Once a Doctor, Always a Doctor

Once a Doctor, Always a Doctor

Once a Doctor, Always a Doctor

 

Due to the somewhat insecure nature of the business, many pilots who fly airplanes for a living also have a backup career. When those secondary skills are called for while aloft, it can make for some novel deviations from regular pilot duties. In my case, being a doctor with an emergency medicine background has from time to time added to the interest of the trips I fly as a pilot professionally. A couple trips over the past year or so to Alaska and Europe are cases in point.

Fellow corporate jet pilot Doug and I leave Skagit Regional Airport just north of Seattle in the Lear 35 just before dawn. It is a cold winter morning, and we have seven passengers on board the business jet with the plan to leave three in Ketchikan, two in Juneau, and take the remaining two to Valdez. We are to wait there for a couple of hours, then reverse the whole procedure, ideally getting everyone back to Seattle by dinner time.

A small arc of the sun is visible on the eastern horizon as we start down from FL360 near Annette Island, about 70 nm southeast of Ketchikan. The weather report says it is snowing in Ketchikan with visibility of one to 2 miles, scattered clouds at 2,000, broken at 2,500 and overcast at 3,000. The wind is from the west gusting 12 to 20 knots. Anchorage Center clears us for the instrument approach to Runway 29, and hands us off to the local frequency. Ketchikan Flight Service tells us there is snow on the runway, and braking action is unknown. We break out of the clouds at 2,500 feet about 2 miles from the runway, to see that at 144 knots we are a bit high and fast. This is not where we want to be given the runway conditions.

The power comes all the way back, full flaps go down and pretty soon we are nicely established on the glide path, doing the calculated correct speed of 132 knots. We make a smooth landing in blowing snow, the thrust reversers are deployed, and I tentatively test the brakes. They seem OK, although hard to tell with all the deceleration generated by the jet engines.

An Alaska Airlines 737 crew behind us on the same approach asks about braking. We are nearing the end of the runway and nail the brakes to see what happens. Good braking, we tell them. It is pretty clear their concern, (like ours) was not the instrument approach so much as rather what was going to happen once on the airplane was on the ground.

When we exit the taxiway and enter the Aero Services ramp, the Learjet nearly comes to a crunching stop. No one has plowed the ramp and the Lear’s high pressure, small diameter tires have trouble getting through six to 8 inches of thick, wet snow. We power way up just to keep the airplane rolling and with some difficulty reach the lineman who is energetically waving us forward.

Doug and I are working our way through the airplane’s 14-item shutdown checklist, when one of the passengers pokes his head in the cockpit and ask if he can open the door. With my headset still on, I nod “yes” and return to the checklist. Through the pilot’s window, however, I see that as the first man out the door reaches the ground, his feet slide forward and he loses his balance. He starts a slow-motion fall on what is a sheet of ice covered with snow.

As his right arm moves backward to break his fall, my pilot brain goes quiet and the doctor one kicks in with an unsolicited stream of diagnostic considerations. I first think, “He must be right handed.” I then see his right hand extend at the wrist, and I think, “Young guy and his protective reflexes are working pretty good.”

But I also think, “Hmm…right hand extended at the wrist, probable Colles fracture or a fractured scaphoid (a small bone in the wrist) coming up here…or both…and on the dominant side…this guy does construction work… not good. I hope his arm takes the damage, not his head. What would we do about a subarachnoid hemorrhage here in Ketchikan anyway. That would be bad, a subdural hematoma would be better, we would have him back in Seattle by the time that showed up.”

He catches the worst of the fall with his right arm, bends at the waist and as his gluteal muscles suffer a pretty good impact with the ground. I think, “I hope the snow gives enough cushion so his does not fracture his coccyx…those really hurt.”

Now in full ER doctor mode I am loosening my five-point pilot seat belt harness and heading for the airplane’s door. But before I can get there, he gets up, shakes his wrist a bit, rubs the snow off his pants and heads into the terminal.

Fifteen minutes later, I have my “pilot” hat back on and am getting some coffee in the pilot’s lounge. One of his buddies, having heard somehow that their jet pilot is also a doctor, asks if I wouldn’t mind looking at his arm. With seven guys looking on, I have him take off his shirt and conduct an exam specific to the arm. I see his distal circulation is good, the radius and ulnar are both anatomically aligned, there is no point tenderness over the anatomical snuff box or over the distal radius and ulna.

But I also remember that sometimes you can get an elbow injury or shoulder dislocation with that type of fall. So now in “full-on” doctor mode, I say, “Hmm,” nodding my head slightly, continue my exam proximally all the way to his chest wall. My seven-man audience is confused.

When finished, I nod a bit more and then say his exam appears normal. I recommend a follow-up X-ray because based upon exam alone, I cannot exclude a wrist fracture. Yes, corporate jet pilot or not, I am still indeed a doctor, and apparently acting just like they expect one to.

My passenger/patient says, “Thanks doc,” and the entourage file out of my “examining room/pilots lounge,” making respectful and grateful gestures.

Shortness of Breath Over the Atlantic

A couple of months go by and I am on another trip, this time over the Eastern Atlantic between Iceland and the Outer Hebrides at FL410. I am working as the co-pilot on a flight that started in Vancouver the day before and will end in London in the evening. The airplane is an almost-new CitationJet and we have an hour to go at 400 knots before reaching landfall. Fred, the pilot in the left seat, and I are making small talk between position reports to the Oceanic Controller, when one of the passengers comes forward and with slightly slurred speech says she is dizzy and doesn’t feel well.

Fred and I both check the cabin altitude meter just above my right knee on the instrument panel. It says 8,000 feet, which is normal when the airplane is this high, and well tolerated by most healthy passengers. We tell her the cabin altitude is just fine, and she should return to her seat. We both watch as she gets about halfway back into the cabin, then falls in the aisle and stops moving.

I retrieve the portable oxygen bottle and mask and head back. As I approach her on the floor with oxygen bottle in hand, the doctor part of my mind starts waking up, and I get another stream of diagnostic observations and thoughts. I see a normal height and weight female in her 40s. She has an anxious and frightened facial appearance, pink fingernails and lips, and a respiratory rate I estimate to be about 20. As my right hand shakes her shoulder and I ask, “Are you OK,” my left hand finds her wrist and a pulse of 90 or so.

She mumbles she cannot feel her fingers and her lips are tingling. I think, “Not hypoxia…more likely too much oxygen and not enough CO2, probably with some respiratory alkalosis thrown in…looks like hyperventilation syndrome to me.” I wish for a blood gas machine to confirm my working diagnosis.

While the other passengers look on with worried expressions, and with some difficulty in the narrow space available, I get my passenger, (now patient) in a recovery position, put aside the oxygen bottle and search through the CJ’s small galley looking for a paper bag. I find a small plastic one, return to my passenger (now patient) and in my best ER doctor’s voice say, “I want you to breath into the bag for five minutes, at which time I am confident you will much feel better.”

The time goes by, and then in a somewhat surprised voice she smiles a little and says her fingers and lips now feel OK. Ten minutes later I have her belted into her seat and between tears she starts telling me how stressful the previous several days had been, and how anxious she had been feeling. After ensuring she is comfortable, I then go back to being a pilot and return to the front of the airplane.

I am putting the pilot’s seat belt harness and headset back on just was we cross over the Hebrides and are cleared directly to Manchester, England by a radar controller with a distinct Scottish accent. A half-hour later we descend out of the clouds on an instrument approach into London’s Stansted Airport and see the green fields and stone fences of England beneath us.

For some reason, the tower controller has the runway lights turned up high, in spite of the fact it is still day time. We land without a problem and taxi to Harrods Aviation, the business aviation terminal. I head back to open the door, and our female passenger (patient) gives me an appreciative look and silently mouths, “Thank you, doc.”

In contrast to that greeting, as the door opens, Her Majesty’s customs agent is standing on the ramp. He sees my uniform shirt with four stripes and he says, “Welcome to England, captain.”

Fred (who is a fully qualified engineer) and I are finishing our post-flight pilot duties when he suddenly stops and says, “You know Kevin, I guess once you are a doctor, you’re always a doctor, aren’t you?”

I answer, “I guess so, but I also think that “once a pilot, always a pilot” is also true. Activities like engineering, medicine and flying take a lot of effort to learn well, and with time they just become who you are.

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