Thank fucking god, I thought to myself, it doesn’t sound cardiac, pulmonary, or neurologic. I think this guy is going to be okay. The nurse next to me asked what I thought. I looked at her and tried to sound confident but the increase in pitch at the end of my sentence likely gave away my doubt, “a panic attack?” She concurred and suggested aspirin just in case. Good thinking, I thought, I am so glad you are here. Aspirin is the first step in cardiac care and has proven benefit. So I said outloud to the patient and those listening, “Though we don’t think this is cardiac in origin we are going to give you some aspirin. It’s only precautionary and won’t hurt you.” So the flight attendant got the aspirin and the nurse gave it to him.
It all started with the innocent little ding of the seatbelt noise on the airplane. “Any medical personnel on board, please ring the call bell, your help is needed at the back of the plane.” Before I had time to decide whether or not I was actually the medical personnel of whom they spoke, my friend in the seat next to me had already rang our call bell, forcefully, four or five times. Well, I am sure there’s a doctor on the plane, I’ll just go back and see if I can help.
I trail a woman who says she is a nurse to the back of the plane. When we reach the galley at the back I notice three things: 1) there is a sweaty man lying on the floor; 2) the only two people who have responded to the request for help are me and this nurse; and 3) I am sweating and after that long walk to the back of the plane my face is certainly bright red.
The flight attendant looked at me, are you a physician? No, I am a fourth year medical student (yes, I emphasized those words), can you tell me what’s going on?
I crouch down on the ground next to the man, ask him his name, and introduce myself as a fourth year medical student. “Bruce,” he responded. Okay good, I thought, airway intact. I did a quick survey, breathing is fast but unlabored, radial pulse is 110 and strong. Determining what appears to be immediate stability I continue with questions.
And so this, organized as a medical HPI (history of present illness) as I might present to an attending, is what we were able to gather:
50 year old man with a past medical history of asthma and high blood pressure is presenting with shortness of breath. The shortness of breath started about five minutes prior to presentation while sitting in his seat on an airplane, shortly after the initial symptom he felt as if there was mucous stuck in his throat. This made him aware of his breathing, which subsequently made him extremely anxious with associated feelings of imminent death. He was diaphoretic, lightheaded, and noted a tingling in his fingers. He denies chest pain, back pain, nausea, vomiting, loss of consciousness, or numbness anywhere in his body. He has no history of diabetes, his last meal was breakfast, he had only water on the flight, and took his daily hypertensive medication this morning as scheduled. His asthma is well controlled, he uses his rescue inhaler one every 3-4 months. He had one panic attack, one year prior, that felt similar but not identical.
The nurse mentions that she has a prescription for clonazepam, an anti-anxiety medication. She asks me if she should get it. Umm, why are you asking me? I’m a med student. And why is everyone is looking at me? Oh. Okay I get it. I am making this decision. I racked my brain for any contraindications. If this is cardiac clonazepam won’t hurt. If this is neurologic clonazepam won’t hurt. If it is a panic attack it will help, shit, even if it’s not a panic attack it will help. There are no contraindications with asthma, and in this situation with such a low dose I’m really not worried about respiratory depression. Is there anything else I should worry about? Fuck Shit Fuck. “Okay, go get it,” I respond. She returns and shows me the bottle. I nod.
Twenty or thirty minutes have gone by and I crouch back down by the man lying on the floor. “How’re you feeling, Bruce? Any changes?” “No, feeling a bit better,” he responds. But he looks terrified and his legs are trembling. I tell him that it doesn’t appear that anything acutely dangerous is going on and that I think he is going to be okay. Most likely this is a panic attack, but with the resources we have there is no way to know for sure and that I want him to go to the doctor when he gets home. “I am so embarrassed.” Don’t be, I tell him. I had a panic attack before and I felt like I was going to die, it’s a real and seriously scary feeling. I explain to him that if anything changes, if he starts having chest pain, if he starts having more difficulty breathing, if he feels numb anywhere, I want him to tell me or the flight attendant immediately.
We all stand around for another while, watching Bruce, checking his vitals, trying to think of things to talk to each other about. His pulse is down, his BP is down, he is looking much better. The nurse heads back to her seat. Slowly I start feeling like my old self again. I am left with Bruce and the flight attendant who asks me for help with the paperwork. I help her fill out the presenting symptoms and vital signs and I see there is a spot to write down the name of the medical personnel. I remind her, “You know, I’m just a medical student. I am not sure that counts as medical personnel?”