In-flight readings

A doctor making a fraught journey finds that matters of the heart are set to spring a surprise when there is a mid-air emergency

- Vikramajit Ram

Forty minutes to touchdown, we have a situation. "Is there a doctor on board?" says the flight attendant in the frontrow aisle.

The hush is immediate. Even a squealing infant in the rear knows something's up. I can choose to volunteer, or sit tight in 13A, Emergency-Exit. The clack of my seatbelt buckle kills the silence.

The passenger in ID is in his 70s, dapper, balding, greying, and unconscious. "I thought he'd fallen asleep," says his wifebirdlike, looking and sounding more annoyed than worried. "And just like that he made a sound and slipped sideways. Has he...expired?"

I smile, and gently move her hands from his chest. His airways are clear: he hasn't choked on the sandwich. I find a pulse, faint, in his neck. Textbook syncopedehydration and cabin pressure, in this instance; and a heart condition, perhaps? It's been a little over a minute. He must come round in the next two, four at a pinch, if his brain is not to be compromised. In the crew-zone, a calm, collected drill underway involves the opening and shutting of cabinets with discreet clicks, an oxygen canister and emergency medical kit, the handset of the intercom, and the door of the cockpit. The oxygen mask is appointed to our patient. The emergency kit is equipped to address trauma, allergy, heart attack; with any luck, the defibrillator will not be needed. On earth as it is 30,000ft in the air, the protocol is standard-even if the floor space for it here is the length and width of a body-bag. Passengers IC and IF help manoeuvre our patient flat on his back: his feet and knees raised on cushions, a folded pullover under his head. Blood pressure, 44/20; oxygen saturation, 94. We keep the oxygen mask in place.