A pre-pandemic reflection on travel medicine

6 minute read

Music and planes both have the magic to transport you to other times and places, to make time fly. Nothing can take away the music

Dear Julia,

I sometimes wish I could fly. I spend a lot of time driving between jobs now. The roads are eerily quiet, the radio bores me and I still haven’t worked out how to download a podcast, so I spend the time listening to CDs and remembering. I recall all the places we visited and the things we learned, back in the time before the pandemic, when we used to travel in planes.

Flying was the quickest way to get somewhere and was generally very safe, unless you were the passenger in a two-seater piloted by a World War Two veteran with a dodgy cardiac history. I once “went up” with a patient, Charlie, to experience the joys of aerobatics – it was white-knuckle scary and I just had  to drop the F-word when we looped the loop and followed through with a barrel-roll.

Twenty-four hours later I saw Charlie again. He had collapsed with chest pain – a heart attack complicated by ventricular tachycardia – and never flew again. (Lesson: Timing is everything).

Big planes, on the other hand, had multiple pilots who tended to be pretty young and healthy, unlike some of the passengers. On domestic flights I remember responding to the dreaded: “Is there a doctor on board?” question a couple of times and can confirm that the Airbus was a fine plane, but a far from ideal emergency room.

Space was tight, equipment negligible and the audience large and attentive. The management of anaphylaxis and vaso-vagal syncope was challenging and the rewards variable. Virgin grudgingly said “Thanks, doc”, (in retrospect, probably all that they could afford). Qantas  provided bonus points and two bottles of wine, which we had to gift to the hotel cleaner as we were travelling on to a dry Indigenous community the next day. (Lesson: Don’t hold your breath for an upgrade).

Answering an emergency call on an international flight was risky. A colleague flying from China to Europe provided extended (hours) resuscitation to a gravely ill lady. The flight was diverted to Russia but the patient didn’t make it and was pronounced dead just prior to landing. Unfortunately, while it was acceptable to die in modern Russia, it was not OK to be dead on arrival. Result? Plane with all passengers, including the deceased, forced to turn around and return to China. (Lesson: Never certify death on the wing, wait until you hit the ground).

Fortunately, our flight to Europe with 20 colleagues last year was incident free. Hippocrates’ birth place is an appropriate venue for a medical conference, (Lesson: When travelling overseas, make it tax deductible), so we touched down at Alexander The Great International Airport to find the Greek-Macedonian rivalry alive and well.

There is no dispute over the provenance of Mother Theresa (Macedonian) but naming rights to the rapacious Alexander (maybe Macedonian, probably Greek) are hotly contested, both countries are studded with statues of him rampaging forth astride Bucephalus. Memorials to Theresa are more subdued and less plentiful. (Lesson: Victory in battle is venerated more than charity).

GPs are hard to find in both countries. I failed to spot one in Macedonia, and

with unemployment at around 20% and taxation of 70%, most Greek graduates have moved to Germany. There is no shortage of smokers. While the Greeks are fond of a fag, they are comfortably out-puffed by the Macedonians who sustain an adult smoking rate of 75 to 80%. The upside of this is that Macedonian surgeons are highly experienced at unblocking a coronary artery and amputating a gangrenous leg. (Lesson: Experience is the best teacher).

The Greek gifts to medicine are historical and found in their language rather than their hospitals. Most of the human body, from the trachea to the fibula is written in Greek, as are diseases (anorexia, malaria) and medical procedures (endoscopy, paracentesis).

This contribution to modern language is not confined to medicine, often has origins in mythology, and can still be wonderfully apposite. My particular favourite is narcissism, from the Greek youth, Narkissos, who fell in love with his own reflection. Annie and I were lucky enough to witness a 21st century re-enactment of this story. While enjoying a relaxing spa we were joined by a young lady who sat on the edge of the pool and took selfies; Narcissus with double twist and pike. (Lesson: Human behaviour has not changed).

Our fellow travellers were not content with selfies, most succumbed to an urge to photograph everything in their wake. Like dogs checking out a new street and marking territory, endlessly pointing and shooting.

This compulsion to visually record is not new; the walls and ceilings of the ancient churches and monasteries we visited were oppressively frescoed. I find the modern mania for grain silo art in the country towns I am driving through now brings more joy and enlightenment. Similarly, graffitied  trains and city walls are bold and honest testaments to individuality. (Lesson: Man always needs to leave his mark).

And so it goes with the tales we employ to explain life. The Greek myths and legends are no more credible than the Bible stories, but are more entertaining and tend to have happier endings. My Indian friends tell me that Hinduism is similar and the same can be said of Aesop’s fables, fairy tales and Harry Potter.

The language of music is also universal. I remember a dinner in a small Macedonian farming village concluding with an acoustic set, courtesy of our host and his son, featuring Neil Young (‘Hey Hey, My My’), The Rolling Stones (‘Angie’) and Pink Floyd (‘Wish You Were Here’). Perfection. I immediately felt myself  back in a Fitzroy share-house in the early 1980s; an innocent decade cruelly scarred by AIDS and Grim Reaper advertisements.

Music and planes both have the magic to transport you to other times and places, to make time fly. Nothing can take away the music.

Don’t let your passport expire.

Love, Dad

Dr Max Higgs is a former country GP, a current rual and remote locum and a collector of stories


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