Monday, 10 October 2016

Family Medicine Tales - The last argument.

 "Is there a physician aboard the aircraft?" The Captain's voice rang out over the intercom system of the 747.
    I lingered in my seat for a moment, as long my conscience would allow me to, hoping there was another physician on board who would come forward before I did.  This was the first holiday we had managed in two and a half years and our first trip to Hawaii. I  knew I'd been too preoccupied with work for too long, and hoped this holiday would restore us.  I pushed myself wearily out of my seat, and identified myself to the stewardess.
      "We have him up in first class, doctor, there's more room there. He's having a fit," She said.
      I rapidly moved up to the front of the aircraft, beyond the curtained partition, into the comfortable, spacious, first class area.  A disheveled, heavy-set man was convulsing on the floor.  A stewardess knelt beside him, trying to push a wooden tongue depressor between his teeth. White foam escaped from his mouth as amidst the seizing, he attempted to turn his head away.
      "What sort of medications do you have on board?" I asked the stewardess as I knelt down beside the patient, and taking the tongue depressor in one hand, I  firmly grasped the man's chin with the other, forcing his jaws apart sufficiently to insert the wooden stick between his teeth.
      "I'll get the medications bag," the stewardess said, moving quickly into the storage area in the front of the cabin.
      I  loosened the man's collar and tie, and then took the black medications bag that was handed to me.  I quickly rooted through it's untidy contents, then emptied it on the seat beside me.   I found a small cardboard container with some ampoules of phenobarbital, and a syringe and sucked up the contents of two of them into the syringe. 
      "Need any help?" one of the few passengers who had been watching apprehensively, asked. 
      "If you can give us a hand to get his jacket off, I'll be able to inject this right into the vein and get this seizuring stopped," I said.
      With the help of the man, and the stewardess we got the patient's jacket off and  managed with difficulty to get the needle into the vein and inject the phenobarbital.  A few minutes later the seizures had diminished, and the man slipped  into an uneasy sleep. 
      "Has this man anyone with him?" I asked the stewardess.
      "No," said the stewardess, "he's on his own."
      "I think he'll be okay now, but he should be checked over by the airport physician when we land.  We'll need to find out about his previous history, and if he's on any medications, to decide what needs to be done next. How long will it be before we land?"
      "About two hours, we'll radio ahead to make sure the airport physician is available to look after things".
      "Well, I'll go back and join my wife, you can come and get me if you need me," I said.
      "Would you give us your name and address, doctor, so we can account for the drugs we have used?"
      I gave them my name and address, and went back to join my wife.
      "No rest for the wicked," I said. "The least they might have done is moved us up to first class for the rest of the flight," 

      About three months after the Hawaiian holiday I had to attend a meeting in Toronto. The professional association to which I belonged and served on the executive, met several times annually, usually in Toronto.
    Earlier in the day, the chairman, Don Watson had suggested that after the meeting the group go out to dinner in a nearby restaurant that had recently opened.
      "Great," said Rick, "I hear this place is really good, although I haven't actually eaten there yet."
      "It's excellent," Don said, "Will I make reservations for about seven?"
      Everyone agreed that this would be a good idea, and a few minutes after seven o'clock, when I walked into the Magnolia Grill, everyone else was already working on their first drink.  Several members of the party spotted me enter the restaurant and waved to me.
      "I'm with the Watson party over there," I indicated to the hostess who greeted me.
      She waved me on, and I made my way through the noisy restaurant over to the group of seven physicians sitting in an alcove that slightly muffled the ambient sounds. I took the empty seat next to Joelle Levesque, one of the two women in the group.  Joelle was a lively attractive thirty two year old physician from Quebec.
      "Half the department heads in family medicine are so busy with their administrative work that they only see patients one or two half days a week.  No one can maintain either their credibility or competence with that limited amount of practice," Ian Hamilton was saying, "Hi Stan." he added as I sat down.
      "I hope you guys aren't going to talk shop all night. Haven't you had enough all day?"
      "Dr. Smith wants some scintillating conversation," Joelle Levesque said sarcastically."
      "Well, I wouldn't actually expect that from this group," said I facetiously.  At the same time I thought to myself,that no one seemed to think that was funny!
      "I just had an interesting experience on my way back from Moscow," Don Watson's timely interjection defused the developing tension.  "I got the Moscow - London fight, and we were barely in the air, when the Captain wanted to know  whether there was a doctor on board.  Well, I sat for a moment, hoping some eager young physician would rush forward and leave me sipping my scotch, but of course no one did, and I reported for duty to the stewardess.
      'just up there in first class, Doctor' she said'
      I went upstairs into a very fancy looking lounge, and found a perfectly healthy looking young woman, who had some pain in her left shoulder and had read somewhere that this can be the first sign of a heart attack, which very obviously it wasn't.  So I gave her the appropriate reassurance and was heading back to our rather modest seats in the back of the aircraft, when the stewardess said, 'we'd like you and your wife to enjoy the first-class facilities for the rest of the trip, Doctor.'  So Ann and I came forward and go the royal treatment for the rest of the trip."
      A chorus of "lucky so and so " went around the table.
      Then I said, "I guess that wasn't Air Canada, then.  Let me tell you what happened to me," and I recounted my story of a few months earlier, finishing with, "and I didn't even get a thank you note."
      "What you want, they kiss your ass?" Joelle said rudely, her French Canadian accent coming to the fore.
      "No," said I, a little taken aback at the strength of her reaction,and the obvious resentment in her voice, "all I wanted was a little common courtesy."
      Joelle pulled a cigarette out of the packet sitting on the table beside her, put it in her mouth and lit it herself, and then rummaged around her bag, finally pulling out a pen. (We all smoked like troopers in  those days, especially when we were drinking!) She then fixed her angry gaze on me.
      "What flight was this supposed to be on?" she quizzed me.
      "It was January 17th. Air Canada. I don't remember the number, but how many flights can there be from Toronto to Honolulu in any given time."
      "Yes, we can find that out" Joelle replied, noting the date that I had given her.
      "Why are you so interested in this?"I asked .
      "Because my husband is the Head of public relations for Air Canada."
    I couldn't suppress a chuckle."I see," I said.
      She scribbled furiously on the back of her cigarette package, her crescendoing anger becoming increasingly evident.
      "Air Canada routinely sends out a letter of appreciation all passengers who come to the aid of others." Implying I didn't mention I had received one.
      "I certainly didn't get one."
      "If you didn't, we'll check it out and send you one."
      She continued scribbling on the back of her cigarette package.
      "I will give this information to my husband and you will hear from him, if you didn't get a letter." she said sourly.
      "Don't worry about it," said I casually.
      The evening wound down uneasily, and at about 11.30pm the group stood  up and started their goodbyes.
      "See you in the morning," said Don Watson, "We should have our business completed by noon, so those of you with early flights should have no problem."
      The gathering broke up, with those with cars making sure that everyone had a ride back to their hotels.  

      Following the meeting I took a limousine out to the airport to catch the mid afternoon flight back to Saskatchewan.  I was glad to get back at a reasonable hour for a change and have a little time to spend with the kids before bedtime, and a pleasant long evening at home.

      Eight O'clock Monday morning, I was at Family Medicine Rounds.  The rounds, usually over by nine am dragged on until nine thirty.  As soon as they were over I slipped away to the office to check my mail as I had been away for several days.  It was the usual rubbish, advertising literature which had slipped past my secretary, usually not much did, some teaching activities from other departments that I wasn't much interested in, a complimentary copy of a book in which I'd written a chapter and some notifications of upcoming events.  A pretty boring assortment,all in all.  I was getting ready to go over to  the clinic, when the phone began to ring insistently.
 "Hello," .
 "Hi Stan," said Peter, executive director of the Association of Family Physicians, "I'm afraid I have some very bad news for you.  Joelle Levesque was pulling out of the parking lot, leaving the hospital this morning, when she slumped unconscious over the wheel of her car.  By the time they got her to the emergency department she was dead from a brain hemorrhage."
      "Oh my God," said I,wondering for a moment whether I had played some part in causing her death.
      "We are going to send regrets from the executive, and suggest that we would like to establish a scholarship in her name  As an executive member would you be supportive of setting up such a fund?" asked Peter.
      "Definitely," said I, for some insane reason feeling as though I had contributed to her demise.



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