The man is already dead. He is lying in the aisle of the airplane as my daughter trades off on chest compressions with a firefighter and a couple of nurses. “One, two, three…,” they count out loud for each other. Thirty compressions, then two breaths. Thirty compressions, two breaths.
The monotony of the counting, the silence of the other passengers, the lack of response, the futility — the nothingness is building into something. In the void, the urgency swells. The defibrillator beeps, again and again. No response. No response. The air is prickly with his life force waning. “One, two, three…,” they count.
His lips are a violent blue. Like a shiny navy lipstick. It is obscene to look at. I should not see, but I have a front-row seat. “One, two, three …” His body convulses under their hands, as if they are violating him. Flesh on flesh, their hands on his bare chest. My daughter’s turn. My daughter, a medical student. She feels his ribs break under her force, she tells me later. “One, two, three …” No response.
They take it in turns, breathing their breath into him, hands on his cooling flesh. She searches hungrily for a vein, penetrating with the needle, looking for a route to feed him epinephrine. “One, two, three …” No response.
Their breaths, sometimes misdirected, bloat his stomach, which eventually regurgitates. They move the breathing bag off his mouth, wipe it clean, and replace it. “One, two, three …” No response.
They are emptying themselves into and onto him. Breath, sweat, hope mingling. “There is no response. It’s been 15 minutes. O.K. to stop,” says the flight attendant. We still have four hours left in the air.
Afterward they clean their hands. They exchange words, tell the story of his death as his body lies under their words. “He was already dead. There was no pulse. It was too late.” They eventually disperse back to their various seats and he is carried, unceremoniously, hands bound together for ease of transport, to a seat near the back where he is propped up, with an eye mask, blue lips displayed for all to see.
In-flight medical emergencies are rare, I later learn: an estimated 16 of them for every million passengers. Deaths on board are far rarer: one for every 7.74 million passengers.
So it’s unlikely the crew on my flight had much experience with an in-flight death. But would that have even made a difference? Not a meaningful one, I suspect. The man could not have been revived.
Could the process of his attempted resuscitation have been handled better? Who knows. One flight attendant seemed to take charge, his hands also pumping the chest, his voice counting, directing, instructing. But his instructions floated aimlessly in the air as his colleagues fumbled with keys, rummaged through overhead compartments, inspected the contents of the first-aid kit and failed to find or recognize the items that were being requested.
Was there an intubation kit? The urgent demand from the floor was met with blank faces. Epinephrine? An IV? They did not know where to look or what to look for. A tourniquet? The request floated down the aisles as one attendant started to unlace his shoe. I handed them my headphones.
Yes, they remained calm. To a fault? There was little sense of urgency in their efforts, as if they had already decided it was futile.
And then the decision to prop him up in a seat, with an eye mask. This was terribly unsettling. His face should at least have been covered, I thought. But I looked it up after. The guidelines from the International Air Transport Association recommend such passengers be given a seat, the blanket lifted only to the neck. Why? We lay dead bodies down. We cover their faces so they may rest in peace. But he was not “officially” dead yet, only presumed so until a doctor could declare it.
And what about the team that shot up from their seats and threw their hearts into the frenzy of the rescue? What about my daughter, just 22 years old and handling her first death outside of the hospital setting? I tell her through tears that I am glad she broke his ribs because she left on his body a sign of her sincerity, her promise to his family that everything possible was done.
The pilot makes an announcement as we jet on through the turbulence: “There was a medical emergency — it’s been dealt with.” The crew takes a statement from my daughter, and she signs a form, the dead man’s name printed clearly in the middle of the page. The flight attendant fortifies us with wine, which we drink together, plastic cups shaking in our hands. The man sits as the drinks and snacks are served.
But my daughter wants more. She needs to know the start of the story, and the last of it. She needs to know the cause of death, the preceding symptoms. She needs closure, to speak to his family members, to tell them he was surrounded by positive energy, a force of will to save him. He was surrounded by caring and concern — and much regret.
But this information cannot be shared with her, they say. “He was our passenger, after all.” As was she. He was also her patient.
When we land, my daughter tells the police that she is available, should the family wish to speak with her, should they wish to know anything. One officer shrugs and says that won’t be necessary. But it is important. She talks to another, who takes note of her offer. There are details, final moments that the family may cherish like polished pebbles, arranging and rearranging to put this or that at the foreground, to put away for safekeeping and retrieve now and again for the rest of their lives.
When we leave the plane the healers straggle off, no words exchanged. Their hands that shared his flesh do not touch each other, do not share again. Their breath that mingled within him does not join together to speak of him, to conjure a prayer or a tribute. They dissipate, like his spirit.
I think back to the announcement: “There was a medical emergency — it’s been dealt with.” So much that was not said. On a lonely flight, 30,000 feet in the air, the pilot failed to announce The Departure.