Epilogue Part 1 - Medical Saga

(This continues the previous post, from 02/02/2023 to 03/20/2023)

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Then, suddenly, everything changed.  Buckle in, folks; this is a long story.
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     On Thursday, February 9, I awoke at 3 a.m. with double vision, or diplopia.  Initial self examination indicated that my eyes seemed to be crossed slightly.  I went back to sleep and woke back up at 10am; the double vision remained.  Staring at my bedroom TV I could see the red "off" light; there were two of them.  Covering each eye in turn showed only one light; the way each light was displaced with one eye covered indicated that my eyes were still crossed slightly.  Within a few moments I could concentrate on focus and regain proper binocular vision.  If I relaxed my concentration or moved my head, the symptoms would reappear but with any concentration they disappeared immediately.  As the morning progressed, the overall symptoms seemed to gradually lessen.

     I had a previously scheduled doctor's appointment that afternoon with my primary care physician Dr. Gorz.  After making certain that I would be able to drive safely, I went to the appointment.  Dr. Gorz suspected a possible stroke and ordered me to go to the St. Joseph Mercy Oakland Hospital Emergency Room in an ambulance.  Before I left, I told Dr. Gorz that I would effectively self-suspend my 3rd Class Medical Certificate until I got a diagnosis. By the time I arrived at the hospital my symptoms had disappeared completely.  I should also note here that during the entire time from February 9 to the present, the diplopia has not reoccurred and I never experienced any other stroke-like symptoms: no headache; no weakness; no numbness; no asymmetry of appearance, ability or strength. I remained in the ER ward until 4am February 10 when I was finally admitted to a hospital room.  During that time I went through various tests and wasn't able to sleep that night.  The entire day of February 10 was spent in the hospital getting more tests and examinations.  It was very weird being in the hospital, wearing the ubiquitous hospital gown with an IV lead in my arm and my chest wired up with sensors connected to a harness... and I felt just fine.  The final test was a CT scan done that evening; due to the late hour a review of the results couldn't be done until the next morning.  I was finally discharged around noon on February 11.

     The initial diagnosis was diplopia, secondary to possible TIA or Transient Ischemic Attack.  Further research revealed that a TIA diagnosis was essentially based on the absence of any evidence that could confirm any other diagnosis; what I would call a Diagnosis In Absentia.  The FAA takes a dim view of TIA; if that diagnosis was upheld it could mean the suspension of my 3rd Class Medical Certificate for up to two years.  There needed to be a lot of follow-up examinations to determine if that would actually be the final result, but it certainly gave me plenty to worry about.  If that scenario prevented me from flying my RV-8 I would sell it immediately; it wouldn't make sense to keep it grounded for two years.  It would also cancel all the flying plans I've made for 2023 and 2024.  This could very well change my life forever.

     The next day was a beautiful Sunday morning... a perfect day to fly.  Yes; I was self-grounded, and for good reasons.  But if I was to lose the ability to fly the airplane that I'd devoted seven years of hard work, triumph, hardship and heartbreak to create, I wanted a Final Flight for closure.  The way I was feeling that morning, no one on earth could stop me except myself.  I drove the Mustang to the hangar, plugged in the preheater and drove back home, thinking all the while about how I felt, and pondering all of the possible consequences of any of the potential actions that lay before me.  I prepared for flight, drove the Explorer back to the airport and began pre-flighting the aircraft.  My Pilot's License and 3rd Class Medical Certificate were both still valid; I was confident that I was physically fit to fly.  But my mind was racing and my emotions were unsettled.  As I went through my RV-8 checklist I was also going through the IMSAFE checklist in my head.  I didn't have to worry about Medication, Alcohol or Fatigue. Illness: I felt fine but some questions remained unanswered.  And to be honest, if it were just another day I'd probably have flunked myself on Stress and Emotions.  But this might be the Final Flight, and conditions were ideal!  But... if it were determined later that I was indeed unfit to fly, I knew it was a potential outcome and chose to disregard it, I could lose not only my Medical but my License.  Come on, Marty; that would just be stupid, wouldn't it?  Ok... how about if I just do a taxi test?  Get the engine warm, do a run up and a few full-length taxis without leaving the ground.  Surely that would be legal; I've got the Repairman Certificate for my plane.  Any mechanic is allowed to run-up and taxi an aircraft in the course of his work without a license or medical clearance.  I could still operate my plane and savor the experience without leaving the ground.  It seemed the wisest choice, so that's what I did.

     Nice weather in winter makes for a busy day at the airport, and it took a while before I was able to take the runway.  I did two full-length taxis and pondered a third but decided to quit while I was ahead and leave the runway to the flying traffic.  After putting the plane away, I joined a few of my airport friends at their hangars and shared my situation with them in confidence.  I did capture the experience on video but for now it will remain a personal archive.

     I made a follow up appointment with Dr. Gorz on February 15.  It did not go well; he was initially curt, and his demeanor continued to devolve into confrontation and anger.  He had misunderstood the intent of my self-grounding and insisted that if I was unfit to fly, I was unfit to drive.  I tried to explain that I never said I was unfit to fly or drive; I was merely being proactive in protecting my 3rd Class medical certificate by refraining from flight until a diagnosis could be confirmed.  The more I tried to explain, the more he interrupted me and the angrier he got.  He actually left the room twice, saying he was getting too upset and needed a break.  Eventually he called in a witness which I assume was in order to protect himself from liability if I crashed my car after leaving his office.  I finally got him to calm down, but he kept saying that if I wasn't safe to fly, I wasn't safe to drive.  I asked him if I got my neurologist to declare that I was safe to drive, would he accept that opinion?  He agreed that he would; we shook hands, but he was still visibly upset.  He told me to see him again in six weeks and left the room abruptly.

     I left his office in shock, feeling like I had just been assaulted.  The more I thought about it, the more upset I was by his behavior; it seemed very immature and self-centered.  He could have explained his position in a calm, rational and even soothing manner, but instead he displayed anger.  That was the worst possible way he could have chosen to express his concerns.  Instead of showing any care about what I was going through, he got angry about what it might mean for him: exposure to litigation.  In deference to his somewhat misguided medical opinion, I drove home very carefully and refrained from driving again until after my follow up appointment with Dr. Basel Assaad on February 16.  

     Dr. Assaad was my attending neurologist at the hospital; my wife Amy drove me to the appointment.  She has a Ph.D. in psychology and has specialized in neuropsychological assessment and testing.  I requested that she attend the consultation to hear what he had to say and ask questions as she saw fit.  Dr. Assaad's demeanor was upbeat and jovial; he stated that he had no major concerns and assured us both that I was safe to drive.  I requested that he forward his findings to Dr. Gorz.  When I read his notes later I was a bit dismayed to see that all he wrote was this: "The patient had many questions about his TIA and restrictions and I answered them."  I subsequently learned that it was actually good news.  The absence of written concerns in his notes about my ability to fly or drive means that there are literally no concerns.

     At this point I decided to contact Dr. Gregory Pinnell, the aeromedical specialist that has issued all of my recent 3rd Class Medical Certificates.  I compiled all the current test results, wrote out a timeline of events and submitted them to his office at AirDocs prior to our phone appointment on February 23.  I recorded this conversation with his permission so that I could review it with Amy later.  He was upbeat and encouraging; we discussed potential scenarios but he would wait for all the follow-up appointments to be concluded before coming up with a plan of action.

     My follow-up appointment with ophthalmologist Dr. Arlin French took place on February 24.  This was recommended on the basis that an ophthalmologist can detect stroke symptoms earlier than any other examination.  This appointment was also very encouraging.  He found no evidence of stroke or damage and told me that it has been his experience that "sometimes, diplopia can just happen" and in his professional opinion that is what happened in my case.  Although we discussed TIA, he downplayed it in my case and his notes make no mention of that diagnosis.  I was encouraged by that.

     My follow-up appointment with cardiologist Dr. Feras Aloka took place on March 2.  This was recommended on the basis of a hospital echocardiogram that indicated the possibility of an intracardiac shunt.  If a shunt is serious it can require surgical repair, but that repair can be done vascularly.  Dr. Aloka assured me that based on the test results my shunt was probably congenital and the safest course would be to avoid surgery and maintain a healthy lifestyle.  However, to be on the safe side he did recommend that I wear a heart monitor for two weeks to make sure I had no heartbeat irregularities.  On March 24 I will ship the heart monitor to a lab in Illinois; the results should be available a week later.

     My follow-up appointment with Dr. Gorz will take place on April 3 2023.

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Thus ended the draft of the previous post.  I will attempt to continue from there.

Wow.  Eight more months.  How on earth am I going to catch up? 

I should probably start by wrapping up the cliffhanger I left you with.

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     My follow up appointment with Dr. Gorz was surprisingly cordial; we discussed what had happened at our previous appointment and I left his office feeling better about our relationship.  After follow-up visits and further tests with positive results, my Neurologist, Cardiologist and Ophthalmologist all cleared me for driving and flying.  I forwarded all the information to Dr. Pinnell and initially received no response.  I still had a valid License and 3rd Class Medical Certificate and all the specialists had cleared me to fly.  Dr. Pinnell wasn't responding to further inquiries at this point, so I assumed no news was good news, un-grounded myself and resumed flying.

     A couple of weeks later, I finally received a response from Dr. Pinnell.  He said that "the documentation received provides a very mixed picture" and stated that he had forwarded all of the documentation to the FAA for their review.  I was floored by the fact that he would get the FAA involved without at least telling me first and I told him so in my reply.  I asked many questions about the status of my current Medical Certificate, the retainer fee and where I stood in relationship to him as a patient versus his obligations to the FAA and protecting his own interests. 

     I got no response to my queries until a month later, when I received a rather rude email from Anne Schroeder, Director of Operations at AirDocs (Dr. Pinnell's medical office).  Her reply included a list of services rendered and a demand for payment.  She stated that no more action would be taken until the bill was paid and a retainer fee was received; if I wanted "free assistance" I should contact AOPA or EAA. 

     I paid the bill immediately by phone and responded to the email, restating my concerns and requesting the scheduling of another phone consultation with Dr. Pinnell to discuss my situation and the cost of a retainer fee.  For some reason, they did not process my phone payment for two days until I prompted them with a voicemail message; the payment was then processed five minutes later.  I never received any response to my email request for the phone consultation, nor any amount required for a retainer.

     Four months passed without hearing anything from the FAA or AirDocs.  My current 3rd Class Medical Certificate remained valid, so I flew as much as I could while I could.  In September I tried requesting a 3rd Class Medical renewal via email, as though I was just any other pilot.  The next day I got a call from Shannon whose initial statement was that they were backed up and she wasn't sure I could be scheduled anytime soon.  I explained the backstory to her and said I was just trying to get a response.  I was willing to schedule an appointment; I was willing to take a phone call.  I just wanted a response, or at the very least the cost for for a retainer.  I asked her to check with Anne; Shannon suggested that I try contacting Anne directly.  I told Shannon that I really wanted her to do it because I wanted to know what kind of reaction she would get from Anne regarding my inquiry.  She said she'd see what she could do and get back to me.

     A week later I got a call from Shannon saying she had a note on her desk that I was seeking a 3rd Class renewal...?  Oh, really?  After picking my jaw up off the floor, I said yeah, um, remember me?  We talked last week and you were supposed to talk to Anne for me.  She finally remembered and said that she never got a response.  I asked, didn't you talk to her in person?  She said no; she'd sent a message to Anne via Skype... which made no sense to me at all.  In any case, she agreed that it was odd that neither of us could get a reply.  She would reach out again and get back to me later that day.
     I never heard from Shannon again.

     In October I investigated the possibility of getting BasicMed and made an appointment with Dr. Mark Richter.  He said that because I didn't want to make him my primary care physician and given the complexities of my situation, I would be better off trying to find out why AirDocs was being so unresponsive.  I called AirDocs and left a message asking once again why they would not respond to my queries.  An hour later I got a call back from a scheduler whose name I missed, but it wasn't Anne or Shannon.  I was told that they could schedule me for the 3rd Class Medical renewal examination on October 23 if I agreed to pay $900.00 for a retainer that day.  I replied that I might not have $900.00 available at the end of the month; would it be possible to schedule a $150 phone call?  I was told that the only option they could provide was to schedule the appointment and pay $900.00 that day.  Dr. Pinnell was apparently not willing to speak to me at all anymore unless he had the money up front.  I was uncomfortable about paying that kind of money without even knowing what my chances were or even knowing what was covered by the retainer.  AirDocs charge $300.00/hr. to work a case; did that mean that my $900.00 only got me three hours of their time, and that it might cost me a great deal more in the long run?  The scheduler explained that they wouldn't have been willing to schedule the appointment if they weren't reasonably certain that I'd be able to renew my certificate.  I agreed to schedule the appointment and if I couldn't afford it or wanted to cancel in advance, I would be able to do so.

     Two weeks later I called AOPA Pilot Services and spoke to the Director of Medical Certification, Gary Crump.  I tried to explain the situation with AirDocs to him; initially he kept interrupting with "Ok, but what do you want us to do?"  After finally hearing my request for his appraisal of the situation he said that if the FAA already has the documentation, then there's no need to talk to Dr. Pinnell at all until I hear from the FAA.  He did suggest that I contact the FAA Great Lakes Regional Flight Surgeon's office and find out if they received the documents.

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Four days later I would embark on a cross country flight  that would change my life forever.
Some of you already know where I was going, what I did and where I find myself now. 
But for now, I will leave you with this teaser photo and continue my tales in Epilogue Part 2.

STAY TUNED!