“Missed it by that much …”
That was one of the catchphrases from the farcical spy situation comedy “Get Smart,” a Mel Brooks brainchild. Maxwell Smart, Agent 86, frequently uttered those words while holding up his thumb and index finger nearly together. The gesture and proclamation always summarized a scheme gone awry by the thinnest of margins.
My first post-college job was as a reliability and quality engineer in support of the design and manufacturing of medical devices. The product line I was initially assigned was intravascular administration sets, essentially the tubing and integrated componentry between an IV container and catheter.
In a worst-case scenario, failure modes could present high drama. The importance of producing within specified tolerances was paramount. Missing by any amount — particularly a vital, predictive, functional aspect — was a serious offense. Our own catchphrase “tubing or not tubing?” became our gallows humor imperative.
At that time, Six Sigma — a system initially aimed at eliminating manufacturing defects — had only been theoretically implemented in academia, so we were left to the old-fashioned manner of assuring quality. We conducted sampling inspection by attributes. We were guided by the now-defunct Military Standard 105 D.
That standard set sample sizes and acceptance levels of occurrence across three categories of defects:
- Critical — results in hazardous or unsafe conditions;
- Major — likely to result in a failure of the product for its intended purpose;
- Minor — not likely to reduce the usability of the product for its intended purpose.
When the defect level for any of those classifications was exceeded — zero in the case of critical — production would be halted. Attempts to isolate causality would ensue. A go-forward preventive action would be instituted. And we’d try anew.
Life with ALS can resemble that. The acceptable tolerance range for successful activity is often maddeningly minuscule. The practical outcome of any “defect” ranges from annoying (minor) to life-threatening (critical). A deviant occurrence may necessitate a pause-regroup-fix-safeguard-resume iteration. My personal experience with “critical defects” certainly reflects that.
One time, a fatigue-accompanied transfer left me face down in a pool of blood emanating from a nasty cut that was precariously close to my right eye. After being stitched up in the emergency room, I undertook a series of process overhauls, with the intent of rendering such occurrences in the future next to impossible. Ultimately, a major technology upgrade was deemed necessary, and I procured a transfer lift.
Another critical defect source sprang from my increasingly diminished swallowing skills. The best-case byproduct is momentary choking discomfort. In the worst case, one might aspirate food into the lungs, which I did, leading to a six-night stay in an intensive care unit.
Following a swallow study, and under the direction of a speech pathologist, my approved raw material list (menu items) has been seriously refined, and I now adhere to strict GMPs (good mastication practices). While this particular failure mode will never disappear, statistically speaking, it has been minimized.
“Major defects” are attended to similarly, although with less rigor. For example, preventive measures — cushioning of probable areas, and frequent repositioning — are in place to mitigate my propensity to develop pressure sores. Beyond that, since the acceptable level is higher, they are addressed as they arise: batch to batch.
The seemingly ever-growing list of my “minor defects” are largely overlooked when detected. They are noticed and tallied. A temporary substitution or waiver is then typically granted. I grin and bear them, while privately pledging to do better the next time.
Thinking back over all of the ALS-related defects that I’ve endured, a harsh reality strikes me. In the real world, such a preponderance would precipitate urgent senior management review. Consumer rancor would be enormous. Drastic measures, such as a recall or even product discontinuation, would be contemplated.
Transactions are sometimes termed as either caveat emptor (buyer beware) or caveat venditor (seller beware). That gets complicated when, like me, you are both sides simultaneously. Yes, many times I abhor my output, yet I fervently desire to produce more of it.
I turn to William Shakespeare for consolation. In “Macbeth,” he wrote, “The attempt and not the deed/ Confounds us.” In “Measure for Measure,” he offered, “Our doubts are traitors/ And make us lose the good we oft might win/ By fearing to attempt.” I don’t want to meekly lapse into the habit of forgoing gain by fretting over its probability.
To that end, I will rationalize away future failures in much the same way as Maxwell Smart did from time to time. Another of his catchphrases was, “The old [so-and-so] trick,” in which he would blithely dismiss unmet objectives due to the intersection of highly unlikely developments. Something like “the old no known cause, baffling to the sharpest minds, random trajectory disease trick.”
Note: ALS News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of ALS News Today or its parent company, BioNews, and are intended to spark discussion about issues pertaining to ALS.
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