Subway syncope

by Lorien E. Menhennett

The view from inside a NYC subway car, where I evaluated a woman for syncope (fainting).

Sitting on the New York City subway, immersed in the world of my true crime podcast, I suddenly heard a commotion. I looked up and saw that a group of passengers had stood up and gathered in front of me, staring at the woman directly across the aisle. She was slumped over against the shoulder of the woman next to her.

I pulled off my headphones, my ears alert. What I gathered from the murmuring passengers was that the woman had suddenly passed out. In doctor-speak, she had a “syncopal episode.” She was awake now, but obviously woozy.

Usually in this sort of situation, someone with medical qualifications presents to help — a doctor, nurse, PA, paramedic. No one did so. I realized I might be the person with the most medical qualifications in the train car. That was a scary thought.

You are 9-1-1.

The words of my CPR instructor from nearly two years ago rang in my head. That was his response when one of my classmates proposed “calling 9-1-1” as the appropriate course of action in an emergency. Of course, there is some truth to both perspectives. When an emergency happens outside the hospital, you should call 9-1-1 if that’s an option. The paramedics have equipment and knowledge that you don’t. The CPR instructor’s point was, though, that in that critical moment you are the one who is actually there and can make a difference. So if you are appropriately trained, you should act.

With that in mind, I yanked my stethoscope out of my backpack, slung it around my neck, and crossed the aisle to evaluate my “patient.”

By this time, we had pulled into the next train station. Someone alerted the conductor about the emergency, so we stayed put while the paramedics were summoned. In the meantime, I conducted my initial assessment.

I explained that I was a medical student. I cradled the woman’s wrist in my hand so I could take her pulse — faint and slow, I noted. I tried to listen to her heart but it was difficult to hear anything with everyone around me talking. I decided it was more important to take her history. I asked whether this had happened to her before, if she ate or drank sufficiently that morning, whether she had any medical problems.

“Are you a nurse or something?” asked the policeman who was standing in the open doorway of the train car, watching me.

I felt a prickle go up my spine. Clearly, old-fashioned assumptions about gender roles were very much alive, even in progressive New York City in the year 2017. I doubted he would have asked a man with a stethoscope around his neck the same question. But my goal here was to practice medicine, not feminism. So I swallowed, and calmly answered.

“I’m a medical student.”

This seemed to satisfy him. He told us the paramedics were on their way. Another passenger offered to stay with the woman who’d passed out until help arrived. The two women slowly stood up and exited the train car.

Minutes later, the doors whooshed shut, and we were on our way. I sat down, my own heart still racing.

My physician preceptor told me later that morning that as the medical professional, I should have stayed until the paramedics got there. Not necessarily because this woman was going to need more intervention. But because I could better communicate her condition to the paramedics, and because I could prevent bystanders from doing something like starting CPR if she passed out again. Lesson learned for next time.

I learned a lesson about myself that morning, too — about how I respond in an emergency. Namely, that I did respond. I remembered what I’d learned over the last two years and applied it.

In medical school, we hear about how being a physician entails great responsibility. There is a standard of professionalism, and the so-called “social contract” that we’re expected to maintain. As a medical student, I didn’t expect to put that into practice — at least, not without supervision — for some time. I’m honored I had the opportunity.

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