Two hours into a fifteen-hour flight between Chicago and Beijing, while sitting alone in my seat debating between watching a low-budget Hollywood flop or attempting to find a comfortably uncomfortable position to sleep in my 17-by-32 inch temporary home, I noticed a commotion brewing down the aisle. Given my knowledge of free spirits on international flights, and especially the amount of those spirits business class flyers consume, combined with the fact I had my headphones on trying to ignore the overly friendly young couple next to me, I assumed the fuss to be an unruly patron with a penchant for wine. But as a crowd gathered it began to become apparent that the cause was something more serious.

At first I was hesitant to help, given the number of people already assisting and the faint inflections of mandarin my ears heard, so I monitored the situation from my seat for the next ten minutes. Eventually, as the chaos continued to ensue and, more importantly, the couple next to me needed to go to the restroom, I was forced to get up from my seat. At this point the flight attendant asked if I was a doctor; to which I could not deny. Quickly escorted down the aisle, I was briefed on the situation by a Chinese radiologist and an American ENT, but sadly the flight attendant provided a better medical assessment: Prior to beginning dinner a middle-aged man became non-responsive, began dripping sweat, and now was unable to be awakened. They quickly asked my specialty and when I informed them internal medicine they both sighed with relief and began questioning me what to do next. My pulse began to race as I assessed the situation from a broad perspective.

It is at this point that common sense tempered with trained instincts took over. Given the non-responsiveness of the patient and the absence of any useful medical equipment, I had to rely on my own instincts and the observances of the strangers seated around him during the event. Beyond the fact that the man was morbidly obese and traveling alone, I did notice a pen shaped device in his left breast pocket and was able to confirm with those around him that he had used this about an hour earlier.  Given that information, I asked the attendant to bring the plane’s medical emergency kit. I frantically searched through the kit and found an ampule of 50% Dextrose but no IV catheter. A passenger from across the aisle passed me his belt for use as a tourniquet and I was able thread and stabilize a 20-gauge needle and syringe into his vein. Before I had injected five of the 20 milliliters of D50 his eyes were open and he was talking and interacting. After reassuring the pilot that no diversion was necessary, I returned to my seat without need to adjust my tight schedule of visiting orphanages.

Throughout my training and the start of my professional life, it is at these moments when practicality, combined with well-developed instincts, are applied to patients or problems that unexpected and even brilliant outcomes flow forth.  In fact, some of the most salient experiences and lessons during my training involved not the application of empirical medical knowledge but use of a broader intuition, something more aptly titled common sense.  Though a term used on a daily basis to mean good judgment, historically, the common sense actually denotes a weighty philosophical concept and continual debate starting with Aristotle. It heightened during the 16^th and 17^th centuries through philosophers and physicians, such as John Locke. Common sense to Aristotle was an inner sense, which combined the external senses and, when used properly, resulted in sound judgment and reasoning.  Whether this inner sense is innate or developed will always be the debate of scholars but viewing it in the context of the medical profession, common sense often runs counter to the empirical and scientific paradigm of medical practice in the 21^st century.  Scientific endeavors and the scientific method specifically rely on hard empirical data and measureable phenomena. Data and measurements are acquired by the external senses, tabulated, and tested.  Evidence is the new engine of medicine. In contrast, common sense, though depending generally on the external and empirical, utilizes the totality of the external and innate to produce new possibilities and results.

 

During my second year of residency, I was called down to evaluate an elderly patient for which the physician on the phone knew very little other than he needed to be admitted. Though this type of transaction was commonplace during my training – and oftentimes was due to laziness or apathy on the part of the caregiver – when I arrived in the emergency room to see this patient it was apparent that nothing was going to be easy or forthcoming, as neither the patient nor any individual was able to provide any information. No wallet, no family, and therefore no history.  As I examined him, however, I noticed an overlooked item between his legs, a cell phone. Though cracked and mangled from a possible fall, without hesitation I began to call all the last numbers that were dialed from this elderly man’s phone. As opposed to the eight hours he slept nameless in the emergency room, in the matter of eight minutes and eight calls, I knew almost everything about this patient and was able to meet him and his caring family’s needs.

These are just two vignettes out of many when my sense trumped my science. In a medical environment where the words ‘Cutting Edge’ and ‘State of the Art’ adorn every hospital addition and new intricate physician procedure, it is a challenge for the well-equipped physician to balance specialized expertise with a broader development of practical common sense. However, I know that absent this balance, our profession and our patients suffer.