Panic With A Twist

The 28-year-old naval aviator Tomcat pilot appeared chagrined as he entered my flight surgeon office on the aircraft carrier. His demeanor lacked the typical elan of a tactical jet pilot; the love of flying that we see in the attached video was absent from his eyes and voice.

“Doc,” he said, “I think I’m afraid to fly.”

“How does a trained naval aviator with over 600 hours total flight time, 300 in the Tomcat, suddenly become afraid to fly?” I wondered, especially one with an above-average flight performance record.

He described a pattern of anxiety dating back 18 months to an episode while flying level at 16,000 feet. He had suddenly felt hot, flushed, and nauseated; but the symptoms abated when he removed his oxygen mask and decreased the cockpit air temperature. (The fact that he waited for 18 months and several more episodes before reporting to the flight surgeon says something about the inherent fear that most aviators harbor about flight surgeons. A stroke of the doctor’s pen can end a flying career.)

Six months later while flying over water he experienced another attack. Again he felt hot and flushed, and severely apprehensive over his ability to control the airplane. He became intensely anxious over the welfare of the radar intercept officer in the back seat, whose life depended on the pilot’s ability to fly the jet. Our pilot remained anxious until landing was assured, and then the symptoms went away.

Two more episodes occurred in the subsequent year, each time on a long cross-country flight at altitude in bad weather. Each time, he became hot and flushed, and felt a powerful desire to divert and land the airplane. He completed the missions only by intense concentration on the flying tasks. But as soon as landing was certain, his symptoms disappeared.

I asked him the usual questions. No, he did not have any serious life stressors. His five-year marriage had gone through a tough period — including a two-month separation — but had weathered the storm through counseling. He was able to compartmentalize, a vital trait for aviators wherein they concentrate only on flying without intrusion by thoughts of other aspects of their lives. He denied nocturnal panic attacks, and stated that aside from recent pre-flight anxiety he only experienced the symptoms while flying at a distance from a landing site.

Then he mentioned some other symptoms, visual and physical disturbances while flying. He would see “shooting stars” in the periphery of his vision, and feel dizzy and disoriented. Those symptoms would occur only when he rotated his head while pulling positive Gs in a high performance maneuver. (The video sequences between 1:16 and 2:05 show that environment from inside the cockpit.) The symptoms would abate when he straightened his head. He said that those symptoms, like the anxiety, had gotten worse over time.

I figured this aviator had a limited symptom panic disorder, but I could not reconcile that diagnosis with the visual and physical symptoms. I referred him to an aviation neurologist for further evaluation. After a series of tests, the neurologist discovered that the aviator had congenital narrowing of his left vertebral artery. (Most people have two normal-sized vertebral arteries that join to form the basilar artery that brings blood to the brain stem, which controls vital life functions.) This aviator’s physical symptoms were caused by occlusion of his one good vertebral artery with head turning in a high-G flight profile, interrupting blood flow to his basilar artery. His anxiety symptoms were secondary to his physical anomaly, because he recognized but did not understand the threat to his ability to control the aircraft.

We managed to salvage this pilot’s career by getting him reassigned to non-tactical naval aircraft, where he would not be subjected to high-G flight maneuvers. Relieved of his anxiety-producing symptoms, he once again was free to relish the beauty of flight.

My Flight of the Intruder

   An Attack squadron 36 (VA-36) A-6E Intruder aircraft lands on the nuclear-powered aircraft carrier USS Theodore Roosevelt (CVN-71) during Operation Deny Flight .

“Hey, Doc. Let’s you and me take an A-6 and fly over Bosnia tomorrow.”

I nearly choked on my slider (Navy cheeseburger). Had the CAG (Air Wing Commander) just invited me to fly with him over hostile territory? On a real mission? We were in USS THEODORE ROOSEVELT’s “dirty shirt” wardroom, where aviators dined without changing out of flight suits into the more formal wash khaki attire required in the main wardroom. I took my time finishing the burger morsel, trying to ascertain whether my boss had just made me the butt of one of his infamous pranks. (Aviators take extra pleasure in gigging the doc.) The dead serious look on his face, with just a hint of a smile on the corner of his mouth, told me he meant what he said.

The boyish thrill in my voice betrayed my effort to appear nonchalant. “Sure, CAG, I’ll fly with you.”

The year was 1993, and the mission was “Operation Deny Flight.” Our carrier air wing played a key role in enforcing the UN prohibition on flights over Bosnia and Herzegovina, where civil war raged among various ethnic groups. CAG had just invited me to be his BN (bombardier/navigator) for one of those enforcement missions. A seasoned naval aviator who had flown attacks over Vietnam, he knew that he could fly this recon mission with only a sack of potatoes in the right seat. With me on board, he would at least get another set of eyes and someone who could push a button or two when directed.

Prior to that day in the Adriatic Sea, I had logged some A-6 right seat time, mostly training flights at NAS Oceana, or tanker flights circling over the carrier as the airborne “Texaco” giving fuel to Hornets and Tomcats. So I tried to maintain a casual air the next morning when we manned up for the flight. I strapped on the offered 9mm pistol, just in case we went down and had to defend ourselves. (That happened to Air Force aviator several years later.) But I kept the pistol unloaded, stuffing the ammunition into a pocket on my flight suit. A flight surgeon accidentally discharging a pistol in the cockpit of an aircraft in flight over Bosnia would make the cover of NAVY TIMES in a way my family would not relish.

I lost all semblance of aviator swagger when I struggled on the ascent to my seat on the right side of the airplane. Because the fuselage curved outward, one had to be more nimble than a short stocky flight surgeon climbing up the side railing and stepping into the cockpit. A push in the rear from one of the enlisted plane captains finally got me over the top. CAG was already strapped into his seat, chuckling as I huffed and puffed into mine.

I handled the radio calls for the preflight, launch, and approach to our destination. When we went “feet dry” over Bosnia, we switched to our FAC, forward air controller, who was positioned somewhere in the former Olympic complex in Sarajevo. Flying low over the site of the 1984 winter games, I was aghast at the devastation that civil war had wrought on a place where the world’s finest athletes had once celebrated international fellowship and camaraderie. But the most sad-making sight came when we flew over villages and towns. Intact homes stood next to the wreckage of those destroyed by ethnic cleansing, as if some cruel fist had randomly squashed the lives of certain families, and preserved those of others.

Beyond that chilling site, the mission was uneventful. I never had to load my pistol — an altogether good thing. With the help of our FAC, we spotted a few hidden airplanes on the ground, but no signs that anyone intended to fly them. Two hours after we launched, we trapped back on board the TR. My one and only “green ink” flight was over — too soon. (Aviators record actual “combat” flights in green ink in their log books.)

A year later, I would have the honor of flying the right seat of the last A-6 from my air wing as it was delivered to NAS Norfolk for decomissioning. The Intruder was a fabulous airframe that played a stellar role in the grand history of naval aviation. It was also a great platform for a flight surgeon aviator wannabe to bag exciting flight time.
I close with a video that honors this venerable bird: