Tuesday, February 16, 2010

A salute to air travel

I am recently returning from a short jaunt to New Hampshire. Since embarking on my approximately 30th flight since September, I’ve been thinking a lot about flying. The turbulence exacerbates my irregular pulse, the turbid air recycling makes me nauseous, and the company on the plane can sometimes be exceedingly obnoxious (quoting entire choruses of Jimmy Buffet songs while professing the pathetic level of your love life and talking about your bankrupt houseboat casino to unsuspecting strangers is never a good idea). But none of these things bothers me as much about flying as the fact that in May, I will be a doctor.

Only at 30,000 feet could it really mean so much to be a physician. For example, if there were a medical emergency at the Cleveland Symphony, there are probably between 300 and 500 physicians of various specialties ready to run to the rescue before the patient was carted off to the hospital approximately 500 feet away. Contrast that to the isolating altitudes of the airplane, where there may not be any health care providers at all and the presenting pathology could range from heart attacks to labor to seizures.

“Are there any doctors on the plane?” as I sheepishly raise my hand…am I really (or will I really be) that person? Even though in the hospital as a new intern my life will be extremely challenging and exact responsibilities such as writing orders, performing procedures, and signing my own notes (no co-sign!), never will I be without some sort of supervision within earshot. But in a few months, I will take the Hippocratic Oath and with that oath, it will be my duty to at least try to do no harm.

Unfortunately, there is not much good data on the topic as airlines have variable reporting standards for medical incidents. According to a recent review paper, a medical emergency occurs in about 1 out of 10,000-40,000 passengers, and on overseas flights there is a doctor on the plane about 85% of the time1. (Yay, doctors get to travel!) The most common presenting complaints are fainting, followed by abdominal symptoms, followed by cardiac problems 2. Doctors are not legally required to offer assistance in the US or Canada, but are in Europe. Regardless, they are well protected on flights by Good Samaritan laws, and thus should volunteer unless they feel that they for some reason are unable or exceedingly inebriated.

This is a salute to all my friends who will also soon be doctors. Let’s hope we were well trained enough to at least give it a go. Let’s also hope that there’s a well seasoned emergency room doctor sitting next to us. And I’m sorry to produce anxiety for all of you by writing this.

Not to worry however. There are cookies on the plane to give you energy (at least on some airlines). I leave you all with a recipe for chewy molasses cookies as a substitute for the better-than-peanuts, crunchy spice cookies offered on Delta, the worst airline in the world. May everybody have safe travels and until then…eat chewy, spice laden, richly colored cookies.

Chewy Molasses Spice Cookies Adopted from The Martha Stewart Living Cookbook

2 ½ cups all-purpose flour
2 ¼ teaspoons baking soda
½ teaspoon kosher salt
1 tbsp freshly grated ginger
½ tsp ground allspice
¼ tsp ground cloves
½ tsp ground black pepper (sounds weird but SOOO delicious)
2 sticks plus 2 tbsp unsalted butter
½ cup granulated sugar (plus more for dusting)
1 large egg
¼ cup plus 2 tbsp molasses (or if you run out of molasses as I did, sub a couple of tbsp of maple syrup)

In a medium bowl, whisk together flour, baking soda, salt, allspice, cloves and pepper, set aside.

In the bowl of an electric mixer, cream the butter, ginger, brown sugar, and white sugar until light and fluffy, about 5 minutes.

Beat in the egg and molasses. Add the flour mixture, mix until combined. Form into flat disc, wrap in plastic wrap, and chill the dough at least 2 hours. (Chilling dough is annoying but it helps shape the cookies). Preheat the oven to 350. Pour sugar into a bowl. Form the dough into 1 inch round balls (although I like them a bit bigger), roll each ball in the sugar. Place the cookies on a baking sheet, spaced about 2 inches apart. Flatten each ball with the palm of your hand into a disc. Bake the cookies until browned about 10-12 minutes.


Cocks, R. and M Liew. 2007. Commercial aviation in-flight emergencies and the physician. Emergency medicine Australasia : EMA 19, no. 1:1-8.

Sand, M et al. 2009. Surgical and medical emergencies on board European aircraft. Critical Care. 13 (1).


  1. Time for blogging AND baking? This medical school thing sounds like a breeze!
    Maybe I will be that ER doc next to you on a flight. Til then, I'll just be the ER tech studying o-chem and could splint your arm if the turbulence got to be really rough.
    (P.S. should I apply to Case Western?)

  2. Hi Liz! Thanks for reading (and tell your friends!) I have time now because 4th year of medical school is a breeze. Also, you have to maintain your passions. You should definitely apply to Case, but get ready for Cleveland winters...they are unfortunate. I'm proud of you for doing it, I think you'll be absolutely great.

  3. Thanks for the encouragement. Some of the docs I work with did their residencies at Case, and they say all good things about it. (As many good things as you can say about residency...)
    Cookies look scrumdiddlyumtious!