The Challenger Principle

The Challenger was a disaster that should not have occurred. It was known by the Morton Thiokol company that the "O rings" might not function effectively under cold conditions. On January 28, 1986, the temperature was below 30 degrees Fahrenheit at Cape Kennedy. The company knew there could be a problem with sealing the fuel joints on the rocket, but agreed to the launch anyway. NASA and Morton Thiokol were both pushed into taking a chance because of the cost, the importance of this launch, and constraints of time. The result is too well known.

I have used this incident as a reminder to NEVER BE AFRAID TO CANCEL SURGERY.

In our busy schedules, with multiple operations and multiple patients, it is not unusual to miss some important result that once discovered raises the possibility of danger with the procedure. Discovering something we did not know, prior to an operation initiates an internal debate," Should I cancel this operation? When will I do this case; my schedule is full. The family has come a considerable distance for this patient, and they will have a fit!" When I have this debate,and we all will at some point, I think of the Challenger, and cancel the case.

Going to talk with the family can be difficult, for they have most often taken time off from work, traveled long distances, and waited in anticipation for the surgical result. Talking with the family about the decision to cancel surgery can be acrimonious.

After allowing the family to vent their anger at this situation, I then tell them that I have a specific reason for canceling the surgery, because I discovered something I was uncomfortable with. Then I remind them of the Challenger.

If they don't remamber the Challenger, I briefly reiterate the story of this unfortunate incident. I remind them that a debate occurred for at least three days before the launch, and NASA finally agreed with Morton Thiokol that they would "probably" be alright even though there were questions about the safety of the "O rings." I let them know that I discovered "x" and that I am NEVER AFRAID TO CANCEL AN OPERATION.

All anyone can see when remembering the Challenger is the poof of smoke and the steller cloud slowly sinking back to earth. My experience has been that the family then enthusiastically thanks me for cancelling the surgery.

So, when faced with some new information that brings up doubt about proceeding with surgery, think of the Challenger, and never be afraid to cancel an operation.

James P. Weaver, M.D.