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Up in the Air with Pediatric Oncologist Don Small

January 26, 2012
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At the controls, pediatric oncologist Don Small.

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Don Small and his Piper Cherokee at Martin State Airport.

Growing up in the Washington, D.C., suburbs in the 1960s, Don Small relentlessly read books about military aviation and World War I and II fighters and bombers. He was further hooked when his cousin, a flight surgeon at Andrews Air Force Base in Prince George’s County, Md., invited him to watch F-4 Phantom jets take off and land. It became a day-long affair for Small, who couldn’t be budged from the runway. Years later, weekend flights with a medical school friend with a pilot’s license sealed the deal – Small himself would one day become a pilot.

“I immediately connected with the whole concept, the freedom of flying, breaking the surly bonds of Earth, being out there in the sky,” Small chuckles.

But flying has been anything but a laughing matter for Small, now director of pediatric oncology at Johns Hopkins. Since 1982, when he was pursuing a Ph.D. at Hopkins and sneaking off for early morning flying lessons to make it to his lab by 10 a.m., his affair with the air has been intense and persistent. After a year of these one-hour lessons he had a pilot’s license. Rental planes gave him plenty of air to soar, but then he set his sights on a one-tenth share in a Cessna 172.

“The right rear passenger seatbelt and the beacon on the tail were mine,” says Small.

With his partial ownership he pursued instrument rating, which meant he could fly in “instrument conditions,” or when you can’t see the horizon because of clouds or rain. A haze can obscure orientation to the ground, too, as can the dark of night, especially over water. Which way is up is not always so clear. Having an instrument rating, Small says, is a much safer way to fly.

“Let’s say you fly visually to Ocean City, New Jersey for the day and on the way back you run into clouds and have to fly under the clouds,” says Small. “That’s how people have accidents.”

With instrument rating certification under his belt, Small acquired a Piper Cherokee 6, which sits in a hanger at Martin State Airport 10 quick miles from his office at Hopkins’ East Baltimore campus. He concedes that just as a boat is a hole in the water you pour money into, a small plane powered by a 300 HP single piston engine – with fuel costs of about $100 an hour – is a hole in the sky you throw money into. But ownership does give you that quick trip to the Eastern Shore or to the medical conference in North Carolina, as well as the planned excursion to Milwaukee for a sailing trip with the in-laws or to Iowa to visit a friend from medical school. In his numerous family trips with eager kids and a somewhat reluctant spouse, Small has traveled as far west as Denver, as far north as Vermont, and as far south as Key West.

The appeal for Small, however, is not only where but how high. Small-plane altitudes, or those well below the 28,000-feet airspace commercial jets occupy, best capture the local topography, especially in the fall. An adventurer at heart who also enjoys extreme skiing, scuba diving and free climbing, Small would tree-top fly if he could. It’s the action of piloting that stimulates – and oddly, relaxes – this pediatrician pilot, too.

For example, Small explains, during a day of instrument approaches he flips a hood down so all he can see is the instrument panel. In other words, he simulates simulation flying while actually flying. Maintaining his altitude and tracking radio navigation beacons, he touches down on a runway he cannot see until he flips the hood as close as 200 feet.

“Needless to say,” says Small, “when you’re doing those things it’s very intense and things happen very quickly.”

The focus of his work – clinical care and research – is intense, too, Small adds, especially in the area of childhood cancer. Young lives are at stake, too, and that brings constant concerns. Flying, explains Small, provides a brief break from those worries.

“For that one hour, you can’t think about the patient who has relapsed, the research that’s going on in the lab, that research grant you submitted,” says Small. “All you can think about is exactly what you’re doing in the plane at that time, and that kind of intense focus, in a lot of ways, is very freeing.”

Interestingly, Small adds that the discipline of flying plays into and even enhances his role as a pediatric specialist, too.

“Much of the training in aviation is learning how to overcome risks by using checklists for every phase of flight,” Small says. “I approach patient care with this same attitude of making sure we consider the risks in anything we do and proceed in a systematic way.”