Fasten Your Own Mask First

My first job in aviation was flight attendant. Anyone who has traveled by air is likely familiar with the preflight briefing. Remember what you do with an oxygen mask?: “In the event of a loss of cabin pressure, the panel above your seat will open…fasten your own mask first before assisting other people.” That verbiage is in the briefing because your first instinct may be to help the people sitting next to you. Those people might include your children and your grandparents – people you would typically be willing to sacrifice quite a lot for. Have you ever wondered why you must put yourself first?

As you ascend through the atmosphere, the air gets thinner and thinner, meaning there are fewer oxygen molecules per unit of volume than at the surface. Since you breathe in fewer oxygen molecules, less oxygen gets to your brain. This reduction of oxygen in your bloodstream is called hypoxia. Hypoxia makes you lethargic, and affects judgment and reaction time. Most dangerous for aviators is the tendency not to be aware that they are functioning at a cognitive deficit until it is too late to do anything about it.

In aviation, we are taught “time of useful consciousness.” For each altitude, there is an approximate time span before a person is rendered unable to take action, even though they may still be awake. At the altitudes where most jet aircraft cruise, it may only be about 30 seconds before you may not be able to make a good decision.

That is why it is critical to ensure that you have oxygen first: you cannot help anybody if you are unconscious, but you can help others by helping yourself first.

It would be nice if there were a similar chart – “time of useful energy” maybe? –  for autoimmune diseases like lupus. You could enter some data and end up with a reasonable goal for the day. The catch with lupus seems to be that you never know at what altitude you are flying. I still think I am mostly invincible, or at least that I know my limits, so I push myself to the limits that used to work for me. Sometimes it turns out okay. More often that not, I end up feeling like I can’t get my head out of the low-oxygen clouds.

Several people have reminded me that taking care of myself is in fact helping to take care of my family and friends. Getting enough rest, eating right, and getting regular physical exercise are a few things that make me more healthy in the long run and create less worry and stress for the people around me. I know this, but it has been difficult to put into practice.

Every day, I am trying to make small improvements in the three factors listed above: rest, diet, and exercise. The number of days I fall short of my goals since I got sick far outnumber the days when I feel success. Those goals often compete with the goals of working 40 hours a week and spending quality time with my family. I struggle with the mindset that if I am not able to accomplish something, it is my fault, that I needed to try harder or have a better attitude. Sadly, I find that work ethic and optimism can only do so much to change my circumstances, and often pushing myself has the effect of exacerbating my symptoms. At some point, it is better to throw in the towel than to keep fighting.

One thing I learned in aviation, both as a pilot and an air traffic controller, was the importance of knowing your limits. Each one of us is different from the others and comparisons to other people may not be helpful. Once we are comfortable with our typical performance, individual physical and mental ability may vary from day to day. Lupus has been an ongoing process of relearning my limits, and learning how to give myself permission to take care of myself: to relax, turn in early, to try to boost my energy reserves so that I can start the whole process again tomorrow.


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