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Chapter Six recounts a long mission in the Leatjet to return a patient who had deteriorated into a vegetative state and needed to be returned to his family in Montevideo, Uruguay. We were called on the fly him, even though the 5,500 mile trip was well beyond the Learjet’s capabilities.
CHAPTER SIX – THE LONGEST FLIGHT
One prominent management guru was heard to say that a teaching hospital is a political quagmire like no other organization. The academic staff are the best and the brightest medical minds, intent on passing along their wisdom to their students. My transplant doc buddy was one of them.
Hospital management, on the other hand, has to generate revenue to pay the bills. The two factions are by nature, set against each other – great minds teaching medical wisdom while they ignore the realities of keeping the lights on, and the management staff constantly struggling to balance the budget and fund the academics’ lofty goals.
We were caught square in the middle, the academics pushing us to bring them patients with high-order maladies for them to show their students. But those patients were too often non-payers, no insurance, and sometimes not even qualified for medical aid programs. Management wanted those cases picked up by parapublic agencies and taken to the County Hospital.
Many times, when a call came in the squabble erupted around us while we stood by to take directions from whoever prevailed, the final decision often coming from the Hospital Director, our ultimate boss, the head of the management faction. He was a practicing MD himself, a wise man, a pragmatist, and the ultimate referee between the two factions. I admired his patience, toughness and endurance.
It was his office who called us one day as I sat in the lobby of a fuel facility in Las Vegas waiting for an ambulance with a patient we were flying back to our hospital. The pager went off: Call the base.
“We’ve had a request to fly a patient to Montevideo,” Charles, the dispatcher told me.
“You mean, like, Uruguay?” I asked, chuckling, thinking he was putting me on. When things were quiet Charles was quite capable of calling me with some goof ball request he cooked up for his own entertainment.
“Yeah, Uruguay,” he replied. “Dr. Simons’ office called. He’s asking for one of the departments that’s never used us before how much it would cost.”
“You’re feeding me this in bits, Charles. What’s the deal here?”
He went on to explain that the department had accepted a patient from Uruguay who needed a high-risk procedure that could cure his problem, a genetic neurologic defect. Or it could put him in a vegetative state. The latter had been the outcome, and his family wanted him back in Montevideo. The national health system in Uruguay agreed to take him back but had no way to pay for the transport. Our hospital wanted to accommodate the family but needed to know what the trip would cost.
“I’ll have to make some calls before we can respond, Charles. Tell them we’ll have an answer for them tomorrow.”
When we got home I started working on the trip. The requesting department wanted us to leave within forty-eight hours so the heat was on. I made some calls to friends of mine who’d flown to South America. They advised the best route was through Central America, then down the west coast through Ecuador and Chile and across the Andes into the Atlantic coast countries.
The Learjet wasn’t made for this long a trip. We’d have to make four fuel stops, not a big deal as long as we could stop for a night along the way. Therein lay the problem: in the nineteen hours the trip was going to take, counting the fuel stops, we couldn’t stop to rest because no foreign country could take our intensive care patient for an overnight stay.
This trip would push the pilots and the med crew beyond any reasonable limit of duty. The pilots’ duty day would be double what the FAA defined. But we could get away with it because this wasn’t a charter flight. We weren’t getting paid for it. Under the broader rules that covered private flights, there were no duty time limits.
The nurses would work literally two shifts back to back while caring for an ICU patient in the crowded confines of the Learjet’s cabin. Two of our nurses had already volunteered to go.
One of my friends that I talked to about the trip asked me why I would consider doing it at all.
“Because it’ll make us heroes in the hospital, and with so many people complaining about the money we spent on an airplane, it would prove its worth,” I told him.
“That would be great, if the guy doesn’t die on the way because your oxygen system craps out, or you end up in the middle of South America with a maintenance problem,” he replied.
I thanked him for worrying about me and went back to my calculations. ‘Was he right’, the voice whispered in my head. ‘Are you pushing beyond reasonable limits for a PR win?’
We would look like heroes having transported a permanently disabled patient back to his home and his family. Without us he would spend the rest of his life in a near-vegetative state in an ICU bed at UCLA. Wasn’t that a notable achievement, good for the patient and noteworthy for the institution? That was it. We were going and the hospital and the aviation unit would be better for it.
Once I had the plan together I gave my management the trip details and a cost estimate. They were lay people when it came to flying. If I said it was OK, they were good with it. The Director of the Hospital, our boss, called.
“I appreciate you figuring out how to get this done, Woody,” he said.
“Glad we could do it, sir,” I replied.
“But, nineteen hours? How are you going to do that?” he asked. That question was on everyone’s mind and I had to figure out a credible answer. There wasn’t one, actually, a fact that should’ve finally pushed me to the reality that this was a bad idea. But I was hell bent to do the trip and therefore had to answer my boss’s questions and calm his fears.
“Sir, the military runs bomber missions longer than this one with crews of no more than two or three pilots. It just takes a good rest plan and I have that,” I said. Pressing on before he could stop me, I said, “I’ll get twelve hours’ rest just before we leave. That will see me through, no problem. I wouldn’t do this if I had any doubts about fatigue compromising the flight.”
He thought about it for a moment. He’d had lots of practice managing driven people who worked too many hours at a stretch.
“OK, Woody. Get some rest, have a good trip and keep us informed,” he said.
My rest plan was soon shredded. I had hours of planning and coordination to work through - overflight permits, fueling arrangements, flight plans, and a hundred other details. None of the other Learjet pilots had any international experience so, I couldn’t delegate any of the planning chores.
Working well into the night I caught a few hours’ sleep and was back at it. The day was spent organizing the crew, my copilot and the two nurses, and making sure we had the supplies we’d need to take care of the patient and ourselves for all those hours.
After a short nap that evening I arrived at the airport about eleven PM. My copilot, Jim, was already there, overseeing the Learjet’s fueling and servicing. He had joined us about three months earlier and was still learning the Lear, but he had a good flying background and was diligent about his duties, in this case, supervising the fueling to make sure we had all we could carry, all while loading supplies into the back of the cabin.
Jim had put in his time as a flight instructor, like most civilian trained pilots. Then he graduated to a charter operator flying piston twins. Those were single-pilot trips into all kinds of backwater airports in crappy weather, great seasoning for becoming a real pilot. Slight of build, he was a good fit in the Lear’s tiny cockpit. He was meticulous about his duties, so I could always count on him to take care of the details. But, his focus on detail left him short on managing the big picture - where we were going, the weather up ahead and our options if we had problems.
When I brought it up to him, suggesting that as a jet pilot flying 450 knots he needed to be ahead of the airplane, he drew back, his body language letting me know I was picking on him. That played out badly because, where I was those days, sweating bullets to keep our program going, I didn’t have the patience to slow down and work with him. So, when we flew together we spent most of the time in a quiet stalemate. I could count on him to do his job, though and left it at that. We would end a trip with a polite but brusque parting after which I was relieved to have him gone.
When this trip came up all the other Lear pilots were on days off, spent from a nonstop string of organ harvest flights. Jim was the only choice. Now, tonight, I was relieved to see he had things well organized, a good start to this marathon adventure.
A half hour later the ambulance drove up with the patient and our two nurses, Sylvia and Jane. Sylvia and I had flown together a lot and were good partners. She had an air of class and quiet confidence about her that I found comforting, especially on a trip like this where we were going to face long hours of who knew how much crisis. Her physical stature and her poise– she’d been a dancer in college – lent strength to the mission.
Jane and I had flown together in the helicopter on a number of missions, including the one with Mr. Farnham. She knew how to manage pressure and how to stay on focus no matter how gnarly things got. Married to an insurance guy, Jane had two children in grade school and like so many career moms, managed to keep up with all that and still be a strong partner on a mission. This was going to be a tough trip. Having trusted buds on the med crew would be a real asset if things started to come apart in the hours ahead.
As the patient was being loaded, Sylvia asked, “So, Woody, how much sleep have you had?” She was facing me, her blue eyes looking into mine, assessing me as only a flight nurse can. Ready for the mission, her flight suit was neatly pressed and her blonde hair was tucked into a UCLA Medical Center ball cap.
“I got a few hours of real quality time not that long ago, Sylvia,” I said, embarrassed at my lame answer. It came out pretty weak but then, I figured anything else I tried to add would only make it worse.
“Yeah I can tell,” she said with a half smile. I think she decided to take it on faith I knew what I was doing.
We took off at midnight. Flying straight south, we landed in Acapulco about six AM with a one hour time change. Our handling company was tracking us and advised the fuel facility there to have a fuel truck waiting. We all got out, did a bathroom stop and grabbed coffee. At seven AM we lifted off into a dawn sky.
About ten o’clock we landed in Panama City and taxied up to a busy ramp. The fuel truck pulled up to the plane and again we piled out for a break. Ten hours into the trip and I was feeling good. Amazing how much you can accomplish on raw nerves. We were almost halfway there, the weather was clear the rest of the route and the jet was running flawlessly. Things were going our way.
Mid-afternoon we arrived in Guayaquil, Ecuador. Another easy turnaround and now, box lunches awaited us. I’d ordered peanut butter and jelly sandwiches, no local meats or veggies to create gastric issues. If any of us got sick, the trip would be over and we’d be stuck somewhere trying to plan for a patient who needed ICU-level care before the plane ran out of oxygen and drugs.
We opened our box lunches after we left Guayaquil. Sylvia stuck her head in the cockpit, waving a sandwich at me.
“Peanut butter and jelly? Really?” she said.
“I didn’t want us to get sick on South American meat or veggies,” I said. “How would we manage if we started puking our guts out?”
She thought about it for a moment then took a bite, grimacing as she worked the peanut butter around in her mouth.
“Right,” she replied, and disappeared back into the cabin. I heard some animated conversation about the food, something like, ‘This food is crap.’ But when we arrived at our next fuel stop, the boxes were empty and no one was sick.
It was winter time when we did this trip, that is, winter in the Northern Hemisphere, summer in the Southern. So, the further south we flew, the longer the days got. We left Guayaquil about five PM in a bright, afternoon sky. It’s on the Pacific Coast so we had a great view of the ocean and the long, empty coastline along our route. When it veered eastward we flew out over the Pacific on course to the last stop, Antofagasta, Chile, a beach town near the southern border between Chile and Bolivia.
“Beautiful country out there,” Jim said breaking an hour-long silence since we’d taken off from Guayaquil.
“Yeah, it is, like nothing we have in North America.” I agreed.
On the first two legs of the trip we’d been pre-occupied talking to our international handling company on the flight phone about fueling arrangements and overflight permits. Some of the countries we were flying over were sensitive about who crossed their airspace. We could be fined and even prosecuted if we didn’t have the proper permits in place.
But by the third leg things had started to quiet down. It was nice to have Jim relaxed enough to enjoy the beauty around us.
“How you holding up, Woody?” he asked.
He startled me. He’d never been that warm before.
Staring out the window, the serene, other-worldly beauty soothing after the chaos of the last thirty hours, I replied, “I’m OK, thanks, Jim. We’re on the backside of this thing now. Be nice once we get there to crash in a hotel bed.”
“Yeah, it will,” he said, smiling. Then it was quiet again.
I looked across the cockpit as if I was checking a gauge, but I was looking at him. He was staring out the windshield at the vast emptiness, his face calmer than I’d ever seen.
Maybe bringing him on this trip was giving him a new level of confidence. How nice it would be if we could capitalize on it and bring him into the fold.
We descended into the vast empty land we’d been marveling at, barren terrain, like Mars. Wind and weather had blasted it for eons into sandy berms and ridges that flowed to the horizon, giant waves frozen in time.
A two-mile long strip of concrete appeared out ahead of us, our landing runway. Off to one side was a huge ramp that could hold maybe twenty giant freighters, but there were none there. Where was the terminal? The only building on the entire airport was a double-wide trailer in a remote corner of the ramp.
Oh, my god, I thought, there’s no one down there. We’re landing at the wrong airport. What were we going to do? We didn’t have the gas to go anywhere else. Our handling company had told us there was fuel here twenty-four hours a day, hadn’t they? My nerves were starting to fray, and, all of the sudden, I wasn’t sure what the handling company had told me. The whole trip was crashing down on me. How could I have thought I could go without sleep for days then fly this long and still be on top of things? But then we landed and a Follow Me truck came racing up and swerved in front of us, the driver waving for us to fall in behind him. We were OK.
We taxied up to the double-wide trailer and right next to it, there sat a huge, semi tanker truck. Deplaning and stretching our legs I walked up to the counter. A well-dressed young man greeted me.
“Kind of fooled us when we landed,” I said, smiling. “Thought maybe we were at the wrong airport.”
He laughed, his eyes lighting up as he smiled. In his neatly pressed golf shirt and khaki slacks he looked like he’d just stepped off a college campus. “Yeah, we get that a lot,” he replied in perfect English. He went on to explain that cargo jets bringing in mining and construction gear for projects up in the hills landed there, thus the long runway.
Seeing my questioning look, he said, “I’m from here actually, just finished school at ASU in Phoenix and came back home to conquer the world in Antofagasta. Too bad you can’t stay and go into town tonight,” he said. “We have some really great seafood restaurants.” I thought about that, how nice it would be to sit at a table overlooking the Pacific, sip a glass of wine, and enjoy some fresh seafood. Then I would go to bed for a week.
“That’d be fun,” I replied. “But we need to keep going. Appreciate the thought, though. We’d take you up on that invite in a heartbeat if we didn’t have a patient.”
The nice thing about right now: we only had two more hours to Montevideo.
We took off and flew east over the Andes, their peaks reaching up to 18,000 feet. But we were flying at 39,000 feet, Flight Level 390, so they looked like foothills. Pretty soon darkness enveloped us. As we flew through the clear skies of the Southern Hemisphere the constellations were different from what we were used to in North America. With no lights and no civilization for hundreds of miles they were as clear as if we were in space. The air at this altitude was thin. It whispered by the jet so quietly we could hear the nurses speaking in low tones in the darkened cabin, their patient lying still and silent. It didn’t take long to lose myself in the pristine blackness. The waves of fatigue subsided and I was at peace in a way you could never experience on the ground. Time seemed to dissolve as the pure white light of each tiny star touched my eyes ever so delicately.
My old childhood yearnings to go into space re-surfaced, the dark skies drawing me out there into the far beyond. If I’d become a military pilot I’d be sitting up here even higher, closer to space, in a fighter jet, all alone. The view would be a 360-degree panorama through the cockpit canopy. I’d be in a helmet and flight suit strapped into an ejection seat, dashing forward on a mission that mattered. But then, my mind snapped back to the flight, time to get back to work.
Jim and I briefed ourselves on the arrival flight path then took out the descent checklist. It was time to start down, to leave this deep tranquility and return to the noise of the world. Soon we were greeted by the lights of Buenos Aires, spread out across miles and miles of the city. Crossing them as we re-entered the lower atmosphere we were vectored over to Montevideo, a country town in comparison. The landing was smooth, a nice closeout for this crazy trip. A Follow Me truck took us to our parking spot where an ambulance awaited us, the glow of its lights a welcome sign. We had made it.
I shut the engines down and the nurses opened the door. The ambulance crew and a friendly lady who seemed to know exactly what was going on greeted us. We climbed out of the plane and looked around at Montevideo, its streets and buildings surrounding the airport. I stood on the ramp, savoring the warm night air, relieved to the depths of my soul to be done with it.
The lady who greeted us was the attending physician for our patient. She’d done her residency at our hospital and that was the connection.
“We have you booked at the finest hotel in Montevideo, but I’d love to take you to dinner at a nice restaurant in town, if you’re not too tired,” she said.
Sylvia was standing next to me.
“What about it, Captain? You up for it?” she asked, a tired grin on her face. She saw the exhaustion in my eyes.
I thought about it. Should I just go to bed, maybe just find a couch in a hangar and pass out? But I was so happy to have finished this trip that I had a second wind, or maybe it was the third or fourth.
“Sounds like a great plan,” I said.
We stood by as our patient was unloaded. As he passed us on the gurney on his way into the ambulance we all stood in a little group near him. His face, with its classic Indian lines so numerous in this part of the world, was peaceful as he slept, his neck straight and his slim body lying almost regally on the gurney. We each silently wished him well.
Still in our uniforms our host drove us to this quaint little place and, having not had a square meal in twenty hours, we gorged ourselves on plates of Uruguayan delicacies. We drank several bottles of wine, something we would normally never do in uniform. But we were 5,000 miles from home, so who knew? And we were beyond caring. Mellow with wine and food, our hostess dropped us off at our hotel. I laid out the plan to the gang.
“Everyone sleep as long as you want. Tomorrow morning when we’re all in the restaurant, we’ll talk about our route home. The good news, we’re not on the clock anymore.”
With that we all split off to our rooms. I unlocked the door to mine. It seemed small, like it was made for short people. I managed to smack my head painfully on the top of the door frame as I entered. The bed was tiny, like one you’d set up for kids. I fell on to it, my legs hanging off the end. Had we landed in some Gulliver-like reality? As my burnt-out brain was trying to process all that, I dropped off and didn’t wake up for twelve wonderful hours.
Gathering in the restaurant in the morning, poking fun at each other for our baggy eyes and gaunt complexions, and at me for the ding in my forehead, I gave everyone the options for flying home. We chose to go through Rio and up through Caracas. Two days later we descended back into L.A. about midnight, 72 hours after our departure.
This was a memorable mission, but afterward I asked myself why had I agreed to it. We had to fly far longer than we ever should have, the pilots well beyond reasonable limits, the nurses administering ICU-level care to their patient for almost twenty hours with no break.
The political win was a big part of why I’d gone for it. We proved to all the doubters in the hospital that we could pull our weight and were worth the expense.
And then, there was the patient. Had we not done the flight he would’ve never gotten back to his home, instead spending the rest of his comatose life in an ICU thousands of miles away. His family appreciated what we’d done, in part, I guess, making up for the risks we faced.
But there was no way around it. I had made a bad decision. It was only blind luck we pulled off this flight without a disaster, as my friend pointed out before we took off. What if we’d had a mechanical problem? We’d have been stuck someplace in the Southern Hemisphere with few options for maintenance and a patient we had no way to take care of. He could’ve died in the plane. A death like that in a foreign country could have tied us up there for weeks.
I realized how foolish I’d been. Those nurses’ lives, and the patients' were not mine to expose to what could’ve been a disaster. But I kept those thoughts to myself, intent on not airing the what-ifs after the fact. What would be the point?
Go-no-go choices in flying are supposed to be made strictly on technical factors. Throughout history, though, they have often been made based on military or political goals, the technical factors many times ignored altogether – bombers launched against targets in WWII, the generals knowing full well most of them would be shot down. Flights of helicopters full of troops launched into the jungle battlefields in Vietnam with the odds slim any of them would survive. My situation was much less weighty than any of these but the logic was similar, and just as thin.
Lesson learned: I would never again put the mission ahead of my team mates’ lives. Much later in my career, in another situation, it would come down to that, things would go terribly wrong and we would face a grim outcome.
Copyright © 2021 Woody McClendon. All rights reserved.
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