I was reclining on an easy chair in the balcony of the Dean’s bungalow engrossed in the saga of Sir William Halstead’s biography ‘Cancer Cocaine and Courage’. A steaming cup of coffee stood on the small table next to me. I was engrossed by Halstead’s fight against his cocaine addiction. He had gone on a cruise to the Caribbeans to get rid of the curse of addiction. On one of the islands he diagnosed a boy with a ruptured appendix. There were no surgeon on the island and finally Halstead operated on the boy miraculously saving his life. Very gripping stuff. My coffee was forgotten, getting cold….
“Hi luv, there is a call for you,” Naina called out to me. I reluctantly abandoned the book to answer the call.
“Is that Doctor Shirahatti?” The voice over the phone inquired. The Irish brogue was very prominent but familiar. It is he, I admitted. “Guru! this is John from Sheffield.” informed the voice. For a moment I had no clue as to the caller. Suddenly it hit me! It was John O’Brien from Liverpool. We had met during a training course in Liverpool two years ago. We had hit it off instantaneously, joshing each other about our accents and trading insults. He was a Senior Registrar in Liverpool and was due for a consultant’s post. I was in England for my Commonwealth Fellowship.
“I bet you can’t guess where I am speaking from!” John said. Not from heaven, surely, I responded, tongue in cheek. “Close enough boyo, I speak to you from close to 40000 feet in the air. I come to you dear boyo, from the cockpit of a British Airways 737”
John was flying from Liverpool to Beijing to attend a conference. While they were flying over Iran when a man sitting next to him just keeled over and collapsed. John, if nothing, is a first rate physician. He felt for the pulse and found it to be irregular and very weak. The man was sweating profusely.
“It gave me real bluidy shock, I tell ye. Here I was, enjoying an after dinner brandy and this guy does the collapsing act! I think he has a myocardial. Needs urgent ICU admission and possibly intervention. The situation was grim. The Air Hostess, a very pretty lass, was wringing her hands. The captain came out of the cockpit. There was a midair conference. The upshot of all this was that the plane would be diverted to the nearest airport and the passenger offloaded. Then I remembered that you had become something of a big noise in Mumbai. I offered to speak to you and get things organized on the ground. So get your brown backside off and rush an ambulance to the airport. We are landing in Mumbai in about an hour’s time. I trust you Indians can do something this simple?” John chortled on the phone.
“OK, you Irish freak, the ambulance will be there. You owe me one. If you welsh, I will set the sassenachs on you!” I disconnected. I fell into thinking. We had no equipped cardiac van to transport patients. I pulled on some clothes and rushed to the ICU.
We rigged up our ordinary ambulance with an ECG monitor, oxygen cylinder and defib machine. I asked the cardio registrar to stock up the ambulance with cardiac resuscitation meds. I requested the anaesthesia HOD to send a registrar to travel in the ambulance, kitted out with tubes and an ambu bag. I called Dr Kale, our cardiologist and asked him to come down and get the angiogram suite ready. We worked feverishly and the ambulance was ready in less than half an hour.
When the plane landed in Mumbai, our ambulance was waiting on the tarmac. The patient was loaded into the ambulance. He was intubated in the van and oxygenated. He was rushed to the ICU. An ECG confirmed an anterolateral infarct. He was pushed into the angiogram suite, where Dr Kale was waiting. He underwent an emergency angioplasty. The whole thing from the cockpit call to the angio suite had taken less than three hours.
The next day, I visited the patient. He was sedated, but stable. The danger had passed. We transferred him to a private hospital for further management. I felt a glow of a job well done. It was possible after all to save lives by timely evacuation and treatment. I felt proud of myself. Many people congratulated me. I started to believe that it was possible to provide emergency care that could rival the best in the world.
I opened the newspaper the next day and my euphoria evaporated. “Doctor from Sion Hospital almost bleeds to death on the platform!” screamed the banner headline. One of our lecturers was traveling to the hospital by the fast local. The compartment was packed to the rafters. Prashant was hanging on to dear life. Suddenly the train gave a lurch and he was thrown out. Both his legs were crushed by the merciless wheels of the train. Someone pulled the alarm chain, bringing the train to a stop. Helping hands loaded Prashant into the luggage compartment, which was uncluttered. He was offloaded onto the next station, bleeding profusely all the while. He lay on a stretcher in the far corner of the platform while the police and the station master argued about whose responsibility it was to evacuate him. Finally, it was a porter who took matters into his own hands, loaded Prashant onto the next train and brought him to the trauma ward. Prashant was brought in the nick of time. He was in severe shock and needed several transfusions. One leg had to be amputated but we managed to salvage the other. I went to visit him. He was still groggy but conscious.
“I almost died there, Sir” he told me weakly. “I kept telling those idiots that I was a doctor and that they should get me a rope, a belt, anything that could have been used as a touriquet. But they were more concerned about whose jurisdiction did the accident happen and who was responsible for me. I thought I would die forgotten in that godforsaken corner. Someone told me about your evacuation of a patient from the airport yesterday. Can we not set up something similar for railway accidents?” I had no answer……