Impending delivery at 35,000 feet
About five hours into the flight from London to Boston a voice came over the speakers: “If there’s a doctor or other medical personnel on board, please make yourself known to a flight attendant.” Unlike many doctors who seem to dread such an announcement, I always welcomed one. Not only did providing medical care make the time pass, but more importantly it gave me the opportunity to help someone.
I quickly pushed the call button, and a flight attendant walked down the hushed aisle to my seat. She asked to see identification proving that I was a physician. After she was satisfied that I really was a doc, she told me the story: There was a 32-year-old woman in row 46 who was 26 weeks pregnant. Her water had broken, and she was going through a pad every five minutes. Would I talk to her? I briskly walked down to row 46 and saw an anxious-looking woman leaning on the shoulder of a man I took to be her husband. I quickly learned that her water had actually broken in the terminal at Heathrow, but for some reason she and her husband still elected to board the plane. They both seemed a bit bemused and disconnected from the reality of the woman’s situation. I learned that this was her first pregnancy. And that she had a master’s degree in something or other—she was not a dummy. It amazed me that neither she nor her husband realized that having ruptured membranes meant it wasn’t a good idea to board a transatlantic flight.
By this time several other “medical personnel” had found their way to row 46—there was an ER doc and two nurses–a surgical nurse and, fortuitously, a labor and delivery nurse. We quietly conferred in the aisle, mutually rolling our eyes that our patient chose to board the plane. All were in agreement that she needed to be examined. So we had the flight attendants set up an examining room in one of the galleys—they spread blankets on the floor, brought in several containers of medical supplies, including a baby delivery kit complete with forceps. Our patient was led to the galley, helped to the floor, and the curtains were closed to afford her a semblance of privacy. Since I had been first on the scene, I appointed myself to do the examination, even though by training I was a gastroenterologist who had last delivered a baby during medical school, perhaps 20 years previously. In the heat of the moment I didn’t think to defer to the OB nurse, who was clearly more experienced in this realm than was I. While the others watched, I put on exam gloves, got down on my knees, and felt for the cervix. My fingers encountered the baby’s crown, and a cervix that was probably dilated to 4 or 5 cm.
Though our patient wasn’t having definite contractions, our little team agreed that she could deliver quite soon. I communicated this to one of the flight attendants. Soon the captain emerged from the cockpit and met me just outside the exam room. I told him our concern, pointing out that a 26-week-old neonate would be just on the cusp of viability, and asked him how much further it was to Boston. He said it would take about three hours. Was there an airport any closer? Yes, he said, Gander. It was about an hour away. I had no idea where Gander was, but later learned that it was in Newfoundland, the most eastern bit of North America. During the first transatlantic flights it was the usual taking off point for planes heading east—they landed in Ireland, the westernmost part of Europe.
I asked the captain if there was a neonatal intensive care unit at the hospital in Gander (if there even was a hospital in Gander). “Oh, yes there is,” he said without hesitation. So I advised him to redirect the plane to Gander. He should call ahead and have emergency help ready to take our patient to the hospital. Though it seemed like the right thing to recommend, I went back to the galley and talked to my newfound colleagues, who supported my decision.
The captain returned to the cockpit and soberly announced that due to a medical emergency the plane would be diverted to Gander. The OB nurse stayed with the patient, and the others and I returned to our seats.
Soon we landed on a long, dark runway. This was unlike any airport I’d ever encountered–I didn’t see any other aircraft. The blinking lights on our plane’s wings revealed snow plowed up to about 15 feet on either side. The pilot officially announced our arrival, and informed us that the outside temperature was 20 below. We were advised to stay in our seats while the emergency was dealt with.
Looking out my window to the tarmac far below, I saw an ambulance approach the plane. Clearly, the terminal—if there indeed was a terminal—wasn’t equipped with a jetway big enough for a 747. Instead, a portable lift topped by a big square platform was waiting nearby. Two medics extracted a gurney from the ambulance and placed it on the platform, then hopped on. It scissored up to one of the exit doors, which was opened by a flight attendant. The very bundled up and cold- looking EMTs wheeled the gurney onto the plane and were directed down the aisle to the examining room. Soon our patient, swathed in blankets and strapped firmly to the gurney, was wheeled back down the aisle with her husband in tow. I got up and followed the entourage to talk to the EMTs. I told them key details of the situation and answered a few questions. Then I said to the lead EMT, “Wow, this place seems so remote. I can’t believe there’s a neonatal ICU near here!” “There isn’t.” he replied. “The nearest one is in Halifax. That’s a two-hour flight.”
My stomach flipped, and I was speechless. I fished out a business card from my wallet and gave it to the husband, who I hoped hadn’t heard what the EMT guy said. “Best of luck,” I said, “and please let me know how things go.”
I returned to my seat and watched our swaddled patient get loaded into the ambulance, which drove away in the darkness to who knows where. I never heard back from the husband.
Over the years I’ve thought about this woman many times. Where was she taken by the ambulance crew? Where and when did she deliver? And, of course, did the baby survive? Although at the time I felt quite confident that I’d handled the situation well, in all my retrospective musings I’ve never had good feelings about it. Neither the woman nor her husband were very communicative, but I have an uneasy sense that I didn’t do as much as I should have to try to draw them out about why they chose to get on the plane. Maybe they were desperate to get back to Boston for some important reason—a dying relative? A vital Christmas commitment? I don’t recall giving them any say in whether we continued on to Boston or diverted to Gander. But even if I in fact asked for and received their endorsement for the diversion, was that the right thing to suggest? Even if there really were an NICU in Gander, she may not have delivered for many hours, and Boston would have certainly been a better place to be for the care of a very premature baby. I also think I was foolish to have trusted the captain’s glib assurance that the Gander hospital had an NICU. Did he even understand what I was asking him? On reflection, why would he know anything about the facilities of a hospital near an airport where he never flew a plane? Clearly, I should have asked to communicate directly with the hospital, and probably to an obstetrician, who could have provided expert advice on the best course of action.
This experience highlights the responsibility we take on when we make decisions for others. Though perhaps most obvious in the case of physicians, police, judges, and of course parents, at times we all make choices–some trivial, some momentous–that affect other people. And no doubt, just about everyone has regrets about a decision they made that had unfortunate consequences. That’s life—none of us is perfect. But because of their potential effect, I believe that we have an obligation to carefully consider all our decisions, especially those that may affect others. Which, I guess, is pretty much all of them. For my part, I aspire to be as thoughtful as I can in making a recommendation, suggesting a course of action, or otherwise deciding something that may impact others.
(photo by Annie Klein)