Here we go! I finally get to experience the United Airlines famed Pacific island hopper in the other direction after taking a part of it 4 years ago.

Probably the most burning question is where to sit:

If you’re flying from GUM to HNL (eastwards), sit on the right side for all the legs and then switch to the left side when departing and landing in MAJ.

If you’re flying HNL to GUM (westwards), begin on the right side from HNL to MAJ, and then switch to the left side for all the rest of the legs until GUM.



Departing from Guam at 9:20am, we enjoyed 2 hours in the air with a quick snack in between.



Just as I was finishing up reading the last paragraph of the book I had packed along with me on this trip (Hua Hsu’s “Stay True”) Stephanie summoned me to the front of the plane saying they needed me. It took me a few seconds to realize she meant my doctor hat, the side I had long forgotten about the past 2 weeks while on the road. Shuddering to think I would repeat the last time I had to force land the plane in Halifax because of someone going through hemorrhagic shock from a spontaneous abortion, I unbuckled and walked up as fast as I could towards the cockpit.

A girl in her 20s, whom I had just saw a few minutes ago trying to go to the bathroom in the back of the plane (only to be directed to the front instead because of the galley cart that was still serving drinks), was seen to have passed out. While being held upright in the attendant’s jumper seat next to the cockpit, she appeared pale and lurching side to side like a ragdoll. Reflexes immediately kicked in when I tried to wake her up with a sternal rub. She responded to that, immediately coming to and made the universal gesticulation that she wanted to vomit. I then asked for alcohol swabs, an emesis bag, a pair of latex gloves, BP cuff, and a fingerstick with blood glucose monitor (if they had that). I was given everything but the latter.

While keeping her awake by peppering her with questions, I put on the gloves and placed the alcohol wipe underneath her nose. With a huff of the alcohol wipe the color returned to her face. She was able to say her name, where she was, what destination she was going (Majuro), what she was going for (work), what month it was, the date, and that she was from China. She was able to speak to me in both English and Mandarin. I responded back in kind. Then I took her blood pressure: 73/52. Her heart rate was in the 70s. Her respiratory rate was in the 20s. She said she felt like she also wanted to go number 2 and that she suspected it was a couple of take out Burger King patties she had eaten 6 hours prior while on the way to Guam Airport. She denied any medical history, surgical history, or fever. I was suspecting a vasovagal or orthostatic hypotensive event due to gastroenteritis and third spacing from volume loss.

Because of her initially low blood pressure and that she was repeatedly passing out on me, I laid her flat on the jumper seat and asked one of the flight attendants, Dee, to first elevate her legs to bring blood back to her vital organs and then hold her her legs flat so I could perform an abdominal exam: she elicited tenderness on the right side. I then became worried about appendicitis, let alone undifferentiated hypotension in the context of syncope, so I told the captain she may need medical attention when we landed in half an hour in Chuuk. And since we only had an hour on the ground before we would have to take off again (island hoppers have to stick to a strict schedule), it would be better to call it early so we wouldn’t be grounded into overtime and therefore permanently.

During this time, she vomited once in the bag, and then asked to use the bathroom. I asked her to keep the door unlocked just in case. When she came out a few minutes later after having number 2’d, she huffed on the alcohol swab, after which I PO challenged her with a glass of water. She said with that, she began to feel much better. She continued to drink more water at my encouragement and more color began to come back to her face. She said she was now “100%.” Suspicious that she simply didn’t want to be taken off the flight against our better judgement, I negotiated a compromise: she could be moved from the jumper to a regular seat, but next to the staff mechanic that always sits on the island hopper’s seat 7F.



I’d give him (thanks Vergil!) instructions what to look out for, when to call me, and to always keep her awake, make sure she kept sipping on water, and to huff on an alcohol wipe anytime she felt nauseous. Then she could be reassessed when a medical team came onboard after landing to determine whether she should stay on the flight.

After Vergil gave me the OK that my instructions were easy enough for him, I returned back to my seat to finish my book in its last sentences, after which my seatmate soon began chatting with me and identified herself as the Emily, the wife of the plane’s first officer who happened to want to join along this flight. Wow! What luck. I told her if I went up again to reassess the patient after landing, she and her husband could vouch for me in case they won’t let me and wrestle me to the ground instead.



We then landed at 11:10am local time in Chuuk International Airport (fun fact: originally built by Japan!) where we were told wait until medical personnel came onboard to reassess the patient. But none of the passengers listened and hurried to disembark anyway. We’d find out a few minutes later that there was traffic blocking medical transport from the nearby hospital so they’d be coming a few minutes late.

Glad we called them early!



FYI, if you’re curious: Chuuk, formerly known as Truk, is Micronesia’s most populous state with 50,000 people living within 120 sq km or 46 sq miles, and therefore a popular stopover on the island hopper.



But back to the story: I took this time to move to my next assigned seat 4 rows back (I was assigned a different seat for each leg of the island hopper) and identified my bag to the ground staff who wanted to inspect the plane for any unclaimed carry-on luggage left behind in the cabin.

After all the passengers with Chuuk as their final destination disembarked, I returned to the front and reassessed my patient who looked much much better. She was now smiling and thanking me in both English and Mandarin. I was reconsidering whether I really wanted her off the flight and momentarily regretted the huge inconvenience of calling for a medical evacuation, but both my seatmate and flight attendants reassured me this was part of protocol anyway and they were glad with having me onboard.

Five minutes passed and then a local ER nurse from a nearby hospital on the ground came onboard to assess the patient. I stepped away so I wouldn’t bias their assessment. After another 15 minutes, during which I was trying to find an open bathroom to use, I returned at the behest of the flight attendants to give the ER nurse my take. We both agreed she looked stable at the moment and may not need to be removed from the flight. I then asked the passenger to lie down in an open row for another abdominal exam, which she happily agreed to, eager to show me she wanted to be “formally discharged” from our figurative Emergency Room. I pushed on her belly again et voila! she was nontender. Let’s call it food-borne gastroenteritis for now. But I told her I’d keep an eye on her, which she cheekily said she was looking forward to in Mandarin. The ER nurse shook my hand many times in appreciation and left the aircraft, while the passenger returned to her original seat by the exit row. I could now focus on finding an open bathroom so I could finally pee.

Then, as I was waiting in line for the lavatory, one of the Chuuk airport’s ground staff members pointed at me and asked me for my name. I gave it, and he then replied I had been upgraded to first class in seat 3B. I was taken aback, and promptly got off the bathroom line to move my stuff to the front. What is going on this flight?

I don’t know but I’m loving the way it’s trending.

Sitting in my new seat in first class, the other Chuuk ground staff member looked at me and held his stance. I then awkwardly asked him why I was being upgraded; was it for attending to the medical emergency or my Premier Silver status on United? He looked at me for a few seconds without replying, and then said “your membership status.” And then he asked: “you look familiar…are you a YouTuber?” I paused, and then asked: “…maybe? what kind of content do you think I do?” He then said: “I just got into travel content…you’re a travel blogger yeah?”

A few minutes later he’d show me he was already following me on Instagram. You’re the best Christopher! It was so nice to meet you!



After new passengers from Chuuk boarded, I finally had my chance to pee. Delayed gratification. We then forged ahead to Pohnpei, taking off at 12:10pm.


Not to be confused with Pompeii of Italiy, Pohnpei is Micronesia’s largest island and home to Palikir, its capital.



Enjoying business class with my glass of whiskey as long as I could on this 1 hour and 10 minute flight, I unbuckled at the last minute to head to the last row for unobstructed views of Pohnpei islands.



We then landed at 2:30pm local time after an hour and 10 minutes in the air.



Unlike Chuuk and Kwajalein, even if your final destination isn’t Pohnpei, you can disembark in their airport for a quick turnaround stamp in and out, and to enjoy the (relatively) elaborate gift shop in the transit area.

As long as you take all your cabin luggage with you when you disembark and reboard, they’re fine with it.



So I did just that, taking advantage of heading out to get a quick exit and entry stamp just for the story.



But instead of continuing on in immigrations into baggage claims, the immigrations officer said I could turn back into the transit area at the gate without having to go through security.



This gave me extra time to enjoy the gift shop. Pohnpei is known for their local pepper.



I also purchased two boxed sets of cookies for the flight attendants Dee and Kristy, who had been very helpful and kind during the medical emergency.



We only had about 20 minutes before we having to reboard our flight from the transit area:



Once reboarded, I found I was only upgraded for the prior leg of the trip and I had to head back to my originally assigned seat in row 32. I didn’t mind since that meant I didn’t have to move for photos when we’d land in Kosrae, Kwajalein, or Majuro 2 hours later.

The ground staff waves you goodbye at Pohnpei, which I felt was a nice touch.




After we took off from Pohnpei, we continued on United Airlines’ island hopper Flight 133, which flies on Sundays and Wednesdays.

Pro-tip: if you fly on the Wednesday schedule, you’ll be lucky to add on a stop in Kosrae, another island of the Micronesia island hopping airport chain:



After that it’s Micronesia’s last stop at Kwajalein, home to Bucholz Army Airfield.

Unlike on the other islands on the island hopper you are not allowed to take photos outside as the airport is US military through and through. That said, unless you have special permission to disembark here as military personnel or an invited guest of the US military, you are also not allowed to leave the aircraft while the plane stops to refuel here.



Ah Majuro, it’s good to be back after 4 years!



Like in Pohnpei, you can get off in Majuro as well for a quick transit on the group and an exit/entry stamp.



Not sure how much has changed since I last visited here.



Since I had already have stayed in Majuro before, getting off the plane was not as necessary for me, but I wanted to check it out because…nostalgia. But I eschewed the stamp this time and headed straight to the transit area.



The departures gate staff here are so relaxed you can step outside for fresh air and enjoy a banging sunset before boarding.



At this point due to all the standby for upgrades on all my segments, I suddenly received multiple e-mails (upon immediately connecting to the airport WiFi) that United Airlines had both reconfirmed AND cancelled my itineraries at the same time, as well as saying my checked luggage would be rerouted as far back as Pohnpei (even though my AirTags said they were with us on the tarmac in Majuro).

Confused at receiving all these e-mails, I went up to the gate agent to clarify what was happening. She also appeared confused. Then when she looked up my name, she saw two double booked itineraries: one was as is in all economy as it was, and the others were all on standby for upgrades to United First.

As she sorted out some technical wizardry to make sure I’d stay on this flight AND also be upgraded (woohoo!), I could hear her muttering how she wished I had come up to her sooner at the gate. When I sheepishly admitted that I had just gotten off the island hopper flight from Guam and had not been coming through security from Majuro, she made an even more confused look why I would do such a thing. I then just smiled at her.

We then boarded half an hour later than scheduled.



Then enduring an another half an hour delay where the plane was deemed too heavy, they offloaded some cargo and we were then able to depart. Thank goodness for the upgrade because this United First meal of salmon was excellent.


EDIT: March 16, 2024 at 12:22pm

Love having received this comment on one of my related blogposts, as well as the following e-mail from a fellow passenger who found my blog!

I was on this flight with you, and you certainly were helpful to the crew and distressed young woman. I was headed to Majuro for work meetings, and glad you had been on-board. Being a Ski Patroller, and psychologist, with outdoor emergency care skills, I was sort of next up! I’m happy to say I saw the young woman multiple times in Majuro, usually happily enjoying another meal!

I enjoy your blogs, and happy to have crossed paths over the Pacific.

Hi Calvin – I doubt I will ever cross that girl’s path again.  I can report she seemed totally back to normal.


Probably, like you, I’m back at work and waiting for my next escape.  … I must say I enjoyed the Island Hopper outbound to Majuro, but the return trip seemed endless, since the novelty was in the rearview mirror.  I found myself thinking the childlike “are we there yet”…  Man, over 8 hours back to Guam, it was painful.


I have enjoyed your blogs, and once I saw you on the flight to Chuuk, I also remembered seeing you a time or two on the news during the COVID outbreak.  I will stay tuned, and who knows…maybe our paths will cross again.  Dennis


Be Well – Stay Connected


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