Thomas already had some cartridges of short-term fast-working insulin, all he needed was a method to inject them. But he didn’t have one handy.

Thomas already had some cartridges of short-term fast-working insulin, all he needed was a method to inject them. But he didn’t have one handy.

This incident happened in the first week of February 2018, when I was coming back from Geneva to New Delhi via Moscow after writing my final exams at the École polytechnique fédérale de Lausanne. I had gone as an exchange student from IIT Kanpur, where I was senior undergraduate in electrical engineering.

My flight was about half full and I was lucky that the seats adjoining mine were empty. For the first three hours or so, I was enjoying the solitude. Then, I heard an air hostess enquiring whether there was a doctor on board to deal with a medical emergency. After a few minutes, I saw a middle aged Russian man — a doctor — hurrying from the front of the plane to the man in need of attention seated just two rows behind me. I went along to see if I could help.

The flight had originated in Moscow, and the crew members were more fluent in Russian, but the person in need spoke only English and Dutch — I learnt only later that he was from Amsterdam. Luckily for him, the doctor spoke English, and that’s why I too was able to understand his situation.

Thomas, about 30 years old, had been diagnosed with Type 1 diabetes at around 11 years of age, and usually carried his insulin pump with him. Usually, he kept the pump attached to his abdomen, right over his liver, and would give himself an insulin dose before eating anything through a dial in the pump. However, in his hurry at the Sheremetyevo International Airport, he had forgotten to collect the pump after security check. It had already been five hours since he last took insulin, and his blood sugar was way beyond normal. On that particular scale, what should’ve been a normal reading of 6 had shot up to 21, if I remember correctly. He had started to feel nauseous, and felt he might black out.

The doctor tried to calm him down and explained to the crew that he needed urgent insulin or he would pass out with possibly multiple organ failures and coma or worse. I personally think it created more panic than helping the situation. Anyway, Thomas already had some cartridges of short-term fast-working insulin, all he needed was a method to inject them.

The doctor himself was a diabetic, but he used a pen-like contraption to inject insulin. It consisted of a transparent center part where the insulin cartridge loads, a dial on top to adjust the dosage, and a pushing mechanism that plunged out a small but sharp needle from the tip of the pen. The doctor had multiple spare needles, but Thomas’s insulin cartridges were too thin to insert in the insulin pen. The doctor’s own insulin was a long-term slow-working one, chemically different from what Thomas needed.

Since there was no other solution immediately available, Thomas and the doctor decided to go ahead with the latter’s insulin. They went to the back of the plane to inject the insulin, while I went back to my seat, thinking that disaster had been averted. Needless to say, I thought wrong.

An hour later, there was an announcement that the plane would have to land somewhere in Central Asia because of a medical emergency. It turns out that one of the crew, while passing by Thomas’s seat, discovered that he had passed out, and white foam had formed at the corner of his mouth. The doctor was already at his seat with the insulin pen, and explained that possibly owing to chemical resistance to this slow-working insulin, Thomas’s sugar level readings had shot up to the mid-30s instead of the low-20s an hour earlier. There was a severe risk to his life if he wasn’t injected with his own fast-working insulin as soon as possible.

The doctor was fiddling with the pen, and when I asked what he was doing, he said he was trying to adjust the cartridge holding the tube’s diameter, and would use it to inject Thomas’s own insulin. However, when he finished, the needle wouldn’t budge when the cap was pushed, as is normally supposed to happen. The doctor looked like he panicked at this point, and asked the crew to land, else it would be very difficult to save Thomas. However, the crew said it would take more than an hour to land.

I asked the doctor to give me the insulin pen to check what had gone wrong in the last hour. Also, I requested a crew member to let me access the premium Wi-Fi — available only to business class passengers — to check the pen’s online manual. She reluctantly agreed.

I looked up the manual and found a large engineering drawing-style diagram, showing how every part fits together. Now, engineering drawing or TA101 was something I loathed in my first year, but had practiced it enough to score a B, which was also enough to understand this particular drawing. I methodically opened up the pen, counting the parts I was accessing, and realised that one of the 13 parts listed in the diagram was missing – a spring that coiled before the cartridge, which was essential to transfer the push motion from the back to the needle in front.

I searched around Thomas’s seat and the aisle nearby, but couldn’t find a spring. The doctor, too, was nowhere to be found. I asked an air hostess to ask all the passengers for push-action ball point pens, and got four or five pens within a few minutes. Luckily, one of the few springs fit perfectly, and I quickly reassembled the pen and gave it to the doctor, who had materialised nearby. He adjusted the dose, changed the needle, and injected the correct insulin.

In about 15 minutes, Thomas’s sugar levels stopped shooting up, and soon, started coming down. The doctor told the crew there was no need to land anymore; that Thomas would regain consciousness in some time. A few of us helped transfer Thomas to business class so he could lie down, and then, an air hostess moved me to business class too, as a sort of caretaker.

Towards the end of the flight, Thomas regained consciousness, and asked what had happened. I told him the whole story.

Since it was his first time in India and he was still not 100 per cent fit, I assisted him to Gurugram’s Medanta hospital for a check-up, and to get a new insulin pump. While lying on the stretcher in the ambulance, he thanked me profusely and told me to come visit him in Amsterdam, where he owns his own restaurant and brewery. All the free food and beer I could want would be mine, for free!

This incident has made me realise the importance of the basic engineering skills we are taught in our freshman year at IIT-K. I think saving a person’s life is more than what anyone could ever imagine to achieve from the basic engineering knowledge earned in that year. I am grateful to IIT-K for making me capable of actually being able to help in such a critical situation.

Karttikeya Mangalam is a graduate student at Stanford. This article was shared by IIT Kanpur from its official Twitter handle, and has been reproduced with the author’s permission.

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