Traveling

9:00 AM March 2, 2009 – Amsterdam Netherlands

When I climbed aboard the Airbus 330 at SeaTac airport, the overwhelming thoughts in my head were missing my wife and dog/cat, and the 90F 98% humidity weather I was headed towards. Reality not having set in, I settled into my seat for the 10 hour flight. As we passed the 10,000 ft altitude mark, the TV in front of my seat came to life. To my utter amazement, the in-flight entertainment was free! There were about 30 movies to choose from. I watched The League of Extraordinary Gentlemen, The Day the Earth Stood Still, and Australia – all of these having been movies I had hoped to see in the theater but didn’t have the time. We had a hot dinner (that’s right, actual steaming food in an airplane), followed by lunch, and then breakfast. I guess since we were flying against the sun, they decided to serve the appropriate meal for the time zone. Kind of fun to do it backwards! With dinner I had a glass of red wine – again free. Best flying experience I have had since first class during my honeymoon!

My seatmate was from Germany, and we talked about Bush, Obama, healthcare plans, skiing in Whistler, and good German beers. Not a bad chap. Of course we had the token, “is there a doctor on board the airplane” on this flight, but thank god there was a real doctor on board (as apposed to the Italy trip) because this afflicted passenger was suffering from a bad case of the panic attack. I preferred my movie.

In between movies I brushed up on childhood malnutrition, dengue fever, malaria, filariasis, and other things not often encountered in Seattle that I might see. I sat imagining what the clinic might be like, what the patients would present with. Reading through the 2” thick Oxford Manual of Tropical Medicine, I was beginning to feel woefully inadequate as I haven’t seen most of these conditions in person. I’m excited to see what it will be like 5 weeks from now looking back on what I have learned.

I landed in Amsterdam after having a wonderful flight. With about 1.5 hours to kill, I bought 15 minutes of Wi-fi and instant messaged with Agatha. It was wonderful to get to talk to her before she went to bed. I now have a pinwheel Danish and a cappuccino sitting at a café in the local airport – the 4th largest in Western Europe. I’m continually amazed at how much English is spoken around the world. All the signs are in English, and everyone around me is speaking English.

Well, my flight will be boarding soon for India. Should be a similar plane, but I think I’ll sleep this one out as it is 1:10AM now Seattle time, arg. Maybe I’ll be so screwed up on the other side of the globe time wise that if I get enough sleep on the plane, I can convince myself that it is the appropriate time! Good training for night shift work as an ED doc I guess.

12:30 AM March 3, 2009 – Mumbai

My flight from Amsterdam to Mumbai started out wonderfully. My seatmate was a pleasant woman from Finland who was originally from Seattle. I finished the last 20 minutes of the movie that had been previously cut off during my last flight, and got about 4 hours of “sleep.” During our landing approach, a commotion erupted in the seats behind me and to the left. A person was slumped over in his chair, and a flight attendant was violently banging him on his shoulder trying to arouse him. Of course the “is there a doctor on board” call went over the PA, and I nestled into my seat assuming that there would be many doctors on this flight. Nope.

I pulled out my stethoscope and began working this gentleman up for altered mental status… squished between airplane seats and fighting turbulence. He was breathing and had a strong pulse, but he was unresponsive. I have the crew grab the on-flight oxygen and medical kit. We gave him some oxygen and he started localizing to pain, and progressively became more combative, but still not verbally responsive. The first aid kit did not have a glucometer, so I had them page the overhead system to see if a passenger had one. 70, not bad. He had been seen sleeping for most of the flight and possibly ataxic as he sauntered down the airplane isles. I didn’t want to try starting an IV on the plane because he was agitated when people touched him, and I didn’t want to risk hurting him or the crew assisting me. It would have been nice to give him some D50 and see if he responded, as I’m not sure if I was using the glucometer correctly – maybe the 70 was the owner’s last reading and not the patient’s. I figured that giving him some oxygen and keeping an eye on his vitals was as good as we were going to get seeing as how we were approaching the airport.

When the paramedics arrived after landing, in regular shirt and ties, they touched him a little, asked him some questions in English, put their thumb to the radial artery to get a pulse, and declared he was OK and that there were no problems. Now 35 minutes into the ordeal and landed, he was starting to wake up a little, but definitely altered and a little confused. The Mumbai based medical crew began sorting out his social issues on the plane… how he didn’t like his wife, how he… and so on. I was beginning to wonder if we would ever get this guy off the plane. One of the flight attendants asked me if this was normal and appropriate. I said that I had no idea what was normal and appropriate in Mumbai, and that it was certainly not my place to say otherwise unless the patient was looking critically ill.

With his condition improving, although be it a mystery, I disembarked the plane, only to be greeted by a representative of Sri Lanka / Northwest airlines. They wanted to see all my documentation again, and when I pulled out my boarding pass from my document carrier, I only had one baggage slip. When I departed Amsterdam, the desk clerk removed my baggage slips and moved them to another boarding pass. One must have been lost during the transaction. I now sit outside the security check at a little table surrounded by men in drab green army uniforms and Soviet machine guns typing this blog. A flight representative is looking into whether or not I can bring the other bag with me to Sri Lanka – whichever one it is. Either I don’t get clothes and shoes… or the Koelmeyers don’t get ½ their goodies from the US. Hopefully they can figure it out so I can bring both. Ah…. I love traveling!