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.
“That guy can really land the airplane.”
The single engine turboprop aircraft accelerated under full power to traffic pattern altitude, whereupon I cranked it into a 45-degree angle of bank turn per the standard Navy racetrack landing pattern.
|Diagram from www.tpub.com|
To a man (and woman), Navy Flight Surgeon Class 92002 all yearned for one special day. It seemed to hover forever over the horizon as we marched (literally) through officer indoctrination. It appeared to recede into the clouds as we sat through tedious medical didactics on the physiology of flight and other dry topics. As Florida panhandle winter gave way to spring, we gazed out the windows of our stuffy NAS Pensacola classroom and indulged our fancies; not for graduation day, but for the day we would close the medical books and transition to nearby NAS Whiting Field for the final phase of flight surgeon education — flight training.
Where do we get such men? They leave this ship and they do their job. Then they must find this speck lost somewhere on the sea. When they find it they have to land on it’s pitching deck. Where do we get such men?
Thus ended the 1954 film, “The Bridges at Toko-Ri,” starring William Holden as a reserve Naval aviator recalled from his law practice for the Korean War; Grace Kelly as his not-so typical Navy wife (She broke the rules to join him in Yokosuka, Japan.); Mickey Rooney as Chief Mike Forney, a Navy enlisted helicopter pilot; and Frederic March as RADM Tarrant. The movie is based on James Michener’s novel of the same title, written well before women broke into tactical naval aviation.
As a Navy flight surgeon, I’ve known many naval aviators over the last two decades. I’ve shared their wardrooms, their ready rooms, their squadron spaces, and their aircraft. I’ve been through their survival training, initial flight training, recurrent training, and NATOPS quals. (I once earned a bona-fide F-14 NATOPS qual.) I’ve sat with them on Human Factors Boards, FNAEBS, and Mishap Investigation Boards. I’ve signed their annual exams, cared for their physical and mental well-being, and that of their families, given them down chits and up chits, and processed a variety of waivers.
And, I’ve flown with them in just about every platform they operate (P-3 and F/A-18 being notable exceptions).
I’ve enjoyed stick time in dual-controlled naval aircraft, including the Blue Angels’ famous “Fat Albert.” I’ve set up bombing runs in the venerable A-6 Intruder, searched for bogies in the back of an E-2 Hawkeye, done high pops in the S-3 Viking, and performed airborne intercepts in the F-14 Tomcat. I’ve flown close to the ground in the dark wearing night vision goggles in the H-60 Seahawk. I’ve soloed in the T-34B Mentor.
Thirty times I’ve been with them as they landed those planes on that pitching aircraft carrier deck. That includes one dark, cloudy Adriatic night in the back seat of a Tomcat that boltered several times before safely trapping aboard. (CAG had some choice words for me after that flight.)
As I enter the twilight of my Navy Medicine career, its single most satisfying experience is my association with Naval Air. That was why I made the leap from civilian practice, and I’ve never been disappointed. (Except for not getting enough flight time, of course.) I love aviation and I relish flying. So no surprise that I’m thrilled to be part of this elite community, to have felt the head rush of transition from single engine Cessnas to tactical jets!
But it’s not all about the flying. It is very much more about the people. Indeed, where do we get such men? And such women?
Some of the finest men and women I’ve ever known wear those U.S. Navy wings of gold. Their indomitable spirit would infect even the most cynical of hearts. Their commitment, focus, and dedication to mission would surpass many a driven businessman. Their love for life and for fellow man would overshadow even a wide-eyed optimist.
“I could die tomorrow.” I’ve heard Naval Aviators accused of using that phrase for wanton self-aggrandizement. The community is not perfect, nor do I mean to blindly glorify its members. But to this observer that phrase actually reflects an essential aspect of the aviator spirit. Certainly life should be cautiously managed, to include careful planning and deliberate risk mitigation. But we cannot reduce risk to zero, and we cannot outsmart life. Ultimately we must live and enjoy life as if we were to die tomorrow. We strive to achieve what Maslow called “self-actualization.” I know few other communities that capture that self-actualization any better than my friends and colleagues in Naval Aviation.
I’m proud to be a part of the Naval Air community. That’s why I love to don my flight suit, why I will always sport brown shoes with my khakis, and why I proudly pin my own wings of gold above the ribbons and that other warfare device on my left uniform chest. For me, those wings represent peak experiences, not only of slipping the surly bonds of earth and touching the face of God, but also of being a better man for knowing those who do it as a vocation.