As a full-time airport physician, Nagpal has to deal with medical emergencies large and small, and patients from every country and culture. "The reason I took up this practice is that it is very challenging," Nagpal says of his work at Toronto's sprawling Lester B. Pearson International Airport.

He describes his work as "basically a walk-in family practice," and if this is true it is undoubtedly Canada's largest, with roughly 23 million potential patients passing through the country's busiest airport each year.

Previously, the airport employed a director of nursing services, Dr. Martin Betz, who was on call, mainly for telephone consultations. However, the new head of the Greater Toronto Airports Authority, who used to run the San Francisco International Airport, decided Pearson needed at least one full-time doctor on site; San Francisco's airport employs 4 full-time physicians.

Medical services at Pearson are provided by Wilson Medical Centre Occupational Health Services, which won the contract to operate nursing clinics in Terminals 1 and 3 and the expanded full-service clinic in Terminal 2.

Nagpal, a landed immigrant who intends to apply for Canadian citizenship, moved from Newfoundland to take the position at Terminal 2. That clinic opened in early June, but he already anticipates that it will need more physicians. The popularity of these clinics appears to be growing. The Concept Health Airport Clinic at Calgary International Airport, which opened in March, employs 7 physicians, with a nurse and doctor on duty from 7 am to 9 pm, 7 days a week.

Nagpal works a 9-to-5, Monday-to-Friday shift at his clinic, which features a treatment room, education centre and 4 examination rooms. The equipment includes oxygen tanks and defibrillators, and basic medications such as antinausea drugs and antibiotics are available.

Teamwork and interplay are essential among the 3 clinics, which are open 19 hours a day. Nagpal works with a chiropractor, massage therapist and 25 nurses; the nurses have a minimum of 5 years' experience in an emergency department, plus training in advanced cardiac life support.

The main focus of Nagpal's new practice is injuries. On the occupational medicine side, he provides pre-employment examinations and treats employees who arrive with backaches, muscle spasms and lacerations; most of the cuts are received while handling cargo or doing construction work.

Among passengers, the majority of injuries are due to falls, usually on stairs or escalators. And since many passengers often carry bags that are too heavy, stress injuries and muscle spasms are common complaints.

The international nature of his work comes into play when patients arrive seeking travel advice, immunizations or treatment for diarrhea or fever. Nagpal has treated both airport employees and passengers for chest pains, and he has helped travellers who have forgotten their medication.

Patients pay by presenting their health cards from Ontario or another province; visitors from outside the country pay for treatment with cash or a credit card.

Nagpal acquired his many languages while growing up in India. Born in Baroda in the Gujarat region to parents of Punjabi descent, his first language was Hindi. However, he had Arabic-speaking friends and he always spoke a little English. His medical education at the Baroda Medical College was provided in English.

Following a 1-year internship, he completed a postdoctoral fellowship in immunology at Memorial University in St. John's. He liked Canada, so wrote the Evaluating Examination for Foreign Medical Graduates in order to gain his provisional licence and then worked for 6 years in Newfoundland communities such as Jackson's Arm and Placentia.

The work in Toronto is distinctly different from his practice experiences in Newfoundland. There, he provided clinics in small and remote communities, and in some cases had to be flown to his patients by helicopter.