Connecting The Dots of Healthcare

This is not what I intended to write for today.

This week I’m attending my annual National Speaker’s Association meeting in San Diego and I was working on the article I planned to write on the USAirways flight from Charlotte to California. With ipod music piped through noise reduction headphones I was typing away when Russell White, CSP, a friend and fellow speaker from South Carolina who happened to be seated across the aisle from me, reached across to get my attention.

As I pulled off the Bose headphones, Russell told me there was an announcement asking for any onboard medical personnel to help with an emergency in plane’s aft. A passenger had developed severe substernal chest pain followed by nausea and vomiting. Vitals were OK but the patient remained in distress and was initially incoherent. As we moved the patient to the back galley floor, examination revealed equal breath sounds, (Read: couldn’t hear either side with a inexpensive first-aid kit stethoscope), and our impromptu medical team, an ER nurse, a dermatologist, and this surgeon, started an IV for access, administered mask O₂, gave our patient a chewable aspirin and some sublingual nitroglycerine. That relieved the chest pain a bit, induced a slight headache, and now the patient was more communicative.

About this time the captain called for options. The choice was to start an emergency landing or continue the next hour and a half to San Diego. That was a no brainer. In the back of an aircraft with a patient with crushing substernal chest pain and no diagnostic capabilities other than a relatively normal physical examination, (and after pretty much exhausting the available pharmacopoeia of the airline emergency kit), he was asking did we think things were OK or could bad things happen over the next 90 minutes? Even a dermatologist and a surgeon could figure this one out. We landed as an unscheduled stop in Albuquerque and were happy to have our patient taken by ambulance for real diagnosis and treatment.

So no big deal clinically or even with regard to decision making. But that’s not the point. Before landing in San Diego the pilot used the overhead PA to thank everyone for their understanding and patience during and because of the emergency stop. He also thanked the doctors and nurse, by name, and said that he appreciated us “taking our oath seriously” to care for the patient as well as anyone else on the aircraft that might need us in an emergency. The aircraft’s passengers broke into applause.

As a speaker, I’m used to applause. Even standing ovations. But I have never, ever received applause for doing my clinical job. The other doctor and nurse also had never received applause for what they’ve done clinically. Actually, we did very little. We did simple things and made an easy call to get this patient off the aircraft a.s.a.p. with a midair-let’s-land-fast-and-punt to a hospital ER. And yet we received applause.

People really do care what we do. But they need interpretation of our value to begin to understand it. On that flight, we didn’t deserve applause. We didn’t do anything heroic, extraordinary, or even slightly difficult. But we have all done things that do deserve applause, even standing ovations that we never have and never will receive. Not even once. As “dots of healthcare” we don’t need applause, but I’ve got to tell you, it felt good. Real good.

Please share the applause we received on this USAirways flight with you for what you do every day, and night, even for “no big deals.” It doesn’t matter if you’re a “dot” in direct patient care or if your job is to support the direct care “dots,” let the applause acknowledge your “every-day-greatness” even for simply choosing to work in healthcare. And for those times when we really do deserve applause from others that is never heard, take a standing-O!