AIR FIGHT

An IIT student explains how he used his engineering skills to save a diabetic’s life mid-flight

Karttikeya Mangalam put his lessons from his first year in college to good use and helped a diabetic flyer get his insulin shot.

I am a senior undergraduate student studying electrical engineering at the Indian Institute of Technology, Kanpur. Last semester, in September, I started as an exchange student in the Department of Computer Science at the École Polytechnique Fédérale de Lausanne in Switzerland. The incident I am about to narrate happened in the first week of February this year. After my end-term exams at the École Polytechnique Fédérale de Lausanne, I was headed back to New Delhi from Geneva.

My flight was about half full and the seats adjoining mine were empty. I sat enjoying the solitude when I heard a flight attendant enquire if there was a doctor on board to deal with a medical emergency. A few minutes later, I saw a middle-aged man hurry down the aisle. It seemed he was a doctor and the man in need of medical attention was just two rows behind me.

As a fellow traveller – almost a neighbour, in fact – I went over to his seat to see if I could be of help. The patient, whom I will call B, spoke only English and Dutch, neither of which the crew spoke fluently. Still, they seemed to have understood that B needed medical help. Luckily for him, the doctor spoke English and that was why I was able to understand the patient’s situation. B was about 30 years old. He had had Type 1 diabetes since the age of 11 and always carried his insulin pump with him, attached to his abdomen over his liver. Before eating anything, he would set the required dosage of insulin through a dial in the pump. But the pump had to be removed for the security check at the airport and he had forgotten to collect it from the deposit tray. It was already five hours since his last insulin dose. Having been a diabetic for over 19 years, he always carried his sugar level monitoring equipment with him, and it showed a value of around 21 (I cannot remember the exact number. It seems intense mental pressure has a curious way of blocking details). B explained that it should ideally be around 6.

Mid-air scare

The doctor tried to calm him down and explained to the crew that B needed insulin urgently or he would end up with multi-organ failure or worse, lapse into a coma (I think this only ended up creating more panic). While B had with him some cartridges of the short-term, fast-acting insulin he normally took, he needed a way of injecting himself. It turned out that the doctor himself was a diabetic and used an insulin pen to inject himself. The pen had a central portion to hold the insulin cartridge, a dial to adjust the dosage and a plunger that when pressed ejected a small but sharp needle from the front. He also had spare needles. The problem was that B’s insulin cartridges were thinner than the insulin cartridges used in the doctor’s pen and so would not fit properly. Also, the doctor’s insulin cartridges were of a long-term, slow-release insulin that was chemically different from what B usually used.

Seeing no other immediate solution and in a situation of such urgency, B and the doctor agreed on using the doctor’s insulin. A flight attendant escorted them to a private space at the back of the airplane and I went back to my seat to sleep, thinking the emergency had been dealt with.

Bad to worse

But an hour or so later, the crew announced that the flight would be landing at some airport in the Afghanistan-Kazakhstan region because of a medical emergency. On asking around, I found out that one of the crew members had found B passed out on his seat, a white foam forming at the corner of his mouth.

Hearing this, I went to B’s seat, where the doctor was already present, holding an insulin pen. He explained to me that over the years, B might have developed a chemical resistance to the long-term, slow-release insulin that had been administered to him an hour ago. Now B’s life was at severe risk unless he was injected with the correct insulin as soon as possible. The doctor said his blood sugar levels were now in the mid-30s. When I asked what he was doing with the pen, he said he knew a way of adjusting the diameter of the tube that held the cartridge, so he was going to try to do that and then use it to inject B with the correct type of insulin. He did this, but when he inserted B’s insulin cartridge into it and pushed the plunger, the needle would not budge.

I think he panicked at this point and asked the crew to land immediately as it would otherwise be very difficult to save B. The flight attendant said the landing would take at least an hour and a half, and that they had already begun descending from cruising altitude.

Since the pen was working just fine an hour ago, I asked the doctor to give it to me so that I could see what was wrong. I also requested the flight attendant to let me access the premium wi-fi, available only to business class passengers, to check the pen’s manual online. She reluctantly agreed. I looked up the manual and found a large engineering drawing showing how each part fitted with the other. Now, engineering drawing (IIT-K’s course #TA101) was something I had loathed in my first year but practised enough to get a B grade; it was certainly enough to allow me to understand this particular drawing.

Back to the classroom

I opened the pen and methodically counted the components. I realised there were only 12 parts, while the diagram clearly showed 13 different parts. On cross-checking, I saw a spring was missing from in front of the cartridge. This spring was essential to transfer the plunging motion from the top of the pen to the needle. I searched for the spring around B’s seat and in the aisle area, but in vain. All the while the plane was descending, and the doctor seemed to have vanished.

Keeping a cool head, I requested the flight attendant to ask the passengers for ball point pens, as these usually have a spring. In a few minutes, I received four to five pens from anxious passengers who, I believe, were terrified at the thought of landing in a terror-stricken region. On trying out the springs, I found one that perfectly fit the insulin pen. I quickly reassembled it and gave it to the doctor who had, by then, re-materialised. He adjusted the dose, changed the needle and successfully injected B with the correct insulin.

Some 15 minutes later, the doctor reported that B’s blood sugar levels had stopped rising. Then they started to come down. The doctor told the flight attendant there was no need for an emergency landing now, as B would regain consciousness in some time. The flight attendant seemed relieved to hear this. She asked us to help transfer B to business class so that he could lie down. She transferred me there too, as some sort of caretaker. Later on, as the flight neared its end, B regained consciousness and I narrated the whole incident to him. He told me he was travelling to India on vacation, to see the Taj Mahal.

Since he was on the verge of collapsing, was alone and completely new to India, I accompanied him, after the flight landed at New Delhi, to the Medanta Hospital for a check-up and to get a new insulin pump. On the stretcher in the ambulance, he thanked me profusely and told me to visit him in Amsterdam, where he owned a restaurant and a brewery and where I would receive as much free food and beer as I wanted.

This incident made me realise the importance of the skills we are taught in our first year in college. I think saving a man’s life is more than anyone could have ever hoped to achieve from the basic engineering knowledge imparted in that year. I am grateful to the Indian Institute of Technology, Kanpur for making me capable enough to actually matter in such a critical situation.

This article first appeared in a slightly different form in the April issue of the IIT-Kanpur campus magazine Eyes.

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