'After 11 years of medical education, training in various hospitals, giving various competitive exams and finally, if you're able to save a child's life at 20,000 feet above the ground, in the air, with limited resources, that is like an unbelievable feeling.'
Eleven years after he entered the All India Institute of Medical Sciences, New Delhi, Dr Rishabh Jain, last weekend, found his calling.
It took saving the life of a tiny child of maybe 18 months or more, while airborne, and under the most harrowing circumstances, to make him realise that this was exactly why he had become a doctor.
Dr Jain, in the precise, clinical voice of the capable medical professional he seemed to be, related the events of the night of August 27 onboard Bengaluru-Delhi UK 814.
The abiding, takeaway image -- that will no doubt be seared forever in his memory -- of that evening, was of looking at a really "cute child", lifeless, blue around the lips and tongue, a cyan tinge emanating from her skin, her eyes rolled upwards and then, unbelievably, after he and his four fellow colleagues literally breathed the life back into her, how pink and even cuter her small face became, her chance at living given back.
That the child was Bangladeshi, belonging to the country of one of India's friendly neighbours, also made it a wondrous tale of medical diplomacy unfolding in the skies above the heartland of India and illustrates the fantastic healing power of Hippocrates' profession that knows no boundaries.
Dr Jain does not have any information on how the little girl is faring and he is clinically aware that it is a tough path forward for any patient returning from a cardiac arrest, let alone a toddler below two.
But to have participated, for half an hour, in the highly scientific yet magical and divine process of restoring life, was a soul-changing experience for him.
The physician, who has been living in New Delhi for 13 years and now works at the Institute of Liver and Biliary Sciences as a radiologist, but is originally from Roorkee, near Haridwar in Uttarakhand, recounts the heart-uplifting events aboard Flight 814 to Vaihayasi Pande Daniel/Rediff.com:
"It was not a normal child, who fell sick on a flight, and went into cardiac arrest. It was a patient, with already heart disease, who had undergone open heart surgery only days earlier in Bangalore.
The parents had a safe-to-fly letter from the hospital. The hospital had examined the child and deemed her fit to travel. Actually, the patient was from Bangladesh; a lot of patients do come from Bangladesh for treatment in India.
The patient was travelling back and it was Day 20 after surgery had happened. I think the child had recovered in the hospital quite well. You can't really predict these things and when they go wrong. Unfortunately, it happened for the child and for the parents. Nobody knows what happened. What caused it? We can only speculate.
There were five of us travelling from Bangalore -- an interventional radiology conference had happened on the weekend of August 26th and 27th and me and my colleague Damandeep Singh had both travelled to Bangalore to attend it, and the third doctor was Dr Avichala (Taxak).
We three were attending the conference. The other two doctors were our spouses. My spouse is Dr Oishika (Chakraborty) and Dr Damandeep's spouse is Dr Navdeep (Kaur).
The flight was in the night at 9.10 pm, flying from Bangalore to Delhi. It all happened around 20 minutes into the flight, when the seatbelt sign had been turned off and when the cabin crew started serving dinner to the passengers.
A distress call was raised by the parents and the cabin crew rushed to their (side). Within a minute, they asked if there were any doctors on board. "It's an emergency."
My wife quickly raised her hand. She is a gynecologist at AIIMS, Delhi. She examined the child, rushed to the back of the aircraft, where the cabin crew sits and there are curtains, and found the child to be limp.
She was all blue. Not breathing.
My wife checked the child's pulse. There was no pulse.
The child had had a cardiac arrest in the air. The child's heart had stopped beating. She quickly started chest compressions on the child.
Meanwhile, the rest of the four of us immediately joined her in the back area, asked the parents about the medical history. They showed the hospital papers that they had with them. It was a case of a heart disease, which had been operated in Bangalore 20 days before.
One of the doctors, Dr Navdeep, is a critical care physician. She is an anesthesiologist by profession and used to handling (these) situations in the hospital as well, because in AIIMS an anesthesiologist handles both the things -- general anesthesia as well as critical care.
She quickly assumed the team leader role -- she was the one who was the best suited for this job and she really assumed that role and all of us kept calm and followed her instructions.
The cabin crew, meanwhile, provided us with the medical kit that they have (airlines are, says Dr Jain, required by law to maintain a basic resuscitation kit, though he wished it also had a kit for children).
One of us opened it, examined what equipment we could use -- the airline had a bag and mask to give air to the child. One of us (rapidly) started with chest compressions.
The other (swiftly) started with the bag and mask ventilation for the airway.
The third person looked for a vein for the IV cannula to administer drugs.
The fourth person arranged the oxygen cylinder and the tubings.
And the fifth person began preparing the drugs quickly.
It was all in (perfect) sync, (like we were aware) that this situation has happened and something needs to be done about it quickly, because we were running short of time.
The flight had just started (out from Bengaluru) and it was a three hour-long journey to Delhi.
(That there were five of us doctors) was definitely, definitely (lucky). If it was one of us, I'm sure the outcome would have been very, very different. It's not a single person's job. It's not like somebody having a stomach ache (onboard) or somebody's feeling dizzy. There's a one-and-a-half-year-old child who has gone dead.
While we were all arranging this, we did not have a monitor to look at the heart rate or the oxygen saturation or the blood pressure. It was all the clinical judgment that we were working on, with the limited resources.
Then one of us spoke to the captain of the aircraft and told them (in the cockpit) what exactly was the gravity of the situation and that the aircraft needed to land as soon as possible.
The nearest airport, Nagpur, the pilot told us, was like 15 minutes away.
We planned that during these 15 minutes, we would try to resuscitate the child, keep the child alive. And as soon as we landed, we would hand over the child to a better-equipped team, maybe airport staff or a hospital ambulance might come to the airport to take the child to a better place and a (medically) better situation.
In those 15 minutes we resuscitated the child and fortunately, her pulse came back, because during the resuscitative efforts there was a return of spontaneous circulation.
We thought the celebrations were a little premature, because as soon as the aircraft started landing... Landing is a very critical step for the aircraft, the passengers and that patient as well, because there was a little jerk that happened during that time. To add to it, it was an emergency landing, not a routine landing. The child again went into cardiac arrest.
We resumed chest compressions, the drugs, the oxygenation, everything.
Fortunately, once we had landed, we quickly transferred the baby to an ambulance, which had arrived just at the landing site and further resuscitative efforts started in the ambulance. The airport hospital staff was called and they brought in an endotracheal tube intubation kit. The child was intubated, and her vitals gradually improved.
We finally handed over the child, in a stable condition, to the hospital staff, but she was still intubated.
The parents were very distraught, the mother was distraught. She was crying. The father was praying -- he was speaking some verses. And he was praying to the god: 'Please, please save my child'.
I really appreciate that the parents gave us the space, without interfering much, to let us do what we could do -- to do our best. And finally, when the child's heart started beating again, the parents were teary-eyed and they thanked us for saving the child.
The learning point for me was that all doctors should be well-versed with the basic life support. And airline cabin crews as well.
The cabin crew was exceptional. They were very fast. Whatever we were asking of them, they were very clear about whether they had this (or that) or not.
And the captain, in the one minute or two minutes, we talked to him (and his team) was convinced that: 'Okay, it's fine with us'.
And even though there were 200 passengers on board and yes, they (the airline has) hade to attend to them and their families, as well, and the flight might get delayed two to three hours and there might be a financial burden on the airlines, but the captain was very supportive: 'Okay, we will land the aircraft.'
The passengers did not hinder in any way and nobody like objected, even once, about what was happening (or about the delays).
I remember that when the child's heart started beating again, I could feel the heart in my palm. When I kept my hand on her chest, and I could feel the heart pulsating.
That was a sign of victory for all of us that: 'Okay, with the limited resources that we have, we just saved a child's life!'
That feeling was -- you know -- unbeatable.
After 11 years of your medical education, your training in various hospitals, giving various competitive exams and finally, if you're able to save a child's life at 20,000 feet above the ground, in the air, with limited resources, that is like an unbelievable feeling.
It was a very cute child, in a black and white checked shirt and a diaper, wrapped in blankets. My wife and I were just talking about that, that the child was very cute and unfortunately when we saw her in that state she was all blue, her tongue was blue, her lips had gone blue and her eyes were up-rolled.
But finally, when we handed over the child to the pediatrician, the child was pink meaning her heart was beating.
Feature Presentation: Aslam Hunani/Rediff.com
The little child, whose life was saved on board Vistara's UK 814, sadly passed away in a hospital in Nagpur on August 31 at 3.15 am at the KIMS-Kingsway Hospital, according to a press release issued by the hospital.