Thursday, July 24, 2008

To soar, or simply to survive

This weekend, after 6 years in Yellowknife, I finally joined local aviation enthusiasts for the city’s annual air show.

I went for my son’s benefit, but I will never miss the show again. My 2-year-old ran wildly in circles among the planes near the hangar, trying out one cockpit after another and gleefully crowing to me from the windows: “Mummy! I’m in the plane! I’m in the plane!”

Since my husband has more energy than I do these days, he did most of the chasing while I watched the aerial performances — mesmerized by the beauty of a single plane in its huge playground of sky, rolling and twisting its way through figure-eights simply for the joy of flying.

The north has a love affair with flying, and with the pilots that opened this land to development and discovery over the last century. The local heroes (except for prospectors, hunters, and community nurses) are often the pilots who could fly in the most desperate of circumstances, fix their own planes if needed, and wisely recognize their own limitations in extreme weather conditions.

Preparedness is essential, and even a business traveler on Air Tindi will be refused boarding in February if the flight crew don’t think his parka is adequate. Some flights to my travel clinics have only a pilot and co-pilot, who calmly explains where to find the emergency transmitter and survival gear in the event of an unforeseen landing. When a flight attendant is present, passengers are treated like royalty; no first class is necessary, since everyone is fed and generally spoiled on even a 45-minute, mid-morning flight.

Northern pilots and medical staff are inextricably linked, since we frequently collaborate to bring patients from far-flung communities and camps to a point of medical care.

More difficult, though, is the relation of a physician to a pilot as a patient. How can I hope to obtain an accurate blood pressure in clinic, when the pilot knows he will be grounded until I certify him as healthy and ready to fly?

A young man who spent his entire life longing to fly, and training as a commercial pilot, was recently diagnosed with diabetes. My role, at his second clinic visit, was to confirm his worst fears — he would need insulin to control his blood glucose, and would never fly again.

Another pilot, who lives with his wife and children on a remote homestead surrounded by wilderness, was grounded when an ECG showed inferior Q waves. Although he was only grounded for a week (until I repeated the ECG with more careful lead placement and performed a stress test), he faced the possibility of giving up his home, his lifestyle and his profession since even a trip to town for groceries depended on his pilot license.

My greatest fear for a pilot is that he or she will not seek medical help in a timely manner, due to fear of being grounded.

When I was still quite new to Yellowknife, I was called to a code in the emergency room for the husband of our finest critical care nurse. He had been mentioning some arm pain for a week, but wouldn’t seek medical attention. He shoveled the driveway one morning, drove to the airport, and was stopped for driving erratically — fortunately before he strapped on his pilot gear and put other lives in danger.

By the time he arrived in Emergency, the pilot was asystolic and could not be resuscitated.

My colleague was now a young widow with children, all because of a pilot’s fear of losing his license.

His career had included flights to Antarctica and he was head pilot for the toughest employer in the north. His employer’s father, 82-years-old, was recovering in hospital from an uncomplicated myocardial infarction on the day that pilot was brought in. During rounds, I spoke with the weathered airline boss – he flies DC-3’s and looks as tough and indestructible as those planes.

“Yeah, they brought in my head pilot today,” he commented, looking past his elderly father. “Forty-three years old. Makes you wonder.”

The memorial service was held in the huge hangar at the airport, and the deceased pilot was honoured with a fly-by of his own plane.

I was still new to the aviation culture, and much of what was said in the service was beyond my comprehension.

But I realized that aviation seems to mirror the landscape of the north in many ways — with its power and fragility, its complexity and grace, its very human desire to soar — or simply to survive.

And perhaps, to that extent, it’s a lot like medicine too.

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