someone quite so scruffy could actually be a respectable physician.
"Um... well, technically yes I am... I graduated 2 weeks ago and have yet to start my first job. So, I can help as much as I can... but it might be good to see if there is anyone more senior about?" I said, probably far less eloquently than Ive written.
And off the stewardesses went, leaving me thinking that surely there's someone better than me aboard.
But apparently not, as they soon swooshed back, and there I was, ushered up to the Upper Class section of the plane, my head racing with gory thoughts of of throwing minature bottles of vodka across someone's chest before I pierce it with a coat hanger. Or having to deliver twins. And other such outlandish scenarios that would befit a disaster film.
And then, there was my patient. He wasn't a woman lying screaming with babies all ready to come out. Or an old guy clutching his chest. He was a young Japanese boy, sat in his mummy's arms. And I have to admit, I mentally (if not, indeed audibly) let out a sigh of relief. It wasn't SERIOUS serious. Phew.
Now I don't want to say too much online about the individual details of the case; confidentiality and all that. But essentially, I did what any medical student has done a lot of in their GP placements. There was enough, however, to get worried about, there were some high temperatures, lack of equipment, difficult history and of course the fact that everything had to be translated via a crew member. It's hard to appear empathetic when all you can say is, "two beers thanks ['ni biru, arigato', by the way]" in someone else's language.
And so, after I'd examined my patient and decided that whilst he was ill, there was nothing serious enough to divert the plane, I reassured the family and took a seat to write some notes, whilst chatting with the cabin crew, who all seemed to think I was some kind of hero just for smiling and prodding someone with a stethoscope.
I got invited to the bar, though realising I now had to keep a clear head for the flight should anything change, I didn't take up the opporunity, and actually just wanted to head back and finish my film whilst having a sleep. So I did just that, feeling pretty good about myself and what a good story this would make. And for the next few hours, I got waited on by the staff, who kept offering me things and making me feel pretty special. Hell, the manager came and gave me some bottles of wine to say thanks!But that wasn't the end.
Later on, as meal #2 arrived, and seconds after I'd unwrapped my vegetarian quiche, a stewardess appeared. With a face that said, "I'm really sorry... but"... and sure enough those words came out of her lips too. And so off I trotted back up the plane, where there was now a new problem with my new Japanese friend... some tummy trouble.
I had a look and concluded it was probably constipation, and said to simply let me know if the pain got worse.
As I headed back to my seat, the senior crew member followed, carrying my dinner which they had kept heated for me. But one senior crew was apparently not enough... her Japanese counterpart also followed, carrying a plate with an Upper Class meal of steak and potatoes... I was being well and truly pampered. I sat and tucked in whilst my fellow economy passengers pretended to enjoy their quiches. But barely was I halfway through when I got called back up to the front of the plane.
The abdominal pain had got much worse. Now, the thing here is that, were I an F1 (junior doctor) in A&E with a kid presenting with increasing abdominal pain on a background of high temperature... well I'd want to at least consider the possibility of appendicitis.
And the trouble was, despite my suspicions that it was NOT appendicitis, that I couldn't seem to definitively rule it out - indeed, symptom wise, it was getting hard to ignore.
A quick glance at the Handbook did nothing to help me relax. And we had just under 3 hours left to fly. Everything was complicated by the fact that the family were due to fly onwards from London to another country. And I was the one having to weigh up being over-cautious with being safe. When I'd never actually worked as a doctor, let a lone a paediatrician, before in my life.
I took the Japanese senior crew member aside and just told the truth:
"Okay, if we were in a UK hospital, I would have referred this to someone senior by now... it's beyond my experience... I've done 8 weeks of paediatrics as a student and my career goal is in psychiatry. I've not even started work yet... and even when I do, I'm supposedly under supervision! I can't rule out the possibility that we might need an ambulance waiting for this little boy when we land. We probably don't... but right now we need to be ready because I can't, in all good faith, just say everything is fine."
"Essentially, I need this boy to go to the toilet, then feel better, for me to feel better. I'm going to keep checking him every 10 mins or so, and we'll be better able to decide in about half an hour. What kind of help do we have access to? Can you find out?"
Cue, some brief stuttering from my new air steward friend, but he quickly regained his professionalism and we sprung into action.
So did we have to land the plane in Kazakhstan?
Well... no. Indeed, never have I been happier to see a little boy emerge from a toilet having been sick, and "feeling better". Thank heaven.
I wrote up my plan and explained it with the family. The Japanese crew had rememebred there was a Japanese medical centre in London, actually fairly near Heathrow, and so we organised for the family to be fast-tracked through immigration to a taxi so hey could go straight there once we arrived in Heathrow. And I think we skipped ahead in the landing queue too (we landed 40 mins early).
We prepared the boy for landing... with sweets and also the help of my 24 year old teddy "Panda" (who goes everywhere with me), and I sat and chatted with the crew, whom I'd gotten to know pretty well during the flight.
Landing was uneventful, luckily, as I'd insisted to Lucy that should we crash, I would not be fufilling my duties as an emergency exit operator as I had worked enough for one flight!
Indeed, we reflected on the fact that I'd just done my first ever official duties as a real doctor, a mere 14 days after my GMC registration had come through (hell... it's so recent I've yet to be put on the updated list of registered medical practitioners yet!). And where I'd been worrying about starting on my ward in Bolton, I'd actually just done something far scarier. So Bring it on Bolton (actually, please don't)!
As I got off the plane, saying goodbye to the family, wiking at the crew, I went for it, boldly commenting that "I never actually got to sit at the Upper Class bar, this time, did I... and my name better be on a database somewhere now for when I next fly..."
Cue laughter, and lots of smiles... but I'm not lying when I say that if I don't get a letter from Richard Branson, I'll be mightily disappointed...
Signed,
Dr. Sebastian L Pillon
GMC Number: 7017305
