Can you imagine the terror of managing a sudden, complex and life-threatening emergency when your actions in the next few minutes determine life or death? The film ‘Sully’ gives us an insight into what airline pilots and doctors have to endure. Personal opinion by Robin Youngson.
I just watched the brilliant new movie Sully featuring the actor Tom Hanks. It’s a true story of the heroic actions of Captain Chesley “Sully” Sullenberger, who miraculously landed an airliner on the Hudson River saving 155 lives, after a bird strike destroyed both engines. I think this film will win an Oscar, it’s utterly compelling and Tom Hanks is perfect in the role.
As a doctor, and particularly as an anesthesiologist, watching this film for me was a harrowing and emotional experience. I still feel tearful as I write these words. Why did the film impact me so much?
Partly, it’s because the film is such a raw story of human peril, heroism and survival – with a happy ending. In the cinema, I could hear people crying and sniffing around me. Anyone who has so nearly lost a loved one, felt that terror and then the unspeakable relief of salvation, will find strong emotions stirred up by this film. Even those who have led safe lives cannot help but be moved by the story, which is sensitively portrayed by the film director, Clint Eastwood.
But beyond the common human elements of the story, I found myself caught up in the role of a pilot dealing with a sudden and petrifying emergency, in which he had mere minutes to make the right decisions and fly a planeload of passengers to safety. Summing up the impact of the incident on his career, Sully says, ‘I’ve had 40 years in the air but in the end, I’m going to be judged by 208 seconds.‘ This will be his legacy.
The beginning of the film shows a bewildered Captain Sullenberger being lauded as a hero in the media and simultaneously judged by the National Transportation Safety Board (NTSB) where he’s told that computer simulations confirm he had time to return to LaGuardia airport and land safely on the runway (I won’t give away any more of the plot).
These scenes impacted emotionally on me as an anesthesiologist because I face similar situations with sudden emergencies in the Operating Room. Indeed, we take lessons from airline safety including ‘crew resource management’ and ‘human factors’ in learning how to deal with very sudden, life-threatening situations. Like pilots, we train on high-fidelity simulators and practice our response to complex emergencies – while our every reaction is recorded and analysed.
This is total-immersion learning. The simulators reproduce every aspect of a real patient: they have pupils that react, pulses you can feel, and breath sounds in the chest. The monitors show realistic vital signs and I administer an anaesthetic to the ‘patient’ in the normal way. When I give a dose of anaesthetic drug, the numbers on the monitors change correspondingly. The trainers can program any kind of sudden emergency, so you have no idea what is about to happen. The simulation is staged in an operating room complete with patient, anesthesiologist, surgeons, assistants, surgical instruments, drapes, blood dripping on the floor, phones ringing, and conversations going on. When you are in the middle of a simulation, there’s complete suspension of reality; you are sweating with the stress of having just four minutes to diagnose the problem and take the correct actions to save a life.
As you can see in the picture, the complexity of the anaesthetic machine, dials, gauges and monitors approaches that of a flight deck.
Simulation training has taught us about ‘human factors’ – the completely predictable ways human beings make errors when faced with sudden, life-threatening emergencies and a complete overload of information and tasks to perform; we all make mistakes. When the trainers trigger the emergency, all hell breaks loose: the alarms start beeping and flashing and vital signs drop like a stone. You have probably never experienced this situation before and you don’t initially know what’s wrong; it could be a sudden drug reaction, an anaesthetic complication, something the surgeon has done, concealed bleeding, a patient problem like a heart attack, or an equipment failure. People start yelling, running around and chaos ensues.
It is sobering to watch the video replay of your own behaviour together with all the monitoring data – rather like the air investigators do when they play back the cockpit voice recorder (CVR) and flight data recorders. I couldn’t believe the mistakes I made. But then you watch multiple scenarios and realise that every other anesthesiologist, and even the instructors, all make mistakes when placed in similar situations.
It’s a powerful lesson: we’ll all make errors unless we are specifically trained and practiced in automated routines to deal with a whole range of possible emergency scenarios. Simulation exercises are now a mandatory part of our training and continuing certification as anesthesiologists. They are also conducted in a safe, confidential, no-blame environment. The only way to improve performance is to make mistakes and learn from them.
While there are many similarities between an airline emergency and patient emergency in the OR, there are differences too. The pilot is responsible for many passengers, not just one. Also the pilot’s life is at stake too, not something that doctors have to face. But pilots are flying highly reliable, modern aircraft with multiple safety devices and backup systems; a life-threatening emergency is a once-in-a-lifetime event for a commercial airline pilot. Doctors face this situation commonly; we’re ‘flying’ sick or critically injured patients and there are no backup systems – the patient has only one heart, one brain, one ‘hydraulic’ system. Some of our patients die in our hands because they have unsurvivable injury or medical problem; others pull through and we tell heroic stories of miraculous rescue.
Thus the beginning of the film was harrowing for me because it triggered many traumatic memories: doing my best to respond skilfully in desperate situations when a life is at stake. Unlike pilots, we get to do it again and again; when my patient dies I still survive. Like Captain Sullenberger, I do my best to stay calm, to resist panic, to draw on every ounce of my experience and knowledge to survive the crisis. With my experience and background, I stand in absolute awe of what Captain Sully achieved that day. I understand something of the complexity and impossibility of his actions. He truly is a hero.
As doctors we face the shadow side too: sometimes a punitive response to our actions, scapegoating, blaming by authorities, legal action, commissions of enquiry, and trial by media – whether we are innocent or guilty. So the early scene in the film where Captain Sullenberger is pre-judged by the NTSB board of inquiry was visceral for me, a painful reminder of the times when I was unfairly judged and blamed.
The film also portrays Sully’s creeping self-doubt, the terrifying thought, ‘What if I was wrong?‘ This too is a familiar experience. How many times do we replay in our mind the emergency situation that went badly, wondering, ‘Did I miss something, could I have done better?‘ This is a heavy burden of responsibility, which we largely carry alone.
In medicine, we have an heroic culture where we just carry on as if we don’t have emotions. There’s often no debriefing or support, we live with our emotional trauma and wonder if the next incident might end our career, leaving blood on our hands. There’s a common saying in medicine that we whisper to ourselves when hearing a story of a disaster befalling a patient and colleague, ‘There, but for the grace of God, go I‘.
Watching the film ‘Sully’ was a heart-wrenching experience but I’m grateful. I’m grateful that here is a film that might give ordinary people a glimpse of what we have to endure as doctors: the terror of life-threatening emergencies, the injustice of investigations, the deep hurt of being unfairly blamed and judged, the loss of reputation, and the grief of losing patients. Yes, we should be held accountable for our action; yes, critical incidents need to be investigated; yes, we need to continually train and improve our skills.
What’s missing from the system is compassion. Every incident of unexpected patient injury or death has a second victim: the health professional. As I watched the film I cried for some of my patients, a burden of trauma and grief came to the surface.
If we litigate and blame, regardless of the innocence or otherwise of the doctor, then learning stops. As doctors we become afraid to share our mistakes and we don’t learn from them. We practice defensive medicine, which is not in the best interests of the patient or the healthcare system. Doctors harden and become detached from their feelings, losing the capacity for compassionate patient care. When the system reacts to healthcare error in this way, then injured patients and families suffer a second wounding; in the aftermath of a critical incident they are too often abandoned with no apology, no support, no explanation, and no confidence that the system has learned from the mistake. After major incidents, all involved deserve compassion and support.
We can do better. We need more initiatives like MITSS, the Medically Induced Trauma Support Services, jointly set up by an injured patient and her anesthesiologist whose error nearly cost her life. We need to provide emotional support and caring to health professionals involved in critical incidents, such as the ‘Code Lavender‘ response at the Cleveland Clinic.
We need to take more responsibility for our own vulnerability and emotional wellbeing. After my last ‘plane crash’ – in which a young mother died of a catastrophic brain haemorrhage – I requested and was granted two weeks’ sick leave. I acknowledged to myself and my boss that I simply wasn’t in a fit state to be caring for patients after witnessing such a tragedy.
My thanks to Clint Eastwood for directing such a powerful and moving film. For my colleagues in healthcare, I hope it will make you reflect on your own experiences.