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Being human Reflections on Life, Being Human, and Medicine Reflections on the Christian Life Updates on my health

Crash Survival Training and How to Navigate Challenges in Life

Have you ever watched the movie, “An Officer and a Gentleman?” If you have, you might remember the jet crash survival simulator. While in the cockpit simulator, the officer candidates are sent down a rail at high speed into water and then flipped upside down. They have to get free of the “cockpit” and swim back to the surface.  In a dramatic scene, one of the officer candidates has a problem and nearly drowns in the trainer. He later DORs (disenrolls on request) because of that trauma.

I had to go through that training when I was in the Navy. I was in training to be a flight surgeon. This included aviation survival training.

I worried about what the jet crash survival simulator would be like. How would I do? Would I too end up having to “DOR.” It turns out the jet crash simulator was nothing compared to the challenge of the 9D5A. The 9D5A is otherwise known as the “helo dunker”.  Both simulators were required. The 9D5A was designed to simulate the crash of a helicopter into water. The jet crash simulator was mostly just something to be endured. The 9D5A however was a real challenge. 

The Training:

There are several key things to survive a crash. 

  • Believe you can survive:  The most important thing is to remain calm (not panic). This is probably the most important part of the training. The goal was to give us the confidence to not give up.  Whether you survive or fail in any situation may just depend on whether you believe you will survive or not.
  • Develop a plan: You must establish a plan in advance before everything gets confusing and stressful.  We were trained to think about reference points (landmarks in the cockpit around us) and what would be our plan to get free of the helicopter (simulator).  
  • Wait for all motion to stop: You must wait for the rolling and pitching of the trainer to stop. If the instructors saw us release and try to exit too early, it would be counted a “fail.” We would have to go through it again. In the real-life scenario, the idea was to have optimal timing for action. You don’t want to release early and be injured by the tumbling aircraft.
  • Use your reference points: Your first step was to grab a reference point (such as a window beam or brace). We needed to plan to move from one reference point to the next. This is the key to counter the confusion and disorientation of the moment. We were to never ever be without one hand on a reference point. Losing your reference point is a sure way to get hopelessly disoriented and not survive. Before we could release our safety harness (seat belts) we had to have one hand on a reference point. We would then release and move one hand to the next as we executed our plan of escape.
  • Ignore the discomfort: We needed to ignore the water going up our nose and sinuses as we were suspended from our safety harness under water. We needed to ignore the strong desire to breathe. We needed to be calm. We had plenty of air to get free in a controlled manner and swim to the surface. We had plenty of time as long as we believed that we did.
  • Swim to the surface: This was the easy part. Swim up to the surface. Know that our bodies want to float, and they would naturally pull us upward. Know that victory was coming. We should not worry or despair as we ascended.

What it was really like:

We climbed up steps to a platform to enter the 9D5A (“ helo dunker”). It was suspended 15 feet above the surface of the swimming pool. We were in full flight gear. We strapped into our seats in the trainer and then we waited. I looked at the window and the window frames and planned where my hands would go – one hand after the next – to guide me out of my seat – through the cockpit and out the window.  I waited like I was on a carnival ride for the crash. My heart pounded. The suspense was enormous. 

Suddenly the trainer dropped through the air and then hit the water. As it hit the water it rolled upside down. Down we went – until we were 15 feet underwater and hanging in our seats upside down.  As soon as we hit the water I started counting. That helped to reduce the urge to release from the trainer too soon. Once we hit the count of 10, we could be fairly certain that motion had stopped. Water rushed up my nose from being suspended upside down. My nose burned from the chlorine. I ignored it. I grabbed my reference point and then with my other hand I released the safety harness. I had to shake the shoulder straps to be free of them. There was a brief moment of panic as I worried that the harness was stuck. I then moved my hand to the next reference point. I moved hand over hand as I pulled myself out of the cockpit window. 

Once free it was disorienting to know which way was up. The feeling of panic was rising inside me. I was feeling short of breath. I HAD to get a breath soon. Was I going to drown? How could I find out which way to get to the surface? I HAD to get there soon. I could feel the pull of my body which did indeed want to float to the surface. I could see the light now above me and I swam to the surface. My lungs burned for air at the surface. It felt so good to fill my lungs and breathe deeply as I treaded water in the pool. 

Victory! I did it! 

Round Two:

We all swam to the edge of the pool.  They told us it was time to climb the platform and do it again.  Really?  Really?

This time they handed us speedo goggles that had been spray painted with black paint. We were to do the trainer again but this time we had to do it without being able to see.  We climbed into the trainer (which had been pulled back up out of the water and suspended back in position). Once again we took our positions and off we went.

This time it was easier. In spite of the blacked-out goggles, I knew that I could do this. I knew exactly what to do. But even more I knew that I was able to do it. There was no panic this time. I was building confidence.

Victory (as I broke through the surface of the water)! Again.

Back up the steps again. The third time we were to do it without the speedo goggles, but we all had to exit out the main door in the back of the helicopter.  That time there was some chaos as we had multiple men kicking and squirming to get free and all get through the same exit. By now, however, I had confidence. I knew that I had time to wait patiently for all of us to file out the door. I could hold my breath. I could just deal with the burning chlorine in my nose and sinuses. I calmly pulled from one reference point to the next to the next – pausing in some places for others to pull past me – and then eventually I was free.

The fourth time was not a surprise. We once again had the blacked-out goggles and were all going out the main exit. I remember some legs kicking into me in the darkness but all in all we were fine.

We got out of the pool as victors. We felt like we could survive anything. Later that day we were in class together. All of us were sniffing and snorting from the chlorine water that had rinsed through our nose and sinuses. But we were sitting in class as victors. We had overcome the trainer and knew that if we ended up in a crisis situation, we could survive.

The Lessons:

To this day I can remember the training but more than that I can remember the confidence it gave me. It showed me that I was capable of remaining calm, developing a plan and executing the plan. I could be a survivor.

I was impressed with the way they set up the training.  They did a great job. I looked online and it looks like they may have refined the trainer some since my day. The general principles look the same, however.

What are the biggest lessons?  They are listed above in case you didn’t catch them.

The most important one is that you are capable of a lot more than you think. You can survive if you think you can survive. You can do things as long as you remain calm and convinced that you can do them. This is not absolute of course. I cannot jump out of an airplane and fly like a bird. But when faced with a challenging but achievable task, I can push through and achieve some things that might be hard for me.  When I am called on to do something hard, I take a deep breath and walk into it and just do it.  

One of our transplant directors used to have a “Wonder Woman” poster on the back of her office door. When hard things came up, she used to say that we needed to take the “Wonder Woman” pose. Before an especially challenging meeting, we went into her office and stood with our hands on our hips like Wonder Woman. We took a deep breath. I was humble enough (and thought it was funny enough) that I too participated in the Wonder Woman pose with her. As ridiculous as it sounds, it really worked. Doing that, I felt stronger. I was ready to walk into the meeting even though it was not going to be fun. One day I had a difficult patient to see. I had to tell her things that she didn’t want to hear. We had security guards in the clinic in case she became violent. The Wonder Woman pose helped a lot. I could handle this. I was strong enough. I was capable. Now just do it.

Wait for all motion to stop. Sometimes the most important thing to do is to sit and wait. This can be very hard especially when you feel yourself hanging upside down, under water, with water going up your nose. But clearly there are times when action can do more harm than good. You have time. You are not going to drown. You just have to figure out how to keep yourself calm and not act. Know that it is temporary.   

Keep your frame of reference. Do not get disoriented or lost. There are times in life when you know clearly where you are, what is important and what principles exist to guide you. Other times life will do everything it can to disorient and confuse you. As you go into the chaos, look at those reference points. Do not let go of them. Once the motion stops grab onto one and then the next and then next. Do not let go lest you become disoriented and unable to navigate your way through the crisis.

Some days I have meetings that become chaos. Things are going in so many directions that I barely feel competent to do my job. In those moments I want to run away and hide.  But sometimes I just have to sit back in my chair and wait for the motion to calm down. I look for my reference points. What are we trying to achieve? Can we remember the key principles? Once the chaos starts to quiet, I grab one reference point and then the next. With this then I can start to navigate through to what the meeting ought to achieve. It may not be all the crazy directions that were going on in the meeting. But it could be one clear direction that leads us to the exit where we are all well and good.

Of course, my reference points in life are crucial for me. In the midst of the uncertainty of a cancer diagnosis this became more important than ever. I know who I am before my Lord and Savior. I know that regardless of whatever happens, I am His. I know that He is in control and His purposes will eventually be worked out. I know that not everything in this world goes well. But my reference points are that on a much longer and broader scale things will work out. I had to grab onto one reference point and then the next. It gave me amazing strength to go forward and not panic.

Radiation Therapy

Last year I had to have radiation therapy. To properly target the radiation, I had to do a fairly sophisticated breath hold. This involved blowing out all of my breath, then taking a partial breath and holding it while they delivered the radiation. To be very precise they use a device that measures your breathing. Getting set up they brought me into the radiation therapy room to practice. First they positioned me and marked my skin. Then they put tiny tattoos on my skin as a permanent alignment mark. I asked if they could make them an anchor or a sailboat. They laughed (Yeah, and I am sure they have never heard those jokes before!) Next was the training on the breath hold machine. They put a mouthpiece (like a scuba mouthpiece) in my mouth. They put a tight clip on my nose. They put glasses (like virtual reality glasses) on me. In those glasses I could see my breathing on a graph. Up and down and up and down the line went as I breathed. Then they would activate the device and on that breath cycle I had to lock my breathing in a narrow band. 

I tried. I failed. When I failed a loud alarm would sound. HONK. I tried again. I failed. HONK. And again. HONK.

I could feel the feelings of panic rising up inside of me. My mind started going wild. I was going to be the person who failed at radiation. I was not going to be able to get this treatment. My cancer was going to recur, and I was going to die. I was going to leave my family without a husband and a father. And it was all going to be my fault because I failed! 

It felt like I had just entered into a deadly final exam. Can you pass the test? If you don’t, then you die! Or some morbid video game. You have to guide your character through a maze. If you do it successfully you get to live. If you fail, then you die (not just in the game but in reality.)

I recognized the panicky feeling. It was one that I had felt many years before in the 9D5A. It was the feeling when the shoulder straps hung up a little bit. It was the feeling when I wasn’t sure which way was up. It was the feeling that I didn’t have enough breath left to survive.

I remembered. I remembered the feeling of victory as I got the surface and swam to the edge of the pool. I remembered sitting in the classroom and the smell of chlorine in my sinuses and feeling like we were all some of the greatest persons who had ever lived. 

I could do it. I just needed to believe that I could.

We tried again. It took several tries and then I learned the technique. For the next 5 weeks I did it over and over again and became quite expert at it. I never liked it. But I could do it. I could endure.

Now

I will confess that there have been times lately when I have felt the panicky feeling inside. It is such an odd time to be locked away from people facing an uncertain threat. I am generally very calm but there are times when I wonder if I am able to cope with everything. 

The panicky feeling is a trigger however to remember the lessons from the 9D5A.  At the moment it feels like we are strapped in and waiting for the 9D5A to drop to the water. You have been given your training. Of course, you might be nervous. You might even feel a little bit panicky. That is natural. You are going to do fine. 

Someday we will be sitting together in class with chlorine dripping out of our noses knowing that we made it through this. 

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Reflections on Life, Being Human, and Medicine Updates on my health

One Year Scan Is Negative and “Good Morning Right Adrenal Gland!”

The short story: I had my one-year CT scans. No evident disease. Also, I have successfully been able to wean my steroid doses down. All is good!

The longer story:

I am on a schedule of CT scans of my chest, abdomen and pelvis every 3 months. We are watching to make sure I don’t have a recurrence (or perhaps better described as any remaining cancer cells growing enough so that they are able to be visible.)  The strategy is to identify any residual cancer early enough so that it could be effectively treated. With each scan we gain more confidence that the cancer truly is gone. Maybe these scans are all just for naught. Maybe the surgery removed everything. But in the chance that it didn’t we continue with the scans. Now 1 year later they still don’t see any cancer.

In prior blogs I have mentioned what others have called, “scanxiety.” This is the normal anxiety that comes before each scan. 

It never occurred to me before how in medicine we have these odd “all or none” scenarios.  

For those of you that know the game “Monopoly”: 

  • I am sitting on the “Waterworks” space. 
  • It is my turn to roll. 
  • The other players have houses and even hotels on all the green spaces plus Boardwalk and Park Place. 
  • The result could be absolute catastrophe. Or I could be ok. 
  • Here we go…

The result came via MyHealth. First came an alert that there was a message. My heart pounded as I opened the app. Nope. It was just a post-visit survey. I waited another 2 days then came the alert again. Another deep breath and then there it was: Normal

I had gotten a favorable roll. I skipped over all the hotels. I made it past “Short Line.” I missed “Luxury Tax.” I landed on “Go!”  

Normal.  Then I laugh. Really – I expected it to be normal but just having the scan raises all sorts of thoughts.

I now realize how I have done this with my patients. It could be a stress test or echo or heart cath that does it. They walk in with a nervous laugh and then they wait. I walk into the exam room with their results. We have two options: (a) You are doing fine, and we can just have you take a few pills, or (b) You are in real trouble, might die, or maybe we need to do a heart transplant. 

Crazy. 

This life is a wild ride.

Back to the recent scan and what it means.  Before the scan all sorts of thoughts start to run in the background. Do I pay for the insurance for the airline tickets for the upcoming trip? Should I even book a trip in the next few months? What about work? Should I keep pushing for change or things that are important? What if the answer is that I have to go back on mitotane? This medicine really hurt me before. I still struggle to remember names from the neurotoxicity. The dizziness hits when I am tired. Most of the time it is all gone now. But what if the scan was bad? Is that what my future was going to be?

Normal.

The racing thoughts in the back of my mind were all for naught. And now it is time to move on. 

That too is confusing and takes a little bit of time to process. It is making more sense now.  It means that I am going to get the chance to recover. The residual fatigue, brain fog, and neurotoxic effects will wear off. It means that I could be normal again. It is just going to take a little more time. And it is time for me to shift my thinking (again). It is time to think of goals – personal and professional. It is time to work – invest in what is important. It is time to not be anxious. My body can recover. It is worth pushing to get it to that point.

Lest you think I have not been enjoying life, the scan did show one more thing. It showed “old incompletely healed rib fractures.” Did I mention that I fell off of my bike this summer on vacation? And yes – my left chest did really hurt. I still played golf the next day. I wondered about whether I might have broken something but hoped that I had just bruised myself. Besides – we never do anything about rib fractures anyway… 

So that is life for now. 

  • No evident disease
  • Slowly weaning my hydrocortisone doses down and having success. I used to be on 20 mg morning and 10 mg afternoon. I am now down to 10 mg morning and 5 mg afternoon. I can see being off of the hydrocortisone in the next couple of months. My right adrenal gland must be waking up. “Good morning! I have missed you. Happy to have you back in the game!” 
  • My energy is better. I still get tired but not as extreme as before. Now I just need to be patient and work to regain stamina. Looks like it will come. I won’t have to (at least for now) suffer more insults to my body that will push me backwards.

To finish I will tell two more stories from this past week.

I worked a patient in. He is struggling with energy and post-work fatigue. He is highly motivated to work but works in a job where they are unwilling to make accommodations for him.  As we sat in the exam room and I spoke with him, I deeply felt what he was talking about. He would work through his day and then come home with nothing left. I could see on the face of his wife what I have seen so many times in the past with Sarah. With me, Sarah could see it even more clearly than I did. In this situation his wife also had much more insight than my patient. She had watched his decline. She talked about how he was a different man than a year ago. He is trying to get by. She knew he wasn’t. It was time for him to move to a disabled status. 

I have improved. I am better than that now. But it amazed me how strongly I could understand what was going on in this man’s life. I could ask more probing questions from deep down inside me. With each question I could see them soften and relax and nod. They felt like someone was really hearing them.

The next patient made me laugh at how much I could identify. She is struggling with fatigue perhaps as a result of some of the medications. It really frustrated her when she had an episode of “rebound fatigue.” 

Rebound fatigue is a well-recognized phenomenon. There are times when you can feel good, or you feel the need to push to get something done. Your body handles the demand in the moment but then you pay for it later. In her case she went shopping with her family. That was more stress than she could handle. She spent the next two days exhausted recovering from the one outing. 

I laughed to myself because two days before I had a really good day where I put out a lot of energy. I was nervous about it. I got a lot done but as expected the next day I hit a wall. I came home after work and all I wanted to do was sleep. I had spent the night working to recover. Rebound fatigue is real. It is less intense and less frequent for me than it used to be. But the night before seeing her I lived it. This time I went ahead and told my patient of my experience. Once again, I saw her soften. We were still talking as doctor and patient, but we were also talking as friends on a shared journey in life.

Then she stopped me in my tracks. She said that she would rather have a few years of living and feeling good and being able to live her life even if it meant a risk that she might not live as long. That was the discussion that Sarah and I had in February when I was taking mitotane. Was it worth it just for the unproven idea that it might reduce the chance of a recurrence? It was destroying my life. At that time, I worried that I was heading for full disability. How would I feel if the cancer recurred anyhow? Frankly, I knew I would be angry at having given up so much for an unknown magnitude of reduced risk. When we spoke with Dr. Hammer (the adrenal cancer expert), he was on the same page. We talked about risk and benefit. We agreed that I could stop the mitotane. 

Now the shoe was on the other foot. We talked together. We worked on a plan to try to help her. I hope that I can help her start to get her life back.

But back to me: So how am I doing?

  • Scan was negative. (I rolled a favorable roll in my monopoly game!)
  • Hydrocortisone is being successfully weaned.
  • I think my remaining right adrenal gland is waking up.
  • My energy and stamina are improving. I have a lot of good days now.
  • I continue to learn.
  • I am so thankful for the support and the patience of my family, coworkers and friends.
  • I think it is time for me to start thinking of the future. I may even get back to “normal” soon!