EPISODE 28
Flying My Helicopter to Surgery
Episode Transcript
Dr. Randy Lehman [00:00:11]: Welcome to the Rural American Surgeon. I'm your host, Dr. Randy Lehman, a general surgeon from Indiana. This show is tailored around the nuts and bolts of rural general surgery practice. You'll find topics such as practical surgical tips, rural lifestyle finance, training, practice models, and more. We have a segment called Classic Rural Surgery Stories, where you'll get a feel for how practice in the country differs from the city. If rural surgery is your passion, this show is for you. So now that the Chloraprep has dried, let's make our incision.
Dr. Randy Lehman [00:00:42]: Welcome back to the Rural American Surgeon. I'm your host, Dr. Randy Lehman. Today, I'm going to be talking to you about one of the most favored tools that I use to serve rural hospitals and perform rural surgery: my helicopter. I've been encouraged to record a podcast about this because there've been some episodes alluding to the use of the helicopter, and it's a somewhat unusual thing. So I figured I'd record an episode for you guys today on that topic.
Dr. Randy Lehman [00:01:12]: Currently, I've described my practice. I'm covering basically three small rural hospitals all around my town and then one that's in my town. The geography of that becomes a little bit challenging. I'm living in Northwest Indiana. There are windmills in my area, but the land has generally flat topography. I moved back to the family farm, the farm I grew up on, which has plenty of space.
Dr. Randy Lehman [00:01:43]: We have a county airport that's about a ten-minute drive from my house, about a three-minute flight from my house. My family got into aviation when it was basically my grandfather's passion. My grandpa, who I'm very close to, is 95; we still talk regularly. He's been one of my biggest mentors in life. He was essentially always interested in flying, but when he was younger, he told me he took a lesson and it was $5, and he just couldn't afford to keep it up.
Dr. Randy Lehman [00:02:13]: So the $5 lesson was it. He waited until his retirement, and in his retirement, he ended up purchasing a small airplane. He took lessons from a local instructor who was also his cousin. They flew a bunch together on his cousin's grass strip. Eventually, he got his license and flew that Cessna 172 airplane to every public use airport in the state of Indiana at the time. He flew to Meigs Field in Chicago before it was tragically closed down by Mayor Daley.
Dr. Randy Lehman [00:02:44]: If you haven't heard that story, I would recommend that you watch a documentary called One Six Right. We're having a lot of issues losing rural hospitals in the United States: over 100 closures in the last decade. A lot of these hospitals are not having surgery. That's what we talk about a lot of times. But we're also losing a lot of small general aviation airports. Basically, what happened with Meigs Field is, you know, there are people that are anti-aviation for different reasons.
Dr. Randy Lehman [00:03:14]: Right now, we're currently going through what I think is a big publicity thing. I don't really understand what's going on, but airplane crashes are making the news. I don't know if they're necessarily happening at a higher rate right now. I don't think they probably are; I think the rates are probably stable. It's just that everyone's awareness and sensitivity are heightened. But there are always some people against it, and the noise is one reason.
Dr. Randy Lehman [00:03:45]: Meigs Field was an airfield outside of Chicago, essentially on a peninsula near the Shedd Aquarium and the Bears stadium, where it juts out into Lake Michigan. Basically, what happened is Mayor Daley came out in the middle of the night. The universal sign for a closed runway is to put an X. Normally, if the runway is getting maintenance, they'll put an X. If it's permanently closed, they'll paint a big X, but if it's temporarily closed, they'll put lighted X's out on the end of the runway.
Dr. Randy Lehman [00:04:15]: He came out in the middle of the night with bulldozers and bulldozed two-foot-deep X's at the end of each runway, and no airplane ever landed at Meigs Field again. All the aircraft that were on the field, some 60 airplanes, had to depart on the taxiway, and that was it. I don't know, it's very criminal. It seems sneaky, wrong, and frustrating. I've said multiple times that there are lots of wrongs in the world, and if I could wave my magic wand and right one of the wrongs in the world, I don't know if it would be anything about rural surgery, except to restore Meigs Field.
Dr. Randy Lehman [00:05:16]: So that'll all said a little tongue in cheek. Obviously, there are a lot bigger problems than that, but it's very frustrating that that field shut down. Anyway, I'm telling you about my grandfather, right? In his retirement, he then managed two small airports, in Rensselaer first and then Kentland in towns around where I grew up. When I was in grade school, that's when he started doing that. I remember getting picked up at school by him.
Dr. Randy Lehman [00:05:46]: I'd go out there, watch Arthur and the Magic School Bus, and whatever. I remember going out there and watching Michael Jordan in the '90s with him and Grandma and getting KFC pot pies. These little things that you remember are just good memories that are probably part of the reason why, for me, I wanted to come back to the place that raised me, you know, where I had a good childhood. I wanted to come back to the place that felt like home. My dad ended up getting his license to fly with my grandpa. This is fixed-wing aircraft.
Dr. Randy Lehman [00:06:17]: I grew up all around it and always kind of had an intention of getting my pilot's license, but I never really knew when. I remember as young as 18 being in Haiti and talking about having a helicopter one day. At that time, I was thinking of having it in Haiti because who wants to drive up and down these roads? Like maybe being some sort of missionary surgeon in Haiti and being able to fly around. At this moment, Haiti's in really bad shape. I've heard some terrible stories. A friend of mine flew recently into Haiti and delivered some supplies on a six-helicopter team.
Dr. Randy Lehman [00:06:47]: You can't fly to Haiti right now in a fixed-wing aircraft. The gangs control all of the airports, and unless you're… First off, it's super unsafe. Secondly, unless there are massive bribes or something, you might just get killed and your aircraft might be destroyed. You can't get in by airplane. They flew in on these six military-grade helicopters with essentially SWAT team, SEAL Team Six type guys, bodyguards. They went to these orphanages.
Dr. Randy Lehman [00:07:18]: These had been supported by this essentially philanthropic family and my friend's nurse practitioner. She was part of this team doing this delivery. It was under cover of night. They were there for less than 24 hours, all scared for their lives. She knew a lot of the people working in this area, and the missionaries running the orphanages that they were delivering supplies to. She said it was just different. The fear in their eyes made them feel like they're probably going to die there. There have been orphanages where the gangs have come in and just killed all the kids. It's tragic and seems like there's no solution. I mean, when it's right in front of you... Long story short, now's not the time to take a helicopter to Haiti. I've been doing missions to another impoverished nation, which is Honduras. I think that's the fourth poorest country in the Western Hemisphere, I heard recently. We were there recently, a month ago, and we went out into the town. Yeah, there's a lot of, you know, kind of like mud hut-type things with dirt floors or concrete block houses. People are living without electricity, without running water, and basic necessities, which make regular old life super difficult. So I guess I have to pivot with my overall strategy. But anyway, my point of saying that is to convey that as soon as I was 18 years old, I was very interested in aviation and having a helicopter. But, you know, I was a planner and wanted to do things in a logical, stepwise fashion, to ensure I didn't overreach. I wanted to become financially independent and let my passive income pay for life's more expensive things. I moved away from that and got my fixed-wing aircraft license starting as a fourth-year medical student. On a psychiatry rotation, what better do you have to do besides flight training? So I started that, but I didn't quite finish it then. I got busy with interviews and things, but I eventually completed it during the summer between my fourth year of medical school and my intern year of residency. I had about a six-week block of time there to finish it up. At that point, I think I was around 26. Then, later in residency, I was able to use my grandpa's airplane to fly back and forth between Rochester, Minnesota, and home in Rensselaer, Indiana, which would normally be about an eight-hour drive through Chicago. Going up I-65 through Chicago, and then kind of go north, then west, then north again. Grandpa's airplane is not very fast; it goes 105 knots, which is roughly 121 miles an hour. But it's not the speed; it's the fact that you can just fly direct, cutting off Chicago, all that traffic, and just fly in a straight line. So basically, for that airplane, saving you time depends on what your mission is. Where are you trying to fly to? Generally, a good mission for an aircraft is reaching a destination nonstop. Once you have to stop for fuel, it becomes tough, especially with my grandpa's airplane. If you've got a direct interstate between two points, it's going to be hard for the airplane to beat the interstate, but sometimes it can. If you have bad roads, requiring more miles than the crow flies, the airplane can shine. So, realistically, what did it amount to? The cost of flying my grandpa's airplane, historically, has always been about $100 per hour. But now it's probably like $130. Then, there's the cost of driving a car, right? When we flew, it took around three-and-a-half hours of flight time, maybe three hours and 15 minutes. It actually costs more than driving, but not much more—not twice as much, maybe like 1.4 times more. It depends on what you're driving, obviously, but I was using government mileage rates and things. There are unique circumstances where flying can be more efficient. When you're a resident, time is at a premium. You only have a couple of weekends off per month, from 6 PM on Friday until early the next week. To get home, sleep, and spend time with family was really worth it for us. I ended up getting my instrument rating while I was up there, and my wife got her license while we were in residency. Now, I've been flying fixed-wing for over 10 years. It's become a part of our life that we really love. The main thing I like is getting up there and the perspective it gives you. It's kind of like, you know, frozen. It's funny how some distance makes everything feel small. That's how it is when you get up in an airplane, far away from everything. I flew over my dad's town of 900 people. His stepbrothers, after my mom passed away and my dad remarried, were essentially my brothers. His wife, whose husband died of brain cancer, had these four little boys. My dad basically started over again with a new family, which is great because he's a wonderful dad. Now I have brothers that are 18 to 22 years younger than me. I flew them over their little town. You know how it is in small-town America: peeling paint, stuff sitting in the yards, broken glass. We flew over the town, and they said, "Wow, Wolcott looks like a pretty nice town." It's funny how some distance makes everything feel small, and you can see the beauty. Coming into a community by plane gives you a different perspective of the people you're there to serve. You can see the infrastructure, which you don't truly appreciate from the ground. The train tracks, for instance, bump across them or wait for a train, and you're annoyed. From above, you see how much thought, time, and effort went into laying those tracks. It's like we stand on the shoulders of giants in surgery, but also in the world, particularly in the United States, designed by smart, intentional people who set up a great government. It was like an untapped, natural potential and breadbasket of the world, leading to this incredible country like never before. Even coming into rural America, you see those little elements at work—the old courthouse, businesses around, and the school—all right there. It's like a snapshot of the whole community. Speaking of long-term goals, I once had a dream to own a Cirrus SR22 and eventually a Vision Jet over a decade ago, when I was a medical student. I remember the Vision Jet coming out, being in Christ Hospital, looking at it on one of the hospital computers in Cincinnati, thinking, "That's my jet someday." I don't have a Vision Jet yet, but I did sit in one in December for the first time. I will have one; it's just a matter of time. You've got to find the right mission for it. Fast forward to now, I actually fly three aircraft. The first one is I now own my grandfather's old Cessna 172. And this is the plane that he soloed in, my dad soloed in, I soloed in, and my wife soloed in. It's very sentimental, yet it's still functional. We've flown it in instrument conditions; it's instrument rated. Because it's one of the most inexpensive and efficient aircraft, it's still relevant and can be used for certain trips.
Dr. Randy Lehman [00:16:29]: Everybody always asks me, "Oh, what's gas in the plane? What's gas in the helicopter?" That is a frustrating question to me because it means people are basically driving and thinking about the cost of gas in their car, not realizing all the other costs of their vehicle. Certainly, in an airplane and in a car, gas is about half of your expense. To answer your question, avgas, which is 100-octane gasoline—also called 100 low lead—actually still contains lead. We haven't been comfortable letting that out of the gasoline we use in aircraft because of the wear and tear on the engine. It basically makes the engine run smoother. You have 100 low lead gasoline or jet fuel, which is kerosene. Jet engines obviously run on jet fuel, and piston engines run on avgas. I use avgas in all three of the aircraft. At my airport, which is usually one of the cheapest ones around, it's been running around five bucks a gallon, maybe a little bit more. Of course, if you go to a bigger airport, you'll pay a lot more, especially if you're getting full service. But that's a very small part of it because the part about the helicopter that's different from the plane is there are lots of lifetime-limited parts on the helicopter. What I mean by that is you always have an engine overhaul in every airplane. Airplanes are designed to be able to just indefinitely function. They're not just going to be scrapped out because they'll always have a whole value since you can just replace the parts. That's how they're designed. But it costs a lot of money to maintain them and keep them airworthy. If you buy an airplane and don't fly it, it doesn't really lose a lot of value because there's not much that has to be maintained if you're not flying it much. Things don't break, and it all stays pretty new, as long as you're keeping it enclosed and covered.
Dr. Randy Lehman [00:19:06]: The helicopter is different because on the helicopter I fly, which is a Robinson R44, it has a bunch of time-limited parts. For example, the blades—every 12 years they have to be thrown away. Whether you flew a single hour or not, at the end of 12 years, those blades are getting taken off and replaced, and that's about $75,000. You also have an engine overhaul. The other limitation is some parts are limited to 2,200 hours, and your engine overhaul is 2,200 hours. Most people try to time the use of their aircraft so they time out at approximately the same time as things age out. If you can fly around 150 hours per year, then you'll time out around the same time that you'll age out, which conveniently works out to about how much I'm flying my helicopter. The interesting part about the helicopter is your time counts when your collective is up, and most of my flights now are quite short. The mission for the helicopter, the point, is you can take off and land directly on site, fly straight there, but it's not as efficient, especially in terms of gas. In overall cost, it's not as efficient as the plane. The performance-wise of my helicopter is around 650 pounds of payload, which is almost exactly what the Cessna 172 is. It cruises at 109 knots, which is about 125 miles an hour, whereas the plane cruises at 105. So about exactly the same speed. The plane, historically, costs about $100 an hour, maybe it's $130 now. The helicopter is about $400 an hour. The reason for that is it burns 16 gallons an hour of gas, instead of eight. It also has a 300-horse engine and is much less efficient to fly because it's not flying based on the principles of lift of this big wing. It's basically a machine that beats the air into submission. That's what I've heard. So you have blades designed like a wing, and they're spinning like that. But it requires much more power to get lift than an airplane does, which is like a glider with a prop in the front. About half of that $400 an hour, though, is the 12 years down the road budget for this big overhaul that's going to happen. You have to budget for it because it's a real expense. The thing is, the helicopter's value doesn't just stay static. As you approach that overhaul, costing about $250,000 total, most people don't do it. They just get rid of their helicopter and buy another one. There are businesses that will buy those helicopters, fix them up, make money off them, and then sell them. The value of the helicopters goes down, maybe it's $110,000 hull value. After the overhaul, it's worth like $400,000. They could just sell it, and someone else would rather not sit around with no helicopter; they just sell that helicopter and buy another one. That's probably the most common way it's done. So why a helicopter and not a plane then? Well, like I said, the plane, my grandpa's plane, for example, is perfect for a mission like a drive from Rensselaer, Indiana, to Rochester, Minnesota. It's like an eight-hour drive that gets converted into a three-hour and 15-minute flight. You can take advantage of the winds; if the winds are usually out of the Northwest, as you go higher, you fly home high, fly low there, and you can actually beat your average cruise speed just on average. Sometimes you'll have a headwind. But the helicopter would not be a good choice because it wouldn't be any faster, you'd probably have to stop once for fuel, and it would cost you four times as much, so there's no reason. You'd have the same payload, but I can't take off from my house yet with the airplane, and I can't land direct at the hospital with my airplane. I can land at a nearby airport, and I do that at one place. I land my helicopter at a nearby airport, keep a car there, and then drive to one of the hospitals where I work. It's the closest one to my house. I own the clinic across the street, and I just land right on my own property. The rules are you can land on private property as long as you have permission, or if you own the land, as long as there's no other rule against it. I talked to the police before I started landing in Rensselaer, and it's in the city limits. I asked, "Are there any rules, you know, that I can't land here?" And they said, no, there's no rules that you can't land a helicopter in town as long as it's on your own property, that's fine. The only thing we would say is there's a noise ordinance, and so you can't. We would appreciate if you didn't, like, joyride at night, you know, off of your property, because that would break our noise ordinance. But at the same time, they said, but if there's a surgical emergency and there's a thing that like a person needs to be taken care of, please feel free to break the noise ordinance and come on in. As a surgeon, if you need to use the helicopter for one reason or another, it's just like, don't give rides, you know, at 10 o'clock at night. Which I think all that's very reasonable. And mostly I've gotten a lot of positive feedback and positive interest from the helicopter. But, you know, there's been a couple people. That one neighbor in particular that I had a bit of a. She. We had a conversation, and she was very upset in general but also not willing to actually engage and have a conversation back and forth. It was a highly emotional interaction. I feel bad about that, but what are you going to do? It's what would basically a reasonable person know, normally say. And then two other places that I go to. One is 45 minutes from my house, one would be an hour and five minutes from my house, and that turns into a 15-minute or an 18-minute helicopter flight for me. The main reason is that there's not a direct fast road for me to get to either of those places from my house. And so I'm cutting out a lot of twists and turns in addition to going faster. And the other cool thing that I have going on right now is my kids go to a private school, and it's basically like almost a one-room schoolhouse out in the middle of a country. I mean, there are other classrooms, but I mean totally there. I think there's 40 kids that go to the school, and I like. This morning my assistant scribe came over to my house, we loaded up my two kids, I flew and I timed it, and it was seven minutes from takeoff to landing, which would be normally about a 25-minute drive. Dropped my kids off in the backyard of their school, which everyone is cool with there. And I'm out in the middle of nowhere. There's nothing around besides cornfields. It's super convenient for me. It's on my way to basically anywhere because it's only seven minutes, so how could it not be on my way, but dropped them off and then kept flying to the hospital that would be 45 minutes from my house, but that was only about another six-minute flight from dropping my kids off. It's a connection with them. It's just part of my everyday life. I mean, it's not even really something that I think about, but I realized that it's not a normal thing for other people. That's why I'm throwing this podcast out there. My goal when I came out of residency was I was going to buy a faster plane than my grandpa's plane. But then after I was out for about a year or so, I realized actually how much more practical a helicopter would be for everyday life for me. And so then in 2022, I obtained my helicopter license when I was practicing as a general surgeon living back in Indiana. I did it in just 54 days, which is quite intense and efficient. For example, my dad took three years to get his airplane license, right? But that's because there were multiple fits and starts when you already have your airplane license and then you're getting your helicopter or vice versa. Instead of the 40 hours of training, it's only 30 hours of training because there's a lot of overlap. For example, weather, communication, airport patterns, those things are all the same. I got my helicopter license with Gary Cleveland, who is, I have trained with probably a dozen different instructors through all of my aviation experience so far, doing different biennial flight reviews and check-offs and things like that. Gary's the best. I mean, he is awesome with Cleveland Helicopters out of Plymouth, Indiana. If you are interested in getting your helicopter license, maybe fly in and fly with this guy because he's a retired police officer. He's just an incredible human being, and his goal is to teach you how to fly. Unfortunately, a lot of flight instructors, their goal is to build time for their commercial career, especially airplane flight instructors. And so that's why it's important that his goal is to teach you to fly. Because we did it in 30 hours, and he was happy and proud of that fact. In the last couple of hours, we were just burning time because I had already learned everything, and we were both very comfortable for me to go take my exam. He's just been a wonderful resource for me, and he loves flying, and he's got over 3,000 hours helicopter flight time. So I can't say enough about that guy. Mostly if you're considering any kind of aviation certificate, like a pilot's license too, make sure you know before you start what exactly you need to do to get your license. Because what will happen is I think your instructor will say, yeah, let's go, let's, what do you want to do today? And you're like, well, let's go practice takeoffs and landings. Because who doesn't want to do that? And they'll say, okay, let's do it. Then they go out and fly. But you didn't actually make any progress towards your goal because there's actually these other things that you need to be checking off, and you can always go practice takeoffs and landings, you know. But nonetheless, let's talk about the efficiency of the helicopter. So now with my helicopter, I can land at my house, at my dad's house, at both sets of my grandparents' houses, in two different towns. So if I need to get to anywhere in those towns, I've got like people around that I can land and use their car and go somewhere. One in Francisville, I land at my grandma's house, and she lets me take her golf cart over to do clinic. I can land at my clinic in Rensselaer, direct on site, walk across the street to the Jasper County Hospital. I can land direct at the Monticello hospital, I can land direct at the Williamsport Hospital in different areas where they have plenty of space. One place I land directly on the helipad, throw the wheels on, drag it off to the side. The other I land in the back. They've got a lot of space there. I can also go to Vertiport Chicago. So Chicago put in a helicopter airport, and there's four landing pads. When I was a resident, I took Brittany, my wife, I think it was Valentine's Day or something like that. An eight-minute tour of Chicago, 79 bucks or something like that, I don't remember per person, and loved it. It was a Robinson R44, and we both loved it. She sat in the front and she flew, and we both were like, we need one of these. And then I had this sort of surreal experience, you know, a couple years ago or I don't know, a year or so ago whenever I went in there the first time. And I just flew in and landed my own Robinson R44. And that was probably in, I'm betting it was 19. And in a period of four years, you know how different things can be and the power of setting goals and having a plan, practically knocking things out and going after it. You know, you can really set, do anything that you set your mind to. You just have to imagine it and then break it down into steps and have a plan and do it. I can fly into there. I can also fly into Midway and Indianapolis International Airport. And basically by doing this, it takes me about maybe 35 minutes to get to Midway or Indy International, either one. And that's as long as it would take somebody from the suburbs to get there. So I'm just as connected, living in rural Indiana with my closest neighbor being an eighth of a mile away, my wife's grandma, and the real closest neighbor a quarter mile away. You know, I'm just as connected to the rest of the world as someone who lives in the city. I mean, I could be on a flight to London whenever I wanted to. I also regularly use this to go pick up travelers. And I wanted to talk about one memorable flight story recently. Let's see, this was last summer. I have a friend from Minnesota who is a go-getter and has a busy life with a lot of stress that came out of that. He's got an insane story; he really swung big and then, just, you know, more money, more problems kind of situation. Great guy, but I think he's just buzzing, you know, on a daily basis with not just busyness but stress. Anyway, I flew into Midway to pick him up. He flew in from Minnesota with his fiancée, and I picked both of them up in the helicopter and flew back to my farm. It's like, get off your jet, take an Uber around to the general aviation side of Midway. I meet you there. It's still kind of busy; it's still kind of the city, right? We go get in the helicopter. Now it's much more intimate, right? It's not a commercial jet. We take off, you fly out, and you see under you the city sprawling out. You're not so high like a jet with a tiny window. You have the big bubble windows, and you can see everything. It's just rows and rows of people and houses one after the other. Then the houses start to space out, and you start to see fields and farmlands. You see how big Lake Michigan is and the space it occupies. Chicago starts to melt away, and rural America comes into view. This is all happening over about half an hour. You see the water tower painted in a Holstein cow pattern, and you start to see barns, livestock, and space. There's just not a lot to occupy your mind. It's not so overwhelming to me as flying over rows after rows and wondering what all those people are doing and why they want to live like that, where you can throw a rock and hit your neighbor's house. Then we landed, and there’s a cool-down process of a couple of minutes on the helicopter. So it gets slowly quiet, and we're having a conversation about what's the point of life. Then we walk out to the barn where Brittany's there. My kids aren't, so that helps with the peace, right? We took a side-by-side ride through the pasture around the cows, went and parked, and ended up at my house, just quiet. Brittany had some piano hymns playing on Alexa or something. We sat down in my living room, and it was just quiet. My buddy visibly changed. He said, "This is peace that I haven't experienced. It's so peaceful here." It was this progressive, probably six-hour experience for him; five hours, going from his busy life in the city to flying to Chicago, helicopter out of Chicago, into Indiana, watching it all melt away—the noise melting away, going out in nature, and coming to my house. There's no noise, no honking horns or sirens or anything. You can hear I-65 from my house if you know what to listen for, but if you don't, it just sounds like a real quiet hum. That's why flying to me is not just about logistics but also about changing headspace and perspective. It's a bird's-eye view of the land I serve, the farms, the roads, the lakes, the snow. Farming helps me to decompress, to think, to pray. There's something very clarifying about looking at your home from a thousand feet up, and I think it's worth doing. Obviously, it takes the worst part of my day, which would be my commute and my drive, which I absolutely hate, and makes it my favorite part of the day. So it saves me time. I can make a money argument about it, but at the end of the day, it's a headspace game that I'm talking about. So I'll talk about the limitation of flying moving on. I would say weather is probably the number one limitation that I have. You always want to have a plan B. I have a long history of saying no and not flying. I also have a history of things changing, and if I don't feel comfortable, just landing my helicopter, also landing my plane. People often think that flying is dangerous, and like I said, a lot of everybody says, "Oh, Kobe," you know. And it's like, okay, my mom died in a car accident on I-65 when she was 49, and I'm 23, and I often dig into that. Everything that I do has a lot—I do a lot of dangerous stuff. But maybe people wouldn't think, "Okay, you're going to raise cattle, and that's dangerous." But it is dangerous. Like, I have horned cattle, a 1,200-pound animal with a four-foot horn span, and a newborn calf. I don't really know what's the most dangerous thing I can do, but I do know the statistics are that for my age group, the most likely way to die is by trauma. Snowboarding and raising cattle, driving, are all quite dangerous things that I'm still going to do. I'm not going to not do them. It's not that I'm being reckless. I'm trying to be smart and manage risk, not be terrified of risk and not be able to act and not have a life. I have a very full and rich life because I'm managing risks, managing my time. I guess I'm saying yes to the things I want to say yes to. Statistically, per mile, the riskiest way to commute is walking. The highest number of deaths per mile is walking, right? But that's obviously tongue in cheek because you don't walk thousands of miles necessarily, but that is a true fact. But I think probably if I'm driving to work an hour away, that hour is definitely the most dangerous hour of my life at this moment in time. If I replace that with a helicopter flight, that's probably the most dangerous 20 minutes of my day. Honestly, it's fair to say that, but the chances are that I am still going to make it through my day, and it's probably not going to be a life-threatening situation. The other thing is there's a feeling in general aviation that it's possibly a minority of the pilots causing a majority of the accidents. But this is very hard to prove. That's why I'm proud of all the times when I haven't flown. You don't want to get "get there-itis." You always want to be able to say, "I'm going to stay on the ground, I'm going to do my plan B." Also, the fact that I have a family that I grew up flying with and we all feel the same way, like safety is the most important thing—I'm also motivated by the fact that I don't want to be a statistic. I know that even if I drove to all these rural hospitals regularly and then died in a car accident, it would not make news. But if I died flying there, it would make news, right? Which is almost very frustrating. That's why I get frustrated by the question. Then I come back to people with the statistics about, you know, right. Where I live, within a 1-mile radius, if you draw a 1-mile circle from my house, right, in my lifetime, there have only been, I don't know, like 30 people that have lived in that one-mile circle, and four of them have died in car accidents. Right.
Dr. Randy Lehman [00:41:40]: So, you need to be safe, wear your seatbelt. Obviously, my mom wasn't wearing her seatbelt. Always have a plan B, whether you're driving or flying. And that's why I say weather is probably the number one limitation for me. Just, you know, being aware also of the recency of flight experience and the fact that I literally fly every single day. You know, regularly, I probably fly about four days a week on average. I would say actually it helps.
Dr. Randy Lehman [00:42:12]: To be that sort of current and proficient, and it might not be very practical and easy for a lot of other people necessarily to do that. I did want to talk a little bit more about the cost savings though, because if I'm going to do an hour and a five-minute flight or drive and it's going to convert into like an 18-minute flight in a zero wind condition. But, with a few minutes on each end, you know, let's say it takes a total of like 22, 23 minutes to make that.
Dr. Randy Lehman [00:42:42]: Flight end to end. I mean, it takes you a little bit of time to get your car parked and everything too. So, I guess. But let's say it’s round trip, you know, you're going to spend 2 hours and 10 minutes versus 45 minutes of flying, and you saved yourself an hour and 25 minutes, and your driving was not free. So the total cost to fly, that is maybe 300 bucks but you're spending 50 bucks.
Dr. Randy Lehman [00:43:13]: Anyway, to drive, right? Maybe 50, 75, something like that. So, what you're telling me is I can get my time back, an hour and 25 minutes for if that's $250, you know, I'm doing rough figuring on the fly, so apologize for my math, but I'm buying an hour of time for like 170 bucks, for example. And I guess what general surgeon would not buy back an.
Dr. Randy Lehman [00:43:43]: Hour of their time? And this is not just an hour of time averaged out. This is an hour of time after your eight hours of sleep per day has already been taken care of, your one hour of hygiene per day has already been taken care of, the time that you spent feeding yourself, right, all the essential things of life are done. So it's not one out of 24 hours in a day. This is actually an hour of your best time, your productive.
Dr. Randy Lehman [00:44:14]: Time, your present time, whether you're going to spend it doing another case and getting into the operating room, you're going to spend it with your family, or you're going to pick up something else, like track coaching right on the side. It becomes a practical, very, very easy decision. Now, if you're going to go home and you're just going to watch TV or play Clash of Clans, you know, okay, that's where then all of a sudden the screws.
Dr. Randy Lehman [00:44:45]: Get tightened on me to make good use of my time all the time. But that being said, you have to have some downtime too. But for me, it clearly is worth it from a dollar perspective alone. That's not to mention the fun, which is way, way better than sitting in a car, and number three, that headspace sort of perspective. Oh, I did want to say one more thing. So, I did recently start track coaching. And then, of course.
Dr. Randy Lehman [00:45:15]: I just approached the vice principal of the school and the AD, and they have obviously a huge area in the back of their school that's again out in the middle of the cornfield. And they were just very supportive, and they said, yeah, absolutely, you can land your helicopter in the back. Right. So these are things that would not happen in the city. Like if you're track coaching at some big city school, there's no space for you to land your helicopter right on site. And even if you did, you probably wouldn't get the support because the.
Dr. Randy Lehman [00:45:47]: Mindset of the people there is backwards. And I could talk about another story that's a little more edgy, but I don't really care. In the state of Indiana, there's a law that says you can't land your aircraft on—well, it says you can land your aircraft on a public roadway so long as you're not blocking the flow of through traffic. And you can't be breaking any other laws too, like if there's a city municipal law that says something. Well, I have an investment property in Crown Point, Indiana, right. So Crown Point is Lake County. That's the.
Dr. Randy Lehman [00:46:17]: Second biggest county in Indiana. It's essentially Chicago, right. It's an extension of the Chicagoland area. And so I've been up there two times to visit this investment property by helicopter. The first time, there's this area of construction and there's a roundabout and there's a little extension coming off the roundabout. And I landed my helicopter there, and my broker was with me, and he picked me up in the car. And this is like a half-mile away from the property, and my property, it's like the area in the back that's sort of open, it kind of drops off and.
Dr. Randy Lehman [00:46:48]: It's not really a good place to land. So this is a much more wide-open, safe place to land. Nobody's doing anything. This is a future construction site, but nothing's going on at the time. So I landed the helicopter and went over there. I came back another time to do the same thing. And the first time I was there, there was one person, like a construction worker kind of person. And I did say something to them. I said, hey, would it be okay if I landed here and left the helicopter here while I went and did some work? He said, you know, that was fine. I don't know if it's.
Dr. Randy Lehman [00:47:19]: His, you know, right to say that or whatever, but I did at least say that to somebody. And then I came back the second time, and nobody was there at all. This is not a road, right? It’s not blocking anybody. It's a future road. It's coming off of a roundabout. So I landed there, and I get a call after about an hour, and they said. From the police, and they said, you own this helicopter? Like, yeah. All right. Are you okay? Yes. Okay.
Dr. Randy Lehman [00:47:50]: Well, we just saw that it was here, and we wanted to make sure that it wasn't a forced landing, an emergency landing, and, you know, that everything's okay. I'm like, no, no, it's fine. Like, I landed there on purpose, and I'm over here doing work. They're like, okay, well, you. Could you come back over here? I'm like, well, kind of in the middle of something. Can I just not do that and continue to do what I'm doing, and I'll move it when I'm done? And they said, no, no, we want you to come back over here now. So, I came back over there, and.
Dr. Randy Lehman [00:48:20]: There are like a whole bunch of police cars around there. I was like, did I break any rules? Did I. Did I do anything wrong? And they're like, no, you didn't. And they had a state police helicopter guy out there who could attest to the rules and things. And they're like, no, absolutely no problem. You did not break any Crown Point laws, didn't break any state laws or any laws whatsoever. You didn't do anything wrong. I was like, okay. And then they're like, okay. I said, so can I.
Dr. Randy Lehman [00:48:51]: Go back to do my work? And they're like, we'd like it if you just take the helicopter and just go. And I'm like, okay, fine. So I went ahead and got in, and I said, there's nothing else I need to do. No, there's not, and just took off, right. Fine. Then I get three or four attorney's letters in the mail about, I don't know, a month and a half later. Hey, we see that you've been slapped with the. Whatever class misdemeanor for something.
Dr. Randy Lehman [00:49:22]: You know, it doesn't really say specifics, but it says. It does say blocking a roadway with a motor vehicle. So I've been charged with a crime. And of course, before I get the letter from the government, I get multiple letters from multiple attorneys right in the land where 70% of the world's attorneys live, the United States of America. It's very stressful. I get the letter from the city, and basically what happened is, you know, there's a guy that there's just a lot of small minds and people that I don't know have nothing better to do, don't appreciate or enjoy their own lives. They want to, I don't know if jealousy is involved, probably, it's so frustrating. But there's a guy that's got a small Facebook, local news thing. He's got a following of around, I don't know, 20, 25,000 people, and he took some pictures, and that went off viral, you know, low-key viral. I did see it, but I can't find it again for some reason. There are a lot of comments like, oh geez, somebody got wind of the doctor thing, and it's like, oh, this doctor doesn't have a brain in his head, doesn't have good judgment. I hope he's not my, I'm glad he's not my doctor, stuff like that. You know, I'm glad they're not my patients, you know, and I'm glad that I live in rural America. Again, it just doesn't happen. It's totally a different attitude. It's more of a pioneer, independent, proud of your own self and what you're doing, not caring so much, I don't think, about what other people are doing attitude. In rural America, because you don't have the houses that are like, you know, 100 of them all in a row and they all look exactly the same, like in this competition thing. I don't get it. Anyway, I did fight it, you know, got an attorney and fought it. They were wrong. But they charged me with blocking the roadway with a motor vehicle, which is what you're not allowed to do. That would be what the law would say. But I wasn't doing that, because nobody was actually going down that road. It's not an actual used road. So it was just ridiculous, like somebody got pressure at the prosecutor's office, I'm sure, from a person in town to, you gotta, you gotta put your foot down about this. Well, it's just pathetic, you know, and it's a small-minded attitude, and what it's gonna do is it's gonna drive my investor money out of their county. I'll tell you that much. I'm not interested in the future of Lake County, like especially as I am in the future of Jasper County and the surrounding areas. So, pretty crazy story. Anyway, it was a pretty expensive trip, you know, but at the end of the day, there's no long-term consequence. Basically, I was accused of a crime, but then it's totally gone and taken away now, because I didn't perform a crime. I wasn't planning on sharing that story, but that's your bonus. So, I appreciate you taking the time to listen to this episode. I hope that it was of some sort of value and interest, and at least entertainment value for you. I'm not telling you what to do by any means, but I just wanted to give you an idea of how I have designed my life and my practice with intention. Whether it's in a plane, a truck, a side by side. Flying for me is just one example of thinking creatively as a rural surgeon. Time management is very important, and I never want to be the surgeon who says I'm too busy, and flying helps me to be present both at work and at home. I have used it for emergent things. I probably use it once a quarter to go someplace that I need to be sooner, because usually it's a patient in the ER that's going to need something. It has opened doors for emergency care for patients as well that would not have otherwise been possible. I don't really rely on it for that, because again, there is that weather limitation thing. But when it works out, I don't hesitate to use it, and I have several patients that would say thank you for that. So, I appreciate you again listening in general to the Rural American Surgeon Podcast. It's been my pleasure to be your host for this show. I hope you're getting value out of it, and I know I've been reached out to by several residents as well as other people, and I just appreciate the positive feedback. I appreciate you sharing this. Please give me a like or review if you've had any value at all from this show. Share some links from the Facebook, share some of the YouTube shorts, give us a rating or review. Most importantly, share it with people that are interested in rural surgery. That's what you could do to help me back. I really appreciate that, and I will catch you on the next episode of the Rural American Surgeon.
