Down for Repairs

About 60 miles out, a surprise. Georgetown, Delaware, reports a ceiling of 200 feet and visibility of a mile. This comes to us via the automated surface observation system (ASOS) and is below minimums for all approaches to the airport. We're already descending, talking to Washington Center, carrying my daughter, her husband and their two young boys back home. I turn and look back at the four of them and my wife, all blissfully arranged in the comfortable seats of our Cheyenne. The nearest available forecasts, for Dover and Salisbury, Maryland, were way better than this. It looks like we might end up at one of these airports. Or maybe not, for a quick check of the metars on the Avidyne EX500 shows that these airports are at or close to minimums, too. Whatever is causing the low weather at Georgetown is not a local phenomenon and is an unexpected development throughout the area.

I shed the headset for a minute and tell my wife, Cathy, that the weather is well below forecast and that we might end up somewhere other than Georgetown, KGED. Too bad, as this first-rate field sits just a mile from the kids' architecturally stunning and welcoming home. Though a diversion is unusual and a nuisance sometimes, it is more than that with two little boys who have been very patient but do have their feeding and napping schedules. Thank goodness their mother has been flying in general aviation airplanes since she was a week old and the unpredictability attendant to weather flying is well known to her.

I tell the passengers that we might go missed. They appear comfortable with this news. Minutes later we level off at 400 feet and wait. Seconds later we're climbing back out, retracting gear and flaps, starting on the published missed approach, negotiating with Dover Approach for another chance in another place, this time at Salisbury. There were no breaks in the clouds and there is no sense in attempting another approach at KGED.

With strong winds out of the south, it takes longer than I think it should to get to the initial approach fix on the ILS at KSBY. We've got at least two hours of fuel, but the nearest VFR airport is beyond Norfolk to the south. As we're vectored onto the intercept for the ILS by Patuxent Approach, I can see from the Avidyne map that the assigned heading will never get us established on the localizer. I correct another 30 degrees to the left. The winds at 2,000 feet are 40 knots out of the south. The moving map saves the day and we stagger out of the approach to see the runway, almost underneath us. A soft landing comes next. The tower directs us to the FBO and as I shut down I hear the deep exhale of anxiety from the passengers. My daughter tells me later that she has never been aboard for a missed approach. This is hard for me to believe, but I am sure it is true. Thank God for those PT-6 turbine engines, I think.

After a drive in a rented van, a dinner magically produced, and a good need for a good rest, we're in bed early. But sleep eludes Cathy. She awakes with abdominal pain and by 4 a.m. it is clear she has some sort of a surgical catastrophe brewing. I'm pretty sure she has appendicitis, but other diagnoses rush through my mind, some of which are not reassuring. No matter what, though, she's going to need an operation. At daybreak we set off for a local hospital.

By 8 a.m. Cathy has been examined by a physician assistant student and a nurse. Blood has been drawn, an EKG done and an intravenous drip started. The emergency room physician comes in, examines Cathy again, and confirms that the most likely diagnosis is appendicitis. Nonetheless, he orders a CAT scan to confirm our mutual suspicions. I can't for the life of me think of any diagnosis made by CAT scan that would stay the hand of a competent surgeon. She's just too sick to let lay there, no matter what a scan shows. I don't protest, however, and by 10 a.m. a scan has been read. A pleasant radiologist is kind enough to go over the films with me. They carry the subtle clues of appendicitis: an enlarged appendix and a little bit of free fluid in the pelvis.

I call a friend back home in Tampa. Mike Albrink, M.D., an excellent surgeon (he has operated on me), says that he's standing by and will have an operating room ready. I look at the KGED to Tampa trip on and am not surprised to see that it would be almost five hours with these blistering winds. That means a fuel stop. That's a long ride for a patient with a hot appendix. We talk about the possibility of getting home, where recuperation from an operation would be at our house, but when Cathy tries to stand up, it is clear that such a flight in a Cheyenne with me as surgeon, nurse and pilot would be imprudent at the least and crazy at worst.

The long and the short of the story is that, after a 12-hour delay for various reasons, Cathy gets her appendix out. I could have flown her to Tampa and back in that time, but who knew? A hundred years ago patients often died of a ruptured appendix; today it rarely happens. That long ago, the notion of traveling 750 nautical miles to another health care facility was not part of the picture either. A local doctor, if the diagnosis had been made, would have taken the appendix out at a small rural hospital, or maybe even on the kitchen table as the family administered ether to the patient. They didn't have PT-6s back then, either.

A few weeks later, after Cathy was superbly nursed back to health by my daughter, Alix, and her family, we're en route to New Orleans to meet some friends. I'm thinking about the appendix episode and about our airplane. Both have to do with inspection and repair. Our airplane has just returned from an "Event 2" at the capable hands of Bill Turley at Aircraft Engineering in Bartow, Florida. An event is just that: A routine inspection designed to maintain our almost 30-year-old turboprop in good order. It can be a financial event, too, and there's also an "Event 1," of course. These inspections are part of the plan that Piper submitted to the FAA years ago and must be performed each calendar year, at 100-hour intervals. If you don't fly 200 hours a year, you still have to do both inspections to keep the airplane airworthy.

What I didn't know on that flight was that the bill for the Event 2 and for the appendectomy would both be for about the same amount of money, but that my emotional response to the two billing statements would be so disparate. You see, the hospital sent a one-page bill that listed categories of things like "pharmacy" ($4,317.13!), that CAT scan that I thought was not necessary (and wasn't) ($3,837.75), and a charge of $3,671 for use of the hospital's hard to get into operating room. There was very little detail in the $20K bill. And that didn't include the charges generated by various doctors in the emergency room, operating room and those radiologists who "read" the CAT scan.

In contrast, Bill's bill was a blizzard of detail (1 MS 29513 O ring= $5.00). There were 90 hours of labor at $85.00. This rate appears to be somewhat comparable to what the lawn guy gets. There was a prop overhaul (mandated every six years and costly, $4,996.10), an evaluation of the autopilot by Duncan Aviation ($1,108.63), a new heater element (ours failed its pressure decay check, meaning that carbon monoxide could get into the cabin) and a heater switch (the two totaled $3,000), and all new hoses for the engines (they were 15 years old). Parts came to almost $7,000 not counting the prop. The total bill pushed $28K, not far from what the doctors and the hospital wanted for the appendectomy.

To be clear, both activities, though expensive, are absolutely necessary for survival. So why is it that I feel so differently about the bill for inspection and repair of our airplane when compared to the miracle of saving my wife's life? Maybe it is that when I asked for and received the itemized hospital bill, I noted a charge for $78.80 for a drug to treat nausea, when Cathy had no nausea. Not only that, but I know that there are equally effective drugs that are much cheaper than the one given. (They are off patent.) A liter of IV solutions went for $66.25. That's just sterile salt water and sugar, for crying out loud.

Now maybe the markup on the engine hoses that went for $136 was just as great, but I don't think so. And I didn't get a one page "send me the money" bill from Aircraft Engineering, like I did from the hospital. Bill's bill was carefully itemized. I've seen the pages and pages of checklists he uses when doing an event. I know how careful he is.

The hospital, on the other hand, had Cathy wait 12 hours before getting her the treatment she needed. Then they charged her $22.25 for a pair of cheap slippers and $15.00 for a plastic bed pan. Be certain that I am not singling out the hospital in question; they are all like that or they have gone broke and closed.

On the trip back to Tampa from New Orleans, the weather was ugly. Lakefront was reporting three-quarter-mile visibility and a 200-feet ceiling, but when we summitted an overpass on the way to the field we entered cloud. (Must have been a very high overpass.) After waiting for a slight meteorological improvement and a nice discussion with several Flying readers at the FBO, we lined up on 36L and I pushed the power up. I wouldn't have done it without the turbine engines. I wouldn't have done it if Gulfport, 54 nm to the east, hadn't been VFR. I wouldn't have done it if I hadn't been very careful with the preflight. I wouldn't have done it if I hadn't rehearsed the engine out procedures in my mind. But in the end, I trusted those engines and my annual FlightSafety Training. With our lives.

We broke out on top and climbed into some excellent tailwinds. I checked on Cathy back there in her favorite seat. Though she doesn't like low weather flying, she was fine. After I had a cup of coffee, I told her that I had reviewed the bill from her hospitalization and was proud to announce that despite our ages, they had charged us $42 for a pregnancy test. Made me feel like a man.

Dick Karl
Dick KarlAuthor
Dick Karl is a cancer surgeon who appreciates the beauty and science involved in both surgery and flying. Dick’s monthly Gear Up celebrates the human side of flying. He writes about his enthusiasm for both the machines and the people who fly and maintain them.

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