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A medical 'emergency' that wasn't
By ELLIOTT HESTER A few minutes after our plane took off from Miami en route to San Jose, Costa Rica, I unbuckled my jump seat harness, walked down the aisle and was poked in the thigh by a frenzied passenger. "Please, we need to go back to Miami!" he said. "We need to go back NOW!" This was no offhand request from a fearful flier. It appeared to be a matter of real concern. "My friend is sick," the passenger continued, pointing to a man in the window seat who at that moment began clutching his chest with both hands. "I think he's having a heart attack." The man's head flopped in my direction. Through two rheumy slits of crimson, his unfocused eyes swam up in an apparent attempt to meet mine. I hit the flight attendant call light several times; within seconds, my three colleagues appeared. One rushed to get an oxygen generator. Another grabbed the microphone and made a PA announcement requesting the services of a doctor. With help from the remaining attendant, I moved the three passengers who had been sitting in the preceding row and folded the empty seats forward to make more room. We then laid the ailing passenger lengthwise along the row of seats and propped up his head against an avalanche of pillows. Just when the man appeared to start feeling better, he lost consciousness. That's when I rushed to get the onboard defibrillator. The automatic external defibrillator is a marvel of medical technology. Though not much larger than a toaster, it delivers a pulse of electricity that can restart the heart after sudden cardiac arrest. In July 1997, American Airlines became the first domestic carrier to equip its fleet with these life-saving devices. Defibrillators since have become standard equipment on most major carriers and are credited with saving dozens of lives. When I returned with the device, we scrutinized the man, checking for three conditions that must be present to justify use of the unit: lack of consciousness, lack of breathing and lack of pulse. During my brief absence he had regained consciousness. So, despite the "appearance" of cardiac arrest, we were not allowed to employ the device. Luckily, a doctor appeared from among our passengers. I asked to see his medical identification (an awkward, company-mandated question designed to guarantee the practitioner's authenticity and to limit airline liability in the process). He acquiesced, then told us to unbutton the patient's shirt and attach the defibrillation pads. The doctor planned to use the device not to deliver a few thousand volts but as a heart monitor, a task it also can perform. As my two colleagues affixed the pads to the man's chest, the captain's voice crackled over the intercom. "Because of a medical emergency," he said, "we are returning to Miami immediately." He went on to say that the plane would be met by paramedics, refueled and given a new departure slot. In less than two hours after our initial departure, we would take off again for San Jose, with our passenger load reduced by at least one. The aircraft banked left and descended. The accelerated thrust of three engines produced a roar that emphasized the urgency of the matter. As is always the case when the cabin depressurizes rapidly, my ears popped. With one hand, I pinched my nose and blew to equalize. With the other, I held the patient's hand. He lay across the row of seats, shirt open, eyes closed, two 12-inch defibrillation pads glued to his heaving chest like giant Band-Aids. We huddled around him watching and waiting, while the defibrillator took another reading and passed along its finding. Paramedics were waiting when we landed in Miami. One of the flight attendants made an announcement asking passengers to remain seated so that the team would have unrestricted access to the patient. While the paramedics checked his blood pressure and pulse, the doctor offered an opinion. "According to the defibrillator," he said, "his heart seems fine." The problem lay elsewhere, apparently. The paramedics then began interrogating the patient. Something in the way they spoke to him raised questions about the validity of our medical emergency. Their questions seemed a bit too nonchalant, their probe into the problem too matter-of-fact. In a voice filled with suspicion, one of the paramedics finally asked, "Have you been drinking?" The patient responded with a sidelong glance and a halfhearted shake of the head. Two paramedics exchanged a look. Then I remembered: When the drama had begun and I had bent over to adjust pillows behind the passenger's head, I had noticed a whiff of liquor. Scotch, maybe? Had his medical condition been triggered by alcohol consumption, or was alcohol consumption the sum of his medical problem? The paramedics strapped the man to a gurney and packed up their gear. Before wheeling the gurney off the aircraft, one of the paramedics leaned toward me and whispered in my ear, "I think this guy is just drunk." The man's overindulgence had resulted in a two-hour delay that inconvenienced 120 passengers and put them -- as well as my crew -- under considerable stress. And due to our late arrival in San Jose, the return flight from there was delayed accordingly. Passengers missed connections. Tempers flared. The airline lost thousands of dollars. But the defibrillator worked just fine. Epilogue: After being removed from the plane, the "ailing" passenger was examined by a doctor and was released from further treatment. Just as the paramedics had suspected, he had boarded the plane drunk. - Elliott Hester spent 16 years flying for a major U.S. airline. He recently has begun an around-the-world adventure he expects to take a year, and his columns on this journey will appear in the Times starting in late January.
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