Checks & Balances

I’m thinking of consulting a clinical psychologist with regard to my OCD.  I’m having the greatest difficulty getting out of the house in the morning.  Have I switched off the kettle and the toaster?  Is the hot water immersion heater on?  What about the radio, the telly, the computer, and is the back door open?  Then, getting into the car, did I lock the front door?  Did I switch the lights off?  Better go back and check. And then of course, if you get interrupted during the checks, you can’t just resume where you left off; you need to start again.  You stand staring at the cooker master switch and intone, “Off off off off off!”  But somehow, you just can’t “learn” its offness. The fridge is OK.  (As Michael McIntyre has said, why do we trust the fridge?) Then, more bizarrely, have I left the glass paperweight too near the window and is it going to deflect magnified sunlight on to my draft novel and ignite it?  In Scotland?  I ask you. But I’m going back to check.  The neighbours are beginning to suspect.  “He’s just left the house.  Watch this.  In a moment he’ll turn around and go back.  There he goes!”

I’m thinking of writing out a checklist that I could use to facilitate my morning egress, ticking off each item as I go.  Checklists have a noble provenance and a fine track record for safety.  Think of aviation.  I have a PPL and, oddly enough, I can sit at the holding point and carry out the “vital actions” (they really are vital) once, and then forget about it.  People have tried to export checklists out of aviation and into medicine.  The surgeon Atul Gawande is a fan.  See his book “The Checklist Manifesto: How to Get Things Right” (Metropolitan Books, 2009).  In theatre, I always found the ritual of two nurses counting the swabs out loud, in unison, deeply comforting.  Then, as the surgeon is closing up, they repeat the mantra.  “I counted them all out, and I counted them all back.”  Yet many surgeons grumble about checklists.  They say they get in the way.  Actually I think they have a point.  People can get obsessed with process.  GPs now complain that their consultations are constantly being disrupted by a welter of checklists appearing on the computer screen.  Have you checked smoking status, cholesterol, weekly alcohol units, weight…  when all the time the patient wants to talk about something completely different.  Even aviation recognises that checklists are subsidiary to the art of flying.  When your engine fails, the first thing to do is not reach for the checklist, but fly the plane.

Yet some checking procedures are so vital that they are best learned by rote and committed to memory for ever.  I remember when I did a twin engine type-rating in New Zealand (the aircraft was a Beechcraft B76 Duchess with the beguilingly affirmative call sign Yankee Echo Sierra), I had difficulty mastering the procedures, and enacting them, following the failure of one engine after take-off.  From time to time you hear on the news of such an event, the pilots being unable to avert a tragedy, and indeed precipitating it, by shutting down the wrong engine.  You can see how such a thing would happen; two hundred feet off the ground there is a catastrophic loss of power, and the aircraft is yawing all over the sky.  This is when you need to enact a response so hard-wired as to be unconscious and automatic.  So there is a mantra you learn.  I remember – it was 1997 – I was on the phone to my father in Scotland describing all this.  He had been a pilot in RAF Coastal Command.  The last time he had flown a plane in earnest was on September 9th 1945 when he flew from Ikeja to Accra.  (I have his log books in front of me now.)  He said to me, immediately and without hesitation, “Mixture, props and throttles forward, gear up, flaps up, identify, verify, feather!”

This business of rehearsing for an emergency is very important.  One of the most enlightening presentations in medicine I ever went to was one which in my ignorance I tried to avoid.  But it turned out to be compulsory – part of some damned bureaucrat’s checklist.  It was given not by a health professional but by a Fire Prevention Officer with a laconic US drawl and a dry sense of humour.  He was a terrific communicator.  For the first time, I understood fire risk.  He showed a brief – how brief – video of the inside of a department store filmed from a CCTV security camera.  Some draperies caught fire and within the course of two minutes the entire store was a raging inferno.  Then we all went outside and practised extinguishing fires.  Fire extinguishers are designed to be simple but you still need to know which extinguisher to apply to which fire, and how to turn it on, point it, and, as it were, fire it up.  It’s exactly like so many instruments in medicine.  The first time you use a cricothyroidotomy set, you don’t want to be in earnest.

So nowadays I take fire seriously.  If I’m staying in a hotel I actually read that notice about fire exits on the inside of the door, then I rehearse the route, and imagine finding it in the dark, or in thick smoke.

And that’s the trouble with my OCD.  It has a perfectly rational basis.  The laconic US Fire Prevention Officer told me never to leave the house empty with an appliance running.  So I shut my computer down and it says, “Checking for updates.  Do not switch off your computer.  It will turn off automatically.”  Aye right.

Clearly then, it’s all a question of balance.  Maybe if I can whittle the list down to three, at most four vital actions.  And do them once and once only.  Pretend you’re in the cockpit.  The Cherokee Warrior 2 has an avionics master switch.  One switch shuts everything down.  That’s what I need.  To hell with it.  I’d rather the place went up in a puff of smoke than that I continue to live in fear and trembling.  It’s a form of timidity really.

At last!  I’m out, into the car, and away!  No regrets.  Make the journey, park the car.  Brake on, into first gear, steering column locked, lights off, windows closed, valuables out of sight.  Off we go.

Did I lock the car?

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