It's about a two-hour flight from Boston to Presque Isle, Maine. I have never met my passenger, Donna Voisine, but I know she's an old hand at flying in small airplanes.

It's a great day to fly. There's barely a cloud anywhere. At 5,000 feet, we'll have Maine's rocky shoreline passing on the right and an explosion of fall color rolling by on the left. It will be one of those days where you feel like you are the only thing in the sky.

Two years before it was a different story for Voisine. Back then, she was standing on the ramp in Presque Isle, about to get into another pilot's single-engine Cessna, and she was scared. Not of flying--a few weeks earlier she had learned that she had bone cancer. If untreated, her doctor told her, she had a year, maybe a year and a half. Her best hope--perhaps her only hope--was to go to a specialist in Boston. But Boston is more than 400 miles south and a nine- to 10-hour drive from her home in northern Maine. The only commercial airline service is through Presque Isle, about an hour and half south of where she lives. With two children to care for, there was no way Voisine could afford the multiple trips needed for treatment. Whatever options she had seemed to be narrowing quickly.

Then Donna talked to a nurse who recalled reading a news story about Angel Flight Northeast, an organization of volunteers who fly patients to medical centers. Typically, the passengers are people whose medical condition has defied conventional treatment, whose health insurance benefits have expired, or who are far from large medical centers.

So there was Voisine standing on the ramp, worried about her health, her family, her future.

For the next couple of years, Voisine relied on Angel Flight Northeast pilots to get to Boston and back home again. After chemotherapy and a bone marrow transplant, her cancer is now in remission. All that's left, she says, are a couple of checkups a year.

My reason for joining Angel Flight was selfish--I love to fly. After getting my license in 1991, I bought a share of a 1968 single-engine Piper Cherokee, continued taking lessons, and acquired my instrument rating, which allowed me to fly in clouds and poor weather. But without a far-flung business or vacation home, I found myself coming up with excuses to fly, either taking meaningless day trips for lunch or repeatedly doing the "Great Circle" (practice approaches at my home airport in western Massachusetts). Realizing that my airplane and piloting skills could be put to better use, I posted an inquiry on the Internet two years ago asking how I might fly for charity. I was directed to Angel Flight Northeast, and have since flown patients all over New England and the neighboring region.

Pilots sign on with these groups for all kinds of reasons. Some need to build up flight time; others want the chance to fly to places they wouldn't otherwise see. Or they may have no other reason than the desire to help others.

When a pilot volunteers to transport patients, he becomes part of the Air Care Alliance, a loose-knit network of charities around the country dedicated to transporting medical patients. It consists of volunteer pilot groups such as Angel Flight Northeast, airline programs offering free or discounted tickets, and the Corporate Angel Network, which finds empty seats on aircraft making business flights (see Seats Available).

In 1998, more than 12,000 patients got medical care via this unofficial network, the vast majority by volunteer pilot groups. Most of the people transported were cancer patients; others suffered from rare or complicated diseases or conditions. In many cases, the specialized or experimental treatments that could help these patients are available at only a few hospitals throughout the country.

And the problem is double-edged: Researchers developing new treatments don't always have enough patients to try them on. At the University of Florida in Gainesville, for example, scientists are testing a new treatment for a disease called congenital lactic acidosis. The condition, which afflicts about 500 children in the United States every year, causes an abnormal buildup of lactic acid in the blood and spinal fluid, resulting in neurological, cognitive, motor, and muscular problems. There is no cure, and those who have it do not live beyond their teens. Researchers at Gainesville are testing a drug called dichloroacetate, and they need patients who can come to the university 10 times over a two-year period. The patients come from as far away as New Zealand. A volunteer pilot organization called Mercy Medical Airlift, based in Hampton Roads, Virginia, has been organizing free transportation--either through other volunteer groups or through free- and discount-ticket programs offered by the airlines.

Unfortunately, information about volunteer transportation services can be as hard to find as information about a rare medical condition. Some groups have made themselves known by contacting nearby hospitals; others have benefited from coverage by local newspapers and TV news programs. And of course many groups now have Web sites. Still, a lot of patients who could use the services aren't aware of them.

Part of the problem, says Mercy Medical Airlift executive director Ed Boyer, is that "no one is in charge of the system." Most of the groups operate independently. For example, Angel Flight Northeast and Angel Flight West share the same name, but they have their own staffs, pilots, and protocols. If some of the groups were to merge, they might be able to consolidate publicity and outreach efforts.

Boyer learned about the transportation problems particular to medical patients in the mid-1970s. Back then he was a partner in a Beech A-36 Bonanza, and a friend asked him to help out a cancer patient who needed to travel from Virginia to New York City for treatment. More patients followed, and other pilots joined in to help, but it was not until 1984 that the group formally incorporated as Mercy Medical Airlift.

Around the same time, on the opposite side of the country, California businessman Tom Goodwin was out flying his Piper Archer one day when it occurred to him that there seemed to be more pilots sitting around thinking about flying than actually getting in the air. "There's a lot of manpower and a lot of machinery that could be put to some good use," Goodwin recalls thinking. "Then it came to me."

Goodwin had been reading about the then-new field of organ transplantation and the urgency of transferring donated organs. "Heck, I can do that," he recalls saying. "I started asking around to see if anybody'd be interested in doing something to help in some way. And it slowly evolved." When he began, Goodwin was running his own printing company and flying as a recreational pilot. In 1984 he gave up his day job to run AirLifeLine. "Oh, I flew doctors to Mexico for eye surgery, we flew for the blood banks, the eye and tissue bank," he says. "We were there to help anybody." From a close circle of 10 or so friends, Goodwin says, the group now has more than a thousand pilots nationwide.

Boyer and Goodwin wouldn't meet each other for several years, but in the meantime other groups around the country sprang up, some after hearing about Boyer's and Goodwin's efforts. Many would seek one or the other's advice on how to organize their charity, recruit pilots, and avoid problems with the Federal Aviation Administration. As a result, many of the groups flying patients are modeled after those founded by Boyer and Goodwin.

Take Angel Flight Northeast, the group I fly for. It was started by Larry Camerlin, a former Franciscan friar who, after leaving the priesthood, got married and started an ambulance service in Massachusetts. In 1994, after 12 years of growing the business, Camerlin sold it. He then pursued a lifelong interest in flying and started taking lessons, getting his license in 1996. While deciding what next to do, Camerlin read an article about an Angel Flight West pilot in California and was so moved he called up and said he wanted to fly for the group. When he learned that there was no similar organization in New England, Camerlin, with his background in the ministry, health care, business, and aviation, decided he was the man to start one.

Camerlin rounded up a handful of pilots, mostly flight instructors eager to fly, for a meeting in the basement of the Beverly Municipal Airport in Massachusetts. From those beginnings, Angel Flight Northeast has grown to more than 500 volunteer pilots, most of whom learned about the organization from other pilots, news items, or the Internet.

Today, more than 4,500 pilots are now volunteering their services across the country; they have flown more than 45,000 patients a total of 28 million nautical miles. Not bad for what started out as a handful of well-intentioned pilots in need of a good excuse to fly.

As the groups have grown and become more visible, they have also become better able to negotiate the waiving of landing fees at frequently used airports and discounts on fuel for pilots on charity flights. For example, Signature Flight Support, a company that operates the nation's largest network of fixed-base operators, gives volunteer pilots a break on fuel costs of up to 50 cents a gallon at its 30-plus airport locations in the United States. Similarly, Massport, which runs Boston's Logan International Airport, waives landing fees for charity flights, saving pilots about $100 a flight. For John Duval, Massport's assistant director of operations, the decision to waive the fees was an easy one. For one thing, Massport was already extending that courtesy for charity-related events; for another, Duval was a volunteer with Angel Flight himself.

Since pilots have to pay all of the operating costs incurred on charity flights, breaks like these, in addition to the tax deduction pilots can take for some charity-flight-related expenses, can keep flying costs down.

In return, most organizations require their pilots to own their own aircraft, have at least 300 hours logged as pilot in command, and have an instrument rating (some groups tell their pilots to fly the passenger leg of each flight IFR--instrument flight rules--to increase safety and reliability).

Angel Flight Northeast requires prospective pilots to attend an orientation. "We want to get the message out that this is much different than flying a friend or friend's friend down to breakfast or lunch," says Camerlin. "It's flying people who don't know you at all, who have never met you, who are under tremendous stress in their life and who now have to travel by private aircraft, probably for the first time." Sensitivity and communication are buzzwords at the orientation.

At Angel Flight Northeast's modest headquarters at the Lawrence Municipal Airport in Massachusetts, Roger D'Entremont is busy on the phone. A retired TWA captain, he is one of five paid staffers in the office (salaries are funded by donations from businesses and individuals). Angel Flight Northeast coordinates up to 50 missions a week. Requests generally come in from patients, families, or friends. D'Entremont figures his office is able to help about 90 percent of the requests it gets; the others are referred elsewhere. Still, the best-laid plans can go awry, and about 20 percent of the missions have to be rescheduled, nearly always because of the weather.

Here's a typical scenario for Angel Flight Northeast: Once a patient's condition and need are verified (patients must get a medical release from their doctor to fly), the office starts calling pilots. A schedule of available flights is also sent via e-mail to pilots, who can choose flights at their convenience.

When a pilot agrees to a flight, he is given the patient's name, condition, weight, the weight of whomever the patient is traveling with, the amount of baggage expected, and a telephone contact number. The pilot then calls the patient to discuss details of the flight and answer questions. Before flying, the pilot has the passengers sign a form releasing the organization from liability. After the flight, the pilot fills in a post-mission report--who was transported, the route and time of flight, estimated fuel consumption, and any other comments--and sends that too to Angel Flight Northeast.

While air traffic controllers have specific written procedures for handling "Lifeguard"--air ambulance--flights, there are no procedures for handling "public benefit" flights, as the FAA terms them. Over time, pilots learned to write the organization's name on their flight plan form and hope that controllers would recognize "Angel Flight" or "AirLifeLine" and give them a little extra help.

Stu Morse of Shirley, New York, an Angel Flight Northeast pilot and an air traffic controller on Long Island, says controllers try to give special treatment when handling a public benefit flight. I experienced that recently; while transporting a six-year-old burn patient from Shriner's Hospital in Boston back home to Baltimore, instead of getting the usual routing runaround that takes you far to the west before turning you south in order to avoid New York's airspace, I got a routing directly over Kennedy International Airport. When an airliner requested an altitude change, the controller returned, "Sorry, we have an Angel Flight transitioning the area." He didn't have to do that, but it was very encouraging to hear.

Last spring, the FAA went further, approving the use of a new call sign to identify public benefit flights. "Compassion," the call sign, lets controllers know the kind of mission being flown. Controllers can give such flights priority handling. To use the call sign, pilots use the identifier ("CMF") before the last three characters of their tail number and identify themselves as such throughout the flight. For example, the tail number N7371G becomes CMF71G and the pilot identifies himself as "Compassion seven-one-golf."

Once pilots complete the first flight, says Roger D'Entremont, "they're hooked." While many join just because they love to fly, "you cannot do this and not be affected by the people you're helping," he adds. Often pilots develop a bond with the patients they transport, calling them afterward to see how their treatments went or to offer encouragement. Some have even visited patients in the hospital. Likewise, some patients like to request a certain pilot whenever they fly.

"I flew in the Air Force," D'Entremont says, "and like all those guys I believed I was a god, that I was never gonna get hurt, that I was gonna live forever. But here the people you're helping are all ages, come from all walks of life, and you just realize how fortunate you are to have your health, to fly, and to have the resources to do it.

"It's such a simple thing," he adds "You're giving someone a ride. But it can mean so much to them."

"Go ahead, take the controls."

Donna Voisine shoots me a look that says, "You've got to be kidding."

"Don't worry," I say. "I won't let anything happen. The plane will practically fly itself." I let go of the yoke to prove my point.

Nervously, she grabs the controls. The plane dips a bit, and Voisine lets go, thinking she's done something horribly wrong. With one finger on the yoke, I correct the plane's attitude and say, "That's okay, don't fight it. Just sort of coax it. Go ahead."

She grasps the controls again.

"That's it. Relax."

Her grip lightens, and after a bit the plane gently steadies under her command. I point to a landmark on the horizon and tell her to just head for it.

She smiles. The plane is hers.

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