A Country Doctor Writes:

I am sitting at Newark International Airport, waiting for a flight to Sweden. Instead of a book I have my laptop with me this time. I think it took longer to log on to the wireless network than it took to fly here.

I am hoping for a quick, quiet flight to visit family for a few days, but you never know. As a physician I have occasionally been called to assist fellow passengers with medical problems.

My last summer sojourn to Sweden ended on a particularly hot day. The economy cabin of the big SAS Airbus was filled to capacity. We were minutes from takeoff from Arlanda airport and the cabin crew was making its way down the double aisles to check seat backs, trays and overhead bin doors.  Just two rows behind us they stopped and I heard them ask, “Sir, are you all right?” and soft voices spoke inaudibly for a while. The purser arrived, and soon that familiar phrase came over the intercom:

“Is there a doctor on board? Is there a medical doctor on board the aircraft?”

I reached over, tapped one of the crewmembers on the shoulder and said: “I am a doctor.”

The middle-aged man was drenched in perspiration. He was American, his wife Swedish, and they had three school age children.

“I don’t feel so good”, he said. His pulse was weak and rapid, but not irregular. The wife described that he had been running high fevers on and off for the past 48 hours. The day before he had gone to a primary care clinic in a distant suburb of Stockholm with no firm diagnosis made. The wife asked him if he wanted to get off the plane and go to the Karolinska Institute. He seemed ambivalent. As I went through a brief review of systems, the Captain arrived. He needed to make a decision and asked for my advice. Should the passenger be allowed to remain on the flight?

It seemed to be my call. On one hand, the man might have had just a garden variety viral illness and might have made it back to the States without losing control of any bodily functions, but on the other hand we could have had a real mess in the cabin. He could also have had something more ominous going on, where his life would be in jeopardy hours later and 30,000 feet in the air. Lastly, imagine if what he had was very contagious – remember the SARS epidemic in 2003, thought to have spread through air travel.

I told the Captain I thought the man should stay in Stockholm. The Captain seemed relieved. The wife decided that she and the children would also get off the plane.

The Captain announced the delay while the family deplaned. The purser brought me some free champagne, and another doctor suddenly appeared from the Business Class cabin with a small box of chocolate for me. He seemed mildly intoxicated at 10:30 am. 

Triage is a crude process. You don’t have to make a diagnosis. You don’t have to be right. All you have to do is choose the course of action that minimizes the harm of any wrong decisions you might make.