I recently was traveling on a plane when I was called upon to the in-flight doctor. It’s not something any physician wants to do, but sometimes it’s unfortunately necessary. I had just settled back into my seat after having waited in the Milan airport for many hours for my flight that was already two hours late to finally arrive. Like any good traveler, we had arrived at the airport in good time that day because you never know what might happen in Italy and it’s good to be early for flights, trains, buses, etc., just in case. (That same day our train from the coast to Milan caught on fire, making things a little dicey for timing.)

On the plane a young woman a few rows ahead of me started to flail around and I noticed the commotion. The flight attendant then brought out the official black suitcase of medical equipment and I realized that they might need my help. I went up to where the passenger was who was having problems. The woman was very anxious, and rightly so, as she felt like she was going to die. Her arms were twisting and her hands were contorted. She couldn’t feel her fingers. We laid her down on the ground and I tried to calm her down to find out what she was feeling, where it was hurting, and exactly what was going on. All she could do was ask me if she was going to die and show me her hands as they seemed to cramp up and contort further.

Eventually she was able to tell me that she had never had this happen before, and yes, she had flown a lot. She had just eaten and had never had a problem with low blood sugar. Her mother told me that she had been particularly anxious and overtired that day, and this was made worse by the fact that our plane was so late. She was otherwise a healthy person, didn’t feel pain anywhere else, but had had some palpitations. She was sweating and trembling, and I had trouble getting a pulse, but she obviously had one as she was talking to me and had good colour. I started suspecting a panic attack, and tried to reassure her as such. She began to feel better and the feeling started to come back into her hands.

Panic attacks are common, and airplanes are one of the most common places that they can happen. They occur in women more than men, and tend to escalate over a period of about 10 minutes and are usually over with after half-an-hour. Signs and symptoms of a panic attack include all of the things that were happening to the passenger I described above. Further, the person may feel nauseous, faint, throat tightness, and difficulty swallowing. That impending sense of death is also often felt. The arms are interesting and this was likely from hyperventilation. With rapid and shallow breathing, a person’s carbon dioxide levels get too low, and this causes numbness in the arms and possibly legs, and can even cause muscles to cramp up. Breathing into a bag helps this, because all of the carbon dioxide that is rapidly being breathed out is then breathed back in from the bag. This quickly stabilizes carbon dioxide levels in the blood, bringing back feeling and lessening cramping in the hands and possibly the feet.

Panic attacks are frightening for the person who has them. They can cause a lot of worry over when the next one might happen as it’s embarrassing. This stress makes a person even more prone to having a panic attack and the cycle continues. There are good medications that can help when a person feels a panic attack coming on. Just having the pills with them often helps a person not to be stressed about having an attack, and lowers their chances of going into a full-blown panic attack. If there is a specific situation that causes a person to have a panic attack, cognitive therapy can help as well. There are relaxation techniques that can be learned.

As for my story, the plane had to be turned around for the passenger on my flight to be checked on the ground properly, and it made us even later in taking off. It didn’t help that in Milan at the Malpensa Airport, the rule is that they can’t re-fuel with passengers on board and since we had taxied so far out before the plane was turned around, we didn’t have enough fuel to make it to our destination. This fact is alarming in itself. If all it took was the plane taxiing towards take off to run out of enough gas to make it to where we were going, then it’s a wonder planes aren’t falling out of the air all over the place, running out of gas! We all had to get off and wait for the re-fueling. Two passengers then decided to go duty-free shopping and somehow missed the call for us to return to our plane. By the time we took off, we were 4 hours late, but we made it.