My brother and I decided to fly up to Laconia, New Hampshire, near the beautiful Lake Winnipesaukee to explore the area. We’re hoping to fly to Alton Bay, an ice runway that opens up every year once the ice is thick enough, as it’s only a 10 minute flight from Laconia. Prudent aeronautical decision making means that we wanted to go explore the area first so were familiar with it before attempting a much more challenging trip!
Author: Sahil Page 1 of 16
Part of a Series: Reflections from Medical School
The evening sun spilled through the leaves of the oak tree, illuminating the parking lot of the church with dancing shadows. The shade provided some refuge from the summer warmth. This exquisite lighting framed our arrival as if it were a movie. My brother and I walked past a lineup of cars, waiting to check in for their appointment at the free clinic. In front of us walked another volunteer who had arrived only a minute before us.
Amidst the line was a small, blue Mercedes SUV with the windows open. Probably a GLC 300. A family sat inside, waiting quietly for a clipboard-brandishing volunteer to help check them in. Instead, the volunteer walking in front of us, who had not even entered the clinic yet, literally stopped in her tracks, mouth agape. She waved her arm furiously, clear disappointment coursed through her voice. “A Mercedes at a free clinic!?”
As we entered the building, waiting for our temperature to be checked, she repeated the sentiment to me. Incredulous, I initially thought she was joking. I was shocked that a volunteer at a free clinic would so openly and vehemently say something like this. Quickly it became apparent that she genuinely thought that any person in a Mercedes shouldn’t be coming to a free clinic. I didn’t want to argue, but I did tell her that I strongly disagree with that. Perhaps the patient lost their job and no longer has health insurance (a common issue, unfortunately)? Perhaps they are bringing an elder who is visiting from a foreign country?
I thought back to an article in the Washington Post which was strikingly similar, describing the experience of getting food stamps in a Mercedes. Either way, however, it is completely inappropriate to say something like this at a free clinic, much less within earshot of the patient.
We bought a house. Then, just three weeks after we closed, the market crashed. The house we’d paid $240,000 for was suddenly worth $150,000. It was okay, though — we were still making enough money to cover the exorbitant mortgage payments. Then we weren’t.
Two weeks before my children were born, my future husband found himself staring at a pink slip. The days of unemployment turned into weeks, months, and, eventually, years.
Then my kids were born, six weeks early. They were just three pounds each at birth, barely the length of my shoe. We fed them through a little tube we attached to our pinky fingers because their mouths weren’t strong enough to suckle. We spent 10 days in the hospital waiting for them to increase in size. They never did. Try as I might, I couldn’t get my babies to put on weight. With their lives at risk, I switched from breast milk to formula, at about $15 a can. We went through dozens a week.
In just two months, we’d gone from making a combined $120,000 a year to making just $25,000 and leeching out funds to a mortgage we couldn’t afford. Our savings dwindled, then disappeared.Darlene Cunha
I was utterly shocked that someone could judge someone and have that much prejudice against a Mercedes when they’re volunteering in a free clinic.
“Sell the Mercedes,” a friend said to me. “He doesn’t get to keep his toys now.”
But it wasn’t a toy — it was paid off. My husband bought that car in full long before we met. Were we supposed to trade it in for a crappier car we’d have to make payments on? Only to have that less reliable car break down on us?
And even if we had wanted to do that, here’s what people don’t understand: The reality of poverty can spring quickly while the psychological effects take longer to surface. When you lose a job, your first thought isn’t, “Oh my God, I’m poor. I’d better sell all my nice stuff!” It’s “I need another job. Now.” When you’re scrambling, you hang on to the things that work, that bring you some comfort. That Mercedes was the one reliable, trustworthy thing in our lives.
That’s how I found myself, one dreary day when my Honda wouldn’t start, in my husband’s Mercedes at the WIC office. I parked gingerly over one of the many potholes, shut off the purring engine and locked it, then walked briskly to the door — head held high and not looking in either direction.
To this day, it is the single most embarrassing thing I’ve ever done.Darlene Cunha
It’s already difficult enough to bring yourself to come to a free clinic. Patient’s judge themselves harshly, thinking that this is not a resource that they should need. As a result, it’s critical that we make the environment a safe space for patients so that everyone can feel welcomed.
“This is what happened when I drove my Mercedes to pick up food stamps,” by Darlena Cunha, July 8, 2014. https://www.washingtonpost.com/posteverything/wp/2014/07/08/this-is-what-happened-when-i-drove-my-mercedes-to-pick-up-food-stamps/
There are so many interesting airports scattered throughout the state of Massachusetts. One that I’ve wanted to visit for a long time is Marshfield, just off of the coast and south of Boston. The fun part of this flight is flying from Fitchburg, and going underneath the busy airspace of Boston’s Class B airspace and through the Norwood Class D airspace. The views were stunning too!
Coming back from a flight, the last thing we do is land the plane! While it’s not all that complicated, it does take a lot of practice and skill to do land smoothly. Here, I go through what I think through as I land — all in real time. Keep in mind, I am not a flight instructor. This is based on my own personal experience as a pilot, so take it with a grain of salt!
Sharing my passion for aviation has always been important to me. I’m excited to launch a new YouTube channel all about aviation, called American Aviator! Check out the first video about flying at night where I talk about the requirements for staying proficient or current while flying at night and my thoughts and commentary during the flight itself.
Take a look and listen into the cockpit below:
A warning to those who may be squeamish, this is a discussion of an experience that includes the use of animals for laboratory animal surgery and surgical training. No images of surgery are included. However, at the end, I do include a video which you may choose to watch or not watch.
This was a particularly difficult article to write. We largely avoid talking about our embarrassing mistakes, regardless of how small they are. But I do think it’s important to reflect on and share the lessons we’ve learned. This is a story from my lab animal surgery course that illustrates an example in which my lab partner and I feel like we failed, even if it is purpose of the class — to provide an opportunity to make mistakes without any real consequences. It’s a chance to explore and learn. And I think this is worth sharing.
This was the first time where we were operating on living animals. We had several weeks of lectures before this, but now it was time to get some hands-on experience.
Before every surgery, we spent about half an hour just playing with the rats — holding them, petting them, comforting them. At first, they’re a little scared and hesitant, but they warm up to you really quickly. They really are just like dogs! Super curious and playful, often excited to see you, and comforted by your hands. If they had a more fluffy tail, people would probably want them as pets.
Not only is playing with them a nice and humane thing to do, but for the cynical minds, it can make or break a study of an implant design. A rat that is calm and at ease makes administering an anesthesia injection much easier and less fussy. Most importantly, surgical outcomes are far better and more consistent. If you’re life’s work depends on the success of a surgical device, it’s worth comforting the rats and playing with them before and after surgery. Each experience with a human should be a positive one.
When it came time to anesthetize them, I was surprised by how emotional it was. The anesthetic agent is delivered through an intraperitoneal injection into the lower left abdominal quadrant. The first time, it was the professor who did the injection, but later ones were done ourselves with the rat held safely in our hands.
The emotional part isn’t the actual injection. If done right, the rat feels a slight pinch, but generally doesn’t react all that much. After a minute or two of holding the rat, we put it back into the safety of its cage. They remain fairly active at first, but over the course of a few minutes become more woozy and disoriented. Eventually, they’re not able to remain coordinated and walk around. So they stumble a bit. They lie down and slowly become totally motionless.
Honestly, it is very hard to watch that. I felt an intense empathy for them and wondered what it was like from their perspective. I was on the verge of tearing up, thinking about that. I felt even more grateful afterwards, and incredibly appreciative for this opportunity to learn surgery from such an uncommon perspective. In this case, the rat will never wake up from anesthesia, so as to prevent any unnecessary pain or discomfort from our bumbling hands and surgical technique. The dose given is much higher than what would be given during major survival surgery, one in which an animal is expected to make a full recovery.
After preparing the rat by clipping the fur and setting up the surgical area, we began. An incision is made at the midline over the linea alba, a tough band of fibrous tissue. Gearing up for the final procedure, which is an ovarian hysterectomy, todays class was all about exploration. The professor had us explore the abdominal cavity to get a physical appreciation for the anatomy.
What a strange sensation to make a cut and see a slight trickle of blood come out from the skin. I had never done anything like this in the past. Of course, we had done dissections of various animals, but they were always dead and preserved. Here we were, cutting open an animal while it was still breathing right in front of us. The pressure required to actually cut through the tissue was quite a lot more than I expected. The skin, being incredibly thin and covering the soft abdominal organs, easily deflected into the abdomen, which made using a scalpel quite challenging. It seemed so incredibly easy when the professor did it!
My lab partner and I took turns to continue the incision. There are multiple layers that we have to go through. The thin skin on the top. Below it lies a thicker muscular layer. After making a relatively small incision with the scalpel, we switched over to using scissors. This allows us to protect the internal organs and not worry about stabbing through. Surgery is a very physical discipline after all! The scissors were a lot easier than the scalpel.
We extended the incision caudally without any issue. However, my lab partner met some serious resistance when extending the incision superiorly towards the head. After much struggling, we finally were able to look at what we did, only to be greeted by a bloody mess. We had breached the thoracic cavity. At first we had no idea what we were looking at. It was just all dark red. Only then did we realize what we had done. The lungs had collapsed due to the lack of pressure, essentially an induced pneumothorax.
We immediately called the professor over and explained what happened. He confirmed our suspicions. Importantly, he reassured us that this is what the class is all about. And today was only the first day.
He told us to hold the heart in our fingers and feel its beat. It is truly an emotional experience.
The professor came back and calmly explained the anatomy. The heart beat was becoming more labored. He injected the euthanizing agent directly into the heart, and we watched it slowly stop. Stillness. A moment of reflection.
To be honest, I was kind of shaken from that experience. But again the professor urged us to continue and learn. We continued the procedure, looking for the anatomy. We saw the two large kidneys, neatly tucked away behind the intestines. We gently pulled the intestines and ran them through our fingers, examining each fold. The uterus was way longer than I thought it would be! It makes sense, though, as rats carry litters rather than one baby at a time.
But it was truly an incredible learning experience. Just like in any endeavor, it’s worth sharing the lessons that we learned. This is certainly something I will remember for the rest of my life. The rest of the class was smooth sailing.
“Doctors make mistakes. Can we talk about that?” by Brian Goldman, November 2011. https://www.ted.com/talks/brian_goldman_doctors_make_mistakes_can_we_talk_about_that?language=en
Winter mornings in New England are not a fun time to walk a half mile without knowing exactly where the hangar is. Walking past the fuel pump and over the wind swept snow piles of the airport apron, we paid careful attention to the numbers on the hangar doors. The blistering cold wind swept through the gaps of our jackets, sapping away what heat we had in our ears and fingers. We breathed a sigh of relief once we got to the right row and quickly rushed in to get shelter from the wind. That walk was brutal.
Pushing the little door open, we were greeted by the sight of the plane resting cozily inside. A small blue blanket covered the engine to keep it extra toasty. (It just looked so cute, 🙂 and now I really wish I took a picture! [Update: I finally got around to taking a picture of it!) The best part of it? The whole hangar was heated too! What a luxury to have a heated hangar to do our preflight in! While checking the oil, I could feel the heat emanating from the engine block and the smell of hot oil filled the air.
After doing the preflight and passenger briefing, we got ready to tow the plane out of the hangar and into the cold air. It took a few minutes to get the block heater and battery tender unplugged, the main hangar door open, attach the tow bar, and push the plane out. Then we had to get the hangar door closed again and get ourselves seated inside. All in, it was probably around 10 minutes or so from the door first opening.
I say all of this because, when it was time to start the engine, it wouldn’t start. The engine cranked and the prop spun for a few seconds, but nothing. I waited and tried again. And again. And again. This time, I waited a good 30 seconds before trying to let the starter cool down. I fiddled with the mixture and primer. Honestly, I thought we might have to scrub the flight and walk back to the terminal in the cold again! I told my passengers that this might happen, but that we should try a few more times.
Finally, I primed it one more time and leaned the mixture. Turning the key once again, and after a second or two of cranking, the engine finally came to life. Relief flooded the cockpit, and especially myself. I thought back to the first time I flew in this particular plane and we had a similar issue. That time, it took us quite a few tries to get the engine started and it made me nervous. I can only imagine what was going through the minds of my passengers today.
In hindsight, I probably should have familiarized myself with cold start procedures before the flight. I really thought that it would be a breeze with the engine block heater, but no — cold starting really is an art form.
It was only a day after 6 inches of snow fell in central Massachusetts. The whole landscape was covered in a layer of fresh, pure white snow. The timeline here may be confusing, as I flew again later in the day. I will intersperse elements from both flights in the story. But we pick up here at the beginning of the next flight.
For the second flight of the day, we needed to fuel up. I’m used to taxiing up to the self serve fuel, but at this airport, the fuel is full service. We called up the FBO and requested fuel at the hangar. By the time they got there, we had towed the plane out — this time leaving the cute little blanket on the engine to keep it warm and toasty! (I smile every time I think about this. . . 🙂)
Quite a bit easier than having to top up the tanks ourselves! I didn’t think to discuss the leaded fuel with my passengers. After fueling and closing the hangar door, we all hopped on board and got ready to fly. I reviewed the preflight check and realized, whoops, I forgot to sump the fuel. After all the difficulty I had with starting the engine on the earlier flight and the brisk weather, I was seriously tempted to forgo sumping the tanks.
A few seconds later, I snapped out of it. I got out of the plane and checked the fuel tanks for water or other contaminants. It took less than a minute to do that. I scold myself now for even thinking about skipping the fuel check.
We eventually got the engine started. A bit quicker than the morning flight, I might add. Now feeling much more confident, it was easy going towards the city for some sight seeing. Worcester is a Class D airport, meaning that in order to enter, we need to establish two way radio communication. While we don’t need permission to do a city tour, per se, it is good to let the tower know what you’re planning to do. We radioed up Tower and let them know our intentions and were approved.
Overflying the city was beautiful, only intensified by the effusive sunset glow.
During the flight, I made sure to ask my passengers how they were doing several times throughout the flight. Key to this was asking them to rate their feeling on a scale of 1 to 10. This helps bring some objectivity into it. Many people, myself included, report that they’re doing fine even if they’re feeling slightly motion sick or tired. It’s not so bad that they feel the need to change the status from “okay.” As pilots, this is not a good situation. It means that passengers are not comfortable. This is a tip I learned from Flight Chops.
Funny story, I forgot to switch on the heat! I didn’t realize until half way when it got quite cold in the cockpit. At least we were all wearing jackets 😛
Flying at night is incredibly beautiful. To see the lights of the city off in the distance and the moonlight glinting off of the small lakes and ponds scattered throughout the eastern half of Massachusetts was an amazing opportunity. For practical reasons — night illusions, navigation, terrain avoidance — it’s a completely different ballgame than flying during the day.
I vividly remember looking out to my right over Boston. Flying further north, I saw the ocean beyond and the immense inky blackness that loomed over the right wing, occasionally interrupted by the glimmers of aircraft landing at Logan. From that first captivating night flight from Mansfield, MA to Portsmouth, NH and back, I’ve continued to look up at the night sky scanning for the red and green navigation lights, yearning to again experience the still night air and glimmering lights.
Because I haven’t flown at night since my training, I wanted to do a night currency flight. So I booked the plane on a Saturday evening and read up on night illusions. After reading about the “black hole,” and the ensuing spatial disorientation, that killed JFK Jr. off the coast of Martha’s Vineyard, it’s no wonder that night flying is a part of our training as pilots.
Later that week, I arrived at the airport. One of the instructors at the local flight school checked me in and kindly showed me how to operate the hangar lights and door. What a luxury to have a hangar to do the preflight in on a frigid December evening!
I unplugged the engine block heater and the battery tender. After putting my bag on the back seat, I pulled out my checklist. Running through the flow, I noticed that the position / navigation lights didn’t switch on, only the strobes.
FAR Part 91.205 defines the minimum required equipment to fly during the day and at night. There’s an acronym pilots use to to remember this: ATOMATOFLAMES, FLAPS. The first, ATOMATOFLAMES is the minimum required equipment for the day. In the night, we also add FLAPS, which stands for Fuses, Landing lights (if flying for hire), Anti-collision lights, Position lights, and Source of electricity (i.e. alternator/generator).
The position lights help other pilots determine which direction an aircraft is heading. For example, if only the green and white light are visible, we can deduce that the aircraft is traveling from left to right. If both are visible, the aircraft is heading towards us.
This particular aircraft is equipped with strobes. I held my hand in front of them so I could better see the bulbs of the adjacent position lights. Perhaps the filaments were broken, I thought to myself. I messed with the brightness wheel and tried a bunch of combinations of switches, but I couldn’t figure it out. Resorting to the only solution that I had, I called up the instructor I spoke to earlier. Luckily he had just gotten in his car and hadn’t left the airport premises yet.
He spent the next 25 minutes trouble shooting the issue. All to no avail. Neither of us could figure it out. He called up one of the other instructors with more knowledge, and on the phone I heard him saying, “I’ve got a pilot here who’s trying to do his night currency, but the nav light is inop.”
Wow! It was really strange to be called a pilot now rather than a student!
He suggested to start the engine and see if that solved the problem. Perhaps it was a power issue and the battery wasn’t able to supply enough current to get the incandescent bulbs going. As he was leaving, however, he tacitly explained that the strobe lights would quite easily make up for the inoperative position lights in terms of visibility to other aircraft.
While he’s not technically wrong, it’s certainly not something that I would be comfortable doing! I ended up canceling the flight and listed the issue as a squawk so it could hopefully get resolved by the mechanic in the near future.
I fly for fun, so there’s no point in even coming close to crossing that line. Once you cross it for something so trivial as this, the whole line becomes blurred. When it matters, it becomes easy to trot into dangerous territory. I’m only flying as a hobby, so there’s no reason to add any unnecessary risk, even for something as minor as this. As Steve from Flight Chops explains, a rule is meant to alleviate the burden of making difficult decisions. You make the decision in advance and stick to it.
Now, with the benefit of hindsight, it turns out that the position lights are wired to the avionics bus, which means that in order to get them to switch on, the avionics master switch must also be on. I found it kind of strange that the position lights are wired differently than the strobe lights, but it might have something to do with the ADSB-out beacon that needed to be retrofitted to meet the 2020 requirements.
Ultimately, it was a great learning experience.
“The Drama of Flight: One Radio Call at a Time,” by David Mamet, February 1, 2019. https://www.flyingmag.com/drama-flight-one-radio-call-at-time/
As an aside, let me know if you would be interested in more posts like this. If it provides a unique or valuable perspective, it would be fun to write more about each flight and the lessons contained within.
I want to avoid the “purple prose” of aviation writing, as David Mamet put it in Flying. To him — and I’m inclined to agree — “the drama of flight does not take place between the pilot and the environment, but between the airplane and the pilot, and between the pilot and himself.”
One interesting concept would be to create an online companion to the digital debriefs that I designed to distribute to my passengers after a flight. It could be akin to the idea of the expedition journal that I’m so enamored by. I’m inspired by the National Geographic Field Notes expedition blog and the Medical School 2020 book.
Edit: I later was able to night flying and have included the video here.
Almost everyone in tune with the general aviation scene has at least heard of Steve Thorne from the YouTube channel Flight Chops. In particular, he is well known for flying a variety of different airplanes as part of his videos and his involvement in the Canadian Historical Aircraft Association (now the Canadian Aviation Museum). Ranging from standard 172s to warbirds like the T6, to hand built experimental like his new RV-14, Steve has likely flown it — and made a video about it!
Suffice to say, he flies a lot of different planes and often finds himself navigating an unfamiliar cockpit. Listening to this seminar, I found myself comparing his experience to my own recent transition from a Hershey-bar Piper Cherokee 140 to a larger, taper-wing Piper Cherokee 151. While largely very similar, there are so many subtle differences in the flight characteristics, panel layout, and equipment, not to mention transitioning to an entirely different airport.
Steve explains that he uses ForeFlight as a “touchstone” of familiarity. No matter what cockpit he’s in or what plane he’s flying, he has an iPad running ForeFlight right in view. I certainly can relate to that, although for me, it was my checklists that served as the touchstone.
The ideas presented in this seminar were intriguing. And because it was right on the heels of performing our final ovarian hysterotomy as part of our lab animal surgery course, it got me to think about the parallels in aviation and surgery. Now, having experienced both fields first-hand, I see the value of the cross-disciplinary thinking that leads to innovation.
What I noticed was that there is so much shared innovation in aviation because of how standardized it is. There is an easy opportunity to continue to learn. It is easy to measure our improvement, even if it’s only a qualitative pat on the back for a good landing. Ultimately, many people seem to think that pilots do the same basic things again and again, day in and day out. In contrast, or so the argument goes, people say that medicine is not standardized. Each patient is unique; during each surgery, the surgeon must deal with the unique anatomy and circumstances of the patient.
But I think that this argument is flawed. Each flight is unique. Just like the anatomical differences in individuals, each flight is slightly different. It’s a different airport, it’s a different plane, a different time of day, different traffic volumes, among others. I could go on about each field ad nauseum. But, therein lies the key takeaway: using checklists and familiarity helps in both aviation and in surgery.
I’ve always said that the biggest part of innovation is cross-disciplinary work. Through that type of collaboration, you get a chance to look at a problem from a fresh perspective. That shift may hold the key to thinking outside of the box and coming up with a new solution without having to force-fit it within the confines of the aggregation of discourses or common knowledge in a field.
“Pilot in Command: The Power of Familiarity in Unfamiliar Cockpits,” by ForeFlight, December 14, 2021. https://www.youtube.com/watch?v=gRxgwwf7NV0
“Ovarian Hysterectomy | Lab Animal Surgery,” by Sahil Nawab, December 12, 2021. https://www.youtube.com/watch?v=5DTgylNFQf8
“Piper PA-28 Year Model Changes,” by Skywagon University, December 8, 2021. https://www.youtube.com/watch?v=-W-A4L4tE70
Most of my training was in a Piper Cherokee 140 with an upgraded 160 hp engine. I used to wonder when entering the designations in my logbook — PA 28 140? P28A 140? What do these numbers and letters even mean?