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    Is there a doctor on board?


    A headshot of Yalda Afhsar, MD, PhDInbox: “0 unread messages.” EMR in-basket: “0.” The 24-hour-call before vacation had been quite productive: emails were responded to, charts were completed, and phone calls made. The service was running smoothly and as such, sign-out was brief. Vacation was at my fingertips. I would plan on going straight to the airport. My backpack was already in the trunk. I would not dare waste a minute and had anticipated my standard back-seat wardrobe-changing routine and light, no-check-in bag.

    Six hours into our transatlantic flight, deep in REM sleep, with no worry but a week of agenda-less frolicking, I thought I heard my pager. Impossible. I did not have one on. Again, there it was: “Attention, ladies and gentlemen, please identify yourself if you are a physician,” I heard on the overhead speaker.

    Back in row 47, where I was wedged in a non-reclining middle seat (tough luck when you check in 40 minutes before the flight), I stood up to scour the aisles, hoping somebody would respond. Nothing. Please let there be an internist on board, I thought to myself. Could I be lucky enough for a precipitous delivery? Nope. I started running codes in my head and imagining trauma-level hypothetical situations. I hoped treatment algorithms were stored somewhere in my brain. A-B-Cs, I reminded myself, ACLS, chest pain, an approach to aortic dissections. Please no. I walked to where the flight attendant was standing and thought to myself, “Ob/gyn residency sure does lack in general medicine training.” No time to think about my desire to revamp medical education now. I began visualizing the pages out of Pocket Medicine as a shower of horrific situations went through my head. The flight attendant smiled and I identified myself as an ob/gyn resident physician who might be able to give a hand.

    In seat 5A, I met my patient. He* was a lovely 68-year-old gentleman who had become light-headed and felt like he was going to pass out when coming back from the restroom.

    According to the International Civil Aviation Organization (ICAO), there are 2.75 billion airline passengers annually worldwide and that number continues to increase. During those flights, there are 11,920 in-flight medical emergencies—one medical emergency per 604 flights or 44,000 medical emergencies annually.1 Luckily for us ob/gyns and our patients, in-flight obstetrical emergencies are rare, confirming that air travel is safe during pregnancy, generally until about 36 weeks’ gestation.2



    * The last time I had a male patient was medical school. The physiology should be the same, right?

    Yalda Afshar, MD, PhD
    Dr. Afshar is a Maternal-Fetal Medicine Fellow in the Department of Obstetrics and Gynecology, University of California, Los Angeles


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