30,000 feet above Las Vegas
"Is there a doctor on board?" A shout came from the front of the plane.
I leaned back in my seat and hoped for another doctor to leap up and go handle whatever the emergency was. But there was no movement, as the passengers looked around questioningly.
"We need a doctor PLEASE" the flight attendant yelled out. This time the fear and panic crept into her voice. Debby elbowed me and whispered in my ear the one word I needed from her to take action, "HONEY!!"
I stood-up and headed forward to the middle of the plane (we were in the very last seat before the aft galley). I felt a hundred or so eyes tracking me with a mixture of relief and worry. It was around 7:00 PM and our flight from Salt Lake City to San Diego was about to pass over Las Vegas and start its descent. I had been looking forward to a peaceful, quick flight after a day in the mountains with our Utah family, but that was not to be.
I took in the scene as I approached a flight attendant and two other women standing around a semi-conscious man in his mid to alte 40's, in the right window seat.
"What's going on?", I asked the flight attendant.
"I don't know. He's been unconscious and foaming at the mouth for several minutes!"
I looked at the other two women, "Are you guys doctors?" (I was still hoping...)
"I'm his wife", said the taller one.
"I'm a PA (physician's assistant)", said the other.
"Great, what do you think?" I said, looking toward the PA.
"We think he may be in shock from internal bleeding. He had a bad fall skiing and thinks he may have broken his rib", the PA responded.
I turned to the wife, "A bad fall?"
"Yes. And by the way, he's a surgeon, and his name is Robbie", she volunteered.
Inwardly I thought, "Great. THERE'S the doctor I need!"
Outwardly, I nodded, and turned back toward the doctor to look more closely at his face.
"Hey doc, my name is Dr. Dave Cutts. What's going?"
"Hi doc, thanks. I just feel really weak and lightheaded", he slurred. His face was pale-white and cool to the touch.
I took his wrist to check his pulse. "It's been above 85", Dr. Robbie mumbled as he felt my hand.
"It's 72 now", I replied after 10 seconds. "So good. That's better", I added. A slight smile crossed his lips. But...something was very wrong.
"Your wife said you had a bad fall. Are you having a lot of pain with your ribs?"
"No, not really", he said.
"Hmmm," I thought. I stood up and saw that the flight attendant and PA were opening the emergency kit.
"What's your plan?" I asked the PA.
"I'm looking for a blood pressure cuff" she replied as she pawed through a jumble of medications.
She was thinking of blood loss and the potential for hypovolemic shock (not enough blood volume for oxygen to be pumped to the brain and other organs), which is what his outward appearance and symptoms would indicate.
In this first minute I had already gone through the mental checklist that has formed in my mind from years of training and private practice.
First, the obvious: internal bleeding? Maybe, but no pain or swelling. So, maybe, but I was already thinking something else.
Cardiac event? No chest pain, pulse reasonably normal, patient conscious and verbal. Again: maybe. But not likely.
Stroke? Gut feeling: no. Speech fine. No obvious paralysis. Plus, Dr. Robbie looked to be in his mid-40s and very fit. Probably a serious runner or cyclist (He was).
I turned and the flight attendant and the PA had just found the BP cuff.
"He needs oxygen", I stated to them. They hesitated and then the PA said, "YES!"
The flight attendant hadn't moved so I repeated it. "He needs oxygen. Now!" I repeated it with added urgency. She left and ran to the back of the plane. By now, 90 seconds had passed. I stepped back-in, leaned over Dr. Robbie and said, "Hey doc, so you know what the best drug is, right?" Again, the small smile, "Yeah, oxygen."
"Good. So they're getting it now and we'll need some nice, slow deep breaths, OK?" I said. He nodded.
I stood back up and turned to Dr. Robbie's wife. "He looks pretty good to me. Pulse is good. He's responsive. No pain or numbness. I think he'll be fine. He just needs oxygen." She nodded with a look of slight relief.
We three chatted while keeping a close eye on Dr. Robbie. One minute. Two minutes. Three minutes. I looked down the aisle toward the back where the flight attendant had disappeared.
"Where the hell is the oxygen?", I mouthed. Debby shrugged and made a gesture toward where the flight attendant had disappeared.
I leaned back-in to check Dr. Robbie's pulse and finally, two minutes later, came a tap on my shoulder (my wife told me that the flight attendant apparently had taken several minutes to find it, and then the restraining straps were a mystery to her for another couple minutes!!).
I stood up, grabbed the tank and turned it on, and then unwrapped the mask.
"What is this?" I asked the flight attendant. "You don't have a positive pressure mask?" (In my hands was a mask like the ones that fall from the ceiling during an emergency. At least it had a small bag that could be inflated to "pump" the oxygen into the lungs.)
"No." She responded, looking frazzled.
Well, it would have to do. I strapped it over Dr. Robbie's face, and he began to take-in deep, slow breaths. Ninety seconds later, a slight pink tinge appeared on his cheeks, and then slowly spread across his face. He became more and more alert and talkative.
"Ok. We need to get him lying down", I said as I looked over to the flight attendant. She scurried off to the back galley to set-up cushions and blankets for him to lie on.
We got him up slowly and started the long walk back to the aft galley, past the 100 anxious faces.
I turned to his two teenage kids as we passed and said, "He's going to be fine." Which he was, with one "little" hiccup. It was still in the back of my mind, "WHY had he gone hypoxic in the first place?" Once he was resting comfortably, I turned to his wife and chatted a bit.
"You know it's funny", she said, and then hesitated.
"What's that?" I queried.
"Oh, just that he HAD a colonoscopy scheduled for tomorrow!", she replied.
I stared blank ahead for about a millisecond...as I realized what we had been missing. "Really? Tomorrow?" I asked again.
"Yes", she replied.
I looked over at the PA and then leaned down over Dr. Robbie, "So doc, you're scheduled for a colonoscopy tomorrow morning?"
"Yeah", he replied softly.
"When is the last time you ate something?" I asked.
"Uh, last night", he replied.
I looked up at the PA, flight attendant and wife.
"What's your favorite soft drink, doc?" I asked, still looking at the two of them.
Now the slight smile was on my lips. A knowing look came over the PA's face. "Sprite?" He replied.
I nodded to the flight attendant, and she hesitated until she realized what the nod was for. Then she grabbed a Sprite from the mini-fridge and handed it to Dr. Robbie. Ten minutes later, Dr. Robbie was as close to normal as one could be, given what he had just gone through.
And 25 minutes later, Dr. Robbie was sitting comfortably next to me as our plane turned and glided past the Coronado Bridge, over the California Tower in Balboa Park, and touched softly down by the Bay onto Lindberg Field.
Beautiful, Blessed San Diego. Home safely, all of us.
Hypoglycemia, low blood sugar, is one of the most common and underrated medical emergencies that occurs thousands of times a day across America. It is usually a short, temporary condition that is easily self-treated before it ever reaches the point where the good doctor did.
However, it becomes highly dangerous if it is left undetected, and can progress rapidly to a lethal status of shock and organ shut down.
The key is to recognize it through all the overlying symptoms and NOT go off on to other unnecessary treatments.
I can thank years of experience with my patients who are comprised almost entirely of those who are over the age of 50, for teaching me this. Treating this special patient population requires a rigorous attention to detail when it comes to the medical assessment that we make a part of every appointment. That always comes with or before the dental assessment.
There is a reason for this that is encapsulated in an old saying amongst anesthesiologists and surgeons. The best emergency treatment is to prevent it in the first place.
That is done by the above-mentioned medical assessment.
Which is exactly what we do here at the Center for Adult Dentistry.
We also use oxygen routinely before and during our dental surgeries, or even routine dentistry, on patients with cardiac and/or lung disorder histories (added oxygen allows the heart to work easier and also adds an overall feeling of well-being and calmness to the patient).
It truly is the best drug. We also routinely carry-out a thorough medical consultation with our patient's doctors to ensure that we as a team have gathered together the complete picture of our patient's health, so any precautions or modifications that will increase the safety and well-being of our patient are noted and carried-out fully. I am quite sure that I am on the phon with medical doctors more than any other dentist around.
And lastly, IF something unplanned were to occur, our staff is highly trained to do the right thing immediately, instinctively...as a team.
Your trust in us is our highest motivation to be the best, and do the best in everything, for you.
Dr. Dave Cutts, DDS
(As a post-script, Dr. Robbie is one of a number of emergency patients that Dr. Cutts has treated successfully out of the office!)