Editor’s Corner: We Will Fly Again!

Joseph R. Mikhael, MD, MEd
Professor, Applied Cancer Research and Drug Discovery, Translational Genomics Research Institute (TGen), City of Hope Cancer Center and Chief Medical Officer, International Myeloma Foundation

Travel has always been an important part of medicine, as the need to connect with colleagues in person to collaborate and learn from each other is synonymous with our profession. This spring, the coronavirus pandemic has made it necessary to adopt virtual platforms for all activities that used to require travel, like attending conferences, giving talks, discussing clinical trials, and presenting abstracts.

Although this move to electronic meetings has (rightly) challenged the need for so many in-person events, I am aching to travel again. Video conferences with colleagues are not the same. Not just because of attempts to speak while being muted, awkward background noise, and the deceptive art of catching up on social media while pretending to listen. I just miss being present with people.

Under normal circumstances, I have the privilege of spending about 25% of my time in the developing world, seeking ways to bring myeloma therapies to resource-poor countries. This has allowed me to meet physicians, health-care workers, and patients all over the planet. On their home turf, I can see, taste, smell, and explore the local culture in ways that aren’t possible from my laptop. It is important to continue to do that.

I believe we will be able to travel again – and hopefully soon. We will emerge from our cages and board planes again, albeit with fewer seats and perks, more distancing, and oceans of sanitizer.

In 2019, I flew more than 500,000 miles, which afforded me the title “Biggest Loser” among colleagues. As we dream of the trips we’ll take once we return to the new normal, here are the top 10 tips I’ve learned for being an air warrior:

    1. Strategic sleeping. I’ve been training myself for years to sleep at will – even in a middle seat on an airplane, or during the daytime when crossing time zones. If you can master this skill, I guarantee that your jet lag will be diminished. If you can sleep (or not sleep) on demand, welcome to the high life.
    2. Efficiency on planes. The entire flying process – from traveling to the airport, check-in, clearing security, boarding, taxiing, takeoff, landing, taxiing again, and arrival – is inefficient. Don’t waste precious minutes and hours. Get CLEAR, TSA PreCheck, and Global Entry. I always work on planes unless it’s after midnight or I am over an ocean (then I may consider a movie). I carry a smartphone, iPad, and light laptop with me at all times. For me, Wi-Fi is essential; I even select flights based on their Wi-Fi rating.
    3. Exercise. Bodies were not designed to sit for 16 hours. Make movement a daily necessity. Use the athletic facilities in hotels and airports. My preference is to wake up early and run – I have toured countless cities this way. At minimum, take a pre- and post-flight walk. You’re in luck if you happen to be flying through the new Istanbul airport – its gates are about half a mile apart!
    4. Healthy eating. It’s easy to default to carb-, fat-, and sugar-laden airport and airplane food. Bringing your own snacks, like fruit, nuts, and homemade meals, can help you stay healthy and save you a fortune. Go easy on the alcohol as well.
    5. Generosity reigns. When I travel internationally, I intentionally bring clothes that are nearing their end to leave them for hotel staff or others. No matter where you stay, chances are the person cleaning your room or welcoming you at the door needs them more than you do. All over the world, I’ve left suits for doormen, clothes for housekeepers, and shoes for interns. Make sure you hand the items over directly or leave a note so they are not mailed back to you. This also frees up room in my luggage (carry-on only) to bring back gifts for my daughters.
    6. Don’t love your airline too much. Frequent flying has its perks, but it’s important to be smart about which airline is best for your destination. For instance, don’t connect through India to go from London to Rome. Traveling through an airline’s hub city reduces the risk of cancellation and delay. Be schedule-obsessed, know which other flights match your itinerary, and beware of tight connections and last flights of the day.
    7. Hydration, hydration, hydration. I don’t want a DVT. Although other factors are at play (no need to write to me, thrombologists), staying hydrated helps prevent them. Don’t start with a $10 bottle of water after security. Start when you get the 24-hour checkin reminder. This tip goes hand-in-hand with what I call my “2 rule”: for every 2 hours on the plane, I must walk for 2 minutes. Hydration makes that necessary.
    8. Seats matter. As a plane geek, I can tell you what every seat is like on most planes. When you book, study the seat map on a site like seatguru.com and try to obtain the best possible seat. Exit rows, for example, often give you more leg room than first class. Upgrade if you can. Three more inches of space can greatly change your experience on a long-haul flight – not to mention a lie-flat seat! I have even had a shower on a flight.
    9. Reduce infection risk. Even pre-COVID, I was always well-stocked with wipes and sanitizer, especially on a plane. That will be even more important going forward.
    10. Find joy in the journey. It genuinely surprises me how sour people can be when they travel – as if their whole life depended on an upgrade, or a 5-minute wait to board was an eternity. Check your attitude. If you have been on a plane in the past year of your life, you are among the most economically privileged 10% of the world population. Be thankful and pass on that gratitude – bring gifts to airline staff and genuinely say thank you. They need and deserve that now more than ever. Find ways to make it fun. I even created my own social media hashtag, #whereisdrjoe.

     

  1. I truly hope these tips enhance your travel in the coming months and years. See you in the air!