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28th of August, 2010
Maya had been a flight attendant for six years, long enough to handle drunk passengers, screaming babies, and the occasional bout of turbulence with professionalism. But medical emergencies were different, they made her hands shake and her mind race through the training protocols she'd memorized but never quite trusted herself to execute perfectly.
The flight from Delhi to Toronto was supposed to be routine. Thirteen hours, mostly over open ocean and some wilderness, with a full cabin of staff and the usual mix of business travelers, families, and tourists. They were five hours in, somewhere over the Arabian Sea, when everything collapsed.
"We have a medical emergency on board," Harendra's voice came through the intercom, trying to remain as professional as possible. "Any doctor, nurse, or EMT please press your call button and we will come get you."
Maya's stomach clenched. She was in the forward galley, preparing the dinner service. She grabbed the red medical kit from its compartment with one hand and the AED with the other, her heart already pounding.
"I got it," she told Cachari, the senior flight attendant, who nodded and moved to cover her position.
The aisle seemed impossibly long as Maya hurried toward the back of the aircraft. Passengers were craning their necks, some standing to get a better view. A small crowd had formed around seat 24B, where a middle-aged man in a wrinkled business shirt slumped against the window, his head at an unnatural angle, his face an alarming gray color with lips tinged an unmistakable blue.
"Excuse me, coming through," Maya managed. The passengers parted reluctantly.
Priya was already there, pale with fear. "He just- he said he felt dizzy, and then he just collapsed. I don't have the-"
"Let me see him." Maya set down the equipment and pressed two fingers against the man's neck, searching for a pulse. His skin was cold and clammy, but she waited, adjusting her position, and tried again. Nothing. Her stomach felt like it had dropped through the floor. "He has no pulse. Priya, help me get him to the floor. We need to start CPR."
"One moment, Beti," Harendra appeared from the other side of the corridor, gesturing for someone behind him to follow along. "There was a doctor in Business class."
The woman behind him was probably around fourty, short and chubby, with ginger hair painted scarlet red on the edges and dark blue eyes. Her only other distinguishable appearance markers were her small reading glasses, and her rainbow blouse, whose sleeves she was already rolling up.
"Are you specialized?" Maya asked, after the other woman made no attempt to introduce herself for more seconds than she was comfortable with.
"I'm Cenedra Necam, disaster medicine physician out of Toronto." The woman was already kneeling beside the unconscious man, checking his airway with both hands. "How long has he been unresponsive?"
"A minute at most?" Maya's mind was spinning. A doctor. Thank God, an actual doctor.
"That's good." Dr. Necam tilted the man's head back, checking his breathing. "Get me the AED, but don't open it yet. I need to start compressions first. What's your name?"
"Maya Kaur, ma'am."
"Alright, Maya. I need you and the others to keep the other passengers back and time my compressions. Can you two do that?"
"Yes, of course."
Harendra had already walked away to report to the cockpit, while Cachari was probably trying to keep the passengers who were still in their seats as calm as possible.
Priya was trying to push the crowd back, but people were reluctant to move. Everyone wanted to help, or just to see. Maya positioned herself between the doctor and the onlookers.
"Please, everyone, give us space. Return to your seats, the situation is under control."
It wasn't, not really, but saying it out loud helped. Dr. Necam positioned her hands on the man's sternum, one palm flat, the other locked over it, fingers interlaced, and began compressions immediately. Maya had seen CPR in training videos, but this was different. In person, it almost looked it there was too much force to it, like the doctor's entire body weight was being pressed down with each compression.
Maya counted silently, watching the watch on her wrist. Thirty compressions, then Dr. Necam tilted the man's head back and gave two rescue breaths, his chest rising before falling. Then immediately back to compressions.
The entire cabin seemed to hold its breath, even the engine noise felt muted. Maya was acutely aware of dozens of eyes watching, of Priya's frightened breathing beside her, of the absolute stillness of the man on the floor.
"Is there anything else I can do?" Maya asked, kneeling on the other side of the patient, feeling useless.
"Just keep timing. And stay calm, your passengers are watching you, not me." Dr. Necam didn't even sound winded, despite the exertion, her compressions never faltered. "What's his name? Did you check his boarding pass?"
"Yes, Rajesh Pandey. Traveling alone, seat 24B."
Another cycle, thirty compressions and two breaths. Maya's eyes were fixed on the doctor's hands, and that's when she saw it.
Or thought she saw it.
A brief flash of light, like static electricity, but brighter, dancing between Dr. Necam's fingers and palms into Mr. Pandey's chest. It only lasted a second, maybe two, a yellow-white shimmer that seemed to pulse with each compression.
Maya blinked hard, her breath catching. Probably just the stress, the adrenaline or the overhead lights reflecting off something. She was just seeing things, she had to be.
"Sixty seconds," Maya said aloud, her voice barely keeping itself together.
Dr. Necam nodded, continuing the compressions.
Another round. Maya counted under her breath, and then she saw the sparks again. This time she was certain, even though it made no sense. It was definitely not from the AED, because it was still closed. This was something else, and it looked impossible.
Maya's mind tried to reject what her eyes were telling her. Static from the dry cabin air, maybe just a trick of the light or even stress-induced hallucinations, even though she had never experienced them before.
Mr. Pandey gasped.
It was a horrible, wet sound, like someone fighting their way back from somewhere very far away. His eyes flew open and his whole body convulsed for a couple of seconds.
"Easy, easy," Dr. Necam said, immediately turning him onto his side as he coughed and sputtered, his chest heaving. "You're okay, Mr. Rajesh. You passed out, but you're breathing now. Just focus on breathing right now."
Maya stared at her watch in disbelief: ninety seconds. From pulseless to conscious in ninety seconds. She'd been taught that brain damage from oxygen deprivation typically began after four to six minutes. Most successful resuscitations took more than two minutes of continuous CPR. This was...
"That was fast," Priya whispered beside her, voicing exactly what Maya was thinking. "I've never seen anyone wake up that fast."
Dr. Necam gave a small, almost dismissive shrug, her attention still completely focused on the patient. "Sometimes you get lucky. The human body is remarkably resilient when you catch signs early." She was checking Mr. Pandey's pulse now, three fingers on his wrist. "Mr. Rajesh, can you hear me? Do you remember where you are?"
The man nodded weakly, still gasping. "Plane," he managed. "I'm on the plane..."
"That's right. It looks like you had a vasovagal episode; you lost consciousness and your heart may have stopped briefly. Can you tell me if you were recently told not to travel? Any medical procedures in the last few weeks?"
Embarrassment crossed Mr. Pandey's face, and he nodded again. "Cardiac ablation, I think, three weeks ago. Doctor said to wait six weeks, but I had to get to my children."
"Right." Dr. Necam's voice wasn't judgmental but still firm. "Well, you're breathing now, which is the important thing, but this is exactly why doctors give those recommendations. Your cardiovascular system is still recovering from a significant procedure."
While they spoke, Maya realized that many passengers were still watching the scene unfold. She stood up to walk closer to Priya.
"Everyone, please return to your seats. The emergency is over, please give us some space."
This time people moved faster, though still somewhat reluctantly. Maya caught fragments of whispering, both in disappointment and in fascination.
Cachari appeared with a blanket and pillow. "Does this help?"
"He'll need to stay in a reclined position, and you need to find an oxygen mask," Dr. Necam explained, not directly answering Cachari's question.
Priya had already retrieved the portable oxygen unit from the overhead compartment, and Dr. Necam addressed Maya and Cachari instead.
"I'll need to do a proper examination. Do you need to see credentials first?"
"That would be standard procedure, yes," Cachari said, sounding apologetic. "Just for our records."
Dr. Necam was already pulling out her wallet, producing a laminated medical license without hesitation or offense.
College of Physicians and Surgeons of Ontario. The photo matched her face. Cenedra Necam, MD, FRCPC. Disaster Medicine specialization, Emergency Medicine subspecialty.
Everything looked legitimate and current enough.
"Thank you, Dr. Necam," Maya returned the license, wishing she could have photographed it if not for the restrictions the company still had about flight attendants using cameras; they'd need to file the report with everything they remembered.
"No problem, comes with the territory." Dr. Necam accepted the medical kit from Cachari and began going through its content: blood pressure cuff, stethoscope, basic medications.
As she did it, she added conversationally, "I spent the last four months in West Bengal after the storm in April. Massive flooding, infrastructure more than destroyed. I saw more than my share of deaths and life support in temporary field hospitals."
Her tone was light, almost joking, but they knew she was just venting. Working in impossible conditions, holding lives in your hands when there weren't enough supplies or time... They understood, and they let her.
"That must have been very difficult," Maya poked.
"It was necessary," Dr. Necam replied simply. She wrapped the blood pressure cuff around Mr. Pandey's arm. "That's what disaster medicine is; going where you're needed, making do with what you have, saving who you can. Mr. Rajesh, I'm going to take your blood pressure now. You'll feel some tightness."
The whole examination took nearly fifteen minutes. Dr. Necam was thorough: pulse oximetry, pupil response with a penlight, listening to his heart and lungs, checking for chest pain or numbness. She asked about his medical history, his medications, what he'd eaten earlier that day. Mr. Pandey answered in a weak voice, looking embarrassed and grateful in equal measure.
Maya watched it all, unable to shake the image of those sparks from her mind. She'd seen them, she was certain, but how could that be possible? And why had seemingly no one else seen it?
But when she glanced at Priya, her colleague was simply watching the doctor work like a child watches a magician perform something amazing. Nothing too strange.
Maybe it had been in Maya's head after all.
Finally, Dr. Necam sat back on her heels, removing the stethoscope from her ears.
"No immediate complications. Blood pressure is low but stabilizing, heart rate is returning to healthy speeds, oxygen saturation is good and the lungs sound clear." She stared at Mr. Pandey with a serious look. "You got very, very lucky. When we land in Toronto, you need to go straight to the hospital. Nowhere else, just hospital. They'll need to check if this episode caused any damage or if there were unforeseen complications from your ablation. Do you understand?"
"Yes, Doctor, thank you. I'm sorry-"
"Don't apologize to me. Just promise you'll take your doctors' advice more seriously from now on."
"I promise."
Dr. Necam looked up at Maya and Cachari. "Keep him on oxygen for the rest of the flight, no getting up except for absolute emergencies, and I mean emergency emergencies. Someone should check on him every twenty minutes. And please-" she fixed them with an intense look, "notify me immediately if his condition changes in any way. Any sign of chest pain, difficulty breathing, confusion, anything at all. I'm in Z-14 on Business."
"Of course. Absolutely," Cachari said before Maya could. "Thank you so much, Doctor. We would have struggled if you hadn't been here."
Dr. Necam stood, brushing off her jeans. "I'm glad I could help. It's why I became a doctor."
She helped Maya, Cachari, and Priya get Mr. Pandey back into his seat, this time fully reclined with the oxygen mask in place and a blanket tucked around him. The man was already looking better, the color returning to his face. Several nearby passengers expressed their gratitude as well. Dr. Necam accepted their thanks with nods but seemed eager to return to her own seat.
"Maya," she said as she prepared to leave. "You did well. In an emergency, the most important thing is to stay focused and keep moving forward. Please don't forget that."
"Thank you," Maya responded, and meant it.
As Dr. Necam walked back toward Business, Maya found herself staring at the woman's back, though she was unsure of what was still bothering her so much.
Alyssa, or just "Lya" to friends, passenger on seat Z-15, marine zoologist for Australia's AQWA who was trying to enjoy her two weeks of vacation, had been waiting for Dr. Cenedra, whom she had been having a very pleasant conversation with, to return for close to half an hour now.
After the intercom announced a medical emergency, the only indirect information on Cenedra she had heard from one of the flight attendants was that the situation was being taken care of.
Finally, after a bathroom trip following two rolls and one cup of juice, Cenedra came back, not looking particularly exhausted, though the state of her clothes and hair denounced that she had probably needed to perform something big.
"Big thing?" Lya asked Cenedra, as the latter sat back in the seat across from hers.
"Just made someone's heart keep up the pace," Cenedra answered, almost sounding bored, grabbing the cup of coffee that had gone cold a long time ago.
"Too bad they don't let us smoke," Lya commented lightheartedly.
"I don't mind. Wouldn't want the smell to stick to me when I visit Célian."
"Is that your son?"
"Yeah, his father was from the French part. He lives in the Atlantic region."
"Can I ask what happened to his dad?"
"He had an accident at work. Touched a loose wire and got all burnt up."
"Oh.... I'm sorry for asking-"
"No need. He was a piece of work anyways."