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Mesothelioma is a form of cancer which occurs in thin membranes (called the mesothelium) lining the chest, lungs, abdomen and sometimes the heart. Although quite rare, mesothelioma symptoms strike more than 200 people each year in the United States. The majority of mesothelioma cases are directly linked to asbestos exposure. Because of the long latency period of mesothelioma, the average age of patients is between 50 and 70 years. Mesothelioma affects men most due to the high exposure of asbestos in industrial typed jobs. Mesothelioma symptoms include respiratory problems, shortness of breath, continual cough and pneumonia. Other mesothelioma symptoms include weight loss, abdominal problems and swelling. In some mesothelioma patients, the mesothelioma symptoms are quite muted, making it hard for mesothelioma doctors to diagnose. Mesothelioma doctors specialize in the study, research, and treatments of Mesothelioma cancers. 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Because of the increase in number of mesothelioma cases in the United States, both governments have increased funding for mesothelioma research. Mesothelioma research and clinical trials have been successful in developing new techniques to fight this cancer and the outlook for more advanced mesothelioma treatments is promising. Surgery is the most common treatment method for malignant mesothelioma. Tissues and linings affected by mesothelioma are removed by the doctor and may include the lung or even diaphragm. A second mesothelioma treatment method is radiation therapy through the use of high energy x-rays that kill the cancer cells. Radiation therapy can be outside or inside the body. A third mesothelioma treatment method is chemotherapy. Through pills or drugs through needles, chemotherapy drugs are used to kill cancer cells. A new mesothelioma treatment method is called intraoperative photodynamic therapy. 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Lessons From the Titanic The Titanic was one of the greatest maritime disasters of all time and still continues to fascinate us today even though almost 100 years have passed since the tragedy. One of the facts about the tragedy that makes it significant was the number of lives that were lost: over 1,500 souls perished in the disaster! The story of the Titanic continues to fascinate us to this day, as witnessed by the 1997 movie: Titanic. The movie had one of the largest budgets of any movie to that date and its success revived interest in the story. That level of interest can be gauged by the amount of information available on the internet. There are scores of YouTube posts, blogs, tweets, you name it. Add to this the books, magazine articles, specials, documentaries, and movies and you can understand why the story of the Titanic is so widely known. I intend to add to the store of comment on this story with this article. I am especially interested in the business of project management and particularly risk management and I believe that the Titanic story provides some Lessons Learned which may improve our performance in the risk management area. Background For those not familiar with the story (is there anyone left who isn't?), let me set the background for you. It is important to view this story in the context of the times it took place in, otherwise learning becomes impossible. Viewing the events from a 2010 perspective gives us access to information that wasn't available at the time; 20/20 hindsight is easily obtainable but isn't very helpful in averting future risk events. The time is the turn of the century - 1900. Travel from Europe to North America is still exclusively by ship and travel back and forth is extensive. The rich travel via ocean liner from North America to vacation in Europe, rich Europeans travel to America for vacations and hundreds of thousands of Europeans emigrate to North America, all by steam ship. Competition of business was as fiercely competitive for steam ships as it is for airlines today. The White Star Line and the Cunard Line were 2 of the key competitors in the trade, both based in England. Competition for passengers drove passage prices down so the number of passengers a liner could carry and the speed with which it could make the crossing were 2 crucial factors in making a profit for her owners. Crossing speed became a rivalry between the two companies with the prestige of the record for fastest crossing being used as a marketing tool. The British government sought to encourage this rivalry by awarding the "Blue Riband" to the holder of the crossing record. They did this to enhance their prestige as a seafaring nation. The Cunard Line held the Blue Riband for 22 years. Their ship, the RMS Mauritania, having made the fastest crossing in 1907. The RMS Mauritania was not only the fastest passenger ship on the Atlantic run, she was also one of the biggest and most luxurious. White Star were desperate to build a liner which could compete with the RMS Mauritania and claim the Blue Riband. They approached the ship builders Harland and Wolff in Belfast Ireland to build them a ship which could take the record and at the same time be luxurious enough to attract the very richest and most demanding of passengers. They also wanted a large enough vessel to accommodate many second and third class passengers. These latter were where the profits lay because of their numbers. The RMS Titanic was commissioned in 1909 and construction started on March 31 of that year. The White Star Line not only wanted the ship to be the fastest, largest, and most luxurious on the Atlantic route, they also wanted her to be the safest. In fact, they wanted to be able to claim the ship was unsinkable. Ship Building in 1900 Ships were built of steel in those days but the steel they were built of and the way the steel was fabricated into a hull were very different. Steel then had a much higher sulphur content which tends to make the steel more brittle. This brittleness increases as the ambient temperature drops and the temperature of the water in the North Atlantic can be very cold, cold enough for icebergs. Steel plates are fashioned into hulls by welding them together today but in 1900 the technology available to shipbuilders was riveting. Riveting can be effective at holding the plates together but is nowhere nearly as strong as welding. This is an important safety factor as collisions are much more likely to cause "holing" to the hull. There were several competing factors to be considered when Harland and Wolff designed the Titanic. Speed was important - speed would improve the business case for building the RMS Titanic (and the 2 sister ships which were to follow). Speed is a result of several factors: the length of the hull, the width of the hull (or beam), the weight of the ship, and the power of the engines and propellers. The longer a ship's waterline the faster she will go. A broad beamed heavy ship will be slower than a narrower, lighter one and engines and propellers must be matched to the hull to achieve maximum speed. Propulsion was by means of coal fired steam boilers on these ships and bigger, more powerful engines required more room for boilers. Not only would boilers have to be larger, more room was required to store the extra coal needed. On ships such as the Titanic space is money. White Star Line believe that their ship should have sufficient capacity to carry 3500 passengers of all classes. They would like to be able to carry 550 first class passengers, 450 second class passengers and 2500 third class passengers, but they must be accommodated in luxury. The White Star Line would like their first class passengers to be treated to a level of luxury not found on any of the competition's vessels, the second class passengers to enjoy conditions equivalent to first class passengers on other liners and third class passengers to enjoy second class passenger comfort. The primary means of providing luxury accommodations will be space. The more space each cabin has, the fewer total cabins the ship will be able to hold (space is finite, the total length overall of the ship will be 890 feet). Harland and Wolff must design a ship that will maximize luxury and speed while minimizing weight. Another conflict White Star and Harland and Wolff contended with was the need for room aboard ship for life boats. The life boats and davits which launch them must all be carried aboard ship and these take up room, the more lifeboats carried the less room for paying customers. Safety Considerations The White Star Line was safety conscious. Prior to the Titanic, safety was pretty much consigned to avoiding collisions that would cause hull damage and the safe extraction of passengers into seaworthy lifeboats failing that measure. Harland and Wolff came up with several new safety features which would make the Titanic safer than her competition. The first of these features was the introduction of bulkheads in the hull which created watertight compartments that could be closed by means of electric motors. The proposed design was for a total of 16 bulkheads, any 2 of which could be flooded without sinking. Operation of the doors would be automatic or controlled manually from the bridge. A second was a second, inner, hull which would protect the ship should the outer hull be breached. Harland and Wolff recommend using these as safety features but the cost of these is considered extremely high, which is why the competition have not seen fit to incorporate them into their designs. A third safety feature was the use of a wireless telegraph which could be used to advise the ship of weather conditions and hazards to navigation. This safety feature is can also be used as a benefit to first class passengers; the ships radio operator can transmit messages from first class passengers to destinations in North America via the radio station White Star uses to handle its radio communications. This is another luxury feature that can be used to promote the Titanic and attract first class passengers. The Titanic is meant to travel the North Atlantic from Southampton, England to New York City, USA. The shortest route is via the Northern route, however the North Atlantic is prone to icebergs in the winter and into the early spring. The alternate route takes ships further south to avoid the icebergs. This approach will avoid icebergs but add time to the trip. Lifeboats are the last resort and will only be used if and when all other safety measures fail. Regulations at this time have not kept pace with ship building technology and passenger ships are required to carry 16 lifeboats regardless of the number of passengers. Lifeboats aren't seen as a primary concern at this point as any emphasis on them would detract from the company's marketing of the ship as the safest in existence. The Disaster The Titanic set out from Southampton, England on April 10th 1912. Departure was delayed by 1/2 hour when the SS New York docked nearby was torn from her moorings by the propeller was from the Titanic. She made 2 stops before her final departure for New York, at Cherbourg, France, and Queenstown, Ireland, where she picked up more passengers. She left Queenstown for New York with 2,240 passengers and crew aboard on April 11th. She sailed the most direct route to New York, through the North Atlantic, and made good time until she reached a point about 400 miles south of the Grand Banks off the coast of Newfoundland. The Titanic was equipped with a telegraph, a relatively recent addition to ships and had been advised that there were icebergs in the vicinity. One of the problems the ship's crew faced was the demand for the use of the ship's telegraph; keep in mind the Titanic carried some of the most influential business people (and socialites) in the world so there was a constant demand to send and receive telegrams. At one point in the evening, the operator became so frustrated with the traffic that he told an operator aboard another vessel trying to warn him of the icebergs to "shut up". Because priority for sending and receiving telegrams was given to the passengers, the warnings about the icebergs in the area never reached the bridge. The Titanic maintained her speed of over 20 knots (approx. 22 mph) through that night. The captain took precautions against a collision with icebergs, he posted a watch in the "crow's nest", an observation platform above the bridge of the ship. Neither crew posted to the crow's nest were able to locate the binoculars which were supposed to increase their range. Under normal conditions the watch would have spotted any icebergs in plenty of time to avoid a collision, but on this night the lookout spotted an iceberg when the Titanic was very close to it. The iceberg the lookout spotted had "turtled", that is it had turned over so that the white snowy surface one normally associates with an iceberg was replaced with a dark opaque surface which did not reflect light. Also contributing to poor visibility was the fact that there were no waves breaking on the iceberg. This combination of events caused the lookout to telephone the bridge with the warning "iceberg dead ahead" when the Titanic had very little time to react. One measure the skipper did not take was to slow the ship down; the Titanic was making 22 knots (approx. 25.5 mph) that night. There are conflicting accounts of the sequence of events in the next several seconds. Steering in those days still followed the convention of tiller steering; when the tiller is moved to the left, the boat steers to the right and vice versa. When an officer wanted to give a command to steer the boat sharply to the left he would give a "hard-a-starboard" order. Some accounts have the First Officer giving an order for "hard-a-starboard", by which he meant to turn the ship to the left (or port) and that the helmsman panicked and steered the ship to the right instead. Others have the helmsman steering the boat to the left as directed. Regardless of whether the helmsman mistakenly steered the ship to the right, or starboard, initially he did bring the wheel around to turn the ship to the left, or port. At the same time the order to change course was given, the order to reverse engines was given to slow the ship down. Reversing the engines will slow the ship but it also creates turbulence around the rudder. Remember that when the Titanic left her dock in London the turbulence her props created was sufficient to break another ship loose from her moorings. The effect on the Titanic in this instance would have been to make the rudder less efficient. A ship's rudder relies on the flow of water passing over it to create force and reversing engines would have lessened this force. Whether or not it would have been possible for the Titanic to avoid that iceberg or not we can't know. What we do know is that the rudder did eventually "bite" and the ship slowly began to alter course to port. The course change was just enough that the Titanic scraped the iceberg with her right side at 11:40 pm Sunday evening, April 14, 1912. The force of this collision was sufficient to open a long tear down the side that stretched to nearly a third of the ship's length. Experts have speculated that if the ship had not attempted to change course she might have survived the impact with the iceberg because a head-on collision probably would not have flooded more than the most forward compartment. Expecting the officers and crew on the bridge to deliberately hit the iceberg is not an option, it would be a bit like advice to hit that deer who wandered onto the road rather than to swerve into another car or off the road. It is great advice but a little difficult to follow in the heat of the moment. Think how difficult it would be to deliberately steer a ship carrying 2200 passengers and crew into an iceberg! The ship began to flood and the closure of the doors in order to seal the flooding compartments off was of no help since those compartments were open to the sea. Once Captain Smith became aware of the collision he went up to the bridge to take command. He sent a fourth officer to inspect the damage and this person initially reported that there was no serious damage. Shortly after that however, the reports started coming in to the bridge that flooding was taking place on a massive scale and that the ship was sinking. Smith's first reaction was to have an SOS telegraphed to summon anyone in the area to his aid. Keep in mind that the Titanic was in the middle of an ice field which other vessels had warned her away from; he must have known that help would take a long time to arrive and anyone immediately steaming to his aid would be taking a tremendous risk of colliding with an iceberg. By 12:30 am on Monday the Titanic was noticeably down at the bow. Now an additional problem evidenced itself. Although the Titanic was equipped with water tight doors to seal the individual compartments, these doors were not water tight at the top so when a compartment was completely flooded water would begin to flow into the next compartment over the top of the doors, much like the water in an ice cube tray when you tilt it. The Titanic's officers began the process of getting passengers off the ship now. Although the Titanic had developed a list, it was not sufficient to communicate a sense of urgency to the passengers. The officers had a difficult time filling the lifeboats with reluctant passengers who would rather go back to their beds, or to the smoking room, or gymnasium rather than leave the ship in a life boat. Reluctance was so prevalent that some of the first ones were launched less than half full. The lifeboats had a capacity for 68 adult men, the first lifeboat to launch on the starboard side contained only 12 people. The Titanic was sinking. There were insufficient lifeboats to accommodate all the passengers so every lifeboat spot that was vacant meant another passenger was going to die! At 12:45 am the crew fired the first distress rockets to attract the attention of any other vessels in the area (some thought they saw a ship's lights some 5 miles distant). This had the immediate effect of communicating a sense of emergency to the crowd which was lacking up to this point. The Titanic was laid out with different areas for 1st, 2nd, and 3rd class passengers with the 1st and 2nd classes having access to the deck where the lifeboats were being launched. These passengers began to fill the lifeboats now. Generally, the policy of "women and children first" was being followed, with some exceptions but this did not apply to the 3rd class passengers. 3rd class passengers were prevented from making their way up to the boat deck by the crew of the Titanic. The ship continued to fill with water more and more rapidly. The bow began to disappear below the water and as the bow began its descent to the bottom it brought the stern up out of the water as the ship began to assume a more vertical attitude. Out of the total complement of over 2200 passengers and crew, fewer than 700 escaped in lifeboats. The last of the lifeboats pulled away from the Titanic at 2:00 am. The 1500 passengers who remained, including the 3rd class passengers, made their way to the stern, or fan tail to await their fate. A wave began rolling up the ship as she sank and this plucked some of the passengers off the fan tail and drowned them. The rest were all in the water by 2:20 that morning when the Titanic sank. The water in that part of the Atlantic at that time of year would be barely above freezing and at that temperature survival is only possible for a matter of a few minutes. Those that did not drown on board the Titanic died of hypothermia shortly after going in the water. No lifeboats returned to help any of these passengers. The passengers and crew who had escaped in the lifeboats were rescued later that morning by the Carpathia and brought to New York city. The tragedy had claimed over 1500 lives. Causes The commonly held view that the Titanic was "unsinkable" runs like a thread through all the events that took place that April. From the decision to provision insufficient lifeboats to accommodate all passengers and crew to the reluctance of the passengers to take to the lifeboats after the iceberg had been struck, the belief that the Titanic was unsinkable influenced everyone's thinking in some way. Marketing the ship as unsinkable was undoubtedly good salesmanship but had disastrous consequences. The Titanic actually carried more lifeboats than she was obliged to carry by the maritime authorities. The rules governing the number of lifeboats a ship was obliged to carry had not been updated to keep pace with the increase in size and capacity of these ships. The result was a feeling that a need for opulence, the existing rules regarding lifeboat capacity, a desire to cut costs, and the fact that the Titanic was unsinkable persuaded her owners to under equip her. She only carried 20 lifeboats, 14 regular lifeboats with a capacity of 65 people, 2 emergency cutters with a capacity of 40 adults each, and 4 collapsible lifeboats with a capacity of 47 adults each. These last were never launched. There seems to have been several breakdowns of communication on board. There were a number of warnings from other ships that there were icebergs in the path of the Titanic. Some of these were taken to the bridge and posted on a bulletin board there. The last warning actually provided information about an area of icebergs identified by latitude and longitude; the Titanic had actually proceeded into the area by the time of the transmission. This last transmission was never relayed to the bridge. The telegraph operator was so overwhelmed by messages to and from the ships passengers that he lost his temper and told the other ship's operator to "shut up". Even though this last message was not communicated to the bridge, the bridge had to have been aware that icebergs were in the area from the previous messages. Smith would have been aware of the risk even without telegrams, this area of the Atlantic always has icebergs at this time of the year. The Titanic was travelling at over 25 mph in an area that contained icebergs, many of which could sink the Titanic. Icebergs come in all shapes and sizes but where there are large numbers, some will always be large enough to cause major damage to the largest ship. This speed meant that there simply was not enough time, after an iceberg had been spotted, to avert a collision. The Captain is ultimately responsible for the vessel under their command and all the passengers and crew, but Smith can be excused to some extent by the pressure applied to make a speedy passage. He was not pushed to set a record but, if he had avoided the ice field or slowed to avoid collision it is likely that his passage would be longer than the competition's. There was lifeboat capacity for at least half the people on board the Titanic, probably a lot more, considering the number of women and children and the calm conditions. Fewer than 700 people actually made it into lifeboats and a number of these were men. The policy aboard that ship and any other of the time was that women and children were to be rescued before men. This policy was defeated aboard the Titanic when members of the crew prevented 3rd class passengers, including all 3rd class women and children, from getting to the lifeboats. The Titanic never had a shakedown cruise or lifeboat drills before setting out on her maiden voyage. This lack of familiarity with the ship was what one of the lookout's blamed for his inability to locate the ship's binoculars. Lessons Learned Maritime regulations were changed to require a lifeboat seat for everyone aboard a ship, and regular lifeboat drills to ensure everyone aboard knows what is expected of them and that the crew is able to fill the lifeboats and launch them efficiently. Regulations were changed to prioritize distress calls and later required an alarm system to be installed that would automatically be triggered by a distress call. The Titanic began sending out SOS's as soon as Smith realized she was sinking but no-one responded. Most operators had gone to bed because of the hour. Maritime authorities established ice patrols to gather information about the ice in the North Atlantic. Up to that point, shipping relied on visual observation and warnings from other ships to advise them when there was ice in their area. The ice patrols spotted icebergs, plotted their drift and advised all shipping of ice conditions. Water flooded the entire length of the Titanic because here water tight doors were not water tight at the top and allowed water to overflow into the next compartment. Titanic's sister ship, the Brittanic (originally called the Gigantic), was equipped with these improved watertight compartments. She was hit with a torpedo in 1915 and sank in 90 minutes, approximately the time it took the Titanic to sink. These lessons were effective in preventing further accidents of this nature, due to this cause. There has never been a maritime disaster to this day which has claimed that many lives. There may be some lessons for the rest of us in the Titanic disaster. Let's start with the problem caused by the boast of the "unsinkable" Titanic and the desire to make the passage to New York as quickly as possible. Marketing and speed spoke directly to White Star's bottom line. There are plenty of organizations that are ready to pay lip service to safety and corporate social responsibility, the ones that are able to demonstrate success are those that put their money where their mouth is. A company, group, or individual that treats these issues seriously will be willing to allocate money to address them. The money should prove to be a sound investment in the long run, because the avoidance of disasters such as the Titanic are immensely expensive, as the folks at BP are finding out in the Gulf of Mexico. Fortunately, the level of class distinction that existed in 1912 is gone today, however it has not completely disappeared. Air carriers still provide the option of business class, or first class to passengers. Those aboard the Titanic unfortunate to find themselves in 3rd class stood no chance of rescue thanks to crew who took it upon themselves to keep them from the boat deck so that 1st and 2nd class passengers could access the lifeboats. Communication failed the Titanic in several specific ways, most chillingly, the lack of response to her SOS's. Communication must be 2 way in order to be successful. We have to have an attentive audience and then verify that they have heard/read/seen the message and understand it. In the case of the SOS signals the tragedy brought about a change in the way telegrams were prioritized and required a 24 hour watch for distress signals. The relative newness of the telegraph was a contributing factor to the lack of communication. Always remember that the promise of new technology can never be taken for granted until it has been demonstrated and the users of the technology have been fully trained. The crew of the Titanic had to walk a fine line between communicating the urgency of the situation to the passengers without panicking them. This they failed to do. They failed to communicate the danger to the passengers and the result was many died who could have been saved by lifeboats. The contingency plan that every vessel that carries people uses is the lifeboat. The Titanic failed to carry adequate lifeboats for the number aboard her, but the crew also failed to take advantage of all the spots available on the lifeboats. This was due partly to a failure on the passengers part to act and partly due to the unfamiliarity of the crew with the handling of the lifeboats. Rollback strategies and contingency plans should always be tested whenever possible to verify their effectiveness and to familiarize the team with them. When the time comes that a contingency plan must be implemented, implementation will go smoothly and there will be no surprises after implementation. The final lesson to learn is that no ship, airplane, vehicle, company, or system, is unsinkable. Thinking that way inhibits our ability to spot risks and mitigate them. We should never make assumptions based on marketing hype (or our own confidence in our work) that prevent us from identifying possible risk events. Remember that no matter how unlikely the risk event, the impact could be such that spending on a mitigation strategy is the only rational decision.

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