by Dr. Nwando
February 22, 2017
This week, I had a wonderful time at the annual meeting of HIMSS, the Health Information Management Systems Society, which hosted over 40,000 attendees at the cross-section of healthcare and information technology in sunny Orlando, FL. I went to the conference to present the work that my team at University of California, San Francisco had been doing on the incredible innovation of electronic consultations, which involve the use of an electronic vehicle to quickly provide communication between primary care physicians and specialty care physicians. eConsults, as they are called, improve the interface between primary and specialty care, but also give patients quicker access to specialty care and expertise when it is needed. One thing we continue to emphasize is that even when healthcare and technology meet, compassion should always be present, front and center. Hearing, understanding, and advocating for the voice of the patient should always be foundational to any innovation in healthcare.
Our team finished presenting and I went to the airport, only to find out that my flight back to San Francisco was 2 hours delayed, due to the delay on the incoming flight from San Francisco. Well, this certainly put a wrinkle in my plans. I would probably not see my kids before bedtime and I would not be able to use the train to go home. By the time I was to arrive at 10:30 pm, I would need to catch a Lyft for the 45-minute ride home.
But there was little time to think about this as I was in the plane. The ride was incredibly turbulent and though I tried to sleep so I could not feel the turbulence, I couldn’t. The flight attendants were asked to stay in their jump seats. When they tried to wheel the cart to serve the passengers after over 2 hours of being seated on the flight, the cart was thrust mightily against passenger seats, coffee spilling, and the attendants rushed the cart back to its station for their safety and the safety of the passengers. I was sick to my stomach from all of the motion, and when the wifi came on, I quickly text my husband and asked him and the kids to pray for me, as they all know how much I fear turbulence in the air.
I arrived safely at San Francisco International Airport at 11 pm, later than planned, and I deplaned, then requested my Lyft. The first driver that accepted my request called me immediately to see if I was already near the pick up area. But, then, he did something he was NOT supposed to do, and asked me where my destination was before he came to get me. I happen to know that Lyft has taken great steps to ensure that profiling and discrimination does not occur with their services, which is why drivers do not see the destination of their passengers until they start the ride. Trying to game the system, this driver told me he was asking innocently because it would not show up on his phone. Then he asked – “well how far are you going? Are you going to San Francisco?” I refused to answer and given his clear disinterest in taking me further than the city, I canceled the ride and requested another driver.
The next driver came and was extremely friendly. I was happy, relaxed and tried to finally get some sleep in the back of the car. Until he woke me up with this question…. “Miss…are there any hospitals around here”?
So, as a doctor, that question is not a random question, and certainly not one you let slip by on the middle of the highway. I asked him why he needed a hospital, and he told me, in his limited English, that he was having a weird feeling in his chest, like his heart was beating too fast. Earlier in the drive, on the Bay Bridge, I remember that he had opened his window, which I asked him to close because it was cold. But, now, he was opening his window again. I told him the closest hospital was a Kaiser not too far away but that he should pull over and I could get him help, while getting myself a ride home. He insisted on driving and said he would drop me off at home and then drive himself to the hospital. As I watched and him becoming increasingly uncomfortable, miles away from my home in busy nighttime traffic on a large highway, I insisted that he pull over. I told him, “this is dangerous, you’re in pain. Pull over and let me get some help.” By the time he pulled over onto the shoulder of the highway, he was clenching his right fist to his chest, writhing in pain, sweating, opening all of the windows and gasping for air. OH MY GOD, I thought to myself, this guy is having an MI (myocardial infarction/heart attack). As a doctor, I recognized the symptoms immediately and took swift action. But I had so many immediate thoughts! What if another passenger had not recognized these symptoms? What if he was still driving on the road? What if we were not able to pull over? He was writhing in pain, moving all over his seat so I calmed him down and put my hand on his shoulder from the back seat.
“Lean back, calm down, relax, you’re fine, it’s going to be okay….” I knew the situation called for some calm given how anxious he was.
I called 911 and explained the situation to the operator, and she dispatched emergency services immediately. While we waited, he kept asking, “are they coming?” “Are they on their way?” I know that minutes can seem like an eternity, but I reassured him – “Yes, they are coming, they will be here soon. Calm down. Sit back. Don’t think about it. Try not to talk.” He started to complain that the pain was going from his chest to his left arm and that his mouth was dry, and his jaw was hurting. Heart attack symptoms. Major red flags. My Lyft driver. On the highway. I was still in disbelief but had no time for reflection at this moment. He continued to lean out of the window gasping for air. I felt his pulse and his heart was indeed racing, but he was still alert so I continued to engage him. In a few seconds, I acquired his full name, age, date of birth, and found out that he was married so I got his wife’s phone number. All the while, I was patting his shoulder and reassuring him that very good help was coming soon. I asked him about his medical history. He told me he had a problem with his heart a few weeks ago and was supposed to go follow up, but he had not. I was scared, for a different reason now, and the second time today, but there was nothing that my fear could help in that situation, so I remained calm, collected and compassionate, as I am trained to do. At this moment, two strangers had become intricately connected around a common purpose- making sure his life was saved. I promised him that I would call his wife, and just after I called and briefed her, the first responders came. The Emergency Services team that came was spectacular. Four fire trucks and an ambulance arrived and some of the men immediately attended to my Lyft driver, while others secured the scene on the shoulder of the road, and some attended to me, brought me a blanket, and made sure I was out of harm’s way. He was in so much pain and disoriented by it all, so I provided all of his details to them, and as they attended to him, I called his wife and updated her that he was now in the ambulance. In her limited English, she expressed her gratitude and said she would connect me to the driver’s brother. She then text me his number shortly afterwards.
The firemen decided to drive me in their truck to a safe place off of the shoulder of the highway. I remembered that my bags were still in the driver’s car, so they helped me to get them and then drove me to a plaza that was close by. My husband, who I also called while the driver was being attended to, picked me up and we went home. I then spoke with the driver’s brother who told me that he would head to the hospital asap and repeatedly thanked me for staying with his brother, getting the family information to call them, and not leaving the scene. “God bless you, God bless you,” he stated again and again. Once I was sure that I had lined up all that was needed and the family was informed, I showered and thanked God. After replaying the scene so many times in my head, asking “what if this?” “what if that?” “what if this was a passenger that didn’t know what to do?” “what if this patient was alone in the car?” “how would the average person know how to handle this?”….I slept.
We spend a lot of time in primary care trying to get people to come into the “doctor’s office”, and this experience challenged me to really think….what is the “doctor’s office”? As this story unfolded today, I have found out so much more about my Lyft driver turned patient turned friend. He did indeed have cardiac problems and an abnormal heart rhythm, and had been having chest pain for a few weeks, which he did not address because, as an immigrant from the Middle East with a wife and young child, he needed to work and support his family, he had poor communication from his doctor and some specialty care fell through the cracks, and he had a limited health plan that didn’t cover much anyway. He worked day in and out to provide for his family, and, frankly, the “doctor’s office” was right there, in his car, where he needed it most. Reflecting on my experience at HIMSS and the intersection of healthcare and technology, with compassion at the core, I really wonder, what do we need to be doing in healthcare to truly make it authentically patient-centered, meet people where they are, and allow for incredible advances in healthcare and technology to impact people like my Lyft driver? Could we be using Lyft to save lives? Could Lyft now become the “doctor’s office” that people really need? Could this marriage between healthcare and tech be more fruitful than it is?
I told my kids the story this morning and they said “Mommy you’re a hero!” I said to them – “I’m a doctor. That’s what I do.”
*some information has been modified to protect patient privacy*