His lips were blue and his breathing had become erratic as we had reached cruising altitude. I measured his pulse oximetry again, it had been 95% on the ground, now it was 89%, and his heart rate was 120. I attached the tubing to the oxygen cylinder and then placed the prongs into his nostrils. His readings started improving and his lips returned to their usual colour. He had nausea and I gave him an anti-nausea injection. I asked him if there was anything else he needed, he shook his head. He was exhausted and in a few minutes he fell asleep.

Although I had already been a doctor for 13 years by this stage, working on this medevac flight was different to what I was used to. As doctors we usually see our patients briefly. The longest time we spend is usually during the admission process, we might spend 30 to 80 minutes seeing the patient for the first consult. In the hospital/hospice setting further follow-up visits are usually short, maybe 5 to 10 minutes. The rest of the time between visits the care is provided by the rest of the team, especially our nursing colleagues. So it is possible that during a week long admission, that a patient might only be seen face to face by their doctors for two hours or much less in total.

During the flight it felt like I worked half a nursing shift. As an untrained beginner nurse I kept an anxious eye on my patient. My head was constantly tilted towards him, watching his chest moving up and down. Making sure that he was still breathing steadily. He awoke halfway through the flight in pain, and more pain relief was administered. He stirred a few more times, as if he was having a bad dream. All throughout the four hour flight I checked on him at least once a minute. This was an exhausting vigil to maintain driven by my own anxiety more than anything else, one on one nursing is hard work. We were getting closer and closer to his home. I silently willed him to hold on a bit longer, that he’d be able to see his family soon.

The captain announced that we would be making our descent, the last 45 minutes of the flight! More pain relief was injected as I was keen to pre-emptively prevent the pain from the likely bumpy landing ahead. On the final descent it became particularly turbulent, and the whole plane darkened as we flew into rain clouds. My eyes stayed firmly fixed on my patient, who thankfully remained sleepy and comfortable as we made our way to the windswept island. It was sunny when we approached the runway and through the window behind my patient I could see thousands of palm trees surrounding the airport.

Welcome to the Islands announced the captain. We had landed safely. I sat back and allowed myself to relax for five minutes as we taxied towards the arrival area, but there was still work to be done for this amateur flight nurse.

Island-Man: Homecoming Part 1