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Aviate, Navigate, Communicate: What Hospitals Can Learn from Pilots

“Could I have some water?” Gary bent his head closer. Apparently, my husband couldn’t hear me. I couldn’t remember ever being so thirsty, and I felt too weak to talk.

We were in the Emergency Room because I had neutropenic fever, a condition that happens sometimes after chemo when a high fever indicates a low white blood cell count. It’s serious and can quickly become deadly. Gary had called Stanford at the first sign of my spiking fever, and he was told to get to my local ER.

“It has to be from a bottle,” Gary said. “You can’t risk getting germs right now, and no one here can find any bottled water.”

A team of hospital personnel was huddled around a screen on the other side of the room. I could hear them talking about the new computer system they had just adopted that day, and how confusing it was to use. Fingertips on keys. Whispered, urgent conversation. An exasperated husband.

All I wanted was a drink of water.

My husband and I are entrepreneurs. We’ve started, developed, and sold all kinds of businesses, from coin-op laundromats to a high-tech start up. One of our endeavors was a flight school.

What’s interesting about flying is that there are check lists for everything. Every pilot, every airplane, every flight has a set of procedures designed to minimize the risk of potentially life-threatening mistakes.

There’s also a slogan pilots memorize in case of emergency: Aviate, Navigate, Communicate.

It sounds simple, but it’s easy to lose sight of what’s important when an emergency comes from every direction. In the air, though, one rule is constant: a pilot’s first job is to fly the airplane, to aviate. No exceptions. Yes, pilots have other tasks and checklists, but if they’re not flying the airplane, none of those other tasks matter.

The second rule is to navigate. Pilots ensure they’re on course after the “aviation” part of their job is done. Finally, they communicate. They pick up the radio and tell appropriate people what is going on.

Aviate, Navigate, Communicate. It happens in that order. Every pilot, every time. And that simple rule saves lives because it works.

It seems to me that on the night of my potentially deadly fever, those medical providers in the Emergency Room could have taken a lesson from my flight school. While pilots have a critical obligation to aviate their planes as their top priority, medical personnel have to treat their patients. I admit that my timing was remarkably bad. Who gets neutropenic fever the night a hospital gets a new computer system?

No, you really don’t need the correct spelling of my middle name in the computer database before starting urgently needed medical attention. Aviate, Aviate, Aviate!

After all, Gary was aviating. He called ahead to let the ER know we where coming, relayed critical health information, and gave them the name and cell phone number of my oncologist at Stanford. My oncologist was aviating. He gave them the exact antibiotic combo I needed based on my chemo treatment. And I was aviating. I needed water and made it known to everyone in that room.

While my husband beseeched doctors and nurses to hurry, I waited for antibiotics I desperately needed — waited and endured my thirst.

Staff continued to huddle at the computer. They were navigating and had forgotten to aviate. They were communicating, with each other, about their training earlier that day. “Look at her!” I heard my husband plead. “I don’t understand why this is taking so long!” If those doctors had been pilots, their plane would have crashed.

That’s why hospitals need a system like the ones pilots use. Medical practitioners need a formula to remind them, no matter what, that the first priority has to be to treat the patient, not interface with the computer.

Aviate, Navigate, Communicate.

What happened to me that night? An ER doc from outside the system came on duty and bypassed the new computer. My husband went to the closed cafeteria and found a bottle of water in an unlocked cabinet. And at midnight, after five hours in the ER, I was admitted to the hospital.

Gary later told me that they had talked about airlifting me to another hospital because so much critical time was lost dealing with the computer system instead of the patient. I spent four nights in the hospital, and after I relayed my story to an OR nurse friend, she wrote the words Aviate, Navigate, Communicate on a white board at the entrance to the OR.

I hope for the sake of every patient who comes after me that those words are still there.

This piece was published first on

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