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Lounge Fiction Special: ‘In-flight Readings’ by Vikramajit Ram

A doctor making a fraught journey finds that matters of the heart are set to spring a surprise when there is a mid-air emergency

A doctor travels for a family function after grappling with loss of his parents in 2021 (Illustration by Nithya Subramanian)

By Vikramajit Ram

LAST PUBLISHED 05.01.2024  |  01:40 PM IST

Forty minutes to touchdown, we have a situation. “Is there a doctor on board?" says the flight attendant in the front-row aisle.

The hush is immediate. Even a squealing infant in the rear knows something’s up. I can choose to volunteer, or sit tight in 13A, Emergency-Exit. The clack of my seatbelt buckle kills the silence.

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The passenger in 1D is in his 70s, dapper, balding, greying, and unconscious. “I thought he’d fallen asleep," says his wife—birdlike, looking and sounding more annoyed than worried. “And just like that he made a sound and slipped sideways. Has he…expired?"

I smile, and gently move her hands from his chest. His airways are clear: he hasn’t choked on the sandwich. I find a pulse, faint, in his neck. Textbook syncope—dehydration and cabin pressure, in this instance; and a heart condition, perhaps? It’s been a little over a minute. He must come round in the next two, four at a pinch, if his brain is not to be compromised. In the crew-zone, a calm, collected drill underway involves the opening and shutting of cabinets with discreet clicks, an oxygen canister and emergency medical kit, the handset of the intercom, and the door of the cockpit. The oxygen mask is appointed to our patient. The emergency kit is equipped to address trauma, allergy, heart attack; with any luck, the defibrillator will not be needed. On earth as it is 30,000ft in the air, the protocol is standard—even if the floor space for it here is the length and width of a body-bag. Passengers 1C and 1F help manoeuvre our patient flat on his back: his feet and knees raised on cushions, a folded pullover under his head. Blood pressure, 44/20; oxygen saturation, 94. We keep the oxygen mask in place.

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The noise from the aircraft engines is deafening at floor level. The stethoscope from the kit could well be a toy. I count the thrumming in my ears: 48. I listen closer. Under the din of the engines and between the heart’s own labours is an intermediate sound like a dry rusted gear—a “murmur", in medspeak. There’s an almost imperceptible drop in altitude just then. The seatbelt signs bleep. We thump into a cloudscape. The patient wakes, blinks, and favours us with a grimace. The development is relayed to the cockpit. I remove the stethoscope and ask the wife:

“What heart medicine is your husband taking?"

She’s been sitting stock-still. “Medicine? For his heart? Nothing. He doesn’t need medicine for anything. No cholesterol, no diabetes, no alcohol, non-smoker; we are very active, four kilometres every morning, this has never happened—never..."

A flight attendant leans over to say we are not diverting, we’ve been granted priority landing, the company doctors will be waiting. On the floor, our patient tries to sit, and, with a gesture that he’s about to be sick, yanks the oxygen mask away. A barf-bag reaches him in time—and, moments later, a second bag. He is cleaned up a bit and given some water to sip; that he empties the cup and asks for more to drink is a good sign. Shaken but lucid, he manages a weak smile and lies back.

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“You’ve been unconscious for about four minutes," I tell him. “An ECG and Echo should reveal what might have caused it; we’ll ask for the tests."

He nods, giving my hand a little squeeze. I ask if he’s in discomfort or pain. He shakes his head, and pats my hand. I ask the wife whether anyone’s receiving them.

“Someone will be there," she says. “We’re going to a family function, his older brother’s granddaughter’s wedding. My son..." She breaks off, making a dismissive gesture, “… is not here."

Family functions always make me think of bowel movements. “I’m going to a family function as well," I tell her, brightly. There is no reason to elaborate that my older brother and sister-in-law finally did it last week under the Special Marriages Act. The party this evening is more in my honour for taking two days off —lucky us, a whole weekend!— for the first time since 2021, when bro and I had been separately but simultaneously and doubly but distinctively bereaved in the April and June of that shitshow of a time. Mum and Dad had both been working—obstetrics, paediatrics—right through it, the way others of our calling had, everywhere. Bro and now-SIL had done whatever had needed doing; I had stayed where I was, keeping complete strangers alive and seeing other strangers off in body-bags. I’ll come home when I can take a proper break, I’d said: There’s still a lot happening.

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“Sounds like a reluctance to fully process your losses, plural," my therapist had said. “While there is no such thing as ’closure’, you might want to set aside some time every day to look after yourself. Make a practice of it."

Excellent advice. I had embarked, post-plague, and between 15-hour shifts and five hours of sleep, on a regimen of “self-care"—nutrition, hydration, meditation, dream-journaling—which lasted all of a fortnight and only left me feeling dazed. Perhaps I needed a change of scenery. Remember revenge tourism? A week, solo, at a deluxe beach resort was a disaster. For starters, there was no “off-season"—tariff nor traffic. I’d checked-out with a rash. A five-day batch-reunion, next, in a freezing hillside “chalet", had escalated into a depression contest. Three surprises, carefully excluded from the original plan, had caught wind and arrived and further complicated things. So much for holidays.

“Try to find joy in the everyday," my therapist said. “You don’t have to go anywhere to find it." Scant joy was to be found in The Tibetan Book Of Living And Dying; a mini-series of coldly-detached mildly-risky app-enabled dates; a hospital support-group for families who wanted to “give back"; and a subscription to a swimming pool, which I utilised thrice. I did rediscover the joy of nicotine. And, belatedly, discovered first-hand the peerless joys of Schitt’s Creek. At each stage, I reported to my therapist my progress in my slow narcissistic journey in grief-management. “So long as you approach it with acceptance and awareness," she said, “it is valid to be thinking solely about yourself. Be open this year to the concept of visiting your brother; you’re not the only one who’s been bereaved." Sage counsel, as always. And what better reason than a wedding celebration this evening. Come Monday, and within hours of flying back, it will be scrubs as usual for me.

“Good morning, ladies and gentlemen," crackles an urbane male voice. “We will be arriving at our destination in 25 minutes, we hope you have had a pleasant flight, cabin crew to prepare for landing shortly."

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A passenger chooses this moment to attempt a foray to the toilet with us hindering easy access—what is he thinking?—and is courteously shooed back by a flight attendant. “Ladies and gentlemen, boys and girls, please remain seated and fasten your seatbelts until the seatbelt sign is switched off. For the convenience of fellow passengers, please use the toilet in the rear."

I look at the wife and smile. “Are you doing alright?"

“How old are you?" she says.

“Thirty-two," I reply. I check her husband’s heartbeat.

“Are you married?"

I give it a full minute. 60. “His pulse is stronger," I say. “The airline might ask to speak to your family when we land. Whom would you like them to contact?"

She fumbles for her phone, selects a number, and has a flight attendant copy it. Presently, there is another announcement from the cockpit. Our patient is helped into his seat.

“Do you have to do this often?" he asks me.

“When I can," I reply.

I am shivering uncontrollably when I return to 13A and can barely get the seatbelt-buckle to engage. My window frames a diagonal section of a wing, and a corresponding section of ultramarine sky. I am still a mess when we land. The shivers subside when we taxi to a standstill. A cheer goes up in the cabin. Weirdos, I think to myself, and look out of the window. An ambulance is waiting a short distance away.

We are instructed to disembark from the rear exits only. It results in a polite uncomplaining crush in the aisle. A few people pause to shake my hand as they shuffle past row 13. It occurs to me that the applause, earlier, might have been for me. Imagine if I had not responded in time. Imagine if I’d been catching up on sleep. Imagine. Hearse not ambulance on tarmac. An idea pops into my head. I assess it for feasibility, practicality, convenience:

I can disembark, nip into the terminal, and hop on to the next flight back. No one will be the wiser. Tonight’s party will go on, with or without me; we FaceTime all the time anyway. Mainly—and this is what it is—I will not confront empty spaces where two people I’ll never see again had once been.

I’m warming to the idea when a senior citizen with overhead baggage opens a gap in the traffic. I snap out of it, collect my overnighter and squeeze my way to the front where two other people are waiting in their seats.

There’s time for a quick round of introductions and thanks: the captain, the first-officer, the flight attendants. The ramp is in position. Two doctors follow the ambulance assistants. Something at once feels different—a crisp citrus zing.

“Cardiology?" asks the consultant physician.

“Cardiothoracic surgery, in training," I reply, and, dropping my voice: “There is a murmur." I then stand aside while he examines my patient—the patient. The second doctor gives me a little nod and a smile. I nod and smile back, glance at his nametag.

“There is a murmur," the consultant physician confirms, straightening up. “We will take it from here. Thank you for your help."

Their patient is transferred to the wheelchair, and his wife assisted with their bags. The consultant accompanies the couple down the ramp. The second doctor hands me a clipboard and pen.

The Handover Form runs into two pages. I tick and cross every box there is to cross or tick, duly record all observations and diagnoses, procedures if any, meds if any, my name, licence number, mobile number, time, date, place. I squiggle my signature and hand the form back. Dr CitrusZing takes forever over it.

“Is everything in order?" I say.

“Yes, yes, of course… Thanks. Just making sure—"

“I haven’t mentioned it, but this is my first time. At a mid-air emergency, I mean."

He shrugs. “That’s fine. We all have to start somewhere. He is lucky."

“I was coming to that," I say. “I have a feeling it’s an atrial murmur. Will you let me know if it is, when the tests are in?"

He gives a little frown and clicks the pen. “Which hospital are you with?"

I name the establishment I’m with. And name-drop some more, needlessly.

“Oh … So you don’t live here, then?"

“I’m sort of … in and out, you could say."

“Can I see your licence?"

Didn’t see that coming. I fish out my card. “Can I see yours?"

He pretends not to have heard—which is encouraging. “Joke," I say. “Forget I said anything. If we’re done here, we’d better get off."

The flight attendants, smiles in place, are waiting for us to do just that.

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“I’ll message you," he says, returning my card. “About the murmur, I mean, and if I need to—" He suddenly grins. “Don’t worry about it, I will call. See you, take care."

I watch him lope down the ramp. I’m not worried. I turn my mobile off airplane mode. It almost leaps out of my hand with WhatsApp-pings. It is simpler to call than to text.

“Hey bro. Just landed. Should be home in a bit."

“Good flight?"

“Couldn’t be better," I say. “See you soon."

Vikramajit Ram is a novelist and non-fiction writer based in Bengaluru. His book, Mansur: A Novel, was shortlisted for the JCB Prize for Literature 2023.