Dr. Joyce Chen, Interplast Webster Fellow.
An hour into our red-eye flight from Miami to Lima, on Interplast’s inaugural team trip to Pucallpa, Peru, a flight attendant announced over the loudspeaker that they needed medical help at the front of the cabin. I, along with two Argentinean physicians, a cardiologist and a critical care physician, responded.
The flight attendant had watched a passenger collapse in front of the bathroom. She was immediately laid down on the floor with her legs propped up above her heart to facilitate blood flow to her head (this is called the Trendelenburg position). The patient was diaphoretic (perspiring heavily) and pale but had a nice, steady pulse. My years of general surgery and trauma training suddenly rushed back to me, and my examination and assessment of her were very second nature. With diabetes, cardiac disease, and head injury ruled out, we learned that this passenger had high blood pressure and had last taken her blood pressure medication during her layover in Miami. The Argentinean cardiologist checked her blood pressure which turned out to be low. In order to increase the amount of fluid circulating in her system and thus increase her blood pressure, we asked her to sip orange juice from a straw. After two full glasses, she pinked up, looked and felt much better. Her blood pressure had already improved!
As we were watching our patient recover, I was able to enjoy a conversation with my two new Argentinean friends. They had attended an international meeting of cardiac-lung transplantation in Chicago and were heading back home to Argentina. They had missed their Dallas, TX connection and were rerouted via Miami, FL and Lima, Peru to Argentina.
Before we left our patient and headed back to our seats, I asked her to see a doctor the next day at home in Lima to have her blood pressure checked and to make sure she was OK. She agreed and then graciously told us “grazie mille” with a genuine smile. Both she and the Argentinean cardiologist were of Italian descent, and I had mentioned to them that in college, I had taken some Italian and studied in Florence, Italy. My last thoughts as I drifted off to sleep…tiramisu, Michelangelo, Vivaldi, BUONA NOTTE!