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SPOTLIGHT
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Is there a doctor in the house?

Published on -11/12/2012, 10:11 AM

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I can't hear that phrase without thinking of Groucho Marx, bent forward at the waist, swatting at the stethoscope dangling from his neck, hoping to con a high-society dame and get his hands on her dowry, among other things.

Such a summons does happen though. I don't know if it happens to other docs as often as it's happened to me, but it's happened to me a lot.

To some extent, that was related to my practice setting. A high-risk population, combined with geographical isolation and the fact that I attended many cultural-social events that other docs skipped, often made me the only doctor in the house, or at the powwow.

The announcers at local powwows usually knew when I was there, since I would've been seen gourd dancing or lurking about with my camera. Sometimes they just assumed I'd be around somewhere.

So when somebody would "go to ground" -- that is, collapse with a seizure, step in a posthole or slip on melted snow -- the announcer sometimes just called me by name to come to the speakers' stand.

Occasionally, I actually saw the event as it happened and responded reflexively, saving the announcer the trouble.

It happens in other settings too. Airplane flights, for example.

We had just taken off from the Billings airport when the summons came. "If there's a doctor on board please come aft! Ah, come to the rear of the plane!"

Seated near the front, I extricated myself and hustled, ah, aft.

A tall man in a suit held a limp infant sprawled across his upturned palms. His face reflected a mixture of astonishment and horror.

"Do you need a doctor?" I asked.

"What kind of doctor are you?" he responded.

"Family prac ..."

"Here!" he gasped, pushing the infant toward me at arms' length. (As it turned out, he was an anesthesiologist himself. He'd have been able to clear the airway and begin CPR, but maybe he wasn't used to improvising. Maybe he was worried about a lawsuit. I figured, let's see if we can save a life, and the lawyers can duke it out later.)

The baby lay supine in his hands, arms and legs dangling, pale as death.

Not dead, though, nor dying. As I reached to take the baby, I spotted the tip-off. Scattered data bits suddenly coalesced into coherence, like they do in cheesy TV crime dramas.

The baby had a little gob of curdled milk in her left nostril.

The scenario would've been this. Mama had been nursing the baby on takeoff, as some recommend, to equalize pressure on the eardrums. The baby fed hungrily without pausing to burp. As the plane took off, cabin pressure fluctuated -- the thing that makes your ears pop. At some point, the pressure on the baby's stomach contents exceeded the air pressure around us.

As a result of all this, the baby "spit up." The caustic stomach juices squirted right up into her nose, where they abruptly irritated the lining of the nostrils.

This triggered an internal response, the "vasovagal" reflex. The vagus nerve kicked in, dropping the pulse and blood pressure, blanching the skin and triggering loss of consciousness. Yet in sum, just a simple fainting spell, quite benign.

I placed the baby tummy-down along my forearm, head nestled in the crook of my elbow, face turned toward me. My fingers encircled her ankles, while her arms dangled on each side.

I flexed my elbow, tilting her feet up at a 30-degree angle. Then I blew two quick hard puffs of air at her face, and tapped her gently on the back.

The blood flow to her head resumed even as the puffs of air triggered an inhalation reflex.

Her color returned; she began to fuss and wave her arms.

I wiped her nose, turned her back over and handed her to her mama, whose panic was only beginning to subside.

Mama held the baby upright on her lap while I ran a quick clinical survey, looking for signs that my provisional diagnosis was wrong. A doc can learn a lot without a CT-scanner down the hall.

"It looked scary," I said finally, "but really it's not. It's just a harmless kind of fainting -- not a seizure, not choking. She'll be fine. See if you can get her to burp, but don't feed her for an hour. Don't lay her all the way down, either."

I returned to my seat. The steward offered me a beer on the house, which I accepted. I wasn't shaky or anything; they were just trying to be nice. I only drink alcohol on airplanes when it's free. So I'm a cheapskate.

Eh. Coors. Not even a Corona?

It might seem like this had a happy ending, but -- not so much.

Fearing some sort of legal liability, the crew insisted we turn right around and land back in Billings. The woman would be compelled to disembark, forego the flight and take the alert, happy baby on an ambulance to an ER. There, concerned about their own liability as well as the child's wellbeing, the staff would subject this healthy-looking baby to many bucks' worth of unproductive tests, then tell momma to "bring her right back if anything else happens."

Reassuring, right?

I hope she had insurance and could afford the consequent increase in her premiums.

Jon Hauxwell, MD, is a retired family physician who grew up in Stockton and now lives outside Hays. hauxwell@ruraltel.net

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