A 36-year-old woman, in overall good health taking oral contraceptive pills (OCPs), was on a prolonged international flight, and collapsed. A physician on the plane found no pulse. A 2-hour long, in-flight, complicated course of ACLS ensued with compromised ventilation, until the plane made an emergency landing in Boston. The patient presented to the MGH ED approximately 2.5 hours after her collapse, with unstable vital signs and arrhythmia. She was intubated with a Glasgow Coma Scale (GCS) of 9 with some lateralization, eyes roving, not tracking with disconjugate gaze, brain-stem and spinal reflexes intact. Her work up revealed right lower extremity DVT, with multiple bilateral pulmonary emboli and evidence of right-heart strain. Initial CT and MR neuroimaging was unremarkable. The patient was admitted to the ICU.