Saturday, September 5, 2009

Resource Management Cockpit - The Brain

The altimeter read thirty-five thousand feet. There was the constant sound of energies being liberated and consumed. The dials and flicker-free glass monitors that weighed each and every aspect of the domain were in harmony, happily displaying their digital world in bright color. The view in front was that of a serene sky with overhead cirrus layer that was flying by. All was well, controlled, conformal, quiet and routine.

At first there was a single beep and an amber light blinked then faded. It was nothing, the pilot guessed, probably a gremlin in the power grid or a lone photon high jacking the LED, or just a plain irritating oddity. Another blink of the same LED and now the pilot gave it careful attention. Still nothing. Seconds later all hell broke loose. Multiple alarms suddenly blared. The howl of the Master alarm sounded with the red caution light blinking furiously. Before the pilot or his co-pilot could do anything the aircraft pitched down 20 degrees and started a steep descent. The sounds grew menacingly and the cockpit became a cavern of sirens. Immigrant Rivers of uncertain thoughts flooded the pilot’s brain as his hands tried with futility to regain control of the aircraft pulling mightily on the yoke, the relentless free dive continued. The lower layered clouds now began to appear in front gradually enlarging as the screaming chaos of uncertainty reigned.

The pilot felt the sting of disaster looming and large streams of sweat broke out, some coursing their way down his spine while others perched precariously on his brow. The hands remained steady analyzing the swift descent and the potential of recovery, the prospects of which seemed to diminish with each passing moment. His voice from the fine thin crisp controlled pitch turned husky, rough and weighted with the sudden burden. He barked out orders to his co-pilot who repeated the order and performed the necessary action. Still nothing. No change in the arrest of this calamitous fall. Something had to give. Hope and despair lurked like two thieves ready to sap the energies of the brain leaving it soft and rudderless.  There was no time for either of these charlatans. The checklists and manuals fell from their respective holders strewing paper on the cockpit floor. A glass of water tipped over and wetted the papers. Among this contusion of confused thoughts the pilot steadied his nerves and called out, “Pull the Autopilot, auto-throttle circuit-breakers.” The co-pilot acknowledged the command and then with deliberate measure the pilot eased the throttle to idle and gently pulled the yoke. The altitude now read twelve thousand five hundred and rapidly decreasing. The tens of feet indicator unwound swiftly jumping ahead to keep up with the steeply falling outside pressure differential. At nine thousand feet the pilot had managed to slow the descent to less than a thousand feet per minute from eight thousand feet per minute. The view outside was limited to thick grayish dark clouds whooshing past. There was nothing to be gained from outside view. Success and failure lay quietly in the cockpit ready to be awakened. As the altimeter slowed its rate of descent the pilot leveled the aircraft at seven thousand feet. He then radioed his orders for emergency landing to the Air traffic Controller and resumed control.

Later the pilot and the instructor revisited the entirety of this event to fathom the time element and fashion the probability of speeding up the thought process. If this had been a real aircraft there would not have been enough time for rosaries. Panic and cries of help would have echoed in the passenger compartment. This was simulator training.

Every six months airline pilots are placed in the simulators to fashion their thinking through one or multiple disasters. This “ride” is what keeps them in sync with their abilities. Proficiency combined with experience allows flying to be the safest mode of travel.

Back outside the Operating Room two men sit in the waiting room chairs. One drenched with sweat, the other getting ready to operate.

“What happened?”

“I don’t really know. I was clamping the regional blood vessel for the colon resection when the sudden gush of blood completely obliterated the field of view.”


“Yeah! It didn’t take more than a fifteen seconds. I asked the nurse to pull on the retractor and she was shell-shocked with the view herself. So I had to yell to get her to listen.”

“Did she?”

“She did. Meanwhile the anesthesiologist yelled the pressure is dropping. And I asked him to increase the intravenous flow rate.”

“So things stabilized?”

“Kind of.”

“What do you mean?”

“The blood pressure did stabilize but then the resident called out that the arterial blood looked a little darker then usual.”

“A newbie?”

“No this one is pretty astute.”

“So then what?”

“I saw it too and called out to the anesthesiologist. The patient was not getting enough oxygen and the saturation had dropped down quite a bit.”


“Yeah.” He said that his scrubs all wet with perspiration and the front covered with a splatter of blood. “Yeah, it poured today.”

“I’m glad not to be in your shoes. How did the family take it?”

“They did well.”


“Sure the patient is in recovery and doing well.”

“That is great! What miracle did you pull off this time?””

“Actually three years ago I had a similar event. My assistant located the anomalous blood vessel and stopped the bleed.”

“Not rare enough for you.”

“Similar rarity twice visited makes me an expert.”

“Good for you! What of this anomaly? Where is it located?” The two heads convene over a piece of paper as one pencils a cartoon of where and what of the human anatomy. Both know that the human body is not the plastic mold of “Operation Game” by Hasbro for children. Embryology and genetics conspire to vary the locations of things inside the human body.

“Hah.” He said loudly with an air of satisfaction to no one in particular, victorious, he now headed to the Recovery Room. All was well at this hour.

The drama of life unfolds in different venues but retains its capacity to unnerve, confuse and detach our senses. As humans we conspire to understand the demons and potential hardships and tuck them away as “maybe not”. Yet the risks are ever present. Risks are defined as probabilities of adverse outcomes. We strive to learn so that we may mitigate the risks in venues that harm no one but teach us our own reactions. However where risk mitigation is not possible, we accept the risks and learn from nature’s curveballs and previous experiences. Sometimes, if we are lucky we learn from others’ knowledge. If lady luck is visiting elsewhere then we become the test pilots.

Both worlds exist in a single frame of reference. The drama of plunging from the sky onto certain annihilation to the reality of an accidental hemo-dynamic compromise of a life, are threads from the same fabric. Fashioning an event out of probabilities creates the illusion of a practiced possibility. The phantom that leaps out like an exuberant flame can douse itself with a sudden sigh through the aegis of experience. It is the unprepared, undocumented mind that freezes on the most unwanted of frames where answers fail and calamity visits.

We organize our lives with decisions, some with days or months of pre-thoughts and other times we intuit and spew at the spur of the moment. Both may lead to good or bad outcomes, but the decisions are always correct as long as they are based on experience and knowledge. Sometimes we base our successes and failures on attribution bias rather then on good decision making skills. It is not the outcome that proffers the way to success but the diligence of the decision making process.

Human frailty is the conspiracy of the DNA. The strength of the mind is via the evolutionary process of experience. Life teaches us. Nature roils and boils and bubbles its surprises at us. We in turn learn, respect and strategize our defenses. The battles continue. 

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