BUMP UP

By Hamish MacLaren
Contact the author via the editor by e-mail at christopher.johnstone@ntlworld.com

This happened last year on a British Airways 747 scheduled to depart for Singapore from Heathrow at 2200. It was the beginning of February and that day there had been a huge dump of snow across the south east of England. Consequently everything had come to a standstill. A backlog of departures was stacked up on the stands outside Terminal 4. At the BA desk an official was inscrutably dispensing parsimonious information. I tried to gatecrash the BA executive lounge with my blue card and was politely but firmly turned away. I went to the toilet and struggled into a pair of full length surgical stockings as protection against economy class syndrome. We boarded at 0130.

And sat on the apron for two hours. Then a machine with the contour of an enormous stick insect de-iced the wings and we were pushed back. The taxi around the airfield perimeter took so long that I began to wonder if the entire journey was to be undertaken on the surface. My left calf was beginning to ache and in the seat in front of me a child was screaming inconsolably. The thought of the impending thirteen hour flight was unbearable. At the runway holding point we came to a halt and there was another inexplicable delay.

By this time I was in anguish with sheer boredom. When the call for “doctor on board” came over the PA system I jack-knifed out of my seat so violently that my headset almost ripped my ears from my skull.

The patient was lying supine in the left hand aisle at the rear of the aircraft. The cabin crew had already put an oxygen mask over his nose and mouth. First Aid is as easy as ABC. Airway... patent; breathing... satisfactory; circulation... his radial pulse was thready and his skin cool and clammy. A crash box had materialised at my side and I extracted a stethoscope and a sphigmomanometer. It was impossible to hear the Korotkoff sounds above the din of the air conditioning, but I could palpate his systolic pressure coming in at about 70 mmHg. After ABC comes D, for neurological disability. Rather a lame mnemonic! I pushed a knuckle into his sternum and he opened his eyes.

“Was mah nah?” The smell of stale liquor was almost comforting, and who could blame him? How else to while away the hours in Terminal 4? The cabin crew nudged my arm and whispered, “Here’s the captain.”

We shook hands and exchanged courtesies. He said, “What do you think?” After D comes E, for environment, and this patient was definitely in the wrong one. I said, “I think we should get him off.” Actually I was really thinking how extraordinary it was that from having been an anonymous cipher in seat 60K a few moments ago I was now giving advice to the man in charge. But he looked relieved. He confided, “You know, we’d just been cleared by the tower. If he had collapsed literally thirty seconds later I’d have been committed. We would have had to climb to altitude, dump over 100 tons of fuel, and land again.”

I love opportunistic medicine; all your professional life you worry, not about the patient in front of you, but about all the other patients in the waiting room. Off-duty medicine affords you the rare chance to live in the present.

Seven hours later, the cabin crew knelt by my berth, seat 3F, and whispered, “Are you awake? Would you like to see Kabul?”

The Afghan Highlands, in their winter livery, looked very beautiful. But that was from seven miles up.

Other online articles by Hamish MacLaren can be found at:
hoolet edition 50 - Pilchard
hoolet edition 49 - Truth or Dare?
hoolet edition 48 - Zeitgeist
hoolet edition 47 - Appraisal Appraised
hoolet edition 45 - Truth or Dare?
hoolet edition 44 - Reverie in a Sauna
hoolet edition 43 - Bump Up
hoolet edition 41 - Mayhem, Clock and Anti
hoolet edition 40 - Christmas Night on Call

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.