Top: Dr. Angelica Zen and her husband Ryan enjoyed relaxing moments during their honeymoon in Bali, but the trip home turned out to be more exciting than they’d anticipated. Middle: Dr. Angelica Zen is a fourth-year resident in internal medicine and pediatrics at Ronald Reagan UCLA Medical Center. Bottom: Dr. Angelica Zen assist a woman in labor during a flight.
My new husband and I were returning from our amazing honeymoon spent lounging on the beautiful beaches of Bali. The flight back to Los Angeles from Taipei, Taiwan, is long — about 14 hours — and, as we soared over the Pacific Ocean, I was getting tired. Yawning, I turned off my TV to get some rest before I had to go back to work the next day.
I had been napping for just a few minutes when I was awakened by the urgent voice of a flight attendant over the intercom: “Is there a doctor or a nurse on the plane?”
My heart raced as I raised my hand. This was the first time I had ever been called on to help outside of the hospital. Now that I was in my last year of residency, with four years of rigorous training in internal medicine and pediatrics under my belt, I felt that I was well-equipped to handle whatever situation presented itself.
A look of relief spread over the flight attendant’s face when he spotted my hand. “Yes! Please come right this way!” he called out. “We have a lady who has abdominal pain, and we don’t know what to give her.”
As I followed him to the woman’s seat, I ran through a differential diagnosis of what she could have. But my first glimpse of her stopped me in my tracks; she was pregnant. As med-peds doctors, we see everyone from newborn babies to elderly adults. Everyone, that is, except pregnant women.
“Hi ma’am, I’m a doctor,” I said to her. “I am here to help.”
She shook her head, indicating that she did not speak English.
Terrific. It was time to haul out the Mandarin that my parents had so desperately tried to teach me. I took a brief history in between her episodes of pain, which were coming every two minutes. She was in her third trimester and had been having this pain for a few hours, and it was becoming more intense and more frequent. Everything she told me confirmed what I feared — she was in active labor.
The flight attendants brought what medical equipment there was on board, and I found that I had everything I most needed: gloves, clamps and scissors. For pain, there was only Tylenol — it would have to do.
I struggled to remember what I learned from my OB rotation in medical school. I now had to examine her to see how far along she was, but where would I do this? The woman had no room to lie flat. The flight attendants moved us to the middle of the plane.
“We’ll drape some blankets over this row,” they said. I looked anxiously at all the passengers around me. So much for patient privacy, I thought. I laid her down and examined her. I felt the baby’s head. The cervix was completely dilated. The baby’s delivery was imminent. When I told the woman, she shook her head no.
“It’s impossible,” she told me.
“Why?” I asked.
She lifted her shirt and pointed to the horizontal and vertical scars on her belly — C-sections.
A VBAC, or vaginal birth after C-section, is dangerous. If one is attempted, women are monitored closely in the hospital to make sure they do not have a complication that obstetricians fear — uterine rupture — which could cause potentially fatal bleeding for both the mother and baby. The more C-sections a woman has had, the higher the risk. And vertical incisions of the uterus portend a 10-percent risk of uterine rupture.
We asked the pilot if he could land the plane as soon as possible. “I’m sorry,” he said. “We’re over the middle of the ocean. The closest airport is Anchorage, Alaska, but we are still four hours away.”
I started sweating. Should I have the woman push? Or just breathe through her contractions? I took what seemed the less-risky route and told the woman to just breathe through her contractions. With time, her contractions became longer and more intense. She screamed through each of them. The air was hot and stifling in our makeshift tent, and I could feel the eyes of the other passengers on us.
It was the longest four hours of my life. When the pilot announced that we were starting our descent to Anchorage, I felt a huge wave of relief. We were almost there. But when I looked at the woman to reassure her, my smile faded. The baby was crowning. Now, there was no other option but for her to push.
“Mom, the baby is here,” I told her. “You have to start pushing.”
“No! I can’t!” she cried. “The pain is too much. I’m going to die! I can’t get it out of me, the doctors have told me this before!”
But we had no choice. The baby was on its way.
As the baby emerged, I saw a translucent cord around its neck. Remembering what I had seen during deliveries I had assisted, I unlooped the cord, and the baby wiggled its head free. The woman pushed a few more times, and the baby came out and gave a loud cry.
Our fellow passengers clapped and cheered, and I quickly clamped the cord and cut the baby free. Much to my relief, she looked completely healthy. I gave her to the flight attendants to warm her up and finished delivering the placenta as the plane landed on the ground.
When we rolled to a stop, paramedics came rushing onboard. As they wheeled the mom and baby away, I suddenly realized how tired I was. I breathed a huge sigh of relief and collapsed onto the seat next to my husband, who was grinning. “Wow!” he said.
“What a trip.”