My Medical Heritage - 3 of 4

Dr Duane Graveline

Duane Graveline MD MPH
USAF Flight Surgeon
NASA Astronaut

Hysterical Conversion Reaction

One of my most interesting cases involved a pilot of a Convair XC-99. This formidable multi-engine aircraft was the world's largest flying machine at that time.

"Doc, I think you'd better give me a checkup," said the pilot. "I've got something wrong with my eyes."
"What seems to be the problem?"
"Doc, I can't see the color red!"

With that he went on to tell me this incredible tale of abrupt onset of complete inability to see the color red. He no longer could play cards as he no longer could tell the red from the black suit.

Reds looked black to him. A red traffic light looked dark gray. Red clothing assumed various shades of gray. He couldn't read maps and couldn't see red lights in the cockpit. Although he passed all other vision tests as well as he ever did, he no longer could pass the various tests of color vision.

I ordered the usual consultations from ophthalmology, neurology and psychiatry but I thought I already knew the differential diagnosis: hysterical conversion reaction vs. malingering. Either he was intentionally making it up or his anxiety was subconsciously doing it for him.

At no time would the pilot express the slightest concern about flying the XC-99.
"Hell, Doc, I'd fly it in a minute, but I can't with these eyes."
The operations officer confirmed my growing suspicion that this was fear of flying in one form or another.

"Ever since we assigned him 99 duty he's been trying to weasel out of assignments," said a Lieutenant Colonel.
"He flies okay, but you have to watch him every minute. I'll bet his wife has called here a dozen times with some excuse why he couldn't come in to fly. Doc, I think he's malingering and I'm going to board his ass out."

The flying evaluation board was held and I had to confess that although I felt intuitively that this pilot was malingering, I didn't feel I could win the war in front of their lawyer, especially since they had found a shrink who would battle their way. I had learned long before that you do not fight a battle you can't win.

I felt kind of sorry for the pilot. Clearly he was in the wrong job.
“I think his anxiety about flying the XC-99 had made him believe he can’t see the color red,” I told the board.
They smiled at my response. What else could I say? At least the board made certain that he changed jobs.

Ruptured Berry Aneurysm

For my elective course, I chose forensic medicine, working with Doctor Paul Guerin, medical examiner for the city of Baltimore. At the crime lab under his supervision, I learned to perform my first autopsies.

One bit of information that stayed with me over the years had to do with ruptured blood vessels.
"Doc, we just got another young trucker dead on arrival with no evident damage," said a technician to Doctor Guerin.
"Do you want a head?"
"Yes, we had better," replied Doctor Guerin. "It's probably another berry."

"You mean rupture of the cerebral artery," I asked?

"Yes," he said, "The so-called ruptured berry aneurysm. This is the usual story. Some apparently healthy young kid slowly goes off the road with his car or truck, hitting the curb or the side of another vehicle with minimal damage and the driver dead at the wheel. This has to be another case. I'm betting on it."

He was right of course. I was impressed. They averaged three cases per year in the city of Baltimore. People are born with these things and they are silent until they rupture. About one-third of them die immediately.

It made me think of high performance jet pilots and unexplained aircraft accidents. These weak spots on brain arteries are completely undetectable unless angiograms are done on everybody. Even then a fair number will be missed.

Many years would pass before I had a chance to use this information in my own office, during a routine physical on a young woman. When I asked her to look at my eyes, she consistently looked a bit off to the side. Now curious, I asked her why she was not looking directly at me.
“If I did I would see two of you,” was her reply.

Her left eye was definitely turning in and I recalled from my neurology classes that this meant the 6th cranial nerve. I sent her off to a neurologist friend of mine. The next day he called me to say I had scored big time.
“Usually we get these after they rupture,” he said.
The lady had an aneurysm that was pressing on the 6th cranial nerve.

Explosive Decompression

In between our academic work and special research projects, we were expected to experience many of the different tests and training procedures peculiar to the military flight environment. One of these was the chamber test of explosive decompression.

"Okay, you guys, we're going to level off at 25,000 feet to permit further de-nitrogenation," said the chamber technician.
"Once we complete this phase, we are going to rapidly decompress you to a hundred thousand feet simulating an explosive decompression of your cabin."

We had all been fitted with pressure suits and had been pre-breathing 100% oxygen to minimize the chances of the bends (decompression sickness).

"I'll give you a ten second count," said the technician. "Try to time your breathing so you're exhaling at the time we blow and remember fog will form. Don't be alarmed. That's normal."

Explosively decompressing to space equivalent pressure sounds formidable even with a pressure suit but they already had gone from sea level pressure of 14.7 psi to 5 psi, the pressure at 25,000 feet. So now all we had to do was go from 5 psi to close to zero.

We would not linger at this altitude, starting immediately a simulated free fall to ten thousand feet. After this was over we would look at the movie films showing our facial expressions and we would laugh. Before the explosive decompression, however, it was no laughing matter.

Even though we had only about five psi to go, it would take place in a second or less. That made all the difference!

"Three....two....one...exhale!"

With a roar barely attenuated by our pressure helmets, dense fog appeared, air in our lungs raced out our mouths, our pressure suits went into action and we were in a simulated eighteen-mile free-fall.

I was most impressed by the Dr Pepper boiling out of the cup. It had been placed there previously by one of the technicians in what had come to be a traditional demonstration of the fact that fluids boil at body temperatures when one is above sixty-four thousand feet.

Dr. Spurgeon Neel (later Major General) was in trouble with severe ear pain. Once we leveled off at 10,000 feet he was examined with an otoscope, revealing blood in the ear canal, hemorrhage into the middle ear and ruptured eardrum.

Since his eardrum was already ruptured, he had no further trouble on descent to ground level. He had temporary hearing loss on that side, but in a few weeks was as good as new.

Project Excelsior

In 1960, Air Force Captain Joseph Kittinger did a real twenty mile free fall to validate ground based research and development and check out protective equipment under operational conditions. In Project Excelsior III, Joe rode an open stratospheric balloon gondola to almost 20 miles high and jumped out.

Can you imagine stepping out into a greater than five minute free-fall, never really certain that your chute would work, hoping your oxygen supply held out, worried you may freeze to death at the minus 60 degrees temperatures and with a free-fall velocity of several hundred mph until you got close to the ground where the denser air slowed you down to 125 miles per hour?

This was the type of incredible individual I was privileged to associate with during this time.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

July 2016


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