Rolling the Dice

It was night, and snow showers were passing through the area. The hospital called me at home. "Can you go to Afton?" Afton is a mountain strip in a deep valley.

I was very familiar with Afton. When I was a 135 (charter) instructor, I used to take new pilots there and say "OK, it may not be legal, but you have to get the antidote out of here or the world will end. Make a plan." The only navaids are GPS and dead reckoning.

They would make a plan for some GPS waypoints to keep them in the valley, and then I would have them fly it. Under the hood. But it was during the day, and I was there to watch out for the mountains.

Tonight it was for real; a patient (they never tell the pilots about the patient, on purpose) in their tiny clinic needed to be flown out of there, tonight. My students did it in a Cessna 182; at least I had the pressurized 414.

The weather was iffy but I remembered that there was a new GPS approach into Afton. I accepted the flight. But then I reviewed the approach chart: "NA [not allowed] at night," it said. Still, the medical team were willing to fly there and take a look into the valley from a safe altitude, like 12,000 MSL. "I'm not going down into that valley for two streetlights," I said. The nurses, who plan to see their families again, agreed. It was a roll of the dice for the patient.

We got to Afton and I set up an orbit high over the valley. The nurses strained to see out the windows. At first there was nothing down there. Then there were a couple of streetlights. And then there was the airport! We spiraled into the valley, staying over the airport and away from the unseen hills, and landed. The crew rushed off to get the patient while I stayed behind, sweeping the snow off the wings, even though it wasn't sticking.

It was VFR when they got back, but it was still dark, too. We loaded the patient, a teenage girl with severe breathing problems, into the airplane. I took off, and followed the departure procedure that I had drilled into my students. I didn't need a hood because there was nothing to see. I put the weather radar into terrain mode; that way it showed me the mountains that I needed to miss. I held the heading and watched the radar and climbed out at full power. While we climbed I could hear the patient laughing in back: Tom had a great sense of humor, and the laughter relaxed her. And me, even though I couldn't hear what he was saying. I felt like I had really done something to make the world a better place.

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But now it was my turn. I was strapped onto the cath lab table. The cardiologist found the problem quickly, and it was a bad one: My left main coronary artery was 85% blocked. Stent or surgery? I had to decide right now. I got a short reprieve while they fetched my wife and the surgeon.

The cardiologist laid out the facts: it would be a tricky stent. There was a 1 in 200 chance that it would fail. If it failed I would die, immediately.

The surgeon laid out his view: because of my previous bypass and the location of the lesion, surgery had a 10% chance of serious complications: stroke, heart attack, death, infection, and the rest. "If you think your first bypass was a bitch," he said, "this will be a bitch-and-a-half."

"If the surgeon isn't enthusiastic then don't choose surgery." That was my wife.

"Statistics don't apply to individuals," I said.

"Exactly," said the cardiologist.

"It's like Pascal's Wager," I said.

"What's that?" asked the docs.

"Don't explain it to them now," my wife interrupted. Stick a catheter into a mathematics professor's heart and you still have a mathematics professor wanting to seize the teachable moment. Pascal's Wager is a situation with a very small probability of a very bad outcome.

"This is dangerous," the cardiologist said, a slight edge of fear in his voice. "I have a wire right in the lesion. You have to decide."

I realized that the next words I spoke might be my last. I was determined to make them count.

"Tell the kids I love them; let's try the stent."

It worked.