“The mass of men lead lives of quiet desperation.”—Henry David Thoreau
Others spend their lives preparing to be heroes.
“The Miracle on the Hudson” seized on our contemporary need to believe in something good, something exceptional and something rare: to recognize that there are heroes among us. In a time when heroes seem absent during our national crisis, Chesley Burnett “Sully” Sullenberger, age 58, did what no pilot had ever done. He ditched a commercial jet on open water without the loss of passengers or crew or plane.
It is said that a hero is an ordinary person who when challenged demonstrates his or her innate greatness through extraordinary courageous acts. However, Sully is no ordinary man. He is a former fighter pilot. He is a crash investigator who has developed the root cause analyses of other disasters. He is a licensed glider pilot who when at the stick of a glider must have imagined what it would be like to be gliding in to land a commercial jet heavy with passengers and fuel. He is an airline safety scientist and an author of scientific papers on prevention of airline accidents. He is a teacher who has developed educational programs and lectured on how airline crews can better handle crises. He is the daily leader of his flight crew, carrying out ground checks of his equipment, drills, and routines designed to ensure safety. He had spent his entire career rigorously preparing for this moment and when challenged he acted magnificently. He had prepared to be a hero every day of his career.
Sully calmly spent what was likely the last 2.5 minutes of his life working with his copilot going through the engine restart checklist, assessing his navigation to optimize the best place to ditch, communicating with the Westbury control tower, managing his crew and passengers, lifting the nose, barely clearing the mid-span of the George Washington Bridge, missing the boats in the harbor, dropping his tail to impact the water first, hydroplaning to a stop, safely evacuating all passengers and crew, assessing that his plane was empty of all souls, and then leading his crew in the water rescue of every single passenger.
Oral and maxillofacial surgeons need to study the elements of Sully's heroism and emulate them in our professional lives. Every oral and maxillofacial surgeon needs to prepare daily to be a hero. Examine those attributes and achievements Sully brought to bear that allowed him to achieve this act of heroism. Sully is a highly skilled pilot, passionate and exceptional student, teacher, scientist, advocate, and leader. He was thoroughly rehearsed for disaster and was cool under pressure. These attributes translate nicely into surgical practice. Here are some of Sully's lessons to pursue in your practice so that when called upon, you can be a hero as well.
A High Level of Skill Helps
The better your skills the more likely you can carry an emergency through to a good outcome. One of the best examples of this is to maintain ACLS, PALS, and ATLS and to continuously hone your airway management skills both in the use of airway devices and in obtaining surgical airways.
Be a Lifelong Student
Emergency management, assessing medical comorbidities and presurgical risk assessment are rapidly developing fields for which you must be an active and engaged student throughout your career.
Have a Passion for Safety
Utilizing patient safety standards in your practice and creating a culture of patient safety in your practice will make you and your team ready for disaster.
Study Surgical/Anesthesia Disasters
Case-based symposia on anesthetic and surgical catastrophes can develop your understanding of how to avoid emergencies and how to intervene. Morbidity and mortality conferences should assess the root causes of disaster and develop recommendations on how to reduce the risk of crises and how to act when a crisis arrives.
Teach Others What You Know
The clinical environment should be a continuous learning environment for the whole surgical team. Teaching includes rehearsing for disaster. Drills for the surgical team can include cardiopulmonary arrest, stroke, hemorrhage, fire, police action, equipment/power failure, etc.
Checklist Your Equipment and Your Team
Pilots learn to walk about their plane and check all equipment before use. Every day, essential equipment in surgery needs to be in working order and the team needs to know its job.
Advocate for Improved Patient Safety
Oral and maxillofacial surgeons have been leaders in promoting improved patient assessment, anesthesia monitoring and trauma care, among many areas that have improved patient safety. Become involved in these activities and always promote ideas that put the patient's well-being above any other considerations.
Demonstrate Grace Under Pressure
The flight recording of the final 2.5 minutes of Flight 1549 are extraordinary in the coolness and business-like words of Sully, ending with “Teterboro no good…We'll be in the Hudson.” As taught in the core of your surgical training, the team leader must offer clear-headed direction, communicating unambiguously and unemotionally.
When asked during an interview if he panicked or prayed during those final moments, Sully seemed surprised by the question. “Why no,” he replied. “There were plenty of people in the back of the plane doing that for me…But afterwards, I really let go.”
“A hero is no braver than an ordinary man, but he is braver five minutes longer.”—Ralph Waldo Emerson
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