Dating back to my childhood, I have always had a fascination with flying. When I was active duty in the Army, I could have taken flying lessons at a variety of airfields but never seemed to have the time or money. I hear this consistently from colleagues and patients as they state that they regret never learning to fly. For my 50th birthday, my wife bought me a “First Flight” certificate that allowed me to go up with an instructor for an hour and experience the thrill of flying. I would consider the following quote by Leonardo da Vinci apropos: “Once you have tasted flight, you will forever walk the earth with your eyes turned skyward, for there you have been, and there you would return.”

“Great pilots are made not born… A man [or woman] may possess good eyesight, sensitive hands and perfect coordination, but the end result is only fashioned by steady coaching, much practice and experience.” –Author unknown

I would say the same is true for great urologists. In my experience hanging around general aviation pilots for the last decade, pilots have a lot of similar qualities to urologists. They are passionate about their trade, have good situational awareness and decision making, know their personal limitations, enjoy new toys and innovation and constantly strive to improve their skill set. When I first started flying, it reminded me of learning how to operate with the robot. It’s very humbling to go from mastering an open operation to taking double the amount of time to do the same operation using the robot and everyone in the operating room wishing they were anywhere but in your room!

I remember a similar feeling as I began to learn to fly. My instructor was 25 years old and a very accomplished instructor. However, he never missed an opportunity to let the “old man” know that some of the most dangerous pilots are doctors. He commented that they tend to have “doctoritis” with the constant need to complete the mission regardless of personal risk. He also reminded me, frequently, that just because I was a doctor and had a lot of “book smarts,” it didn’t mean I would be a great pilot. The young man had a lot of wisdom despite his youth, and I learned a tremendous amount about constantly improving my skill set by adding additional courses and training and creating a set of personal minimums that I would hold sacrosanct.

“Aviation in itself is not inherently dangerous. But to an even greater degree than the sea, it is terribly unforgiving of any carelessness, incapacity or neglect.”
–Captain Alfred Lamplugh

After I received my private pilot license, I immediately completed my instrument rating. Several months later, I was invited to partner with 3 very experienced pilots in purchasing a Piper Mirage (fig. 1). This was a huge step up for me in an aircraft with double the horsepower and much more complicated cockpit and avionics set. I was warned that this might not be wise, by my previous instructor and others, but I was overconfident and self-assured. The day after completing my initial training in the aircraft, I was taking off from Kansas City following a snowstorm. There were still snowbanks approximately 2 feet on either side of the runway from plowing. On takeoff, the aircraft pulled hard to the left, I overcorrected and I was in for the ride of my life. When the main tires hit the snowbank, it quickly whipped me into the snow, and I crashed the plane into the snow and grass. I was lucky to walk away from that crash with a bruised chest, knees and ego. After many sleepless nights reliving the crash and contemplating giving up flying, I elected to continue to fly but vowed to take more lessons, fly a multitude of aircraft and make this a learning moment that would lead to my becoming a more proficient, safer pilot. A costly but constructive lesson!

Figure 1. Telluride Airport in the Piper Mirage.

Figure 2. Stuck in the smoke in my V-tail over Tennessee, November 2016.

After flying the Mirage for approximately 150 hours, I realized that I didn’t need an aircraft that seated 6, had a pressurized cabin etc. Most of my trips were 500 miles or less, and I began to use the aircraft to allow me to fly to other hospitals to perform robotic procedures. This led me to get into a new plane with new partners. The new aircraft was a 1965 Bonanza V-tail, fondly called the “twin-tail doctor killer.” The aircraft was a huge advancement when it first rolled off the line in 1947. Suddenly, those who had learned to fly in a Cessna 140 cruising at 105 mph were flying an aircraft that cruises at just under 200 mph. I had completed my tail-dragger training, high altitude course and flown 5 different aircraft with a multitude of instructors to improve my skills. However, I learned another lesson about weather on my first long trip in the V-tail.

My mother and father had been placed in an assisted living facility in Easley, South Carolina, and I wanted to go visit them from Kansas. The trip was 650 nautical miles, and I felt very comfortable flying the aircraft after approximately 50 hours. I prepared in detail for the trip but neglected to do my due diligence in completing my review of en route weather. I didn’t realize that no fewer than 15 large fires were burning from Kentucky to Georgia. Just past Kentucky, I was locked in smoke and not allowed to change altitude. Airtankers hired to help extinguish the fires had block altitude clearance above and below me. I was locked in smoke that was so bad, at times I couldn’t see my propeller (fig. 2). I realized that my engine could quit at any time since it was sucking in smoke, and I wasn’t allowed to get out of it. When I landed in South Carolina, after 2 hours in the smoke, I felt like I had just finished a difficult radical nephrectomy with thrombectomy. I was wet with sweat and, if you had placed a chunk of coal in my rectum at the beginning of the flight, I could have produced a diamond when I landed!

Figure 3. My new bird, 2006 SR22 G2, at Beaufort Executive Airport in Lady’s Island, South Carolina.

Figure 4. Fripp Island, South Carolina from the air. A bit closer to the ocean than Kansas City!

Recently, I sold my aging Bonanza and bought a Cirrus SR22 (fig. 3). I love the aircraft (and it has A/C!), and with all our family members within 500 miles of my new home in South Carolina (fig. 4), it makes it much easier to see my father in assisted living (mother passed) and my siblings. I fly my wife to see her family, and we have enjoyed multiple wonderful vacations at great sites near us–Saint Simons Island, Jekyll Island, Amelia Island etc. I have learned several humbling lessons from flying just as I have from performing surgery. However, I continue to love being an aviator and learn something new every day.

I will leave you with one of my favorite pilot quotes, author unknown: “There are old pilots and there are bold pilots. However, there are no old, bold pilots.” Words to live by–I hope to remain the former!