Editor-in-Chief, Chester 'Trip' Buckenmaier III, MD, COL, MC, USA.

For years on the various cruises we have taken on Family Knot, I have maintained a daily log of our travels. I dutifully record our position, direction, speed, sail changes, and include any significant weather or events that may occur. From a practical standpoint, a well-kept log is a legal document, admissible as evidence, should something extreme occur. The log begins every day with a series of self-imposed mandatory system checks. Keeping the log (and keeping myself honest about its contents) can be a royal pain. I am constantly conflicted with myself and my crew concerning the monotony of keeping the log. My internal monologue consists of something like, “I have checked the engine oil every day for two weeks, it is always fine, I am dog-tired, so do I really need to check it again?” The list of checks from the batteries, fuel, water, bilge, electronics, to engine checks is burdensome and mind-numbing in its constancy. Nevertheless, I have convinced myself that these irritating details are the difference between captaining a safe vessel versus a vessel that places the crew, my family, at needless risk. 

Before leaving Solomons, Md., I noted the coolant level in the engine reservoir was lower than I recalled. I checked the radiator hoses and could not find a leak, so I topped the coolant off and went on with my checks. As we motored out of the harbor, this inconsistency in my routine of checks caused me to check the coolant just one more time. This time, the leak was obvious from an old, deteriorated hose connecting the reservoir to the radiator cap. Such a simple, seemingly innocuous, piece of polypropylene hose, left unchecked, would surely have resulted in very unpleasant consequences for the diesel engine and the sailing trip in general. We returned to the dock, purchased a new hose (and a spare, which I should have had) and went on to a magnificent downwind run under our brightly colored spinnaker. Attention to the details had rescued the boat and the crew from considerable unpleasantness. 

I find many parallels in my sailing adventures and my life as a federal medicine provider. So much of my work life is invested in constant equipment safety checks, checklists, safety-improvement committees and mountains of regulatory paperwork. The drudgery of these efforts, which often give the impression of having little to do with patient care, can cause providers to cut corners or become apathetic about medical safety procedures. It is these lackluster details of medical care that, more often than not, are the difference between the medical equivalent of smooth sailing with following seas or versions of the Titanic disaster.  It is the details that separate average providers from truly spectacular ones. God truly is in the details.

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