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October 15, 1982

Columbia, Critical Care, Computers, and Consultants

JAMA. 1982;248(15):1884. doi:10.1001/jama.1982.03330150070033

The spacecraft Columbia illustrates the human capacity for developing and solving complex problems. I understand Newton's laws, but my mind refuses to even enumerate the thousands of logistical, structural, and astronautical problems that had to be individually solved and integrated to make the Columbia lift off. People did solve those problems. Columbia flies.

The critical care unit is a complexity I understand. I can appreciate subtleties in problems from medical to administrative to ethical, and their interactions. Daily, I make decisions that are potentially marked "right" or "wrong" by life or death. I am not always right, but I understand the pressures that impinge on and repercussions that result from a single decision. Presumably, my astronautical colleagues would be as paralyzed by their lack of knowledge in my field, as I am in theirs.

Not only do I make decisions in the critical care unit, I explain the decisions and