It is rare, these days, that a doctor gets the chance to be a hero. Medicine in the past 50 years has become a team activity, with every patient cared for by a posse of medical staff and every procedure requiring at least half a dozen hands.
So the opportunity to take sole charge of a seriously ill patient who has fallen ill abroad and bring them safely home is one that appeals to medics searching for a bit of tension in their lives.
The sudden call, the dash to the airport, the adrenaline-charged journey home when anything could happen – all add drama to what otherwise may be pedestrian days in the surgery and wards.
Add to that exotic destinations, the romance of travel, the grateful thanks (mostly) of patients, passengers and air-stewardesses – who may slip you a handful of miniature duty-frees at the end of the trip for your trouble – and you have what many might rate a dream job.
For Ben MacFarlane, the dashing young doc of Holiday SOS, a just-published collection of "holiday disasters, gap year crises and embarrassing incidents", to quote the blurb, it has been his (occasional) way of life for years.
As a working medic in London (more of that later), Ben will from time to time receive a call on his mobile phone, grab his medical bag and become a 21st-century flying doctor, racing to the aid of pensioners with heart attacks on the other side of the world or young men who have come off motorbikes on unfamiliar foreign roads.
For drama there are few emergencies to compare with the patient who collapses mid-flight, unable to breathe. On a journey from Turkey, bringing home Toby, a twentysomething motorbike rider who had smashed several ribs in an accident, the worst happened.
"We often pick up people with pneumothorax (punctured lung). The hospital staff think they are doing you a favour by taking the chest drain [plastic tube] out before they discharge the patient. They may be fine at the time but once they get into the low pressure aircraft cabin, problems develop after take-off.
"This guy, whose chest drain was still in place, insisted on going to the toilet unaided and in the process pulled his chest drain out. He had fractured his ribs which had perforated the pleural space causing his lungs to collapse.
"He was looking right at me and the happy mood was gone. Instead of relief [at going home] there was fear in his eyes. He couldn't speak. His mouth opened wide as he gasped for air.
"I had to get him on the floor, get the equipment – a new drain, a sticker to hold it in place and something to sterilise the skin with, and insert it. I told him, 'Toby, we're going to sort this. Close your eyes. It's easier if you close your eyes.'
"I stuck my right index finger into the wound, which was gaping open and spluttering and sucking air into the space between the ribcage and the lungs, where air really should not go. I kept it there and shouted for the stewardesses to get the stuff out of my bag. An elderly man put the glove on my hand while a lady a few rows back was shouting 'What's he doing? Stop him.' The clock in my brain was ticking so loud it hurt.
"The stewardess calmed the lady down while I squeezed the wound closed and positioned the end of the tube in its mouth. I had to aim over the top of the nearest rib – go too close to the one above and you hit an artery. Every millimetre counts – this is not the moment you need turbulence."
You can read the denouement of this particular episode in the book. It's terrific. He eventually gets the drain in, Toby starts breathing and the elderly gent with the glove congratulates Ben for saving the day. He's a hero – until the next time.
He has done the job – repatriation medicine in official jargon – for many years, starting when he was a postgraduate student doing research and needed to make a bit of extra cash.
"I am young, free and single, so it's not a problem being called up at the last moment. It's a very different kind of medicine. In hospital you are surrounded by lots of staff and equipment. If you are on a plane and someone is going off, you have a few bits and pieces and that's it. It scares the bejesus out of many people but some like the adrenaline rush."
Which patients get treated in the country where they fall ill and which get repatriated is decided by the insurance companies. They do a careful cost analysis before sending someone like Ben on a mercy mission. But often flying someone home, where they can be treated free on the NHS, and where they would always prefer to be, is cheaper than keeping them in an expensive foreign hospital bed. Even allowing for Ben's fee.
"The hourly rate is not fantastic – not nearly as good as private medicine – but we get paid in 12-hour blocks. I love travel, love airplanes and get a buzz from flying by the seat of my pants. It's a break from the sanitised life of a teaching hospital."
The book is packed with tales of derring-do, many involving psychiatric cases – patients who have gone on holiday apparently well and had some sort of breakdown.
"Dealing with a heart attack or asthma attack is usually straightforward. More difficult is the nice little grandma at check-in who turns into a monster at 30,000 feet. Elderly people can have mild dementia that may not have been diagnosed. They go away, pick up an infection and it's enough to tip them over the edge."
On one occasion he was with a patient who was a nervous flyer. The man was sweating and hyperventilating at take-off. Shortly after, he announced: "That's enough," got out of his seat and tried to get into the cockpit before attempting to open the emergency exit (this was before 9/11).
"I didn't want to give him a sedative but he backed on to my needle and went down like a rhino. I worried for the rest of the flight that I would be done for assault. But when he woke several hours later – he had been snoring like a pig – he said it was the best flight he had ever had. I didn't disabuse him."
As a satisfied customer, the snorer was run a close second by the elderly gentleman who had been hospitalised in Asia and whom Ben was escorting home. "Like a lot of middle-aged men he had prostate problems and in hospital he'd had a catheter inserted in his bladder [to drain the urine]."
"On the morning of our departure, the hospital removed it, thinking they were doing me a favour. On the plane, stewardesses kept bringing him glasses of water and after several hours he was becoming uncomfortable. His bladder was up to his nipples but he was too embarrassed to tell me what was going on."
"I got the stewar-desses to hold up blankets, like a Victorian changing cubicle, and somewhere over the Alps I inserted a catheter, pushing 12 inches of tubing up his penis and into his bladder. The gratitude you receive is like nothing else. It brings such relief."
What would be simple in a hospital clinic is never so in the cramped confines of an aircraft seat, with other passengers craning their necks and some trying to snap the scene on their mobile phones. Once, in the midst of reviving a patient laid out on the cabin floor, a large lady rose from her seat, marched purposefully down the aisle, elbowed him aside and announced: "Stand back, young man, I'm a St John first aider."
"It is then that the stewardesses come into their own. They will have a quiet word with the captain, who will announce that we are coming into some turbulence and order passengers to return to their seats and fasten their belts. Few notice that the flight is perfectly smooth."
So who is Ben MacFarlane? Not, it turns out, quite the man he appears. The name is a nom de plume, and the daring young doc with a self-deprecating sense of humour who is hero of the book is, in reality, a 45-year-old consultant, with a fund of stories and some excellent contacts in the scribbling trade.
That the book is a riveting read is thanks to the efforts of Neil Simpson, a friend, former journalist and author of a clutch of celebrity biographies.
"We were at a dinner party and Neil said to me all that anyone is interested in is your gory medical stories – maybe you should publish them. I thought, if I don't do it, some other bugger will."
They hawked a proposal round a few publishers until one bit. Holiday SOS, with its tropical beach on the cover, is the result. Sun, sea and surgery – it's a potent mix. It deserves to succeed.
'Holiday SOS – Sun, Sea and Surgery' by Ben MacFarlane, Hodder and Stoughton, £12.99. Order for £11.69 (free P&P) from the Independent Bookshop: 0870 079 8897
Holiday hell: Hazards to avoid
'Abroad' is safer than it used to be
The risk of dying in a car accident used to double as soon as you crossed the Channel, but successful safety schemes have reduced the dangers of adding to the road toll in France and beyond. Yet there seems no limit to the imaginative ways British travellers come to grief abroad, calling on the services of repatriation doctors or – tragically often – repatriation undertakers.
The rented moped
Perhaps the sun got to you, or maybe it was that third pint at lunch. Either way, you are speeding across a small Greek island on the wrong side of the road, aboard a poorly maintained motorbike. You are wearing a T-shirt, shorts and sandals. The engine is whining at maximum revs when you hit the patch of gravel. The Greek gods will decide whether you come home on a stretcher or in a coffin; one certainty is that you will leave a lot of skin behind.
The magic potion
Vendors of recreational drugs know that holidaymakers like to indulge in mind-altering substances. They also know that travellers are one-off customers, and so supplying substandard, heavily "cut" drugs is a sound commercial strategy. Prepare for a serious chemical attack.
The midnight swim
Whatever your mind says, your bathing abilities are not enhanced by a big dinner, a bottle of wine, and an unwise dose of bravado. Simon CalderReuse content