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Nope. But my wife and I once got removed from our seats. What happened once was as we were boarding our flight from Kauai to San Jose on Alaska Air I asked the door attendant if she would be kind enough to get a cup of 7-Up for my wife who was not feeling too well. She smiled and said, “no problem.” We sat in our assigned seats, buckled up, and waited for the pushback. Then we saw a ground attendant come up the row into the economy section. She came straight to our seat! She said, “we’re sorry but you cannot fly on this flight.” I asked why, she said, “I understand your wife is not feeling well and if she has a medical emergency, there would be no airport to divert to. as the plane flies entirely over water.“ We got off, went back to her brother’s house and spent three more days on the island. However, we did have to get a note from a Kaiser doctor saying she could fly again. Which we did, and flew out three days later, saving $70.00 for the lower price fare. Alaska did not charge any penalties for our flight change. Moral of the story? If you HAVE to be somewhere (work, app’t, etc) Do NOT tell the door attendant that you or your wife or whoever, is not feeling well.

Deborah was 40, a nephrologist, in labor with her second child, when she lost a pulse. Her husband, Derek, an anesthesiologist, was present for the code and wanted to intubate her himself. I said no. I also said no when Deborah, pulse regained, but still intubated, on the breathing machine and half awake, began scribbling notes regarding which IV fluid she felt was most appropriate for her.It was going to be a looooong night.Deborah had a PE— a pulmonary embolus— a deadly blood clot that breaks free from the legs and travels to the lungs, where it lodges, preventing oxygen from reaching the bloodstream. In the very worst cases, such as Deborah’s, this clot plugs up the outflow tract of the heart as well. Pregnant women, because of their anatomy and hormonal milieu, are at particularly high risk of these, although Deborah was previously healthy. The mainstay of treatment is clot busters — powerful enzymes which dissolve the clot and restore blood flow. Problem was, Deborah still had an infant within her, for which she now required a C-section. We would have to dissolve the clot while, at the same time, performing major surgery. It seemed if she didn’t die from clotting too much, she would certainly bleed out elsewhere from clotting too little.I am a surgical intensivist, a doctor who cares for the sickest surgical patients. We made her as stable as possible, then I sat down with her ObGyn, the interventional radiologist (a doctor who uses tubes threaded through the vascular system to attack disease minimally invasively), and her husband, Derek. We wanted to snake a catheter into her lungs to squirt the enzymes on it directly and hopefully minimize bleeding in other organs, like her uterus. But it was a crapshoot at best. A complicated problem, and, unfortunately for both us and him, Derek understood everything.He agonized. He took the decision on himself, and the burden of his wife and his son’s life, all of it, on himself. He was paralyzed with the mingling fumes of fear, knowledge and overwhelming love. He was trying to fly the plane from the bathroom in coach. It was a shitty place to be.Imagine living in the Emerald City your whole life, then tearing back the curtains to find me, in my scrubs, glasses and ponytail, a touch of acne and something in my teeth, working all the levers. Shit, I would be scared too. Sometimes the curtain is there for a reason. Sometimes you can’t handle the truth.In the end, Derek deferred to me, and we rushed Deborah to the OR where we delivered by crash section a beautiful, 8 lb baby boy to join his big sister at home. But Deborah was rapidly decompensating. Her heart could no longer handle the strain. We raced her down the hall, monitors blaring, to the Interventional Radiology radiology suite, where we injected the enzymes and busted the clot. Her heartbeat stabilized. Her breathing slowed. Mine slowed as well. We had made the right decision. She was okay. She was going to be okay.Then she coded again.A rich gush of blood stained the sheets between her legs a brilliant red. Her abdomen looked 12 months pregnant again. Her head lolled back, her face a glistening white. Her eyes rolled back in her head.Back to the OR. We passed her husband in the hall. When we reopened her, we found a uterus hemorrhaging uncontrollably. Derek, now beside us in the room, pulled the next lever, murmuring from behind his surgical mask:“Take it out. Take out her uterus. My son needs his mother. My daughter needs her mother. And I need my wife. Take it out, now, for the love of God, take it out.”We took it out.Deborah made a full recovery, and while mourning the loss of the third child she hoped one day to have, went home to the two children she already did, thanking us for our efforts. Deep in the bowels of the Emerald City, a draft was felt. We shivered, and drew the curtain closed.

I had a dog growing up, a great big, fluffy white-yellow golden retriever who suffered from the world’s guiltiest conscience. If Sydney nabbed a pork chop or pooped in the house, he would hound you mercilessly until you took note and scolded him proportionately. And if he farted, he inevitably told on himself. Sydney’s head would whip back, one expressive dog-brow raised, and give his hindquarters a long and impressive evil eye.Hey! What’s going on back there?!Patients are like that: they tell on themselves. One sniff and you know what’s going on. As an ICU doctor, I very quickly developed a nose for “neuro breath,” a distinctive sickly sweet exhalation from the mouths of patients with severe neurologic dysfunction. It generally indicates invasive pneumonia with a particular bacteria, Staphylococcus aureus. It is very characteristic and very, very accurate.Stench — stench was another level entirely. “Stench” was the term myself and the other surgical residents reserved for the classification of gangrene. A foul, musty scent you had to lean over to appreciate — that was Class I stench. From the foot of the bed was Class 2, and from the room door, that was 3. The kind that mugged you full-frontal as the elevator doors split — that was Grade A Class 4 stench. Class 4 stench was an emergent trip to the operating room or imminent demise.When I awoke from my coma, I could neither see nor feel the bottom of my right foot. The tissue was deadened from a blood clot that formed as a complication of life support. But I detected the familiar dead-wet scent, faintly at first, then stronger and stronger. By the time my doctor saw the blackness spreading across the sole, I knew the foot had to come off. In this case my nose was better than my eyes.So what is my pithy wrap-up for an essay that starts with dog farts and ends with the loss of my leg? What can I say? It just stinks.