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Superman Never Asks for Help…But He Should

Hunkered down here in my self-quarantined, biologically safe space, I find myself working on another very sad anniversary article.

This night eight years ago was the incredibly sad death of Junior Seau; it was May 2nd, 2012. With all the understandable concerns and focus on our current coronavirus pandemic, the terrible event of Junior’s death has passed almost unnoticed. Junior was one of the uniquely good people in public life and professional sports. He was a star in the NFL for an incredible 20 years and was a Pro Bowl linebacker for 12 of those seasons. I was privileged to see Junior often as a season ticket holder at what was then called “The Murph,” San Diego’s Jack Murphy Stadium, where the Chargers used to play their home games (before they ditched us and moved to LA). I’d also see his smile light up the entire room at his restaurant in Mission Valley that was not far from the hospital where my practice was based. He devoted his enormous energies during his playing career, and afterwards for his short retirement, to helping kids combat drug addiction and succeed in spite of tough financial and home environments. Unfortunately, Junior did not devote the same energy to his own psychological health and suffered in silence with a number of personal demons. Junior was only 43 and less than two years out of his playing career when he committed suicide by shooting himself in the chest and leaving a note donating his brain to science.

At autopsy, examination of Junior’s brain showed he suffered from CTE, chronic traumatic encephalopathy, which was likely incurred from repeated concussions. It’s the same diagnosis suffered by Dave Duerson, an honors graduate from Notre Dame and like Junior, a Pro Bowl NFL defensive linebacker. Dave committed suicide the year before Junior, also with a self-inflicted chest injury to preserve his brain for examination. CTE is a chronic and insidious brain injury that’s mostly found in athletes, military veterans, and others who suffer from a history of repetitive blunt head trauma. Neurologists pretty much agree that these types of repeated, even minor, head injuries can trigger progressive degeneration of the brain that’s probably related to a build-up of an abnormal chemical called tau protein. The end result of this is memory loss, confusion, impaired judgment, impulse control problems, aggression, severe depression, Parkinson’s disease, and worsening dementia. Symptoms can begin years or even decades after the last brain injury or sometimes very soon after ending an active athletic career. Unfortunately, as it stands now, CTE can only be diagnosed after death. It’s a horribly debilitating condition that few understand, and that lack of information makes it hard for sufferers to recognize it even in themselves or get much help with treatment.

Throughout his stellar two-decade NFL career, the press and his adoring fans held Junior up as a superhero who was totally invincible. He was impervious to the incredible traumas of NFL football, including multiple concussions, and viewed any injury as a mere inconvenience that he routinely played through. He didn’t miss as much as a training session, let alone a game, for injuries that would have sidelined lots of other NFL players for weeks. “It’s all about the respect that you can only earn on the field…it’s about courage,” he said to San Diego Charger trainer James Collins during many painful treatments. So when the insidious beginnings of CTE set in they were totally unseen. As the months following his retirement unfolded and the demons in Junior’s head started shouting louder, the toughness that made him famous also made it impossible for him to even consider asking for help. As Peter King wrote in his Sports Illustrated eulogy, “He was Superman and Superman never asks for help.”

Junior shared a lot of personal attributes with those of us in my two worlds of surgery and aviation. Both worlds require a profound inner drive, self-demand for perfection, unlimited energy, and a willingness to take on incredible personal challenges. For aviators, the FAA has developed some metrics for self-regulation, assessment, and internal guidance. Unfortunately, not a lot of this yet exists in healthcare. We’ve talked about many of these topics before in the article on “Who Will Guard the Guardians” a while back. It’s a really important topic that we need to revisit in a little more detail. Surgeons make all types of decisions daily regarding whether or not to operate on a patient. We call it balancing risks vs. benefits and we routinely discuss this in detail with our patients and their families when we advise the patient on possible surgery. But exactly where in this equation do we take into account our own current state of fitness? Pilots are probably a little more in tune with our inner clocks and certainly encouraged to make our own fitness to fly part of the go or no-go decision. It’s exactly the same balance act surgeons carry out, but this involves our own safety and that of our passengers.

The profound negative impact of fatigue is one of the most critical factors on safety and we have talked about that in detail in several previous posts in this space. The AOPA and the FAA have promoted a number of self-awareness programs for pilots. One well-known personal flight fitness and safety checklist is well described in the AOPA archives and goes by the acronym “I’M SAFE.” This challenges pilots to assess his or her own personal fitness that might negatively impact their capability to safely fly the mission at that time and in that weather environment and that route. The letters stand for:

     I – Illness: Do I have an illness or any symptoms of illness?

     M – Medication: Have I been taking prescription or over-the-counter drugs?

S – Stress: Am I under psychological pressure from the job? Worried about financial matters, health problems, or family discord?

A – Alcohol: Have I been drinking within eight hours? Within 24 hours?

F – Fatigue: Am I tired and not adequately rested?

     E – Eating: Am I adequately nourished?

These are the questions that we need to ask ourselves to make as objective assessment as we can regarding our own personal fitness to fly a complex or demanding flight. As a matter of fact, the idea of a personal and honest self-assessment is a very important safety skill for lots of risky endeavors we might do, like a long drive or using dangerous shop or gardening equipment. Are you tired or stressed out? Is this a flight you rarely do? Did you take some cold medication and have a fuzzy head? Or maybe still a little tired from a party last night where you had a few cocktails? Truly self-assessing our ability to make the flight might mean finding another pilot to go along in the right seat. Can you go tomorrow instead of today? The takeaway from all this and from Junior’s tragedy is that we must never be afraid or too proud to examine our own inner personal health and safety and ask for help if there is any doubt that we need it.

There is no doubt that the corona virus threat has changed our way of life in many ways. We have been under stress that few of us have experienced or understood how to deal with. It has also changed our own individual flying habits. Many of us haven’t flown as many hours lately and may feel pushed to get back in the cockpit. The corona virus itself and the international response to the disease has without a doubt added risks to all of our lives that weren’t there just a few short months ago. Even though we are supermen and superwomen, sometimes even Superman needs to ask for help. Do a really thorough self-assessment of your current fitness to fly before you get back up in the sky, and seek help if you need it. Junior would still be alive today, smiling his beaming smile, enjoying his kids and helping hundreds of others with his good deeds, if he had only been able to tell someone of the inner demons and dire struggles he faced and that he needed help to fend them off.

Kenneth Stahl, MD, FACS

Kenneth Stahl, MD, FACS is an expert in adapting principles of aviation safety to the healthcare industry for patient safety. He also writes and teaches pilot safety principles and error avoidance. He is triple board-certified in cardiac surgery, trauma surgery, surgical critical care and general surgery and holds an active ATP certification and a 20-year member of the AOPA. Dr. Stahl practices surgery full-time and is Healthcare Division President for Convergent Performance, an industry leader in teamwork, checklist and accountability training and consulting. He can be reached at [email protected]

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