Like many academics, Julie Gralow, MD, breast medical oncologist, University of Washington, Seattle, does a lot of flying to conferences and meetings. But Gralow also wears a second hat in her work: that of a professor of global health. And that role requires, in part, exactly what you would expect: even more flying. Perhaps not surprisingly, Gralow has repeatedly served as caregiver during in-flight requests for medical personnel. "I have responded to more than a dozen medical emergencies on planes over the years," she told Medscape Medical News. "I've always felt that's what we trained for. And that it's just the right thing to do." In most cases, Gralow helped out and then moved on from the event without fanfare or reflection. But her latest intervention produced an unusual response — not from the patient, or the flight crew or the airline — but from an onlooker who had no part, seemingly, in the drama. And Gralow eventually took to social media to document the experience — and her reaction to it. The event happened during her 20-hour journey from Tbilisi, Georgia, to Seattle (via stops in Istanbul, Turkey, and Chicago) last week. Gralow was returning home from a planning meeting of the Women's Empowerment Cancer Advocacy Network (WE CAN), a multiregional, international group that focuses mostly on breast and gynecologic cancers. Every two years, the Eastern European and Central Asian chapter holds a patient advocacy summit. Gralow's trip was in advance of the group's October 2019 summit in Armenia and involved meetings with local physicians, advocates, UN officials, and US embassy personnel. During the last leg of the trip home (Chicago to Seattle), as the plane began its descent (with the accompanying fasten-your-seatbelts announcement), there was in-flight request for professional medical help. Gralow and a paramedic volunteered. The person in need was a female passenger traveling with family to visit other relatives in Seattle. She had suddenly groaned, slumped over, lost consciousness, and was unresponsive. The woman was not responsive for 10-12 minutes and had a weak pulse, said Gralow. "It was a cardiac issue, likely," she said. The woman, according to her relatives, had a history of stroke and atrial fibrillation and was on the blood thinner warfarin. The caregivers administered oxygen (Gralow: "The flight crew brought out the oxygen really quickly.") and an AED was now on hand. The good Samaritans took the woman's blood pressure. Unexpectedly, the pinch of the blood pressure cuff caused the woman to wake up. Her weak pulse eventually rallied and strengthened. As the plane touched down, Gralow and the paramedic sat on the floor alongside the patient, who was now stable and alert. "That's the first time I've ever landed sitting in the aisle," observed Gralow. The events unfolded so late in the flight that an ambulance was not yet at the gate. Eventually, emergency personnel arrived and took the woman away to a hospital. Gralow disembarked from the plane and entered the terminal, assuming the incident was over. That's when a young man, a fellow passenger, "raced up" to her and handed her a note. Gralow was very surprised by the gesture. "I got a little emotional. I didn't think about how everybody else of the plane was observing this and processing this. We should be thinking about that in all of our actions," she said. Gralow's comments, she explained, were aimed at physicians and other healthcare professionals. On Twitter, she (@jrgralow) described the event and added, "Good to be reminded of how our actions are observed by & can impact the lives of many." In short, a life in medicine is one with often far-reaching consequences, Gralow suggested. Usually Helpers Get No Formal Thanks The fact that Gralow was so enthusiastically and personally thanked for her heroics is uncommon, apparently. Whether to volunteer for an in-flight medical emergency was the subject of a 2015 Medscape Business of Medicine feature that produced a strong response: 239 comments, many of which were lengthy and described readers' own interventions. There were a number of recurring themes in the reader comments, including the fact that airlines do not acknowledge or thank health professional responders. That galled multiple physicians, some of whom may have saved a life. Some Medscape readers observed that, in the United States, airlines rely on passengers with healthcare training to act as their in-flight medical staff and don't even have the decency to write a thank-you note. In her comments to Medscape Medical News, Gralow did not discuss that issue. She did, however, observe that emergency medicine is not her specialty. "As a breast medical oncologist, I'm not necessarily the best person when somebody is having a code," she commented. And for that reason, she has, in a number of instances, performed ancillary roles during an emergency medical intervention. She has also recognized, in her various experiences, that some in-flight emergencies simply require a cool head and a warm heart. In 2016, on a flight from Africa to Seattle, she responded to a woman on her way to visit relatives in the United States who was having a panic attack so severe that the flight crew did a "level one lockdown." That means the cockpit was locked to protect the pilots. The flight crew had notified aviation authorities on the ground and "we were about to divert the plane" (ie, perform an unplanned landing), said Gralow. The breast cancer specialist from Seattle and a registered nurse talked to the woman, who was sleep deprived, dehydrated, and hungry, for 3.5 hours, eventually establishing trust and instilling calm. The flight was not diverted. The woman, who was from Nigeria, finally was united with her family in Seattle. "It was all about understanding where she was coming from," said Gralow. She added: "Anyone can do something like that, even without medical training — it was about having compassion." Source
