Impending delivery at 35,000 feet
About 5 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)
Ken, This is an amazing essay! It reads like a film script. And, your observations about how we communicate are so spot-on. I’m going to send this to my daughters; then, I’m going to read it again! Thanks for sharing. Sincerely, Carl
Annie, Your photo is terrific! It made me feel like I was on the plane.
Ken’s essay reminded me of this quote:
“The biggest single problem in communication is the illusion that it has taken place.”
GB Shaw
Thank you, Carl, for your kind words.
Carl, I really like the quote you included in your response to Ken’s blog. So true in many cases!
Ken, at first glance I thought you were referring to a package!
When did it actually happen?
When I read that her water had broken in the airport I was flabbergasted.
Beautifullly written essay.
Thanks, Andrew! I can’t recall exactly but it was sometime in the early 1990’s, say about 1993 or so.
Dear Annie and Kenneth. I always open your written work with the great expectation of hearing about some new or past adventure and how it has factored in the development of your personal philosophy related to how life should or can be lived! This latest offering brought back a number of vivid memories of critical decisions in which I was directly involved as a paramedic in an isolated part of Vancouver Island in the late 60s and early 70s before morphing into a secondary school English teacher!! Although my training and experience was but a mere shadow of yours, there were a number of times when I was forced by the immediate situation to make critical decisions based on my knowledge and what resources were available to me! Your story brings to mind the nagging post-event soul searching and critiquing of the decisions made “ in the heat of battle!”! In looking back as you have done , I believe those seven years under pressure formed my ability to work more successfully with the development of minds, emotions, spirits and the stimulation of knowledge among the young secondary students that I was was privileged to teach in English over the years! As I’ve said before, I really love and enjoy the fact that you are willing to put your thoughts and adventures out there for the enjoyment and stimulation of our minds and souls!! Coffee and great food is always available at our place when next you visit Victoria!! Carol and Dennis. Are you acquainted with the writing of Vietnam Vet , Tim O’Brien ?….” The Things They Carried” and “ If I Should Die In A Combat Zone Box Me Up And Send Me Home”. ?
Thank you, Ken. We never forget these experiences. We do the best we can and later critique ourselves, because we care. But, hindsight is a cruel measuring device. Your story made my heart race, as I was thinking how I would keep that infant breathing. I will be thinking about this essay for a long time….
I don’t think I’ve heard this story in such great detail before (like the part about the snow being piled up 15 feet next to the runway, and how the pilot assured you of a NICU that didn’t actually exist). Wow, what a drama! It must have been such a hart sinking moment to hear the EMT say the closest NICU was two hours away. It would be so interesting to learn the rest of the story!
Ken, Thanks for another beautifully written and interesting, meaningful story. And it has Canadian content, about which I will point out that there is, at least now, an NICU in Newfoundland. It’s in St. John’s, about an hour flight from Gander. This post also resonated with me, as do many of your posts, perhaps because of our similar ages and backgrounds. I sometimes reflect on professor-student situations where my decisions about marks, appeals and admissions have affected students’ future careers and what goes with that. Here is one example that quite moved me.
I barely knew this student who was taking a course from me in his last term before graduation, and the last time I taught the course since I was about to retire. The only times I saw him in class was at quizzes and the final exam, where he seemed to be struggling. Before the exam, he came to my office and politely (though perhaps nervously) explained that he had a lot of other things going on, hoped to pass the course by studying the online course notes, and intended to go on to graduate school. Of course, as the instructor, I had an obligation to mark fairly – not give any students special treatment. Unfortunately, though not unexpectedly, he did poorly on the final exam and his final mark was calculated to be a few % below the passing mark of 50%; failing the course could have resulted in him not graduating that term and not get into graduate school. That presented a challenge to me. I had to make a decision that had major significance to him. In the end, I decided to give him a passing mark (50%), thinking that graduating and his future were more important than me being a strict marker, and that those considering his admission to graduate school would decide how to deal with the barely passing mark. Basically, it was an opportunity for me to be generous in my decision making, and I took it. But I wondered whether I made the right decision, and since then wondered whatever happened to him.
Fast forward 7 years to 2018 when I saw an article about this ex-student. It talked about his many accomplishments (tech entrepreneur, philanthropist, professional musician), calling him a polymath. Apparently, all of these other interests were what he meant by “he had a lot of other things going on” besides my course. I decided to contact him to congratulate him and recount my recollections.
He wrote back: I remember that time in my life very clearly and I remember leaving your office feeling defeated … and feeling that it would be difficult for me to articulate the opportunity I required to hopefully make it through your class. So much of the world is run without compassion, people stick to the rules stringently, …. I came to speak with you because I found myself in a situation where I needed you to extend a kind hand. Not just as my Professor, but as a fellow human being…. To be honest, you made me feel as though you were going to remain true to your obligation, … I put as much time as I could, given my situation at the time and remember leaving the exam feeling as though I had done what was needed to get done. I felt confident that I did well enough to get my 50% and left that exam room with confidence that made me feel as though I could do anything, even when life was pushing back against me. My final grade arrived, and I saw the 50%. My confidence exploded. I took that confidence and started a small company that did well, I completed my 2 year masters in 13 months with a 4.0 GPA, began developing a music career, and enrolled in a PhD which I plan to defend by the end of this year.… Behind the scenes, you had a moment of compassion and your small act has manifested itself in my life in profound ways. You deciding to give me the passing mark created a drive in me that I have been using ever since. …. Your decision to do that after the stern conversation you had with me….I cannot thank you enough. I have been through a lot in my 31 years, and I know that sometimes we need to bend or even break rules to help people out, ultimately we all die and most things don’t really matter. Things that we protect, or hoard get left behind, and the only thing that lives on is how we make people feel. Thank you for taking a chance on me….
Ken, I recently found online that he completed his Ph.D. in engineering, and has continued to do professional music, tech consulting and philanthropy. I am fortunate to have found out what happened to him, and that I made the right decision. And fortunate to be reminded that some of relatively simple decisions can have had profound, unexpected positive (or negative) effects. Perhaps the mother on the plane gave birth to a now 30-something who may now be a mother, and perhaps a doctor.