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The Terminal
September 5, 2005
The author, on the job, manages to strike a pose with model/actress Francine Prieto.
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This is not a review of the movie, which starred Tom Hanks and Catherine Zeta-Jones. Rather, this is an article about my workplace, a place where you see 747s and 737s, a place where PR does not mean pulse rate but Philippine Airlines and CI does not mean contraindication but China Airlines, and most importantly, it is a place where doctors are welcome.
An airport terminal operates for 24 hours, so we go on 24-hour shifts as well. We are stationed either at the quarantine office or at the medical clinic, but most of the time, both. When we are based at the quarantine office, we usually deal with two things: DEPARTURE and ARRIVAL. Aircrafts require quarantine clearance prior to departure. There should be no persons on board known to be suffering from illness other than air sickness or the effects of accidents and there should be no other conditions on board which may lead to the spread of disease. So as would be expected, departing passengers suspected of having an infectious disease are referred for evaluation. The most common presentation is red eyes, which on physical examination would turn out to be just conjunctival irritation in most cases. Some are cases of pterygium. Only occasionally do we find acute conjunctivitis unless there is an epidemic. In such case the passenger is not allowed to depart. Early one morning in the middle of a deep sleep, I was awakened by a referral. I stretched, rubbed my eyes and examined the patient who told me he just lacked sleep. He further remarked, “You have red eyes as well.” He was allowed to depart.
Passengers with fever or rashes are brought to us as well. But sometimes we are the ones who go the passenger. Philippine Airlines flights bound for LAX or SFO depart in the evening. We received a call one night informing us of an infant, already on board a plane bound for Los Angeles, who is having fever and chills. This is one opportunity to get inside the Boeing 747 and meet the flight attendants. We just need to bring the thermometer, stethoscope and penlight. The infant was found to have a temperature of 39.0 C, with HBS and positive TPC. We are still able to practice what we learned in the clinics. The mother of the infant had to reschedule their flight.
For arriving aircrafts, documents need to be submitted to the quarantine office. So when a ground stewardess asks me what documents she needs to submit, I would usually answer, “We need the general declaration of health, passenger manifest, and your phone number (if she’s pretty).”
As for arriving passengers, we are still on the lookout for infectious diseases. Passengers from such places as Hong Kong, Singapore, Bangkok and China go through a footbath for the prevention of Avian influenza (“bird flu”) and through an infrared thermal scanner which takes their temperature. We had a correspondence one time of an arriving AIDS patient. She did not submit herself to us because she was in a hurry to go home to the province. And since we cannot identify her by face, we sought the help of the immigration people who were able to track her down. When the passenger was asked if she knows what her sickness is, she said she does. And she further said, “They say you get AIDS from junk foods!” She was serious.
We don’t only deal with arriving aircrafts and passengers. We also deal with arriving human remains. This time, we go through death certificates, certificates of embalming, and letters from the consulate general of the country of origin.
We attend to non-infectious cases at the medical clinic. A female passenger once came with palpitations, sweating and tremors. Vital signs were normal. She was given hydroxyzine, an antianxiety drug. “So, are you saying I have an anxiety disorder?” she asked. She was a nurse who worked in the US. She took the medication anyway and she was able to calm down. Occasionally, patients presenting with chest pain are seen at the clinic. So it is best to have ACLS training and be able to identify myocardial infarction when you have one. At least I have learned in medical school what an ST segment elevation is and during rounds, you just have to memorize that leads I and AVL refers to the lateral wall and leads II, III and AVF refers to the inferior wall.
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Taken by the author during the arrival of F4 in Manila.
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Sometimes, we have minor trauma patients. A cook once cut his finger while slicing meat in the kitchen and an employee fell off the stairs sustaining abrasions on both knees and elbows. We still do dressing of wounds from time to time. Another patient had fishbone stuck in his throat. After removing the foreign body, he was so relieved that he paid us for the simple procedure.
We did have cases of cardiac arrest. CPR failed. The American Heart Association now recommends the use of the AED (Automated External Defibrillator) because cardiac arrest victims go into ventricular fibrillation anyway. I think in the US they already have AEDs in places where there are fire extinguishers.
All work and no play makes Jack a dull boy. So we always find time to relax in the middle of our work. Sometimes we just watch the latest movie on DVD. In the middle of relaxation, however, we can have sick calls or even calls from the media. Once, we had to read about the Marburg virus because someone from the media was coming to ask about the hemorrhagic fever caused by the virus. Too bad, there was no camera. But I did have the chance to be on TV on a few occasions.
At other times, when there’s not much work to do, we just walk around, enjoy the sight of aircrafts landing and taking off, meet people of different nationalities and practice a little French or German, and go Duty Free window shopping.
The last flight usually arrives at 11:45 PM, the time to take a break from the day’s work, the time to eat the Salisbury steak from Northwest Airlines and have a glass of wine, and perhaps the time to take a nap. Flights, and referrals, and work, usually resume 3:00-4:00 AM. Life goes on for doctors in the place called the TERMINAL.
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Views expressed on this column and any other by-lined articles on this site are the authors' own and do not necessarily reflect the views of the organization or its members.
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