The flight attendant came to tell me there was an unresponsive passenger and that one person had already gone up to help.

This is right up my alley as an anesthesiologist to assess levels of consciousness and all the reasons someone may not wake up.

I carefully laid down my phone, earbuds and notebook and climbed over the gentleman sleeping next to me.

Thankfully, the unresponsive passenger was in a bulkhead seat and they had cleared the two adjoining seats. Sitting next to him was young woman who identified herself as a resident.

I stood in front of him and did a quick assessment of breathing, pulse, and a look at his pupils. I could tell he had enough oxygen, respiratory rate was normal, pulse was a little weak, and we just couldn’t wake him.

The other person who rang the call bell did come up, but I realized she knew him and can’t really attribute her behavior to being a medical professional more than an angry acquaintance.

In a slow unfolding of events, I got a manual blood pressure with the $10 stethoscope as the acquaintance asked for Narcan, (he didn’t need it in my opinion.) but I was disappointed to learn that is not included in the airline medical kit.

I gave him a few sternal rubs and he popped open his eyes. For anyone listening who’s not in medicine, when you put your hand in a fist and rub your knuckles on your breastbone hard, it hurts. To not respond is very telling and not a good situation.

But he did respond and quickly admitted to being intoxicated. It was something other than alcohol as I didn’t smell any of that. He was now coherent and answered questions appropriately.

The resident, bless her, started in with asking him a full medical history. I tapped out and went back to my seat.

The flight crew determined he was not fit to fly, so we returned to the gate. Rounds of police, paramedics, and more crew came to talk with the passenger.

In the end, he stayed!

After an hour and a half delay, we finally took off.

Do Physicians Always Need to Jump Up and Help?

What I want to talk about today are the conflicting emotions, feelings, and thoughts that arise in this type of situation. Why did I begrudgingly get up to assist? Why didn’t I urgently stand up to help?

Well, there are a few answers to this. Practically speaking, I’ve eagerly helped on previous flight medical emergencies, I realize the full scope of how little we can do as a physician on a plane with woefully dismal medical kits and minimal space to lay a passenger supine to even do CPR.

And then, there are the feelings and motivations behind my behavior, and those of the resident and the acquaintance. What a stark contrast between the 3 people responding.

The resident employed her training to assess the cause of being unresponsive. I used my experience to assess vitals and wake him up. The 3^rd respondent likely had some background information on the drugs he did consume.

My compassion tank is nearly empty, even with stepping back to part time. Motivations change as we progress in our career for those of us experiencing burnout … which is the majority.

Doctors Are Humans Too

It’s interesting that the psychology chapters I was reviewing covered different motivations people experience for helping others. I believe these motivations evolve as a medical career progresses. There are three I will discuss that may be a fit for you — depending on the situation of course.

• Prosocial behavior – Prosocial behaviors act to help others such as comforting or cooperating to further the welfare of other people.


• It’s straightforward and thankfully many people exhibit prosocial behavior that keeps society more livable! When someone opens the door for me, lets me in in traffic, or smiles and says thank you or hello, my day gets a little better. And it motivates me to pay forward small acts of kindness.


• It’s interesting that prosocial behavior does not need to have a self-sacrifice component. That would make it altruism.


• Altruism is also helping others, but without regard for self-interest. You sacrifice time, resources or energy purely to help someone in need.


• You may think of a philanthropist who donates anonymously, or a woman who darts into traffic to save a child from getting struck by a car. It’s a raw, instinctual motivation to help.


• Some do argue that altruism isn’t completely pure as most of those who help do get some form of accolades.  I received heartfelt “thank you’s” from the flight attendant which, not going to lie, made me feel good.


• I felt good for following my integrity and contributing to a positive outcome, which for that passenger was not getting hauled off on a stretcher!


• I would also like to think we made it off the ground faster since he was allowed to stay, and maybe some of the people on my flight made their connections here in Houston.


• Who knows, but the positive ripple effect made me feel good anyway.


• So, yes, altruism is a form of prosocial behavior, but a very different concept.


• Compassion – Compassion is the third form of motivation I want to mention. After thinking about why I was hesitant to help on that plane, I realized it was probably a form of compassion fatigue.


• Compassion is the emotional response we have to the suffering of others. I didn’t immediately feel empathy and concern when hearing someone was unconscious, and that surprised me.


• I felt more immune to the possible distress of a stranger I had not laid eyes on yet. I heard two bells indicating 2 other people on board responding to help. Really, did they need me too?


• This reminds me of a famous social psychology case that you have likely heard about.


• On March 13, 1964, Kitty Genovese, a 28-year-old woman, was attacked outside her apartment building in Queens, New York.


• The New York Times portrayed a scenario where dozens of people watched passively as a murder unfolded. This sparked outrage and led social psychologists to research the phenomenon now known as the bystander effect.


• This described how people are less likely to intervene in an emergency the more bystanders are present.


• I wonder if I paused to stand up because of this well studied, and proven effect.


• I personally think that compassion, along with integrity and moral consciousness helped me step up and help. But I was missing some of that compassion component.


• My tank of compassion is nowhere near the level it was my first day of medical school. And then when I started my first rotation in residency, remember that excitement to finally practice medicine!


• It was such an honor, and oh so humbling.


• I saw this in the resident – in her enthusiasm for a thorough history and long differential diagnosis list. Observing her demeanor and kindness, her compassion tank was overflowing!


• That used to be me. Well, it still is to a small degree. Not that I believe physicians should maintain that level their whole career. But I have met a few mom docs who do! These women are inspiring.


• Check out my previous podcast episode 12, A First Step to Rekindle Compassion in Medicine for a Physician Mom, talks about compassion in depth.

In conclusion today, I mentioned I’ve responded to inflight emergencies in the past. One time, when I jumped up more quickly than this recent event, I helped a gentleman who was struggling to breath.  We worked through it and the flight continued.  As I climbed back into my seat I faced the two passengers behind me.

Thank said with a slight laugh, “Thank God you responded! We didn’t want to, we’re two psychiatrists!”

I completely honor their decision both then and now after many years. I am inclined to think by their response, they would have stood up to help if I hadn’t first.

It’s what physicians do. Even though motivations may change a bit in life, you still stand up. You help people.

It’s Time to Take Control and Thrive!