En Route to Afghanistan

23 November 2017

I hadn’t even arrived in Afghanistan and already I was being woken up in the middle of the night.

“Doctor, you’re needed upstairs. Come please.”

It was my second flight of the day and I was exhausted. After a trans-Canadian flight, I was en route to Dubai for a short stopover to pick up my Afghani visa before proceeding onwards to Kabul.

When I checked in earlier, the women at the counter informed me that there were only middle seats remaining for the 12+ hour transatlantic flight.  She must have seen the disappointment in my eyes because she began tapping away on the keyboard, her eyes scanning the computer screen.

“How does the first row of the plane sound?” She asked. “It’s still a middle economy seat but you’ll have so much leg room you could do cartwheels!” I used to love doing cartwheels. It sounded great.

The steward looked at my ticket as I stepped onto the large double decker plane. He pointed directly to his left. I had a front row seat to the parade of passengers that boarded the full flight. The woman to my left at the window seat was friendly and chatty. She lived in Dubai and I soon learned about her two children attending University in Canada. I told her I was an obstetrician / gynaecologist headed to Afghanistan. An expression of concern gave way to confusion as I explained to her why I enjoyed working with Medecins Sans Frontieres / Doctors Without Borders. Still, she strongly encouraged me to look into applying to work at one of the many international hospitals in Dubai – it would be safer, she said. I smiled and understood; after all I have a wonderful and concerned mother of my own.

We had plenty of time to chat as the plane was delayed for mechanical reasons. To kill time, people were walking about the huge Airbus A380. A young toddler running through the aisles hit her head and started to cry. Her mother brought her up to the stewardesses at the front; my neighbour promptly identified me as a doctor.  Her face was covered in blood, oozing from a deep and sizable gash on her forehead. The little girl was inconsolable. As the plane was still grounded, I agreed with the cabin crew that she should be offloaded to have the injury more optimally managed.  We eventually took off, and after a surprisingly tasty economy class meal, I pushed my seat back, put on my blinders and earplugs, and promptly fell asleep.

I was in a deep sleep until I felt a shaking sensation. Earthquake? No, I’m on a plane. Turbulence? Must be turbulence. No wait, I felt a hand on my shoulder. That’s when I heard “Doctor, you’re needed upstairs. Come please.”

I adjust quickly to my new state of wakefulness and am escorted up the grand staircase that leads to the first and business class sections. Lying on the landing just beyond the first class suites is an elderly man, unconscious.

Full disclosure, I’m not an internist or emergency physician, I’m an OBGYN. However, I work primarily in a small isolated community with no other surgical backup, so from time to time, I have been called to assess a male patient. I take solace from those experiences with the situation in front of me.

I gather some information about the event and his medical history. He’s a frail man on a long list of medications for many ailments. My list of possible diagnosis is long. Fortunately his vital signs are stable and I get to work trying to rule out the major concerns such as heart attack or stroke.

I’m handed the radio and communicate with a doctor on the ground and the captain in the cockpit. I’m informed that our last option for diversion before Dubai is Vienna. I’m given 10 minutes before I must make a decision as to whether or not to divert the 500-passenger plane.

Fortunately, his condition begins to improve, becoming more responsive at first to pain, then to verbal commands and eventually is able to communicate again.  The inciting events become clearer: likely a combination of dehydration, diabetes, chronic lung disease and a possible early infection brewing. We escort the man back to his business class seat. The crew is relieved, as am I!

I’m generously offered a choice of meals, beverages and snacks from the first class area, descend the grand staircase and return to my seat. My latte arrives, followed by my meal. The captain comes over to thank me personally and shakes my hand. I’m then handed a bag with a bottle of champagne inside.

My body is exhausted but my mind is wide-awake. This is just the beginning. I cannot stop thinking about what’s to come once I arrive to the field in Afghanistan.