A Conversation with … Cecilia Aragon PhD, Champion Aerobatic Pilot, on Grace Under Pressure : Clinical Orthopaedics and Related Research®

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A Conversation with … Cecilia Aragon PhD, Champion Aerobatic Pilot, on Grace Under Pressure

Leopold, Seth S. MD1

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Clinical Orthopaedics and Related Research 481(2):p 195-197, February 2023. | DOI: 10.1097/CORR.0000000000002524
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Hemingway may have said that courage—he may or may not have called it “guts”—is grace under pressure [4]. Whatever he said, this virtue is one worth aspiring to. Hemingway’s heroes certainly display it, as do many surgeons. But for surgeons, the risks are far greater than they are for fictional characters battling metaphorical fish or make-believe bulls.

Perhaps because the stakes are higher for surgeons, we don’t always display grace under pressure quite as well as Hemingway’s characters modeled it. For those who want to raise their game in this regard—and who doesn’t—this month’s guest should be of particular interest.

Cecilia Aragon PhD (Fig. 1) is a former member of the United States Aerobatic Team, with more than 70 championship wins to her credit, going as far as a bronze medal at the World Aerobatic Championships—the Olympics of that very demanding sport. My favorite among her many remarkable accomplishments is that she holds the record for the shortest time from a pilot’s first solo flight to making the US team: Just 6 years. Not bad, considering that the punishment for lacking grace under professional aerobatic pressure—which may weigh in at nine to 12 times the force of gravity—may be death. If you have trouble conceiving of that kind of force, imagine a block 10 times the weight of your body (or more) pushing down through your head, neck, and spine into your seat. While flying upside down (Fig. 2). Fast.

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Fig. 1:
Cecilia Aragon PhD
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Fig. 2:
Cecilia Aragon flying inverted in a Sabre 320 aerobatic aircraft (Photo published with permission of Katinka Rodriguez).

Following her aerobatic career, Dr. Aragon became a world-beating scientist, engineer, and professor, with a Presidential Early Career Award for Scientists and Engineers under her belt, as well as nearly USD 30 million in grant funding and counting. Getting there required not only facing fear, but also overcoming adversity. As the child of parents who immigrated to the United States as adults, she grew up in a small town that seemed like a dead end for a girl with academic aspirations in STEM. Her ethnicity and her ambitions made ignorant people uneasy, and made her an easy target. She faced not just typical schoolyard bullying but serious physical violence, at one point being beaten into unconsciousness by a group of boys who called her racial epithets. Despite these severe hurdles, she reached the top of a sport (Fig. 3) and subsequently the top of a professional field [6], as both the first Latina to make the United States Aerobatic Team and the first to achieve the rank of full professor in the 100-year history of the College of Engineering at the University of Washington.

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Fig. 3:
Cecilia Aragon flying over San Francisco Bay (Photo published with permission of Katinka Rodriguez).

The ability to manage fear, push boundaries, and achieve the grace despite pressures that seem determined to cause us to err are a few of the skills that champion aerobatic pilots like Dr. Aragon have and surgeons want more of. I believe her thoughts on managing fear and the inner voice that says “I can’t” also will resonate with orthopaedic residents and registrars; many of them will be heading out into the world with a good deal less hands-on preparation than they may have wanted because of COVID-related reductions of surgical schedules. Their patients, quite reasonably, will expect mastery, and these young surgeons will need to deliver it. I believe they will be able to, but I’m guessing they’ll do so under a darker cloud of self-doubt. This is something Dr. Aragon has thought a lot about, and her ideas are worth listening to. She’s not just an expert on aviation and an expert on engineering; Dr. Aragon has devoted a considerable amount of her (apparently substantial) bandwidth to the study of mentorship, something that every surgeon has benefited from and presumably most of us have tried to provide to others. The second of her three books was, believe it or not, about what mentors can learn from the feedback that writers of fan fiction receive from the reading public [1]. What can’t she do?

Read on for a don’t-miss conversation with Cecilia Aragon PhD on grace under pressure, and so much more.

Seth S. Leopold MD:Thanks for visiting with me, Dr. Aragon. Please tell us a story about managing fear when the stakes were high and the need for precision was great. I'm guessing this has come up once or twice for you in your career as a championship aerobatic pilot?

Cecilia Aragon PhD: Many times! But the one moment that stands out in my mind among all of them was my first flight in international competition in France. The stress was incredible. Not only did I have to face my fear of performing wildly unusual maneuvers that would strain my airplane and my body to their utmost, but on top of it all, those 6 minutes of flight bore the weight of all my hours and hours of practice, all the years of working two jobs to afford the training, and all the hopes of my supporters back in the United States. My performance during those all-important, precious moments would, in part, determine the United States’ standing in world competition. No pressure!

I remember it so clearly: I dove to enter the aerobatic box, and my plane screamed as the airflow past my fuselage built to a crescendo. I pulled up for the first figure of the flight, breathing deeply, nailed the vertical line, paused, hit the points of the roll up, one, two, three. I pushed up and over the top, inscribing a perfect half circle in the sky. On the downline, I held an absolute vertical, straight toward the ground. Then I entered an outside snap roll that threw me hard against the straps with 6 negative gs of force. I relaxed my entire body and breathed gently so as not to build up too much blood pressure in my brain.

The ground was coming closer and closer as I was pointed straight at it under full throttle. In that moment, though, I realized I’d traveled beyond fear as I danced through the air. I’d left the fear of heights, of dying, the fear of humiliation, the fear of letting down my team behind me now. There was only the joy of my body and the airplane linked together as a single being, flying in partnership with air and gravity. The thrill of flying each maneuver as perfectly as I could make it became all-consuming, and there was no room for fear.

Dr. Leopold:How can surgeons cultivate some of the skills you’ve developed for managing intense emotions in stressful moments like that? Most of them won’t learn how to fly upside down…

Dr. Aragon: When you’re facing a life-and-death situation, whether it’s flying an airplane straight at the ground or performing a critical operation, my advice is: Discipline yourself into a flow state, one where you’re completely concentrating on what you’re doing and not on the potential consequences. Use checklists! Follow them and keep your mind completely present on each item. Our US Team coach used to tell us, “Fly the maneuvers one at a time and keep them all in the box.” I imagine surgeons could have a similar mantra where they focus on each step, and only that step, as they’re doing it. I would think that for surgery, as for aerobatics, one has to keep safety uppermost in mind.

Dr. Leopold:I feel for our surgical learners—residents, fellows, registrars—whose educations have been truncated by reduced surgical caseloads during COVID. I believe they’ll find ways to learn what they need to learn, but I’m guessing that more than a few of them will be hearing the inner voice that says “I can’t” at times along the way. When I listen to interviews you’ve given, you project a lot of “I can.” How do you manage self-doubt so effectively, and how might others, particularly people learning a high-stakes low-margin-for-error craft, gain some of that aptitude?

Dr. Aragon: Self-doubt is ever-present in many of us. But there’s a great trick people working in high-stakes crafts can use; it's one that I and many of my aerobatic colleagues competing at the world level use regularly. We visualize the procedures we need to go through, including imagining every sensory and somatic detail. It’s very powerful and has been backed up by science as well as practical experience. People who visualize what they need to do tend to perform much better.

I believe it’s because of the intense concentration necessary to put yourself into such a simulation with your imagination alone. Sometimes when you’re physically practicing, you’re not concentrating as much. Your mind may be on other things, such as what you’re going to have for dinner that night, or what’s going on in your life. But repeated visualization practice can lead to incredible skill development. It’s certainly worked for me.

Dr. Leopold:On the subject of learners, you have put a lot of thought and energy into career mentorship, particularly of those whose backgrounds haven’t necessarily set them up for easy success. Orthopaedic surgery is the least-diverse medical specialty. Fewer than 1 in 10 orthopaedic surgeons is a woman, and people of some racial and ethnic minority groups—in particular, Black, Hispanic, and Asian people—face steep barriers to entry [5]. What’s worked especially well for you, as you look back on a career of helping others to make their way in the two different but very demanding professions you’ve succeeded in?

Dr. Aragon: As to mentoring, I counsel students to be aware of discrimination, but to also realize it’s not their fault. They need to try not to internalize the erroneous assumptions of others (which, I realize, may be easier said than done). Now that I’ve reached a position of authority in my field, I do my best to speak up against any form of injustice and support junior colleagues. When I mentor someone, I focus completely on what it would take to help that student succeed. I love teaching and mentoring, and one of my greatest joys is when a student surpasses me. I have some students now I’m incredibly excited about, and I feel their work may just change the world.

Dr. Leopold:It also takes courage to make big career changes, which is something else that you’ve done—and most surgeons will someday do—whether that’s through retirement or just changing professions. What has helped you to gain clarity when making or thinking about those kinds of transitions?

Dr. Aragon: I spend a lot of time trying to think logically about big decisions, writing out lists of the variables involved and generating a decision matrix where each element is assigned a weight, and then I sum them all up.

Then I make a decision based on my gut.

I think taking the time to think deeply about what’s involved in each complex decision is incredibly important, but when the final decision needs to be made, it’s important to trust our unconscious and our emotions, as neuroscience and psychology research has demonstrated [2, 3].

Acknowledgment

The author thanks Clare M. Rimnac PhD, whose suggestions improved this feature.

References

1. Aragon C. Writers in the Secret Garden: Fanfiction, Youth, and New Forms of Mentoring. MIT Press; 2019.
2. Damásio AR. Descartes’ Error: Emotion, Reason, and the Human Brain. Grosset/Putnam; 1994.
3. Kahneman D. Thinking, Fast and Slow. Farar, Straus and Giroux; 2011.
4. Monteiro G. Hemingway's Notion of “Grace”. Studies in American Fiction. 1990;18(1):111-112.
5. Poon SC, Nellans K, Gorroochurn P, Chahine NO. Race, but not gender, is associated with admissions into orthopaedic residency programs. Clin Orthop Relat Res. 2022;480:1441-1449.
6. University of Washington. How one UW professor defeated fear to become an aerobatics champ (video). Available at https://www.youtube.com/watch?v=t6DiolD5554. Accessed August 29, 2022.
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