Most of them stare blankly back, but then one young voice from their midst says, “No. No food.”
Anna turns back to Toby. “Can you blow into his mouth?” She puts a mask in place and Toby reaches the end ofa compression and blows into the patient’s mouth. Anna is watching carefully. She thinks she sees the chest move. It is a tiny movement, but it means the airway is probably clear.
As Toby goes back to his chest compressions, she turns back to the women. “Did he have any weakness, dizziness, or fatigue? Does he have kidney problems?”
The same small voice says, “No. It did not look so. No.”
She keeps up a running commentary for the MedLink doctor as she works. Praying there is no sudden turbulence, she picks up the largest airway, ready to insert. She takes a deep breath, then tells Toby to stop chest compressions. One quick movement, a twist, and it is done. Toby restarts compressions while she attaches the ballon and the mask, placing them over the patient’s mouth. She can see how tired Toby is, so she calls to Susie, “Are you CPR trained?”
Susie nods.
“Then take over. Toby, you can squeeze this balloon. Like this.” She shows him how and follows through with further instructions.
Susie kneels beside Toby. As his hands come up, hers come down. Toby reels back. Sweat patches show through his uniform. But he crawls to the head and starts work.
“Has anyone given adrenaline or epinephrine?” she asks, covering both names for the drug.
Everyone shakes their head. Working quickly, Anna finds the medication in the medical kit. She checks the strength. Then she starts to prepare the patient for an intravenous injection. They are already past the time for optimum efficacy. She draws the drug into a syringe, steadies it above the vein she selected, and slides the needle in. Mercifully, the plane flies steadily throughout.
She breathes and watches, but there is no sign of a return of spontaneous circulation. The defibrillator is still giving itssad message and there is no discernible pulse. Another flight attendant – Vicky, according to her name badge – kneels beside Susie. As they swap over, Anna begins preparation for a second dose. Just as she is about to inject it, the plane jolts slightly. She holds still, in case there is another bump, but all is still. She goes for it, then rocks back on her heels to wait. Still no change. She watches the timer Susie set on a mobile phone. The seconds add to the minutes of the time the patient has been dead.
Anna hangs her head. This was an improbable save from the start, but hope is incredibly strong in humans. She speaks to the MedLink doctor. “No reversible cause,” she states. “Twenty minutes of CPR, two doses of epinephrine administered, and no sign of return to spontaneous circulation. Are you in agreement if I pronounce death?”
“Yes.”
Anna screens out the sobs and the muttering, and concentrates on running through the sequence. Respiration, verbal stimuli, pain stimuli. She uses her phone light to check the pupils, then palpates the carotid artery. When she has finished, she gives her time of death summary. She has no idea where they are or what the local time might be, but presumably the operator does.
Then she turns to the flight attendants. She leans across and stills Vicky’s arms. Toby is openly sobbing as his hands drop away from the AMBU bag. Susie looks like she may collapse. Anna takes one look at their distraught faces and realises they are now her patients.
“You all did magnificently. You were absolutely wonderful.” Where her hands are still on Vicky’s arm, she squeezes gently. “Even in a hospital, this would have been difficult. The odds were always against us.”
It is only as Anna looks up that she grasps how many people have been watching her. One of the pilots is standingbehind her and she doesn’t realise until he speaks. “I’ll let the captain know. He started to divert as soon as notified, but we’ll probably correct for Los Angeles now.”
“Wait!” Anna calls. She stands, so she is closer to his height. “They need a break. They will be physically and emotionally exhausted. Make sure they get some tea and something sweet – cake or cookies.” She indicates Toby, Susie, and Vicky. She’d known from the start how low was the chance they could save the patient’s life, maybe one or two per cent. They hadn’t. She had known that no matter how hard you try, you cannot save everyone. They hadn’t.
He nods. “We’ll rotate some crew up from Economy.”
She leans closer still and lowers her voice further. “And the deceased?”
“The First Class suites are very private. I’ll get two of the strongest crew as soon as I’ve notified the captain. They’ll help me lift him back into his suite. We’ll cover him and keep him there until we land. There’s nothing else we can do. There’s no spare space on an aircraft.”
She lets him go. Then she returns to the dead. She removes the bag and airway, detaches the defibrillator, and tries to pull his clothing together. A nurse would normally do this, but here, she is the best person. An unrecognised flight attendant appears, and Anna indicates the syringe.
“That is clinical waste. It needs careful disposal,” she says.
“I’ll deal with it,” he says with a nod. “Thank you for your help. Is there anything you need? A brandy, perhaps?”
“No, thank you.” Anna gives a resigned half-smile. For someone who was a doctor through the last pandemic, if she’d had a drink every time she’d lost a patient, she’d be an alcoholic by now.
As Anna crosses the short corridor from First to Business Class, she feels as if she has stepped from one world to another.Here, people slumber on, or stare vacantly at screens, entirely unaware of the drama that has just played out. The drone of the engines dominates, a thick, monotonous blanket to other sounds. In that mind-numbing atmosphere so peculiar to long-distance flights, Anna heads to her seat. She is used to this, after all. Moving from drama to calm, death to life.
Strangers on a Train
Anna grabs a snack bar from the Business Class pantry and eats it in three bites on the way back. She slips into her seat to find her bunkmate awake and alert.
“So what was it?” he says. “A woman giving birth? I noticed one of them looked heavily pregnant. I was surprised she was allowed to fly.”
She shakes her heart. “Cardiac arrest,” she answers without thought. “He’s dead.”
