Planes, trains, and automobiles (or, ISHLT vs the volcano)

April 27, 2010

Chicago, IL - What if you held a scientific congress and nobody came? It wasn't quite that bad last week for the leadership of the International Society for Heart & Lung Transplantation (ISHLT), but the weekend preceding its annual meeting found them facing the prospect that hundreds of attendees, including key presenters and society officers, would be stranded in Europe as the meeting got under way in a few days.

The Eyjafjallajökull eruption grounded flights and sent ISHLT organizers into a tailspin.


"The major thrust of this society, particularly the annual meeting, is to provide a forum for exchange of scientific information and educational material, and that's it," current ISHLT president Dr James K Kirklin (University of Alabama, Birmingham) said to heartwire . The travel disruptions could potentially keep 20% to 25% of registrants away, he had estimated: a huge loss for such a small society that prides itself on the "unique international flavor" of its annual showcase meeting.

Ultimately, more than 700 out of 2193 preregistered delegates were no-shows, according to ISHLT executive director Amanda W Rowe, who tallied the attendance numbers for heart wire . Many more arrived only after the meeting was in full swing. Also absent were 110 preregistered nonmembers, including industry representatives.

Amanda W Rowe

Those who couldn't make it to Chicago still could attend the presentations, however, thanks to an emergency plan put together by Kirklin, Rowe, and other society leaders over a sleep-deprived weekend. There would be no global webcast, an appealing idea that was nonetheless financially out of reach for the society. But there were other ways to use the web and still some value in the old-fashioned conference call, they reasoned.

"We combed the book to identify every possible [registered] person who was from Northern Europe," Kirklin said, "and sent out this blast email with instructions." Registrants could log on to the site and "enter" any of the sessions in a half-dozen meeting rooms at the Hilton Chicago.

That took care of anyone who might have missed being in the audience, but what about the many presenters who wouldn't make it? "Monday night, at about 2:00 in the morning," Kirklin said, "Amanda did another blast email to the presenters." They were to email their slides, the many ISHLT board members and session chairs in Chicago would organize them for presentation, and each presenter at their appointed presentation times—late night for many in Europe—would literally phone in their talk. Moderators would be their avatars, advancing the slides. And everyone, including moderators, panelists, and audience members with questions, would speak into microphones that, like the room loudspeakers, had been patched into the phone lines.

Sojourn in a ghost town

Among those missing in action was one Dr Heather Ross (Toronto General Hospital, ON), director of cardiology and transplantation at her center and as close as the society has to a rock star. And that's not only because she plays the sax and is lead singer with the Marginal Donors, the band that traditionally headlines the annual meeting's main social event, the Gala Anniversary Reception and dance, scheduled for Friday night.

As Rowe, Kirklin, and other ISHLT leaders pondered how to bring European delegates to the meeting or vice versa, Ross stood in Norway's Oslo Airport in Gardermoen after enduring "a 20-hour bus drive through a horrific snowstorm." She had just learned that that no flights would be leaving Oslo for at least the next 48 hours, she explained to heartwire . (Find the story of her frenzied journey at the end of this story.)

On Thursday, April 15, Ross had stood at the top of the world with her colleague Dr Michel White (Montreal Heart Institute, Quebec) and, especially, 58-year-old firefighter and heart-transplant recipient Dale Shippam, from Thunder Bay, ON, at the climax of an expedition sponsored by the Toronto cardiologist's Test Your Limits program.

It was the latest in a series of extreme adventures Ross has taken, along with fellow physicians and patients, and one of several with Shippam. Earlier expeditions included a 2004 journey to Bolivia to scale the 21 000-ft Mt Sajama and one in 2006 to the top of Antarctica's 16 000-ft Mt Vinson Massif, as previously reported by heart wire .

Getting home from those trips had been a lot easier. At Oslo Airport, "which was like a ghost town," Ross said, she had no idea whether she would get to the meeting in time to participate. She was on the bill, for example, to cochair a Wednesday satellite on ethical issues of cardiac transplantation and pumps called, in part, "Who plays god?" The meeting also marked the end of her term as ISHLT secretary-treasurer. And there was a gig to play.

"That was the first thing on my mind," she told heartwire . "Was I actually going to get there in time to do anything?"

You don't sense it here at all, but there, there was almost an end-of-days feeling, a clear undercurrent of panic.

By Tuesday, having crossed much of Western Europe at the wheel of a rented truck, with the meeting still 4000 miles away and starting in a matter of hours, Ross slammed into a wall of frustration at London's Heathrow Airport. The best she could achieve at Heathrow was a rebooking to a Toronto flight eight days later, long after the dust would clear on the Chicago meeting and well into her workweek. "Then the question became, 'Am I actually going to get home by Monday to do what I do for a living?' "

She accepted the April 28 booking in case it became necessary and then jumped into a taxi to head for what seemed like her next best bet. Having learned that some international flights on the Continent were getting off the ground, even if most domestic flights were still grounded, she headed for Paris and Charles de Gaulle airport. "By the time I left Heathrow after booking for 28th, I had given up on the meeting. Now, I just needed to get home."

Ross was hardly alone in her frustration. "You don't sense it here at all, but there, there was almost an end-of-days feeling, a clear undercurrent of panic, actually, from airport to airport, with people trying to get home or to their jobs, hundreds of thousands of people in the wrong place. It was remarkable."

"I was one of the lucky ones"

On Monday night before the meeting, program chair Dr Hermann Re ichenspurner (University Heart Center, Hamburg, Germany) was at home, with no way to fly to a major airline hub the day after his Chicago itinerary had fallen apart, on a conference call with other ISHLT leaders. They had an action plan for virtual access to the meeting that would allow any presenter or delegate still stuck across the Atlantic to watch and participate.

Even with his 30-hour journey, Reichenspurner told heart wire , "I was one of the lucky ones." Just hours after the conference call, he jumped on a train for Dusseldorf and caught a direct flight to Chicago, arriving Tuesday afternoon local time, and just made the start of the meeting. He and other senior members of the society, as well as others who travel a lot, he acknowledged, had pull with the airlines and an easier time getting flights. "A lot of the young scientists, the ones who are in the lab and doing so much of the research, they're the ones we really want to be here. But they have the cheap, 21-day advance tickets and are the last ones on the waiting list, so they didn't have a chance."

Dr Mandeep R Mehra

As Reichenspurner related his story, former ISHLT president Dr Mandeep R Mehra (University of Maryland School of Medicine, Baltimore) entered the room with a report on the first Wednesday satellite sessions featuring European presenters speaking by phone: "It's working like a charm!"

Moments before, Dr Jean-Luc Vachiery (Erasme University Hospital-ULB, Brussels, Belgium) had presented "Combination therapy in pulmonary hypertension: Do we have the evidence for it and is it the best approach?" from his home to a "standing-room-only" crowd he never actually saw.

"It's seamless," Mehra announced. "You can barely even tell, because the room is dark, that he isn't there."

In this way, as Kirklin later noted, none of the European satellite-session speakers missed their presentations. But there were still concerns about the abstract-related oral reports that would begin that afternoon and run through Saturday morning.

As expected, not everyone made it. But the phone hookups did keep many of those oral reports, 66 of them by the end of Friday, from falling victim to the volcano's cloud of ash.

You can barely even tell, because the room is dark, that he isn't there.

Elated and jazzed at their success with the oral presentations, the ISHLT leadership refocused their attention on other fallout from the transportation crisis. Friday's gala event would still need music even if the lead singer of the Marginal Donors didn't show in time.

With sometimes-promising, sometimes-dispiriting word on Ross's progress at European ferry terminals and airports arriving sporadically, Mehra and others lined up a Chicago-area band as a backup. The second-choice group, fittingly called Second Opinion, included a cath-lab nurse from Good Samaritan Hospital in Downer's Grove, IL, and a guitarist who is a vice president at Edward Hospital in nearby Naperville.

In a case of life imitating art, Ross, having already taken planes, helicopters, and skis to the North Pole about a week earlier, embarked on her own Chicago trip. She didn't know, however, that it would turn into a six-day odyssey across seven countries by plane, bus, truck, ferries, and an environmentally sensitive taxi. Train-travel plans just didn't work out.

"I thought the trek to the North Pole in itself was a fairly phenomenal event. I thought that would be the news piece, and then the trek home was just epic," Ross said to heart wire in Chicago about seven hours before the Marginal Donors would take to the stage.

After standing astride the Pole on Thursday, April 15 and celebrating with champagne, Ross, White, and Shippam found themselves unable to ski out due to a storm that had also grounded the helicopter available for a faster exit, should one be needed. They endured the storm overnight in a tent, conserving fuel and food and not knowing when they would leave, before the weather cleared enough for the craft to land the next day.

We were told yes, there would be an SAS flight, but actually they didn't know where it was going to land.

The helicopter took them to Barneo, a more-or-less permanent base station for scientists and adventurers about 60 miles from the Pole ("more-or-less" because ice drift forces its airstrip to be rebuilt each year). Then, on Friday, they secured passage on a plane to Longyearbyen, the largest city in the Svalbard archipelago, about halfway between Norway and the Pole.

Waiting in Longyearbyen, something new had entered the picture: real-time information through her Blackberry, courtesy of some of the Earth's northernmost cellular coverage.

"We heard there was going to be an SAS [Scandinavian Airlines] flight from there to Trondheim [Norway]. When we got to the airport, there was mass chaos. We were told yes, there would be an SAS flight, but actually they didn't know where it was going to land." So she and her fellow adventurers and dozens of other determined travelers boarded the plane.

"The pilot took off. We ended up landing in Bodo, Norway, where SAS met us with buses. Then we did a 20-hour bus drive through a horrific snowstorm down to Oslo." At that point, it was Saturday. Ross and Shippam said goodbye to White, who had decided to take advantage of the transportation crisis to spend time in Norway's capital.

The airport there, however, had closed and would remain so for at least the next 48 hours, Ross learned. "I got a little panicked about that, with the meeting coming up soon. So we rented the last car at the airport. It was a beast, a seven-speed Renault truck. Then Saturday night we got some sleep, woke up early Sunday morning and started driving. We did 2100 km that day." Destination: Calais, France, then on to London for a flight out of Heathrow.

They crossed into Sweden, through Denmark, and made their way to Frankfurt, Germany, where Shippam's daughter lives. Shippam was still carrying a good supply of his medications, Ross observed, "so he jumped ship there to wait it out."

At Calais, the foot-passenger ferries were completely booked. So the next day I drove to Le Havre . . .

Ross was now on her own, with a truck and "somewhere around a hundred pounds of luggage, all my gear from the Pole, which was fairly good gear I really wasn't interested in losing—all the clothing, including Canada goose [down-filled] parkas; each of my boots weighed about three pounds. Then, because I was doing my blogs, I had a Pelican case [watertight luggage] with the computer, spare batteries, a satellite phone, two video cameras, and two standard cameras. And I dragged that everywhere."

She set the truck on course for the ancient French town opposite the UK, passing through the Netherlands and on to Brussels (Belgium), and finally into northern France. "It was an amazing day, about 17 hours of driving, I guess. At Calais, the foot-passenger ferries were completely booked. So the next day I drove to Le Havre and there managed to get a foot-passenger ticket. Now it was Monday. I dropped the car off and boarded the ferry for Portsmouth. From Portsmouth I made my way to Heathrow, and spent Tuesday there." Air Canada flights, she had been told, would be taking off that day.

But they did not take off that day. And the next available booking was on April 28, four days after the ISHLT sessions would adjourn. Ross accepted the booking.

"Then Tuesday night I received notice that Air France had added an extra flight to Canada for the next day. So at 2:00 am Wednesday morning I got up, hired a cab and booked a space on the [high-speed Eurostar train through the Channel Tunnel] so I could get to Charles de Gaulle [airport] in Paris. There were no tickets available, so I booked car space on the [Eurotunnel shuttle vehicle-transport] train. We would stay in the car—it was the only way we would get to do the Chunnel."

After reaching the tunnel entry point, Ross said, officials noticed the taxi had been fitted with a clean-burning liquefied petroleum gas engine that, it turned out, was forbidden in the 50-km Chunnel. It was about 5:00 am.

I can't let you get into that car, because then I'll know you're a hitchhiker.

With Ross unable to board trains on foot or in the taxi, "a guy in the car next to us said he was willing to drive me to Charles de Gaulle. But the lady at the gate said, 'I can't let you get into that car, because then I'll know you're a hitchhiker.' I said, 'You need to understand, I have to get home!' She would have none of it. So we did a U-turn."

Within minutes, Ross said, they arrived at the ferry port in Dover. "An amazing lady at the ferry terminal booked us a car-ferry spot over, and booked the taxi driver a car-ferry spot coming back—and they were at a premium, because everybody was trying to get to the UK."

The crossing took a long 90 minutes as Ross assessed the dwindling time remaining before her plane would take off. Once off the boat in Calais, "we absolutely booked it on the highway and got to Charles de Gaulle an hour and 53 minutes before the flight."

The plane flew directly to Toronto, and Ross was home for all of 16 hours before getting on a plane to Chicago.

"In all, from leaving the Pole, it was six days, seven countries, two ferries, the bus ride, the car drive, and six or seven separate flight bookings that I was bumped from." In addition, she said, there were backup reservations that were never needed, including "an April 23 flight out of Lisbon that would have just gotten me here in time to play tonight," and a berth on the Queen Mary II.

A journey from the top of the world

In the 1987 John Hughes film Planes, Trains, and Automobiles, characters played by Steve Martin and John Candy take three days to cross a third of the US, from New York (via Wichita, KS, where a blizzard had diverted their plane) home to family in Chicago for Thanksgiving holiday festivities.

Dr Heather Ross

Ross made it in time to play with the Marginal Donors at the ISHLT gala.



Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.