An early January flight from Tel Aviv to Lisbon turned turbulent for a Soldier when a call for help was announced mid-flight.

Following a stay in Israel, Melissa Lewis was on the second leg of her vacation, on the way to Portugal with her husband. The couple, awake for hours to check in and catch the 5:30 a.m. flight out of Tel Aviv, decided to get some rest during the six-hour journey.

Turbulent Flight

“I was sleeping when my husband suddenly woke me up,” said Lewis, a native of the Palawan Province in the Philippines. “He shook me and said, ‘wake up, wake up’ and I'm like ‘what?’ It was still dark; I think I still had an eye mask covering my eyes.”

Still half asleep, Lewis overheard flight attendants call for anyone with medical training over the plane’s intercom.
With a travel pillow still hugging her neck, the 32-year-old instinctively raised her hand. At the time, Lewis, who enlisted as a Licensed Practical Nurse, was nearing the completion of the Interservice Physician Assistant Program, an accredited program for Service Members furthering their medical education to become Physician Assistants (PA).

“I'm not in any way licensed yet (during the flight) but I'm trained,” said Lewis, who has since graduated the IPAP program and earned her commission as a second lieutenant. “I assessed the situation, and just jumped right into what was going on. I introduced myself to the passenger and asked if they speak English.”

Lewis began examining the passenger and asking questions through an interpreter, under the low visibility of the cabin dome lighting, when she noticed the passenger’s body temperature was low and cold to the touch, the skin was pale, and lips were dry.

“I immediately asked the flight attendants what (medical resources were on board), I needed to check blood pressure, blood glucose, know what medications were available,” explains Lewis. “I've never been in a situation like that, so I was just responding as if as if the patient came into the Emergency Room except, I was in a plane.”

While acting on instinct and military training, Lewis was also devising a plan if she required assistance during the response.

“(While assessing the patient) I’m thinking, in the worst-case scenario (Lewis’ husband) can assist me and we'll just roll from there, because I’m questioning, ‘Is it something deadly? Is this something that will require the plane to divert? Is it surgical?’,” recalls Lewis.

After relocating the passenger to a spacious area, Lewis was relieved when Dr. Joseph Feuerstein, an assistant professor for clinical medicine at Columbia University in New York and attending physician at Greenwich Hospital, part of the Yale New Haven Health System in Connecticut, joined her. After hearing the call for medical assistance, Feuerstein volunteered to assist.

“Before I could even get there, Lewis had already gone and offered her services,” said Feuerstein. “We actually ended up with a little medical team, including an Israeli neonatal intensive care unit nurse on the flight.”

As Feuerstein approached, Lewis began giving him a medical report and providing insight on resources available.
Fortunately, Feuerstein spoke Hebrew and could communicate directly with the passenger, concluding the passenger was suffering from mild gastritis (inflamed stomach lining), mild dehydration, and hypertension.
Following the interview, Feuerstein prescribed Intravenous fluids, along with other medications available on the aircraft to help with blood pressure and stomach issues.

“I said (to Feuerstein) I can put an IV in, I can get blood glucose,” recalls Lewis, which in turn comforted Feuerstein, as he admitted to not administering an IV in over a decade. “I was like alright, let's do this. It was turbulent, it was dark, it was a tight space, and I was just trying to figure out (the directions on the IV), it is not like the (American medical supplies), so it was challenging.”

A veteran physician with the Israeli Navy, Feuerstein was used to confined spaces after serving with two special forces units, one of which was aboard a submarine.

“I came to the (US) 20 years ago but grew up in Israel,” explains Feuerstein. “I do know when problems happen in confined spaces, there are limitations.”

Regardless of the bumpy ride, Lewis managed to insert the IV on the first try and began administering fluids to the passenger as Feuerstein continued monitoring the patient.

“(Lewis) was excellent, she performed outstandingly,” said Feuerstein. “It was quite jumpy, everyone was supposed to have their seatbelts on and (the flight attendants) asked us to just hold on, but when you're not in good situation, you have to (act).”

For the next hour, the impromptu medical team monitored the passenger as the medications and fluids took effect. As they determined the passenger’s condition was improving, a second call for the medical team came from the airline aisles, separating the team between the two emergencies.

“(Airline staff) called to us and said somebody else was not feeling good. (Lewis) went to evaluate while I was monitoring the (initial) patient,” recalls Feuerstein.

Under the guidance of Feuerstein, Lewis tended to the second passenger, who was suffering sever muscle spasms, helping the passenger rest and recover before administering anti-inflammatory medications available in the aircraft’s formulary.

“She's the hero,” said Feuerstein, in reference to Lewis’ actions aboard the aircraft. “If I was by myself, in turbulence, this would have been very, very trying.”

For Feuerstein, the “rather turbulent flight” as he described it, was approximately the 10th flight he’s flown on during which he’s volunteered medical services mid-air. However, this was a first for the novice PA, whom Feuerstein described as “great, thorough and calm.”

“I was grateful of the opportunity (to work side by side in such an emergency),” said Lewis. “It's nice to work with a civilian doctor (in a setting outside the military).”

Following landing in Lisbon, both passengers walked off the aircraft without the need for further medical intervention. Although Lewis valued the opportunity to test her medical training in a real-world emergency, she refocused to enjoy her remaining leave with her husband in Portugal. Feuerstein was so impressed with Lewis, he contacted U.S. Army Maj. Timothy Atkins at LRMC to express his gratitude.

“She was a valued asset to (Feuerstein). Good on her to have that initiative, desire to care, and step up when other people might not have,” said Atkins, the IPAP Phase II medical director at LRMC. “Having a provider (like Lewis) who can step up, remain calm under pressure and provide that medical care to better serve patients is what we (as instructors) hope for.”

Humble beginnings

While the Philippine province of Palawan is regarded as one of the most beautiful islands in the world, the Filipino communities have struggled with poverty for decades. In 2018, Palawan’s poverty index was calculated at 55 percent. Lewis’ family was no exception.

“We were poor,” disclosed Lewis. “I had to fetch water in the well, we didn't have electricity at night. (Lewis is describing brownouts in the Philippines - unintentional or intentional voltage drops in electrical grid output.)

Always fond of science, Lewis decided to venture into the medical field and emulate her mother, a midwife who often helped laboring women, at times in remote locations as Lewis described “up in the mountains.” In return for her work, Lewis’ mother was often compensated with chickens or rice grains.

“Nobody else (worked in medicine) in the family. Growing up, my mom was earning better than some of my aunts and uncles,” said Lewis.

Lewis decided to pursue a career as a nurse, earning a nursing degree from the Philippines, however, was never afforded the opportunity to practice in a clinical setting. Instead, she began working at a Philippine-based American company where she improved her English before moving to the U.S. in 2015 and eventually enlisting in the U.S. Army with the Military Occupational Specialty of 68C - Licensed Practical Nurse.

“The Army provided me with opportunities that I never thought I'd get in my life, like where I came from,” said Lewis. “It has definitely given me opportunities to see the world, experiences like high quality training and I just never thought that I'd be here.”

Interservice Physician Assistant Program

According to the U.S. Army’s Medical Center of Excellence, IPAP is designed to provide the uniformed services with highly competent, compassionate physician assistants who model integrity, strive for leadership excellence, and are committed to lifelong learning.

In the Army, PAs serve under Army Medical Department’s Medical Specialist Corps and provide sustained health services from tactical to strategic levels, increasing readiness of Soldiers in addition to caring for their families and retirees.

“The goal behind this training is to get hands-on clinical skills, take didactically learning from (IPAP) phase one and actually put it to practice,” said Atkins. “By the time (PAs) graduate here, we hope they are competent, and confident Independent practitioners because they will eventually be the sole provider for an entire battalion unit of Soldiers.”

While the Uniformed Services’ IPAP course prepares and tests future PAs competency, they must attain national certification through the Physician Assistant National Certifying Exam (PANCE), before practicing independently.

“Lewis is proactive and eager to learn. Despite her lack of experience in a field environment,” said Atkins. “She has a passion to serve the Service Members and provide better care for them.”