In a small Austrian town in the Alps, a mother and father had been out on a walk in the woods with their 3 year old daughter. The parents somehow lost sight of the girl for a moment, and that was all it took.
She fell into an icy fishpond.
The parents frantically jumped in after her. But she was lost beneath the surface for thirty minutes before they finally found her on the pond bottom. They pulled her to the surface and got her onto the shore.
Following instructions from an emergency response team reached on their cell phone, the parents began cardiopulmonary resuscitation. Rescue personnel arrived eight minutes later and took the first recordings of the girl’s condition.
She was unresponsive.
She had no blood pressure.
No sign of breathing.
Her body temperature was just 66 degrees fahrenheit (18.89 degrees celsius). Her pupils were dilated and unreactive to light – indicating cessation of brain function.
She was gone.
But the emergency technicians continued CPR anyway. A helicopter took her to the nearest hospital, where she was wheeled directly into an operating room, a member of the emergency crew straddling her on the gurney, pumping her chest.
A surgical team got her onto a heart-lung bypass machine as rapidly as they could. The surgeon had to cut down through the skin of the child’s right groin and sew one of the desk-sized machine’s silicone rubber tubes into her femoral vein to take the blood out of her then another into her femoral artery to send the blood back.
A perfusionist turned the pump on, and as he adjusted the oxygen and temperature and flow through the system, the clear tubing turned maroon with her blood. Only then did they stop the girl’s chest compressions.
Between the transport time and the time it took to plug the machine into her, she had been lifeless for an hour and a half. By the two-hour mark, her body temperature had risen almost ten degrees, and her heart began to beat.
It was her first organ to come back.
After 6 hours, the girl’s core temperature reached 98.6 degrees, normal body temperature.
The team tried to shift her from the bypass machine to a mechanical ventilator but the pond water debris had damaged her lungs too severely for the oxygen pumped in through the breathing tube to reach her blood. So they switched her instead to an artificial-lung system known as ECMO – extracorporeal membrane oxygenation.
To do this, the surgeon had to open the little girl’s chest down the middle with a power saw and sew the lines to and from the portable ECMO unit directly into her aorta and her beating heart.
The ECMO machine now took over.
The surgeons removed the heart-lung bypass machine tubing. They repaired the vessels and closed her groin incision. The surgical team moved the girl into intensive care, with her chest still open and covered with sterile plastic foil.
Through the day and night, the intensive care unit team worked on suctioning the water and debris from her lungs with a fiberoptic bronchoscope.
By the next day, her lungs had recovered sufficiently for the team to switch her from ECMO to a mechanical ventilator- which required the team to take her back to the operating room to unplug the tubing, repair the holes, and close her chest.
Over the next two days, all the girl’s organs recovered. Her liver, her kidneys, her intestines, everything except her brain.
A CT scan showed global brain swelling, which is a sign of diffuse damage but no actual dead zones.
So the team escalated the care one step further.
They drilled a hole into the girl’s skull, threading a probe into her brain to monitor the pressure, and kept that pressure tightly controlled through constant adjustments in her fluids and medications.
For more than a week, the girl lay comatose.
Then, slowly, she came back to life.
First, her pupils started reacting to light. Next, she began to breathe on her own. And, one day, she simply awoke. Two weeks after her accident, she went home. Her right leg and left arm were partially paralyzed. Her speech was thick and slurry. But she underwent extensive outpatient therapy.
By age 5, two years after she fell into the pond, she had recovered her faculties completely. Physical and neurological examinations were normal.
She was like any normal little girl again.
How did all of the crew, from such disparate fields, in a random hospital perform all of their procedures so flawlessly?
In San Francisco, a patient came in one Halloween night with a stab wound. He had been at a costume party.
He had an altercation. And now here he was.
The patient was stable. Breathing normally, not in pain, just drunk and babbling to the trauma team.
They cut off his clothes with shears and looked him over from head to toe, front and back. He was of moderate size, about 200 pounds, most of the excess around his middle.
And that was where they found the stab wound, a neat, 2-inch red slit in his belly, pouting like a fish mouth. A thin mustard yellow strip of omental fat tongued out of it – fat from inside the abdomen, not the pale yellow, superficial fat that lies beneath the skin.
They’d need to take him to the operating room, check to make sure the bowel wasn’t injured, and sew up the little gap.
“No big deal”, was the thought.
If it were a bad injury, they’d need to crash into the operating room – stretcher flying, nurses racing to get the surgical equipment set up, the anesthesiologists skipping their detailed review of the medical records.
But this was not a bad injury.
They had time, they determined. The patient laid waiting on his stretcher in the trauma bay while the Operating Room was readied.
Then a nurse noticed he stopped babbling.
His heart rate had skyrocketed.
His eyes were rolling back in his head.
He didn’t respond when shaken.
She called for help and the members of the trauma team swarmed back into the room.
His blood pressure was barely detectable. They stuck a tube down his throat, pushed air into his lungs, poured fluid and emergency release blood into him.
Still couldn’t get his blood pressure up.
So now they were crashing into the Operating Room – stretcher flying, nurses racing to get the surgical equipment set up, the anesthesiologists, skippering their review of the records, a resident splashing a whole bottle of Betadine antiseptic onto his belly.
The lead surgeon grabbed a fat knife and sliced down through the skin of the man’s abdomen in one clean, determined swipe from rib cage to pubis.
“Cautery”, the lead surgeon asked and it was promptly handed over.
He drew the electrified metal tip of the cautery pen along the fat underneath the skin, parting it in a line from top to bottom, then through the fibrous white sheath of fascia between the abdominal muscles. He pierced his way into the abdominal cavity itself-
-and suddenly an ocean of blood burst out of the patient.
The blood was everywhere.
The assailant’s knife had gone more than a foot through the man’’s skin, through the fat, through the muscle, past the intestine, along the left of his spinal column, and right into the aorta, the main artery from the heart.
Another surgeon joined to help, getting a fist down on the aorta, above the puncture point. That stopped the worst of the bleeding. Later on, his comment was that he hadn’t seen bleeding of that sort since the Vietnam Wars.
The description, as it turned out, was pretty apt. The assailant had dressed up as a soldier – with a bayonet.
There are a thousand things that could have gone wrong.
Everyone involved got almost every step right – the head to toe examination, the careful tracking of the patient’s blood pressure, pulse, rate of breathing, monitoring of his consciousness, the fluids run in by IV, the call to the blood bank to have blood ready, the placement of a urinary catheter to make sure his urine was running clear – everything.
Except no one had remembered to ask the patient or the EMTS (emergency medical technicians) what the weapon was.
“Your mind doesn’t think of a bayonet in San Francisco”, the lead surgeon said.
On October 30, 1935, at Wright Air Field in Dayton, Ohio, the U.S. Army Air Corps held a flight competition for aeroplane manufacturers vying to build the military’s next-generation long-range bomber.
It wasn’t supposed to be much of a competition.
In early evaluations, Boeing Corporation’s gleaming aluminium-alloy Model 299 had trounced the designs of Martin and Douglas. Boeing’s plane could carry 5 times as many bombs as the Army had requested. It could fly faster than previous bombers and it could go twice as far.
A Seattle newspaperman who had glimpsed the plane on a test flight over his city called it the “flying fortress”, and the name stuck.
The “flight competition”, according to the military historian Phillip Meilinger, was regarded as a mere formality. The army planned to order at least 65 of the aircraft.
A small crowd of Army brass and manufacturing executives watched as the Model 299 test planned taxied onto the runway.
It was sleek and impressive, with a 103-foot wingspan and four engines jutting out from the wings, rather than the usual two, the plane roared down the tarmac, lifted off smoothly, and climbed sharply to 300 feet.
Then it stalled, turned on one wing, and crashed in a fiery explosion. Two of the five crew members died, including the pilot, Major Ployer P. Hill.
An investigation revealed that nothing mechanical had gone wrong. The crash had been due to “pilot error,” the report said. Substantially more complex than previous aircraft, the new plane required the pilot to attend to the four engines, each with its own oil-fuel mix, the retractable landing gear, wing flaps, electric trim tabs that needed adjustment to maintain stability at different airspeeds, and constant-speed propellers whose pitch had to be regulated with hydraulic controls, among other features.
While doing all this, Hill (the pilot) had forgotten to release a new locking mechanism on the elevator and rudder controls.
The Boeing model was deemed as a newspaper put it, “too much aeroplane for one man to fly.”
The Army Air Corps declared Douglas’s smaller design the winner, and Boeing nearly went bankrupt. Still, what to do with the few Boeing aeroplanes that the Army had bought for testing?
A small group of insiders remained convinced that the planes were flyable, so they got together to decide what could be done about it.
What the pilots decided not to do was almost as interesting as what they actually did. They did not ask more pilots to undergo longer training. Instead, they came up with an ingeniously simple approach: they created a pilot’s checklist.
It was dumb stuff. Hardly complex.
The list was simple. Brief. To the point. Short enough to fit on an index card, with step-by-step checks for takeoff, flight, landing, and taxiing.
One would think it wouldn’t make much difference.
And yet it did.
With the checklist in hand, the pilots went on to fly the Model 299 a total of 1.8 million miles without one accident.
Instead of 65, the army ultimately ordered almost 13,000 of the aircraft, which it dubbed the B17.
And because flying the behemoth was not a possibility, the army gained a decisive air advantage in the Second World War, enabling its devastating bombing campaign across Nazi Germany, changing the face of the world forever in the time to come.
Why Is A Checklist So Unbelievably Effective?
Human behaviour is consistently inconsistent.
Oh sure, you can find with some regularities certain examples of consistency, but dig a little bit deeper and those all fall to pieces.
This is in large part a reason why most people fail at investing.
A simple checklist can look like this.
- Do you know how the company makes profits?
- Does the company’s supply/demand for the future look likely to deliver a good earnings call for the next few years?
- Is management fraudulent?
- Is management in the same boat as the shareholders? Will their own wealth be harmed by doing the company damage?
- Is the company overvalued?
- Is the company undervalued?
- Are you investing in your circle of competence? Do you know the industry? It’s ins and outs? Its mechanics? How things are done? Do you have a finger on its pulse? Do you work in it? Do you have insider information? Are you breaking any laws?
Think about these steps as you invest, and you will realise that methodically going through each and every one of them removes areas of vulnerabilities, stripping away mud and sand from the windshield. Each step serves as a safety valve. A seatbelt. A parachute. Something to guide your money through and keep it safe. That’s what a checklist is all about.
Much of our own world has evolved to its own B17 scenarios. In other words, a whole lot of the things in our world have now become “too much plane for one man to fly“.
Investing is no different.
There a thousand and one scenarios where you can get screwed as a retail investor.
- Management can lie to you.
- Industry experts can be dead wrong.
- Market watchers can be too bullish or too bearish.
- Valuations can be made on shaky legs.
- Analysts could miss something crucial.
Balanced against the backdrop of complexity and thought that investing requires, how certain are you that your life is not going to take away some small edge you haven’t considered?
Some small factor you overlooked?
Why not mitigate all of that with a simple checklist?
Why take the unseen risk destroying investment capital?
We are humans. We can err.
That’s why we use a checklist.
You can come up with one too, with enough time, with enough experience and with enough education. Stick to a good checklist. Something that works. Something that has been proven. Something that helps you avoid bad logical/emotional decisions.
This checklist is ours.
We have written about our checklist and investing methodology extensively before here. Here. Here. And here. We have a whole section of case studies here too. We also publish articles on recent investments.
We hope this has convinced you to take up the use of a checklist when it comes to investing.
And don’t invest without a checklist.
The stories above were lifted from the book called – aptly I might add – “The Checklist“.