With forty-five minutes remaining in the flight, I exited the bathroom, feeling a level of achievement after successfully completing the complex task of figuring out the small bathroom door latch and opening the bi-folding door. As I took my seat, my friend leaned over to me and said, “that man sitting in the row ahead of us just stood up and passed out.” The middle-aged man was slumped over in his seat, hovered over by flight attendants.

I have been on a couple flights in my life where flight attendants ask for physicians or nurses on board to assist. Since becoming a medical student, this scenario has crossed my mind even more. However, I always pictured being many years into my career, residency-trained, and experienced to handle whatever medical situation presents in the confined setting of an airplane miles in the air. Little did I know, that exact situation presented now.

I began to dig for my stethoscope at the bottom of my backpack. It was still there after my last clinical session in medical school less than a week prior. My initial thoughts: Now what? Do I get up and assist? Am I qualified to assist? If I do get up, do I tell them I’m a medical student? I haven’t passed my board exams yet. I wasn’t residency-trained yet.

As I pushed the intrusive thoughts out of my mind, I stood up and approached. Simultaneously, an announcement was made over the intercom for a “nurse, physician, or healthcare provider.” Surely, an experienced physician aboard the flight would eventually push me aside and take my spot.

I was nervous. My hands were shaking, and I was hastily trying to recall the correct order of my history-taking outline in my mind. As I knelt down beside the man, he complained of shortness of breath and left-sided chest pain with radiation into his left arm. Just as I turned and asked the flight attendants for aspirin, he became more obtunded, and suddenly unresponsive. Desperate, I obtained a bottle of sublingual nitro, shook two tiny pills out into my trembling hands, and placed them under his tongue. His mouth was dry, but it was worth a shot. At that moment, the flight attendant asked if we needed to divert and land. I responded with an emphatic “Yes, now!” and immediately started to realize the power that I had.

As I continued to auscultate the patient’s chest, his heart rate became more irregular and distant. Anticipating chest compressions, I made the call to reposition him to the floor of the aircraft. I also asked for the onboard AED, and attached the pads to his chest, ready at any moment to shock. As he lay in the aisle, I maintained two points of reference: one on his chest with my stethoscope and one palpating his left carotid artery. This gave me a sense of control and instant feedback, which alleviated some of my anxiety. I quietly waited, listening and feeling. There were several brief moments of no heartbeat, but I continued to feel a weak pulse. I watched for the rise and fall of his abdomen. The patient remained in an unconscious state. I had no concept of passage of time, but soon felt the flight attendant’s hands on my back bracing me while we landed. EMS rushed the plane and I handed off the patient.

As I reflect back, I realize that experience, particularly under pressure, can be the best teacher: it forces us to focus and perform. I learned more in 45 minutes on the floor of that airplane than I could have learned from any calm, well-planned clinical scenario or standardized patient in medical school. I also learned that we have more ability than we think we do.

During those 45 minutes, a transformation occurred. I went from timid, nervous medical student to assertive, confident healthcare provider. I realized that we don’t become physicians once we graduate medical school, once we’ve successfully passed all of our board exams, or when we complete residency. We become physicians the moment we stand up from our seat and use whatever knowledge we have to help. We become physicians when our decisiveness and action transform anxiety and fear into confidence and poise. It’s when we connect with that person in dire circumstances who needs someone to calmly sit with them and make it a little less scary. That person doesn’t care if we’re inexperienced medical students or practicing doctors. It’s less about being accurate, and more about comforting those around you through your calm and poise.

Afterward, as we walked through the airport, my good friend who I was traveling with said to me, “you looked like you knew what you were doing.” If he only knew.