Surgeons versus Pilots
by Yan Attias
21 May 2020
Tatum, who dropped me off at the hospital for surgery last week, asked me a question while we were driving. “Hey Dad, are you afraid?” Teenagers don’t talk much nowadays, being constantly absorbed in their screens, but her question was relevant.
I said I wasn’t, I truly wasn’t, but maybe she was. Fair enough.
The lines of defences at the hospital were the usual ones. First stop at the reception lobby where a pretty Aussie girl asked me how my day was going today. God bless Queensland I thought, the entire Anglo-Saxon world really. I then took the elevator to the admin area where they take your money and make you fill out a bunch of forms. They too were really friendly, and the girl there looked at me like if I had just stepped off a cruise ship. Couldn’t really blame her. I was really tanned and had my Steve McQueen Italian Persol sunnies on, the only worthy type of sunglasses according to me.
To make me feel better before surgery, I had just gotten a haircut, was wearing my most flashy Okanui Hawaiian shirt with big frangipani flowers on it, and had spent a few days on the beach in Noosa sunbathing with an (un)healthy dose of Hawaiian Tropic tanning oil smeared all over me, you know the one that smells like coconut. I was a walking impersonation of Jimmy Buffett’s ‘Wasting away again in Margaritaville.’
I gave her a big smile and she froze for a moment, not really understanding the situation. Then she gave me a clipboard with a long form to fill out and I took my Persols down, let them hang around my neck on a lanyard (purchased on the ‘Paul Gauguin’ in Bora-Bora I might add) and put on my mint coloured reading glasses. At that point the girl behind the counter was frantically looking for a colleague to pinch her.
When I got to the question “religion” on the form, the thought briefly crossed my mind to write ‘conservative, libertarian, Jewish atheist, pro-NRA and pro-Trump and passionate about freedom and limited government, passionate about Ayn Rand and Mark Steyn, passionate about the U.S. Constitution and the land of Israel, hater of the Greens and the Left, passionate about teaching aviation, in love with my wife and my daughters.’
Lots of passions really.
But there wasn’t enough space so I simply ticked the box “N/A.” What a pity, what a waste in fact. Imagine if people were given enough space to write, on the day of their surgery no less, what they really believed in. How enlightening that would be.
The next line of defense up was the prep girl. She was business like, had no sense of humour but she was professional. Side note: this procedural, borderline OCD behavior omnipresent in the Anglo Saxon world (thank you Brits!) is alive and well in Australia, believe me. She took my blood pressure which was borderline high-ish (it’s normally super low) and I noticed that that my heart rate was slightly over 80, much higher than my normal 55. She shaved my right shoulder and told me to wear a gown.
She then took me to the waiting room where the mood was sombre, and understandably so. About a half dozen patients were all lined up on beds waiting to be wheeled in their respective operating rooms. I must have been there for close to one hour which is probably the worst part of it all.
That’s precisely when I started thinking about John Young, the commander of Apollo 16 and ninth man to walk on the moon.
You may be wondering why a guy most of you probably have never heard of would pop vividly into my mind but he was there and kept me company during this pre-op lonely and anxious time. I’d read his book ‘Forever Young’ but he wasn’t my favourite astronaut; Pete Conrad and Al Bean were. John Young was a hero for sure, a great life no doubt, courage beyond comprehension certainly but a bit too serious for me. Don’t get me wrong I admire the guy, in fact I shake my head in disbelief at his achievements any time I see a documentary about him.
It’s my slightly elevated, resting yet anxious, heart rate that invited him to the party. Here is a little piece a trivia that you may not know. How many of you know what John Young’s heart rate was during the Apollo 16 Saturn V liftoff and more importantly as he climbed down the LM ladder and was about to step on the surface of the moon? Answer: 70 beats per minute. He even talks about it in the fabulous documentary ‘In the shadow of the moon.’ Armstrong’s by comparison was 130 BPM.
Anyway, my turn came and they wheeled me in. The theater nurse came out and talked to me with a strong Irish accent. I asked her where she was from. “Australia Mate” she replied. “We like to put on accents before surgery” she said, “it relaxes the atmosphere and helps us focus on the job at hand.” Another astronaut, Alan Shepard, did exactly that when he launched on Mercury at the top of a notoriously unreliable Atlas rocket, he spoke “Mexican” and his fellow astronauts nicknamed him José. I do that lots also but in my case I hum, whenever I need to concentrate intensely.
In fact before each milestone in my flying career I have done exactly that, I play music really loud on my way to say a flying or simulator check and somehow one song sticks to my mind. That song keeps playing in the back on my head as I set up the cockpit while a check captain breathes down my neck and watches my every move. It relaxes me. The best and most accurate instrument flying and complex problem solving I have ever done in my career were almost always accompanied by some mental music in the background.
Luke, my young and relaxed surgeon, came out to say hi. He’s the one I kept addressing as “Doctor” during previous visits, respect oblige. He set the record straight, in typical Aussie style too:
“Yan, would you like me to call you Captain?” he asked.
“No of course not” I replied.
“That’s what I thought” he said, “then please call me Luke.”
God bless Aussies and their no-nonsense approach to life. As he was talking to me, I could hear some relaxed laughter coming out of the operating theatre behind me. “Is that your team I hear Luke?” “Yeah Mate, as the leader of the pack I insist on a relaxed, friendly yet professional atmosphere. Anyone is free to express anything, works really well that way.”
I told him this was precisely what modern Crew Resource Management encouraged in the world of aviation and that he’d make a great airline captain and an even better flight instructor. He smiled and I was asleep within three seconds.
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The nurse holding my hand and gently tapping on it in the recovery room about two hours later was wearing a bright pink surgery hat. “Yan” she said, “you’re in the recovery room and surgery went well.”
This waking patients up from their abysmal slumber probably never gets old. First reactions upon waking I’ve been told have been priceless. A nurse I know told me someone proposed to her right there in the recovery room. Me, the first words out of my mouth was a serenade to her. I actually started singing, with a mumbled heavily anesthetized voice, a Doobie Brothers song.
”I wanna hear some funky Dixieland, pretty Mama come and take me by the hand. Oh by the hand pretty Mama, come and dance with your daddy all night long…
She laughed, the more she did the more I sang, and I slowly re-emerged, married to my sling for the next four weeks and then a long rehab starts with a physiotherapist. I won’t bore you with that. What is significant though is that it seems medicine has now equalled, dare I say surpassed, aviation in the world of Crew Resource Management. And that I found really interesting.
One of my best friends, a childhood friend in fact, is a plastic surgeon in France. We talk about the crew/team concept a lot. The similarities between our professions are remarkable. We manage rocky and sometimes dodgy situations using all the tools available to us, tools like situational awareness, leadership (not only originating from the leader), delegation of tasks, communication, authority gradient, threat and error management, decision making, etc.
And I also hear from my close friend the plastic surgeon that some dinosaurs, unfortunately not yet extinct, still roam operating theatres, just as they do cockpits and simulators. The high ego-low human factor capabilities-robotic-devoid of emotions-highly opinionated-unable to think outside their prehistoric box type of assholes who think of themselves as God’s gift to their professions, unaware of the fact that they are hated by most and that they in fact provide a disservice to their very profession.
And to add insult to injury, these inferior dickheads are usually out of touch, unable to be dislodged, either because their knowledge is so good, which they always seem to throw at you, or because they are protected by bad managers, the type of managers who don’t want to know about problems as long as the surgery takes place safely or the airplanes keep flying. These blind non-managers, horrible bosses like the movie of the same name, are also dinosaurs and equally understand nothing about human factors. They represent in fact an impediment to flight and medical safety.
One of my favourite quotes in aviation is the following: “There are some flight instructors where the student is important, and there are some instructors where the instructor is important. Pick carefully.”
The same seems to apply to the world of medicine in general, and surgery in particular.
Thanks Luke, it would have been a privilege to fly with you. It certainly was a privilege to be operated on by you. You are a gift to your profession, your team and your patients.
P.S.: I wrote all of this with my left hand, thank you very much!
Yan Attias is a flight instructor living in the earthly paradise of Noosa who, in the tradition of Antoine de Saint-Exupery, uses flight as a metaphor to make sense of our temporal existence.