January 2003 — As Jayne, Howard and I prepared for our recent trip to India, our concerns for our health were foremost in our minds. Hepatitis vaccines, anti-malaria drugs, and bottled water were all injected, ingested or packed. I even carried a three-day supply of Cipro. We shared our collected advisories from friends, doctors and the CDC – don’t eat raw fruits and vegetables, brush your teeth with bottled water, eat only thoroughly cooked and hot food. Little did we know that one of the biggest health crises we would witness would occur only 90 minutes out from our stopover in Frankfurt, and at 37,000 feet.

With the cabin quietly settled in for a long haul, the flight attendant’s unexpected request for the assistance of any passenger-doctor went unheeded by those traveling around me. The announcement had almost the tone of the Hollywood cliché “Is there a doctor in the house?” Lacking any special medical skill, my colleagues and I could safely assume that a plane with passengers traveling from the United States and Europe must have a few physicians on board. A minute later, an announcement blurted in German began to raise our concern. A flight attendant then sprinted the length of the plane carrying an automatic electronic defibrillator, confirming that the situation was not a simple bump on the head or scraped shin.

It cannot be said that I have any medical training. I recently completed a basic American Heart Association layman’s CPR course. My wife’s job as a registered nurse in critical care has helped demystify healthcare in my mind. And I watch ER very closely. Assuming that more competent people were attending the stricken passenger, I ambled to the aft more to ease my conscience than with any expectation of what was to come.

Nearing the rear of the plane, fellow passengers pleaded, pushed and tugged me to the galley where a man in his sixties lay sprawled on his back. The AED already attached to his chest displayed nothing resembling a rhythm. A young woman frantically called out instructions to the 2 or 3 people fumbling to at once perform chest compressions, affix the oxygen tank to the ventilation bag, squeeze the bag, and dig through the available medications to find anything remotely helpful.

What followed were approximately 50 minutes of intense chaos all focused on the single, daunting task of keeping this man’s heart and brain alive long enough for the plane to land at the nearest appropriate airport. The woman leading the efforts was very stressed under the sudden and intense pressure. Her experience as an anesthesiologist in a U.S. hospital did not prepare her for a field environment one hour and 37,000 feet from much needed facilities. Her skills in cardiac life support would prove to be invaluable. I immediately took over performing the chest compressions and, as best as I could, I provided some moral support, constantly reassuring her and the other helpful passengers and crew that they were doing a good job and should continue calmly and carefully.

The anesthesiologist was desperate to find epinephrine. The drugs in the med kit were labeled with a mix of generic and brand names, US and European. Eventually some was found and injected in a vein in the hand. We started an IV in his arm and administered more epinephrine. We continued with compressions, stopping only when the AED alerted for a shock or when we needed to assess his status. The AED must have shocked him at least 10 times. Keeping a half dozen people clear of an electrical shock in the steel and aluminum galley is not easy.

The oxygen line from the tank to the ventilator bag kept popping off. One person wrongly connected the oxygen to the rubber facial seal on the mask – inflating and popping it, reducing the effectiveness of the mask and bag. The victim began exhibiting agonal breaths—final, desperate, and ineffective muscle contractions during respiratory arrest —falsely encouraging some of the helpers. The anesthesiologist swore she was going to pass out.

It was announced we were landing in Istanbul, Turkey. We needed to dump fuel, prepare the plane and cabin for landing, approach, land and taxi to the terminal. The plane seemed to take forever to land. The anesthesiologist and I were left alone with our patient during the landing— bouncing and lurching around the galley while trying to continue compressions and respirations.

Incredibly, by the time the Turkish medical technicians arrived, the AED displayed a sinus heart rhythm. We were able to stop the chest compressions, and he began to breath on his own. We had succeeded were I think we all thought there was no hope. I stepped aside to console the wife while the Turkish doctors prepared him for transport.

We left a horrific mess in the rear galley. Gauze, tape, cracked ampules of epinephrine, shredded clothing, dirty syringes, the AED.

After taking on fuel and resettling the cabin, we resumed our flight to Bangalore. Several hours out from Istanbul the crew received a Telex from Lufthansa’s Istanbul station. The man had been rushed into surgery for a bypass operation. That was the first and last update on his status that we were to receive. The remainder of the flight was punctuated by mini-reunions among those of us involved. We all consoled and applauded each other, buoyed with the belief that his condition must have been good enough for surgery and that was largely due to our efforts, and a good dose of assistance from a level higher than 37,000 feet.