Doctor Uses Water Bottle to Save Pediatric Asthma Patient in Mid-Flight

Oct. 09--Dr. Khurshid Guru was flipping through the channels of his in-flight TV, exhausted from the robotic surgery conference that had just wrapped up in Bilbao, Spain, when he heard the Air Canada crew member make a plea: Is there a doctor on board?

A 2-year-old boy with a cold and a history of asthma was short of breath. The Toronto-bound flight had left the Munich airport three, maybe four hours earlier and was now somewhere over the Atlantic.

Dr. Guru was jetlagged and exhausted from travel but he answered the call, a little hesitantly at first. The Roswell Park Cancer Institute surgeon hadn't worked in pediatrics in many years, he told the flight attendant, and asked her to see if there was anyone else who would be more qualified to attend to the child.

There wasn't.

So Dr. Guru, renowned for his work in robotic-assisted surgery, went to check on the little patient -- and wound up using an empty water bottle and a little bit of ingenuity to save the day.

In doing so, he became something of a social media sensation. The Buffalo physician's story went viral with national networks and international websites retelling the tale. A U.S. senator who heard about the in-flight medical intervention, was inspired to demand changes to FAA rules to make sure child-appropriate medication and equipment are aboard all planes.

The attention has been surprising -- and embarrassing -- for Dr. Guru, who has been called on to help a sick patient two other times just this year.

He doesn't consider his actions to be heroic and life-saving. He just did what he had to do.

"I think that's how people are wired, right?" Dr. Guru said at his training lab at Roswell Park, filled with robot simulators he helped design.

He shared the story of what happened aboard the plane, in detail for the first time, with the hopes that a lesson in common sense can be learned.

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Dr. Guru had heard the little boy crying not long after the plane took off on Sept. 17 for the overnight trip from Munich to Toronto, he recounted a couple of weeks later.

The wailing child was sitting with his parents just four rows in front of him.

"His ears are really popping," he remembered saying to the woman seated next to him.

By the time the call for the doctor on board came, the boy's condition seemed to be getting more serious and his parents were becoming worried.

The flight crew already had moved the family to the back of the plane when Dr. Guru came to see the boy.

The child was still crying and was in his tearful mother's lap. The boy's father was trying to comfort his family.

The doctor asked if the parents had any medicine for the boy and learned that they had put the boy's asthma medication into their checked luggage.

Dr. Guru purposely didn't ask the boy's name or his parents' names. A strict believer in health privacy laws, he didn't want the mother and father, already worried, to feel more nervous.

The doctor and a flight crew member then started looking through the emergency medical kit on board the plane. He already knew it would be well-stocked. This was the third international flight -- in a row -- that the physician had been asked to tend to a sick passenger. They found a stethoscope and a pulse oximeter, for measuring oxygen levels.

Dr. Guru listened to the boys lungs.

"There were some wheezes," he remembered noting.

The pulse oximeter was adult-sized. Normally, it's clamped onto an adult's finger. Pediatricians use a much smaller version for babies and toddlers that can be attached to a child's tiny earlobe.

Dr. Guru tried it on the boy's thumb. He had to hold it in place, and he was relieved that the boy let him. But he found the oxygen saturation level was low. It was about 86 or 87 percent. It should be about 94, Dr. Guru later explained.

The parents told Dr. Guru that the boy had suffered two episodes of shortness of breath aboard the plane. The child was OK at the moment, still able to breathe, but Dr. Guru knew the situation could worsen. Asthma is a chronic lung disease that affects breathing. A severe attack can be life-threatening if untreated.

"He wasn't, God forbid, that sick, sick, sick where you need to get a tube in," Dr. Guru later said of the boy's condition aboard the plane. "But he would have gotten there because he didn't have treatment."

The crew checked in with the doctor. They were nowhere near land but wanted to know whether the doctor thought they should consider diverting the plane.

Dr. Guru and the crew members looked through the kit again and found an adult inhaler. It would be nearly impossible for a 2-year-old to use properly, Dr. Guru thought. It requires the patient to suck in the medication as it's being administered through the press of a button.

The doctor was worried that the inhaler would upset the boy. A father himself, he knew how children can be. The little boy was agitated, probably scared and not feeling well. He didn't want the boy to get so upset that he wouldn't be able to be treated, making more serious medical intervention, like intubation or even a tracheotomy, necessary.

At a hospital, there would be a nebulizer for such situations -- a machine that turns medication into a fine mist that can be easily inhaled. It is often used to treat small children having asthma attacks. But there was no nebulizer on board.

He'd have to build one.

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Dr. Guru grew up in Kashmir, the son of a cardiac surgeon. His father studied under Dr. Sambamurthy Subramanian, a pioneer pediatric heart surgeon known as "Dr. Superman," at Women and Children's Hospital in Buffalo. It was Dr. Guru's father who had told him, as he was finishing up a fellowship in robotic surgery in Michigan, about a cancer center in Buffalo.

Dr. Guru became the director of robotic surgery at Roswell Park and specializes in treating bladder cancer. He has performed over 1,500 robot-assisted procedures and worked with a University at Buffalo collaborator to develop one of the first robotic surgical simulators, used to train doctors in robot-assisted operations. He also started a foundation that helps provide education and medical care in rural areas of Kashmir.

Now, he was faced with a tricky problem 35,000 feet up in the sky over the middle of the Atlantic Ocean far from his lab or even a normal doctor's office.

However, he had the inhaler.

It was an adult one and having too much asthma medication can cause the heart to race, called tachycardia. But Dr. Guru calculated that a young child could handle having an elevated heart rate and that was less dangerous than the child's low oxygen level, which worried him.

So he needed a way to get that medication into the child.

The medical kit included a 4-liter oxygen tank. A flight attendant helped Dr. Guru attach a face mask, the same kind with the yellow cup and inflatable bag that's designed to drop down from above in the event the cabin pressure inside the aircraft should drop.

About the same time, the cabin crew began making preparations for serving drinks and snacks to the passengers, loading up the carts in the back of the plane where the doctor and child were.

Dr. Guru looked around and saw rows of bottled water in one of the carts. That gave him an idea.

"Do you have a new one which isn't opened?" Guru asked the flight attendant who was pouring drinks for the passengers.

She did. She handed it to him and he poured out the water. He wanted it to be clean. He twisted the cap back on.

He then asked for scissors.

That was a problem. In a post-9/11 world, such sharp objects aren't allowed on planes anymore.

He and another crew member went back to the medical kit.

He looked through a numbered catalogue and to his surprise, he found there was a scalpel.

Dr. Guru used it to cut a hole into the bottom of the empty water bottle.

Next, he took the yellow cup of the face mask and the tubing into the bottle.

Then he got some masking tape and sealed the bottom around the oxygen tube.

Dr. Guru turned on the oxygen and put his thumb over the cap and felt the pressure of the air. The seal had worked.

Next, he cut a small hole in the side of the plastic bottle -- big enough for the mouth end of the inhaler to fit. Now, if someone squeezed the inhaler it would mix with the oxygen and form a mist the boy could breathe.

But Dr. Guru realized that the little boy would probably become upset if someone tried to put the weird contraption right near his face and wouldn't let it near him.

He looked around the cabin again and saw a flight attendant pouring drinks into short plastic cups.

A cup.

He asked for a clean one. Using the scalpel he cut a hole in the bottom of the cup, then fitted the top of the bottle into it.

Now, the air would be directed toward the boy.

Dr. Guru told the mother to hold her son with one hand while holding his creation in her other. He told the father sit next to her and directed him to administer one dose of medication twice, spaced 10 minutes apart.

And then he backed off.

"I wanted to be in the background," he said.

It would be the best way to keep the child calm and to make sure he got the medicine.

The father gave the boy the first dose and the mother held the device in front of the boy's chest.

The boy began to calm down and started paying attention to the TV in front of him.

Ten minutes later, the father gave the second dose.

Dr. Guru returned to the family and checked the boy's lungs and oxygen. The wheezing had subsided. The oxygen level was back above 90.

It had worked.

Dr. Guru went back to his seat. About the time that the plane began its initial descent, Dr. Guru went to check on the boy again.

A crew member said they were now near land and wanted to know if they should divert the plane to the nearest airport.

The boy's family didn't think so. Dr. Guru agreed. The crew offered to have an ambulance waiting on the runway. The family and the doctor didn't think that was necessary either. But Dr. Guru did urge the family to go straight to the boy's own doctor as soon as they landed, which they agreed to do.

Before landing, Dr. Guru stopped by the family and took out his smartphone to snap a photo of the contraption he had made, which was lying on a pillow on the seat next to the boy.

One of the flight attendants saw him.

"Hey, why don't I take a picture of you with the device?"

He agreed and held it up, before sitting down.

He never learned his patient's name, but he did end up having to fill out three pages of forms for the airline, Dr. Guru said.

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Back at home finally, Dr. Guru told his wife, a pediatrician, what had happened on the plane.

"That's pretty cool," she said as he showed her the photo of his invention on his phone.

It then occurred to him that it might be fun to share his story with the other attendees of the European robotic surgery conference.

He posted the photo on his Twitter account and wrote: "Flying back from ERUS15 had to design a nebuliser for a 2 yr old asthmatic over the atlantic. Thank God kid did well!"

Then he went to bed.

"So the next morning, I wake up and all the world knew," he said.

The story had gone viral.

A TV crew from WGRZ was among the first to report it, after one of Dr. Guru's patients saw his tweet.

Over the next few days, about 300 news outlets around the world reported on Dr. Guru's mid-air medical caper.

"Doctor Channels MacGyver to Help Asthmatic Toddler Aboard Transatlantic Flight," read the headline of an ABC News story.

"Indian American Doctor Saves Life of Asthmatic Baby on Flight," wrote Indian West, which bills itself as the "Best Indian News in Print & Online."

"Dr. Khurshid Guru saves toddler's life on plane," reported a website called Siasat Daily.

Dr. Guru was terribly embarrassed.

He was no MacGyver, he said. His inspiration, he thinks, came from his work with the Guru Charitable Foundation in Kashmir.

"A lot of times, we have to come up with ideas for ... how to bring modern things back home where a lot of times there's not a lot."

Dr. Guru had not been seeking attention for what happened on the plane and he doesn't believe he saved the boy's life.

"A lot of people reported it as life-saving," he said in his Roswell Park lab. "They don't realize it was a prevention of that. It was preventing things from escalating."

After learning about Dr. Guru's actions, Sen. Charles Schumer urged the Federal Aviation Administration to review emergency medical equipment on planes and require kits including appropriate medicine and equipment for children.

"This fix is a no-brainer," Schumer said in a statement, "that will ensure a child's asthma attack or other medical emergency can be treated as quickly as possible and allow everyone to breathe a sight of relief knowing that children are more safe."

But Dr. Guru, who is being honored next month by the Roswell Park Alliance with the Thomas B. Tomasi MD, PhD Hope Award for his work in robotics as well as his foundation, hopes that if there's one thing people take away from his story is that they should always make sure to carry any necessary medication with them, especially aboard a plane.

He doesn't blame the parents of the boy and doesn't want anyone to feel bad about what happened. But he thinks it might be a good idea for airlines to ask passengers getting their boarding passes if they have their medication with them.

"We need to inform people that it's important to carry your medication," he said.

Doctor's orders.

email: mbecker@buffnews.com

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