Hate having to make that visit to the AME to get your medical certificate renewed? Just thank heaven you're dealing with the American authorities, not the Japanese. AVweb regular Ken Cubbin is a 747 flight engineer for JAL. After reading Ken's riotous account of his recent JCAB flight physical, you'll probably feel a whole lot better about your next FAA exam.
August 7, 2000
My least favorite time of year is when I have to do my
Japan Civil Aviation Board (JCAB) physical. As fate would have it, my flight
engineer license expires in early January of each year. The scheduler whom
I'm sure is somehow telepathically connected with my ex-wife (otherwise why
would he be so determined to make my life miserable?) always inserts my
physical exam (PE) right between Thanksgiving and Christmas. Of course, that is
the only time when he can schedule my PE, however, I would rather
not hear logic. It makes the whole experience more tolerable if I can blame him
and my ex for the timing.
So there I sat in the doctor's office, loathing the fact that I had to be
there and wanting the whole episode to be history. What made it worse was that I
hadn't been to this particular doctor before and I was a little apprehensive
about what to expect. It had been my experience in the past that some medical
assistants do not appreciate the fact that the tests they administer actually
determine whether or not we pilots and flight engineers will still be employed
tomorrow. If they do a sloppy job, they can still come to work the next
Those of you with FAA licenses must be wondering what the big deal is about
having a physical. Well, to start with, there are only three or four doctors in
the contiguous United States who are approved by the JCAB to perform pilot and
flight engineer PEs. This means that unless you happen to live in the same city
as one of these doctors, you have to travel a sizable distance just to get to
their office. Secondly, the JCAB PE is rigorous and includes a battery of tests,
including a full blood workup, urine workup (including drug testing),
comprehensive eye examinations, hearing tests, chest X-ray, EKG, psychological
profile, and examination by the doctor. The parameters are stringent and there
are no exceptions.
Western pilots and flight engineers sometimes run into trouble on the JCAB
exams because allowable levels of portions of the blood work are profiled for
Japanese physiology. Japanese adults are generally lighter-framed and their diet
results in lower levels of such parameters as uric acid and glucose level. For
example, the JCAB limit of glucose level in the blood is 110 microglugs per
miliblip (that's a technical term that I don't expect you to understand). If
your test result comes back 111, then you have to retake the blood work if
the level is 115 or so, then you may have to take a glucose tolerance test ...
in Japan! So you are probably getting an idea of why we western pilots and
flight engineers are nervous every time we do our PE.
Each of us has a pet worry a particular parameter that is marginal and
keeps us on the edge of our seat every year. For me, it is cholesterol. I
exercise regularly and choose the foods I eat carefully, but my cholesterol
level is always in the low 200 range (thanks mom and dad no inheritance, just
cruddy DNA). Of course, having to take my PE right after Thanksgiving doesn't
I was ecstatic when I found recent claims that cholesterol levels can be
lowered by ensuring that you keep your body fully hydrated at all times. As a
consequence, in the last 24 hours I had consumed two gallons of water. When I
walked, I swished. Surfs up!
I waited patiently for my appointment ... I waited ... then I waited some
more. Apparently one of the medical assistants at the doctor's office didn't
make it to work that day. As a consequence, I had been sitting in the waiting
room for over an hour. The ample quantity of water I had consumed was making me
want to urinate constantly and I mean, constantly! I had no way of knowing
when I might get called in to start my PE so I couldn't afford to relieve
the pressure in my bladder fully. Therefore, every 15 or 20 minutes, I went into
the bathroom and expelled enough urine to relieve the nagging pressure. As a
result, I had spent over an hour in constant discomfort. What's worse, I think
the guy pretending to read the paper in the corner thought I had a bathroom
Never mind, I had my JCAB PE renewal form to keep my occupied. I went about
answering mandatory questions on the form, such as: Are you presently taking any
drugs? Do you suffer from constant headaches? Do you suffer chest pain? Do you
consume alcohol to excess? Do you suffer from depression? Not until now.
Have you attempted suicide in the last year? Well ... there was that Texas
Chilli I ate a couple of months ago ... it almost killed me ... did that
constitute a suicide attempt?
Really! Do JCAB officials expect anyone to answer "yes" to one of these
questions? Can anyone be that naive?
"Yes, I have these constant headaches that cause my vision to blur. But never
mind ... it is probably related to the fifth of bourbon I drink every day!
To give you an idea of the difference in logic between Japanese and Western
medicine, I cite the following true story that was related to me by an JCAB
approved physician: A hopeful new applicant for a Boeing 747 first officer
position with a major Japanese airline was undertaking his pre-hire physical.
This individual let's call him, John was a marathon runner and superbly
fit. As a consequence, his heart rate was approximately 45 beats per minute.
John's physical was rejected because JCAB parameters dictate that the minimum
heart rate must be 50 beats per minute or greater. The American, JCAB approved
doctor was incredulous! But no amount of pleading for reason on his part would
sway the JCAB medical authorities from rejecting John's physical. The limit is
there in black and white remember, I said there were no exceptions. As
a consequence, John was not hired.
A door opened behind me and every eye in the waiting room turned in
I shuddered. Doesn't anybody understand how to pronounce my name? It's
"Cubbin." There are two Bs, not one! I accompanied the young lady through
into the clinic.
"Hi, I'm Julie ... did you have a nice Thanksgiving?"
I winced. "I have to pee!"
I had no time nor inclination for friendly banter for my bladder was swollen
to the size of ripe melon. It definitely would not have looked good had I
started my PE by wetting my pants. (Clipboard: patient is incontinent).
In the examination room, Julie a convivial young lady handed me a cup
and ushered me into the bathroom. Haven't you got anything bigger? I
thought. The discomfort that had been nagging me for what appeared to be the
entire morning was finally relieved. Ahhhhh... That cholesterol theory better be
After my ablution, I felt considerably more congenial. Julie wanted to start
with the eye exam. I pressed my forehead against the testing apparatus as though
I were a submarine captain looking through a periscope.
"Tell me which line and what letters you can read please." She
What letters? Those squiggly things?
I squinted. I grimaced. "Can you give me a hint?"
"I'm afraid you are going to have to do this by yourself,"
"Well then," I chuckled. "I had better put on my reading glasses hadn't
Julie made a note. (Clipboard: Patient needs Seeing Eye Dog.)
Near and far vision tested, I then went on to pass depth perception and night
vision tests. Then Julie pulled out the test for color blindness. Despite the
fact that one cannot suddenly become color blind it is a congenital condition
the JCAB test requires that every year, each pilot and flight engineer be
tested. I tried not to say anything I really did but finally I had
to point out once again how useless it was to perform a color blindness test
every year. Julie and I commiserated ... and then I took the test. (Clipboard:
patient has to be coerced into cooperating.)
The test for glaucoma is always such a delight. Puff of air into each eye
while peering at a little red light as though it were the answer to the meaning
"Don't blink," instructed Julie. (Lord, I wish she hadn't said that!)
Finally, she managed to assail my eyes between blinks ... one more step
towards conclusion. Gratefully, she decided to conduct the grip test before
performing any other eye tests. That would give my eyes time to stop rolling
around in my head.
The grip test is interesting. You have to grip a handle attached to a
measuring gauge as tightly as you can with each hand. Each hand has to be able
to grip more than 35 pounds and the right hand must be dominant. What's that you
say? You're left handed? Too bad ... as I said, the right hand grip must be
stronger than the left. Another interesting aspect of this test is that, so far
as I've been able to determine, it is no longer required by either the JCAB
or the company ... however, it is still administered. Hmmm.
For peripheral vision testing, a Humphrey's Test is required. This computer
operated device demands yet another forehead pressing exercise into a cradle.
Do they every wash these things? I imagined cooties crawling all around my
forehead. Enough! Stay focused!
With head cradled against frame, one eye covered and the other focused on yet
another little red light maybe the meaning of life does lie there I
proceeded to click a mouse-like device in response to a myriad of flashing
lights appearing in my peripheral vision.
'The Humphrey's Test is designed to last long enough so that your
forehead aches from being squashed against the cootie-infested frame, your arm
aches at having to hold a cover over the eye not being tested, your eye being
tested reddens in sympathy with the little red light, and your back hurts from
the irregular displacement of body and chair. A buzzer signaled the end of the
test for my left eye.
"Done? Let's do the other eye." Julie entered data into the computer,
initiated the test and then left the room.
I finished the other eye, sighed and sat back in the chair with relief.
Just then, another medical assistant passed the door and noticed me sitting
in front of the Humphrey's test machine as though I were a bored guest at a
"Are you done?" She asked as she proceeded to hit keys on the computer data
keyboard. "Let's set you up for the other eye then."
"No!" I tried to warn her. "I've already done both eyes!"
My warning fell on deaf ears. It was too late. I think she knew that she had
done something wrong because she began to beat a hasty retreat. "I really don't
know how to operate this machine," she said as means of explanation for her
error. "You had better wait for Julie to come back."
Julie appeared several minutes later, tried to extract the data from my tests
"Please don't tell me the other assistant deleted my test," I pleaded.
Several moments of ominous silence.
"I think that's exactly what she might have done," Julie replied.
I fumed. "I told her that I had done both eyes. If she doesn't know how to
operate the machine, then maybe she..." I didn't finish, but the implication
hung in the air like a storm cloud. (Clipboard: Patient makes threats to staff
"I'm going to have to talk to her," Julie remarked as she vainly fought with
the computer to relinquish my test data.
"Don't tell me I have to do this test again," I whined.
No answer. After several minutes, she managed to coax the computer into
printing out my test data. Thank God! Another test completed. (Clipboard:
Patient is a whiner.)
"Let's get the hearing test out of the way," said Julie innocently.
I walked into the soundproof booth, sat down and adjusted the headphones so
they were optimally set against each ear. Julie smiled, closed the door and
walked to the control panel. For those who are claustrophobic, a glass panel is
provided to connect the outside world to the inner sanctum of the booth. The
similarity to old quiz shows did not escape my thoughts.
"Now Mr. Cubbin, for $64, 000 ... name that tone!"
Beep-beep-beep ... ... beep-beep-beep ... beep-beep-beep ... beep-beep-beep ... beep-beep-beep.
"Ah, Julie ... would that be 'I Lost my Beep in San Francisco'?"
"I'm sorry." Audience: "Awwww."
"But you don't go away empty handed! You leave with a lovely gift pack of
At long last after trying not to breathe for fear of missing the highest
tones the test was completed. Julie opened the door of the booth and
remarked, "We're done. You've got excellent hearing."
I beamed at her as though she had just remarked how handsome I was. Of course
I've got excellent hearing! In a vain search of more praise, I related to Julie
just how magnificent my booth performance had been.
"I hate doing this test," I said "It is so hard to hear some of the
So hard for everyone else that is (chest expanding), not me, I've got
"Yes, I know what you mean," agreed Julie. "Even breathing seems noisy
"Yeah, and those voices in my head make it extremely difficult!"
Julie smiled, said nothing and wrote something on her clipboard. (Clipboard:
patient hears voices.) Am I already failing the psych test?
Following Julie's instructions, over to Radiology I went, removed my shirt,
received unwanted Gamma rays in my chest area, and returned shortly thereafter
buttoning my sleeves. She ushered me into yet another room.
"Don't button that sleeve yet," she said. "I need to take some blood."
Now I would like to say here and now that "momma didn't raise no
weenie," but the one part of the blood work I don't look forward to is the
changing-of-the-vial ceremony. You know; that's the part where one vial is
removed and another inserted on to the syringe while the needle remains embedded
in your arm? From a patient's point of view, this is where the whole process
comes down to finesse. Julie, sweet as she is, had the finesse of a Mack truck.
As she changed the second vial, she inadvertently pushed the needle deeper into
my arm. It felt as though it had traveled through my arm and embedded into the
table. I recoiled. "Ouch!"
"Sorry," she said. (Clipboard: Patient is a weenie.)
Julie labeled and set my samples aside and dragged over the electronic blood
pressure machine. I knew from past experience that this machine and I just don't
get along! I sat there dutifully as she fitted the cuff to my upper arm. Once
fitted, the cuff expanded automatically far more tightly than when blood
pressure is taken "the old fashioned way" and the digital readout displayed
143/92. Julie wrote the figures down on her clipboard.
"Don't write that down!" I pleaded. "My blood pressure is never
"That's okay," she said. "The doctor can recheck it when he examines you
Upstairs? What was that? The psych test? I don't need to be examined
"upstairs." Nothing wrong there! If all these people would just leave me alone.
(Clipboard: Patient shows signs of paranoia.)
I glared at the blood pressure apparatus and thought of ways of breaking it
into pieces ways that somehow included a certain medical assistant who didn't
know how to extract data from the Humphrey's Test machine (Clipboard: Patient
has an irrational hatred of machines.)
"I'll take you upstairs to the doctor now. We're done down here."
Oh ... upstairs means ... up stairs!
Like a dutiful puppy, I followed Julie up the stairs to the second floor
waiting room. After several minutes, the doctor came to greet me just as Whoopie
Goldberg was about to give a whimsical answer on Hollywood Squares. He looked
like a cross between a professional golfer and a mortician.
Did you have a good 18 holes doc? Yeah, killed them on the ninth
"Hi, I'm Dr. This-won't-hurt-a-bit. Don is going to do your EKG first
and then I'll examine you when he's finished."
"Okay," I agreed prosaically. Approaching the end of my PE ordeal, I would
have agreed to anything just to have the whole process over. Don came
down the hall and escorted me back to an examination room. I removed my shirt
again and dutifully lay down on the table. Immediately, the designer paper
(cootie barrier) began to stick to my bare flesh. Goose flesh, cootie-infested
forehead, and now sticky back.
Fifteen minutes later Don announced that the test was finished. He instructed
me to put on my shirt and go to the office at the end of the hall for my
examination by Dr. Take-it-like-a-man.
I knocked on the office door and the doctor beckoned me to enter. "Take of
all your clothes except your shorts and you socks," he commanded while shutting
I thought. Okay ... I'll take off my darn shirt ... again! Can't anyone
organize these tests to be done in the same darn office! What's this? The third
time I've had to disrobe? (Clipboard: patient might need to take
Dr. Boy-are-you-gonna-get-it proceeded to listen, prod, feel and
hammer his way through all the routine physical examination requirements. As far
as I could tell, everything seemed to be in the right place and responding to
"Your blood pressure seems a little high," he said while reading off Julie's
test results from the clipboard. "Let's check it again."
"Are you under any stress?" he asked as he wrapped the cuff around my upper
Now let me see ... I have just relocated in North Carolina from Las Vegas; my
car (which I had transported by truck) is somewhere in Wisconsin; half of my
belongings is in storage and the other half is strewn in disarray around our
apartment; I had to wait an hour for my PE to begin; I haven't eaten for 18
hours, I've had to disrobe three times, Julie stuck me and it hurt, and I need
to pee like a racehorse! No ... nothing bothering me doc!
"Well," I remarked casually. "I just moved to a new house, so I guess I'm a
The doctor nodded. "Just relax your arm and think pleasant thoughts."
Like being out of here?
Test done, Dr. Atta-boy announced, "120/78 ... normal."
Only then did I relax. "Those electronic machines always seem to
display my blood pressure higher than it actually is," I said. "Are they
This coming from a flight engineer! Can't trust those rascally machines you
Hey! Give me a break! Maybe if theyt had wings, I'd trust them a little
"Sometimes people get a little tense during the test, " explained the doctor.
"It's very important that your arm and shoulder be totally relaxed when the test
Well, there you go! I've only been doing this &&** test for 25
**&^ years and now they tell me to relax my **&&^^%$ arm! What is
this? A national secret? .
For the psych test, the doctor asked me if I was getting enough sleep
(Doesn't he know what I do for a living?), whether I drink to excess
(Can't doc! Keep falling off the bar stool! Ha!), and whether my marital
relationship is sound (Now let me see? That's the woman I see occasionally
for a few days a month isn't it? What's her name again?).
Finally, he asked me how I would describe myself. Homicidal maniac doc!
Just can't wait to carve the turkey if you get my drift! Do you think I could
dress up in a tutu first? Would that be strange?
I stumble for words. "Honest," I said. "Hard working ... friendly ...
He nodded and wrote on the clipboard. Psych test done normal. Now let's
test that attribute of agreeability you claim to have Mr. Cubbin.
Dr. this-is-the-time-you-hate-the-most walked over to a cabinet and
reached for a latex glove.
Without having to be told, I began to pull down my shorts. Dr.
I'll-do-what-the-hell-I-please walked over, casually grabbed me by my
goonads and instructed me to turn my head and cough. I did as instructed.
What the hell does this check anyway? I thought to myself. Is my neck
somehow connected to this most precious part of my body? No, that can't
be it; I bet it's just Dr. Do-as-I-say-or-else's way of demonstrating his
absolute power over me. With a squeeze he could make me give him the world! What
do you want doc? My 401k portfolio? You got it! Just let go ... please.
I would have asked the doctor about the test, however, it's hard to verbalize
thoughts while feeling so vulnerable. Besides, I'll probably need my 401k
Every guy in the world knows what comes next.
Perversely, I have come to look forward to this portion of my physical ... it
signals the end ... no pun intended.
"Bend over and lay your head on the table."
Such a sweet talker!
Though I have tried various methods over the years, sadly it is impossible to
maintain any dignity whatsoever with your naked butt exposed for onslaught.
Therefore, I have concluded that the best course of action is to cooperate and
get it over as quickly as possible. I complied with Dr.
I-hate-this-as-much-as-you-do's request, took a deep breath and braced for
"Relax," he said.
Is he crazy? How can I relax when ... uummph ...
Done! I couldn't help thinking how symbolic this last gesture was to my whole
PE renewal experience.
"You're done," says Dr. Come-back-and-see-me-next-year. "Everything
I thanked him ... for what I don't know ... and began to get dressed. I was
now verified fit to fly for another year. (Actually, I have to do a company
physical in the interim sixth month, but it is not quite as rigorous ... meaning
no "finger wave.")
Fully clothed, but somewhat disheveled, I shook the doctor's hand and wished
him a joyous holiday season. I'm outa here buddy! "See you next year
doc," I said as I left his office.
Free at last! Free at last! I was so eager to depart the clinic that I didn't
even stop to relieve the pressure in my bladder. I just paid my bill and got the
hell out of there.
As I walked back from the clinic I was jubilant at having completed my PE.
That wasn't so bad. Those medical assistants were very pleasant. Doctor
It's-over-now seemed very professional and competent. I think I'll come back
here next year. Yeah ... it was okay.
I have flown for JAL for over ten years and it has been a very enjoyable
experience. Therefore, if you are thinking of applying for a pilot of flight
engineer's position, I would urge you to do so. Don't let my little tirade of
irrationality sway you from pursuing a career goal I'm sure you would enjoy. As
you may have guessed, I was having a bad day when I took my PE ... and I am
ever-so-slightly prone to exaggeration.
A JCAB PE may be a little more stringent than an FAA physical, however, when
you pass a JCAB PE you can be confident your health is exemplary. You might get
run over by a Mack truck (or Julie's car), but at least you would die healthy.
When it comes to your next physical, I hope you can conduct yourself with as
much decorum and professionalism as I did.