Surgery At 33,000 Feet

It was about two hours into British Airways Flight 32 last week that the cabin crew realized something was wrong with the passenger in seat 53K.

During takeoff in Hong Kong the woman, Paula Dixon, 39, had complained of pain in her right arm-she'd fallen off a motorbike on the way to the airport--and the two doctors who happened to be on board had fixed a makeshift splint for her. Now the pain had spread to her chest and she was having trouble breathing. The plane was at 33,000 feet over the Bay of Bengal when Prof. Angus Wallace, chief of orthopedics at Queens's Medical Centre in Nottingham, England, was called back to Dixon's seat. He immediately recognized that the problem was much more serious than a broken arm. One of Dixon's ribs had punctured the pleura, the membrane that surrounds the lungs. Air leaking into the chest cavity had formed a bubble that kept the lungs from inflating--the condition known as collapsed lung. The nearest airport was in Delhi, but Wallace feared that the change in air pressure in a descent could be fatal. Also, her condition was trustable; if nothing was done, she could die in a matter of minutes. "I told her I was terribly sorry," he recalled later, "but I was going to have to operate."

The treatment for a collapsed lung is to make an incision in the chest wall and insert a tube to bleed off the air. The 747 carried an emergency medical kit containing a scalpel and a local anesthetic but none of the special equipment needed for this procedure. Luckily, the galley was better stocked. Flight attendants cleared the last row of seats and screened it off with blankets, Dixon took a deep breath from the emergency oxygen, and Wallace, assisted by Dr. Tom Wong, cut into Dixon's chest a little below the collarbone.

There were no surgical clamps; Wong held the incision open with a knife and fork sterilized in five-star Courvoisier. Wallace probed the chest wall with the only tubing he had-a length of plastic urinary catheter--but it was too flexible to penetrate the thick muscle. Hospitals use a special tube stiffened with a metal rod for this purpose, so Wallace improvised one from a coat hanger, likewise dipped in brandy. He inserted the other end of the catheter into a bottle half-filled with Evian water, so that no air could flow back through the tube into the chest. The whole procedure took about 10 minutes, during which most of the 800 passengers quietly finished their breakfasts. By the time Flight 32 landed in London nearly 12 hours later, Dixon was feeling well enough to have her breakfast, too, and Wallace had gratefully found a use for the remaining Courvoisier.

Our lives depend, moment by moment, on a series of tiny miracles. Physicists say that the universe had to surmount vast odds to exist at all; if certain physical constants had been even very slightly different, we would still be waiting for the Big Bang. No one stops to think about that, ordinarily, until an event like this one brings it into focus. Thousands of planes take off every day without a surgeon on board. But there was a surgeon on Flight 32.