A nurse practitioner recounts her experience assessing a sick passenger on a flight from the US to Hong Kong.
Late in 1998, my husband and I were on a long-awaited flight on a 747 from Los Angeles to Hong Kong—the last leg of our journey to adopt our baby daughter. Traveling with a few other American couples (also adoptive parents-to-be), we saw many Asian and other international passengers. We could barely contain our excitement.
We had been prepared for a long trip, beginning with our initial flight from the East Coast—almost 20 hours to our arrival in faraway Asia. We were seated in coach, crammed three passengers across, with every seat filled.
Four or five hours into the flight, a request came over the intercom for any medical doctor who might be on board. A few minutes later, the announcement was repeated, but this time the request was for any medical practitioner. Hearing this, my husband nudged me awake, and within minutes, I was telling a flight attendant that I was a nurse practitioner. Apparently the only other person who had responded was a female obstetrician from India who spoke very little English.
The attendant quickly described the emergency. An Asian man was in distress and needed immediate assessment. I was whisked to the seat of a middle-aged man who appeared very anxious, complaining to his wife (in Cantonese) that he felt horrible and was feeling worse every minute. Fortunately, the couple was accompanied by an Asian interpreter, who relayed to me that the man had high blood pressure and had not taken his medication in several days. They had been touring the United States and were now returning to China. Unbeknownst to his wife or the interpreter, he had felt ill for several hours before boarding the flight.
The flight attendant handed me a blood pressure kit and brought portable oxygen. I took the man’s blood pressure and started the oxygen. It was difficult to hear, and I double-checked the first reading by palpation. His blood pressure was sufficiently elevated to suggest a serious emergency. His vital signs indicated a regular but rapid pulse, clear lungs, and slightly dyspneic breathing. I attempted to get more of a medical history through the man’s interpreter.
The flight attendant asked, “What should the captain do?” I never would have guessed that an NP’s recommendation would hold so much weight in a situation like this—flying somewhere over the Pacific Ocean, hours away from our destination. I responded that at the very least, the man was having a hypertensive episode—but at the very worst, he could be having an impending stroke. I offered to stay right beside him and monitor him; I added that the oxygen was helping to make him comfortable but that his blood pressure was still very elevated.
Within several minutes, the captain announced that our huge plane was going to make an emergency landing in Tokyo. The staff had tried to get permission to land on Guam, but the landing strips there would not accommodate a 747.
No sooner had the announcement reached our ears than I could hear several passengers begin to complain loudly, angry that they might miss their connecting flights. When those seated near the sick passenger discovered his illness was the cause of the emergency landing, they had absolutely no concern for him. The flight staff expertly defused the complainers.
As soon as we landed, a small but officious group of Tokyo police came on board and took off the sick passenger, now vomiting, along with his wife and the interpreter. No medical personnel came aboard, and we were not informed whether the man was going to be taken to a hospital or an emergency department.
While the plane was being refueled, the Tokyo police would not permit any passengers or staff to exit the plane. A long hour or so later, we finally took off.
I was ready to return to my seat and try to get back to sleep, but the flight attendants told me, “No! You and your husband are going to fly first class for the rest of the flight.” Someone brought us socks and slippers, and we received carte blanche service, with comfortable reclining seats and movies included. Our flight eventually landed 23 hours after our initial East Coast takeoff.
In retrospect, I have always felt very grateful for the captain and staff on that flight, and I still hold them in high regard; they did not hesitate to take prompt action to address this urgent situation. A flight attendant confided that when the captain radioed my assessment to his medical connections on the ground, they instructed him to land the plane as soon as possible and have the sick passenger taken off. Had a medical person not been on that flight, the pilot and crew would have helped the man themselves, as best they could—all the while aware of the sobering outcome that might lie ahead.