Flying this week from Abuja (Nigeria) to Addis
Ababa (Ethiopia), on my way to a conference in Kenya, I heard those words
coming through the PA system all physicians dread, "Is there a doctor on
board?"
I knew for a fact there were at least six other
doctors on that flight, as I was travelling with them from Jos to the
conference. "Surely the need would be better met by another one of
them, after all, I'm just an OB/Gyn," I thought, "And what if it's
something I can't handle?" While I contemplated remaining quiet and
seeing who else would volunteer, I felt compelled to respond, mostly because I
was sure I knew exactly which passenger needed the help, as she was sitting in
the seats across the aisle from me. Furthermore, all the other doctors I
travelled with were way behind us in the plane. So as a flight attendant
walked toward me, I slowly leaned out to stop him and volunteered that I was
(gulp) a doctor.
I had been watching this same woman since the
waiting lounge at the Abuja airport. She was a frail old woman, probably
about 75, I guessed, slumped over in a wheelchair near the boarding gate.
She looked about 80 pounds, and her crooked shoulders nearly touched her
knees as she sat, with her head awkwardly extended upward. Each time she
breathed, her whole upper body jerked violently. Over the three hours or
so I sat in the waiting area, I would glance up at her from time to time,
wondering why in the world such a woman would be preparing for air travel. She
looked like a typical village woman who had lived a typical village life.
Where could she be going? At one point, I watched as a younger
woman - perhaps her daughter? - carefully fed her some liquid concoction in a
plastic bowl by slowly tipping it back and pouring it into the old woman's
mouth. Ironically, the thought came to me, "If they ask, 'Is there a
doctor on board?' there is no way I'm the right person to answer. She
definitely doesn't look pregnant!" And I laughed to myself.
I didn't notice that the same woman was sitting
near me on the flight until shortly after takeoff. At that time I saw
this thin-framed lady working even harder to breathe, one row in front of me
and all the way on the opposite side of the plane. As flight attendants
took notice, they cleared passengers out of the middle section of the row I was
seated in, creating a makeshift bed for the woman. Of course, it was in that
row that one of my physician colleagues had been sitting, and he was ushered to
the back of the plane to another empty seat to make room for her. I
watched the woman's companion and two flight attendants work to help the old woman
to her new bed across from me. Her breathing was much more labored than
it had been in the airport. A result of the change in air pressure, I
presumed. How hard she worked for each breath and the panicked look on
her face told me that laying her flat would make things worse, not better.
Shortly after the flight attendants walked away, I learned I was right;
her breathing pattern became even more rapid and labored. It was less
than 2 minutes before the woman was seated upright again, with her companion
trying to help support her. Flight attendants returned and a quiet but
pressured discussion began around the woman that I could not hear. The
staff left that place and within one minute, the call for a doctor came
overhead.
As I tried to rationalize not responding to the call, I eventually concluded that I at least
had to acknowledge the fact that the most likely passenger who needed a doctor
was this woman, and I was likely the closest physician to her. I leaned
in toward the flight attendant walking toward me, and said, "I am a
doctor." He pointed me toward the woman I had already been watching,
and asked if I could help her. I leaned in toward the old woman and her
companion. "I am an obstetrician," I hedged, "but maybe I
can help you. What is wrong?"
The younger one told me the old woman was her
mother, then stated the obvious – that she was having trouble breathing.
I probed a little, asking if she had any known medical problems.
The daughter explained that her mother had breast cancer, and had just
been released from the hospital to travel to Delhi, India for the hope of
treatment. This little piece of information changed everything. The
symptoms this woman displayed were clear signs of "air hunger," a
telltale sign that her cancer was metastatic throughout her chest and was causing
her to actively asphyxiate. The decreased oxygen content due to the
change in pressure at altitude was enough for her oxygen saturation to drop.
This decrease made her body feel like it was suffocating, causing her
gasping and sense of panic. This often occurs in the stages close to
death.
The daughter showed me a large bottle she had
brought with her, and said her mother's doctor told her to give it whenever she
had trouble breathing at night. I looked at the bottle and identified it
as liquid morphine. When episodes of air hunger occur, morphine can block the
brain from feeling like it is suffocating. With it the patient usually
stops panicking, and with slower, easier breathing, she will actually improve
oxygenation. Add to it supplemental oxygen, and they will usually be able
to rest calmly. I had the woman give the morphine to her mother while I
asked the flight attendant if they had an oxygen canister on board. I was
brought a small bottle, connected the mask, put it on the old woman, and turned
on the flow. Within two minutes, she was breathing slowly and sleeping
soundly while upright in her seat.
The remainder of the cross-continental flight I
spent near the woman, keeping my eye on her breathing, helping to adjust her
position or the oxygen when needed, and desperately praying that she would not
die on the plane. As I sat, I had a
conversation with God, “Clearly this woman has been misled in thinking there is
hope for a cure in India, as this is end-stage.
But what is my responsibility here?
After all, I’m not this woman’s doctor!
Can’t I just respond to the immediate need and be done?” God responded, “I did not bring you here just
to bring people the minimum of physical care.
I want you to bring hope.” I wasn’t
happy, but relented.
I began conversing with the woman’s daughter again. We talked about her mother’s cancer, her
trouble breathing, and the implications of advanced disease. As we talked I told her that I was from
America and that God had told me to come to Nigeria, but not just to help
people with illnesses, he wanted me to share with them how they can have hope
through Jesus. I asked if they knew
Jesus. “Oh, we’re Muslim,” was her reply. I explained that Jesus came to live on earth
and to die for us, so that we could have hope; that through believing in him
that we could be with God in heaven after our lives on earth are over. I said that through Jesus, we can be sure we will go to heaven. The old woman groaned once again. Her
daughter just smiled weakly at me.
I’m not sure why God set up that
interaction. What did they really need
to hear? What, if anything, will come
from our meeting? Why couldn’t God have
put some great evangelist on the flight, or at least made it clear what he
wanted me to say to them? Times like
that I feel so inadequate. As I walked off the plane I was still mulling
this over, and have thought through it many times since, broken at the thought
that these two may be missing out on the greatest, most rewarding relationship
they could ever have, and the adoption as children of God we can experience
through Christ.
I still don’t know what the answers are, but I
pray that those two will choose to follow Jesus, if they haven’t already. God has reminded me of 2 Corinthians 12:9, “My grace is sufficient for you, for my power
is made perfect in weakness.” The CEV translation says, “My power is strongest when you are weak.”
Praise God that He can work in our
weaknesses! I pray God will bring to
these women whatever they need and whatever He can use to bring them to
salvation – especially for the old woman, since she is not likely far from
seeing God face to face.
