Monday, July 9, 2012

Call Me

Just a few minutes short of six hours, it was—the Boston-San Francisco transcon. We joked. “Who's takin' the first break?” Chris shook his head. “Man, this is damn near a Boston-London run, without a relief pilot.” He yawned. I looked out across the Great Plains, then at the clock. I yawned. We were about half way. Then came the 'ding' that that turns you on your head.

Captain, one of the flight attendants in the back wants the paramedics to meet her at San Francisco.” My antennas went up. I circled my wagons. This spelled trouble.

She went on to explain. It seems the subject flight attendant had recently been tested for possible heart ailments. Now she was experiencing periodic stabbing back pain. She feared a looming heart attack, but didn't want too much attention. She could sweat it out to destination, she said.

My first thought was, where are we setting down if this turns worse? Denver lie 180 miles ahead and south of our course. That was the obvious place. I asked Chris to set up a conference call between our dispatcher and RadioDoc (made-up name). As he went about that, I thought about the earlier times when our company had its own medical staff. Whenever we called for advice we recognized the doc's voice (there were several of them). Those guys were well versed in aviation medicine—ex-miltary flight surgeons—and often gave us our physicals. Now, no more. The medical department was closed years ago and the staff fired.

Chris sent the ACARS message to Dispatch: “CALL ME.” Within seconds the message popped up. Frequency 129.4. Chris tuned in the frequency and tried to establish contact. But the frequency was full of static and a squeal so loud he could hardly understand the dispatcher. He swapped radios; tried dispatch on VHF-1. No joy. He asked for a different frequency but the dispatcher's reply was garbled. Chris tried to tell him we needed a RadioDoc conference call. More static. More squeals. More garbled voices. 

Then the ACARS printer spewed out a form. It wanted a bunch of information on the “patient.” I called back to the Lead and asked her for the info. With Chris shouting into VHF-2 trying to communicate, the lead flight attendant on the interphone spewing info to me, and me trying to monitor Denver Center on VHF-1, the hand basket slid closer to hell. My blood pressure started to rise, but I reminded myself that we were not in the process of crashing. Life will go on—for now.

Finally I got the info and handed it to Chris. He tried to read it to the person on the other end—we didn't know who that was. RadioDoc is a clinic somewhere that supposedly has contracted with our company to provide in-flight medical advice. The woman we heard through the static and squealing was talking too damn fast. She didn't understand radio-speak and had no idea we couldn't read her. I wondered even if she was a physician. Might she be a physician's assistant? Nurse? Candy-stripper sitting at home with her babies?

Chris, patience stretching thin, literally shouted into his mic: “GIVE US A DIFFERENT FREQUENCY!”

Twenty minutes into this goat rope, I noticed Denver passing abeam us. If we couldn't get the medical opinion we needed to assess this woman's condition, would it not be prudent to play it safe and divert to Denver? What a hell of a costly stop that would be. But suppose we passed up Denver and this woman was indeed in more serious trouble than she herself realized? In times like this I tend to notice the four stripes on my shoulder when I look aside, and they feel heavy

A new ACARS message flashed: “LET'S TRY 131.80.” Chris swiftly switched to the new frequency. It was just as bad as the first one. This was now more serious a problem than our medical situation. Without radio contact with Dispatch we are totally independent and cannot get the info we may need in any emergency situation. Your dispatcher is your link to the world, to safety. He gives you everything from weather and performance data to field conditions and game scores. You feel naked without Dispatch contact.

As Chris tried in vain to make sense of the voices on the other end of VHF-2, I began planning our divert to Denver. I decided I will not risk the woman's life and my career by bypassig a safe harbor in the throes of doubt. I was about to press the mic and tell Denver Center to clear us for diversion to Denver when Chris seemed to start making progress. He had to tell the woman to slow down her talking. After asking more questions she advised us to put the flight attendant on oxygen and continue to San Francisco while keeping an eye on her for changes or worsening.

What a relief. Chris signed off with Dispatch and slumped in his seat. I stared ahead and thought about how close we were forced to come to wasting tens of thousands of dollars and causing 185 people needless hours of delay.

The paramedics met us and examined the flight attendant. They found her fine. She merrily walked with us to the layover hotel.

But that wasn't the end of they day's ills. In only one hour after the RadioDoc fiasco—before we landed—the weight of the four stripes would be felt again when another kind of hell broke loose and I would be exercising “Captain's Emergency Authority.” That means, literally, breaking the rules to stay alive.

Stay tuned.

 Funny virga. Why that one little spot?


Fatquiver said...

Darn it.
It's just no fair when you do that.
Stay tuned...

Cedarglen said...

A great post and I look forward to the rest of the story... I know that there are a few details missing in your post. I'm darn sure not an airline Captain, but I've got 30+ years as an Emergency Room Nurse under my semi-large belt. When the first radio contact failed, I would have pointed to Denver. Thoughts into the decision: This is not a customer, perhaps with some ax to grind, but a staff member with more than a few years' service. We'll assume that she is a "Senior Momma" but not a shirk - and I just know that you had that conversation with your senior FA. Despite the useless connection to the "RadioDoc," I wonder. There are just too many variables missing. How did the FA progress over a little time? How old was she?
If given only the details in your post, I'd have pushed for a Denver divert. That said, at least from the medical view, lotsof details are missing. In the end everyone got lucky, but -agasin w ith details given - the risk was high. (I wonder about other details, only because I'm just retired from ER work. With th e small detail given, I'd have diverted as son as the first 'RadioDoc' connection did not work. Still there is more detail that you have not told us and that could (did) affect your choice. I hope that employee/passenger was not part of your evaluation. There just HAS t o be more to this story - and I suspect that you had a lot more of it before you chose to fly on to SFO. Please don't leaving us hanging for too long. -C.

Should Fish More said...

Back pain is not usually associated with cardiac issues, chest, shoulder, arm yes. Back pain can signal aortic dissection, just as serious. The oxygen should have been a first thought, do you need an Rx for that in the air?
At what point to you check to see if there is an MD on board, or a nurse or EMT?
Just curious, I don't know these things. I was on a regional jet before I retired, a passenger got short of breath, sweaty, dizzy, all classic symptoms of a MI. I started O2 on him and monitored until we diverted to SLC. He was taken off the plane and we continued to MT.
Enjoy your posts, Captain.

Giulia said...

What a story! And not over yet? Sheesh...what a day! Looking forward to the next post.

All the best.

BTW...that is cute a leak in Heaven. :)

S. J. Crown said...

I know who you were no doubt talking to. It was your company's health insurance actuary. After it was clear that your patient wasn't going to drop dead and save them a ton of money, and possibly at the urging of the Worker's Comp liability adjuster, they opened up the communication lines. Of course, they kept the signal a bit fuzzy so it wouldn't look too obvious.

Capt. Schmoe said...

Some trips you might be overpaid, maybe horribly so. Other trips, perhaps like this one, you might be underpaid.

Hopefully in the end, it ends up just about right.

Thanksw for the post.

Alan Cockrell said...

OK Cederglen, details. She was in her mid 40s and physically trim. Since we were approaching Denver and not flying away from it, it made sense to keep trying for radio contact. The pains continued intermittently but she didn't have any other problems. Besides, we needed to get to San Francisco before the Gabriel's Mexican Grill closed. The best burritos in the world!

Alan Cockrell said...

For Mike: We can allow passengers to use our onboard medical oxygen at our discretion. There is no guidance as to when to announce a call for medical professionals that may be on board. That also is at our discretion. Only a physician or registered nurse with credentials may use our medical supply kits.

Alan Cockrell said...

For Fatquiver: Is "psh" some local term in Fresno?

Bas said...

Whow Captain,

The weight of the four stripes... Thanks for your post, really shows the troubleshooting and problem solving skills one need up there in the air.


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Frank Ch. Eigler said...

"Your dispatcher is your link to the world, to safety."

Does this point to insufficient self-sufficiency while airborne? To what extent is loss of communications with ACARS/dispatch (not ATC) considered a crisis situation?

Also, is broadcasting such medical discussions on public radio considered uncontroversial, in light of patient privacy?

Alan Cockrell said...

Frank, You are a pile of work. I suspect you already know--but only wish to belabor me--we are self-sufficient without Dispatch. Dispatch is like cockpit automation: it helps us get information quicker than we could if we had to do it ourselves. If we are denied Dispatch's services we survive but our work load goes up and thus also do risk factors. There is no definition in this profession of "crises situation," only normal, non-normal, and emergency situations. Loss of communications with dispatch does not precipitate any of these, but could contribute to one. The privacy thing is way above my pay grade, but I know no other way to handle it short of a military style encrypted frequency.

Frank Ch. Eigler said...

Alan, re. the role of dispatch, that was indeed my understanding: it is a convenience. I am sorry for being over-literal in reading your sentence, that made it sound like, in your view, the relationship between dispatch and safety was a stronger one.

Alan Cockrell said...

Thanks, Frank. You won't beleve it but I just had another "Call Me" event today. It was the proverbial hours of boredom followed by you-know-what. Look for it next week.

Pete Templin said...

Anxiously awaiting your next installment. Hoping, perhaps expecting, that it's a bit more than "water quantity gage circuit breaker" needing a reset. ;)

capnaux said...

Oh, wow, excellent post, well-told.

Been there, done that, LOL!--esp. the part being "without contact", lol! We have ACARS, but NO LONGER have radio contact-ability with dispatch. A hair-pulling reality for us as of course contact is maddeningly slow. But at least we have a fairly decent and reliable Medlink patch...

Can't wait to read the sequel!