as well as medical. ‘Eleanor Forrest, emergency registrar,’ she replied. ‘Thank you. Her pulse and respiration are flat, so we need to start—’
‘CPR,’ he finished, nodding.
Good. They were on the same wavelength.
‘I don’t speak much Italian. The patient’s travelling companion either doesn’t speak English or is too upset to cope in a different language. Can you ask her if our patient hit her head, is taking any medication or has any medical conditions?’
‘Of course. But first…’ He turned to the flight attendant who’d brought him to the patient. ‘We need your help, please, to fetch supplies. Do you have an Ambubag and a defibrillator? It should be kept with the captain.’
‘I’ll check,’ she said, and hurried away.
Then he spoke to their patient’s travelling companion in Italian much too rapid for Eleanor to follow, given the basic Italian she’d started learning two weeks before. The only word she could catch was ‘dolore’—what was that? Sorrow?
And then she heard him say ‘l’infarto’—it sounded close enough to ‘infarct’, she guessed, for it to mean ‘heart attack’. Usually if a patient was unconscious and there was no pulse, it meant a cardiac arrest—though it could also be a grand mal epileptic seizure.
As if Orlando had guessed what she was thinking, he said, ‘Our patient’s name is Giulietta Russo. She’s travelling back to Napoli—Naples—with her daughter Fabiola. Giulietta complained of a pain in her chest and then collapsed. No history of epilepsy, no history of angina, no other medical condition Fabiola can think of, and she didn’t hit her head when she collapsed.’
So far, so good. ‘Can you ask Fabiola if her mother has a pacemaker?’ she asked.
Another burst of rapid Italian. ‘No,’ he confirmed.
At the same time, Orlando and Eleanor moved the unconscious woman to the aisle and laid her flat. Gently, Eleanor tilted the patient’s head and lifted her chin so she could check the airways. ‘No sign of blockage. Airway’s clear.’ But the B and C of ‘ABC’ were a problem: Giulietta still wasn’t breathing and there was still no pulse: no sign of circulation.
‘Then we start CPR,’ Orlando said. ‘You bag and I do the chest compressions, yes? Five compressions to one breath?’
‘Thank you,’ Eleanor said.
At that moment, the flight attendant arrived with an Ambubag. ‘We’re still checking for the defibrillator and the drugs kit,’ she said.
Eleanor really hoped there was a defibrillator on board. Otherwise their patient had no chance, because even if they landed at the nearest airport it’d take too long to get the help she needed. Without defibrillation, even with CPR, their patient’s chances of survival dropped drastically with every minute.
‘Thanks,’ she said. At least the Ambubag meant that they could give their patient positive pressure ventilation. But when their patient recovered consciousness, she’d need oxygen—more than that available from the aircraft’s emergency oxygen masks. ‘Is there any supplemental oxygen, please?’
‘I’ll check,’ the flight attendant said, and hurried away again, quickly returning with the defibrillator.
‘I’ll attach the defibrillator. Do you mind carrying on with the CPR?’ she asked Orlando.
They both knew that you couldn’t stop the CPR except for the moment when she was ready to administer a shock—if this was a case where she could use a defibrillator. If the monitor showed a different heart rhythm from VF, they were in real trouble.
‘No problem,’ Orlando said.
Lord, he had a gorgeous smile. The sort that would’ve made her weak at the knees if she hadn’t already been kneeling next to their patient. She glanced up at the flight attendant. ‘I need your help to keep doing the breathing while I attach the defibrillator,’ she said. ‘If Dr de Luca tells you what to do, can you keep going for me, please?’
The other flight attendant nodded, and followed Orlando’s instructions while Eleanor attached the defibrillator and checked the monitor reading.
‘She’s in VF,’ she told Orlando, hoping that the abbreviation was the same in his language. Certainly the words would be: ventricular fibrillation, where the heart wasn’t contracting properly and was just quivering instead of beating.
She really needed access to Giulietta’s neck veins to administer the adrenaline, but in the confines of the aisle space she didn’t want to interfere with ventilation. ‘I’m going for IV access in the right subclavian vein,’ she said to Orlando. ‘Administering one milligram of adrenaline. Six-oh-six p.m.’
‘Got you.’ Although he was a family doctor—a GP—obviously he knew the protocol in this sort of case: one milligram of adrenaline every three minutes. He smiled at her, and kept directing the flight attendant while Eleanor put the paddles of the defibrillator in place.
‘Shocking at two hundred joules. Clear,’ she said.
As soon as Orlando and the flight attendant had taken their hands off the patient, she administered the shock and continued looking at the readout. ‘Still in VF. Charging to two hundred. And clear.’
Another shock. Still no change. ‘Still VF. Charging to three-sixty.’
‘Mamma?’ Fabiola asked.
‘Um, bene. Soon,’ Eleanor said, trying to remember the Italian phrases she’d learned and hoping that her voice sounded soothing enough for Fabiola to understand what she meant.
She didn’t have time to react to the amusement in Orlando’s eyes. ‘And clear.’
This time, to her relief, Giulietta responded.
‘Sinus rhythm. Can you tell Fabiola that it will be all right? We just need to get her mother to the hospital.’
Orlando nodded, and turned to the flight attendant. ‘Can you ask the captain if he can divert the plane to the nearest airport? And talk to the pronto soccorso at the hospital—we need the paramedics on standby. Autoambulanza,’ he added.
Then he talked to Fabiola again in Italian.
‘I’ve explained that her mother needs to go to hospital,’ he told Eleanor. ‘And we will stay with her until the paramedics can stabilise her.’
It was part and parcel of being a good Samaritan—if there was an emergency and you were present simply as a passer-by and not officially as a doctor, you didn’t charge for your service and you stayed with the patient until he or she was stabilised or a doctor with equivalent or higher training took over. Eleanor had heard horror stories of doctors being sued for good Samaritan acts, but she knew if you kept to the protocol and delivered as near to hospital-standard care as you could, you’d be indemnified by either the travel company or your medical union.
The flight attendant who’d been acting as runner came back. ‘Captain says he’ll land us at Milan. We have clearance, so we should be on the ground in about twenty minutes. The airport’s contacting the hospital for us. Oh, and the supplemental oxygen…?’
‘Excellent
