Physical Duress

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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.

Aviation MedicineMy 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 day.

Cultural Differences

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 help!

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 fetish!


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! Hiccup."

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.

My Turn, At Last ...

A door opened behind me and every eye in the waiting room turned in anticipation.

"Kenneth Coobin."

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 right!

Eye Test

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 instructed.

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 I?"

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 of life.

"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. Done!

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 party.

"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 and frowned.

"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 members.)

"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.)

Hearing Test

"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 tongue depressors!

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 higher tones."

So hard for everyone else that is (chest expanding), not me, I've got excellent hearing!

"Yes, I know what you mean," agreed Julie. "Even breathing seems noisy doesn't it?"

"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?

X-Ray and Blood Work

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 high."

"That's okay," she said. "The doctor can recheck it when he examines you upstairs."

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.)

Seeing the Doc

"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 green!

"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 the door.

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 Prozac.)

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 appropriate stimuli.

White Coat Syndrome

"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 arm.

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 little tense."

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 accurate?"

This coming from a flight engineer! Can't trust those rascally machines you know.

Hey! Give me a break! Maybe if theyt had wings, I'd trust them a little more.

"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 is taken."

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? .

Psych Test

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 ... agreeable"

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.

And the Grand Finale ...

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 portfolio.

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 impact.

"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 was fine."

I'm Outta Here!

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.

Good luck!