, , , , , ,

For the friends of Left on Longwood, It is shaping up to be a busy season for Good Samaritan medical adventures. A couple of days after I posted a piece on in-flight medical emergencies which included reflections on my own volunteer duty, Drs. Kathy and Rhea Sumpter had a harrowing experience on a return flight from the Northwest. A man in his late 20s who appeared to be intoxicated aspirated and lost consciousness. They stabilized his airway and provided rescue ventilation for about an hour until the plane was diverted for an emergency landing. They were met at the gate by paramedics who promptly intubated the man in the gateway. Of course, the doctors who saved the man’s life will never know if he made it out of the ICU or whether he suffered permanent neurological damage. Delving into the literature and industry stats, I was amazed by how frequent in-flight medical emergencies are. The first-hand experiences that many of you, our dear readers, have had only emphasize the point.

On Saturday, I was slowly making my way through the buffet queue at our synagogue. Shabbat morning service was pleasant and brisk. With lay members of the congregation leading services during summer vacations, things tended to run a bit ahead of schedule. The melodies of our Cantor’s incomparable singing played in my head and I hummed along.

“We need a doctor!” one of our congregation’s most charming members called out in his South African accent. He had rushed into the hallway from the seating area next door. His tone was alarming. Mostly snapped out of my reverie, I set down my plate of bagel and salads, and followed him through the doorway. I was thinking, “Oh shit, what is this going to be.” Then a hopeful thought, “Probably someone just vaso-vagaled” (after all, it was a gazillion degrees outside and plenty warm inside). At the first table, he directed me to an elderly man slumped over a plate brimming with food. Seven or eight other lunchers sat quietly at the table looking on.

The man was as white as the tablecloth. He was hunched over, motionless. I wasn’t sure if he was breathing, but he didn’t seem to be. I started calling out “Sir, are you OK” while trying to rouse him by shaking his shoulders. Nothing. I took his heavy, wrinkled hand and started hunting for a radial pulse. It took some time, too long. I started to feel sweat prickles of nervousness. I found a pulse but it was weak. I tried to find a carotid pulse in his doughy neck, also weak.

By this time, two other volunteers joined me. One of the gentlemen I recognized as an active member of the shul who had just chanted the week’s challenging Haftorah portion (he had already more than earned his lunch). We exchanged a couple of quick phrases and agreed to get the man down on the floor. We lifted him up and out of his chair, each with a firm grab of his baggy trousers. The man hunched over further, folding up on himself. We laid the man flat on the ground. Someone said that they were calling 911. The Haftorah-reader crouched at his head. The other physician and I were alongside his chest. The man was not breathing. I re-checked the radial pulse and could not find it. The man to my right said, “OK, I’m going to do some chest compressions”. He nested his hands, placed them on the man’s chest, and plunged twice.

I saw a plug of food come up into view in the back of the man’s throat through his parted lips. I pointed this out to my colleagues; we rolled the man up onto his side. The Haftorah reader swept his finger into the man’s mouth and pulled out a large chunk of plain bagel. The doctor to my right applied a few vigorous smacks on the back. We fished out more food. We rolled the man on to his back. After a moment, he started to breathe spontaneously. His airway was floppy and he seemed to do better with the help of a jaw thrust maneuver. I announced that his pulse came back and was strong. We rolled him up on his side several more times to clear out more food.

The doctor to my right said, “Ok, alright, we’ve got him back.” Someone dragged a couple of seat cushions over to the man’s feet and urged me to help him prop the legs up. The three of us conferred quietly. The chest compressions effectively dislodged the bolus of food. We speculated on whether the cardiac arrest preceded the choked airway, or vice versa. “I’m sure that I broke two or three ribs,” the doctor to my right said. I tried to assure him that there was no choice. The elderly man started to respond, we addressed him by the first name that was relayed to us.

It did not take long for the professionals to arrive, no less than eight Dallas paramedics in blue polo shirts and commando pants. They put the man on oxygen quickly. The first set of vital signs was a heart rate in the 80s, a blood pressure of 130-something over 70-something: encouraging. The three of us huddled off to the side and watched them move the man on to a stretcher. They did not seem to need to ask us what had happened, they already knew what they needed to know. We saw the man and the crew out to synagogue’s marble foyer.

The room settled down to the Saturday afternoon norm. People filed up to the front of the room, where I stood with the other doctors, to claim the choice desserts. Some people congratulated us, in Hebrew and in English, as though we had just read from the Torah. I held my plate of food, which someone had put off to the side, while conversing with the doctors. The man who did the chest compressions was an Ophthalmologist. He told a story about the last time he had to do chest compressions, years before in the lobby of a hospital. He joked that he was going to help out by doing a cataract operation while the other doctor and I resuscitated the man. The Haftorah-reader was an internist, a senior administrator of one of Dallas’ large hospital systems. He told us that he only occasionally works as a hospitalist. The man who was fussing around with propping up the man’s feet while we still were working on stabilizing the airway was an orthopedic surgeon.

This was a debriefing conversation. Although we were relieved that the man was alive, we were all rattled and worried that we had done the right things. We pointed out numerous things that could have gone better – we probably should have started with a few abdominal thrusts a la Heimlich maneuver before doing compressions. My initial assessment should have been faster. I should have had him down on the ground and started working on his airway immediately. Again I was disappointed that I had to work through moments of hesitation while trying to respond to the emergency. I worried that the already frail man was going to be in for an extended ICU visit and that he would still need to be intubated with a severely fractured chest wall. I realized that I was really hungry. I wanted to be polite and participate in the conversation, but really just wanted to sit down and eat.

The following day, the president of the synagogue (a role which must not be that far down from President of the United States on the list of impossible jobs) called. She is a wonderful woman, warm and welcoming with an unexpectedly sarcastic sense of humor. Coming from a medical family, she is well versed in all types of health emergencies. She waited at the entrance to direct the paramedic team and accompanied the ambulance to the hospital. When I asked about the gentleman, she responded in an ironic voice, “Discharged!” I was very surprised. I figured that he was in for a tough road and a long hospitalization. She told me that the doctors thought that he simply choked and that everything else checked out. The president thanked me repeatedly and kindly. She related the lucid conversation that she had with the man in the emergency room. He responded immediately when she asked him for the name of his doctor. When she asked, “Who is your cardiologist?” he replied, “Your husband!”