An ER doctor on triaging your crazy busy life Darria Long
Raise your hand, and be honest,
if you’ve used the phrase “crazy busy”
to describe your day,
your week, your month.
I’m an emergency-room doctor,
and “crazy busy” is a phrase
you will never hear me use.
And after today,
I hope you’ll stop using it, too.
Here’s why you cannot afford
to use “crazy”
to describe your busy.
Because when we are
in what I refer to as Crazy Busy Mode,
we are simply less capable
of handling the busy.
Here’s what happens.
Your stress hormones rise and stay there,
your executive function
in the prefrontal cortex declines.
That means your memory, your judgment,
your impulse control deteriorate,
and the brain areas for anger
and anxiety are activated.
Do you feel that?
Here’s the thing.
You can be as busy
as an emergency department
without feeling like you’re crazy busy.
How?
By using the same tactics that we use.
Our brains all process stress
in similar fundamental ways.
But how we react to it
has been shown by research
to be modifiable,
whether it’s emergencies
or just daily, day-in, day-out stress.
Now contrast Crazy Busy Mode
with how I think of us
in the ER – Ready Mode.
Ready Mode means whatever comes in
through those doors,
whether it’s a multiple-car pileup,
or a patient having chest pain
while stuck in an elevator,
or another patient with an item
stuck where it shouldn’t be.
When you’re know you’re dying to ask.
(Laughter)
Even on those days when you would swear
you were being punked,
we’re not afraid of it.
Because we know that whatever comes in
through those ER double doors,
that we can handle it.
That we’re ready.
That’s Ready Mode.
We’ve trained for it,
and you can, too.
Here’s how.
Step one to go
from Crazy Mode to Ready Mode
is to relentlessly triage.
In Crazy Mode, you’re always busy,
always stressed,
because you’re reacting to every challenge
with the same response.
Contrast that with Ready Mode,
where we triage,
which means we prioritize
by degree of urgency.
This isn’t just a nice way
to get your to-do list done.
Work by Dr. Robert Sapolsky
shows that individuals who cannot
differentiate threat from non-threat
and react to everything
with the same response
have double the level of stress hormones.
Which is why this
is the first skill to learn.
You can’t take care of them all at once,
but you don’t have to.
Because we triage.
Red – immediately life-threatening.
Yellow – serious, but not
immediately life-threatening.
Green – minor.
And we focus our efforts
first on the reds.
Now hear this.
Part of the problem in Crazy Mode
is that you are reacting to everything
as if it is red.
So start by triaging correctly.
Know your reds.
They’re what is most important
and where you can most move the needle.
Now it’s easy to be confused by noise,
but what it noisiest
is not always what is most red.
In fact, my severe asthmatic patient
is most at risk when he’s quiet.
But my patient over here, demanding
that I bring her flavored coffee creamer,
she’s noisy, but she’s not red.
I’ll give you an example from my own life.
Last spring, my house flooded,
my one-year-old was in the ER,
I was supposed to do a fundraiser
for my four-year-old’s school
and the final chapter of my book
was beyond late.
Maybe not ironically,
that was the chapter on stress.
(Laughter)
My red tasks were getting
my one-year-old better
and finishing my book.
That was it.
Remember, relentlessly triage.
The house flood repair?
Well, once we had stopped
and stabilized the damage,
it was no longer a red.
It felt red,
but it was in fact just noise.
No, no really, it was quite noisy,
this picture on the far right
is me wearing earplugs
to focus on my book,
while the floor is being
mechanically dried around me.
Know your reds,
and do not let your non-reds
distract you from them.
By the way, it is liberating
with a green task
to, every once in a while,
be able to remind yourself,
“That’s a green task.
No one’s going to die.”
(Laughter)
It’s OK if it’s not perfect.
Now there’s one last triage level
that we use in the worst scenarios.
And that is black.
Those patients for whom
there is nothing we can do.
Where we must move on.
And although it is gut-wrenching,
I mention it,
because you each have your own equivalent
black tasks in your life.
These are items
that you must take off your list.
And I think many of you
know what I’m talking about.
For me, this was the fundraiser.
I had to step down.
Because as we in the ER know,
if you try to do everything,
you have no hope of saving your reds.
Step two to go from Crazy Mode
into Ready Mode
is to expect and design for crazy.
Half of handling crazy
is how you prepare for it.
So if step one we triage,
step two, we design to make
those tasks easier to do.
Science shows us
that the more options we have,
then the longer each decision takes.
And the more decisions we have to make,
the more exhausted our brain gets
and the less it is capable
of making good decisions.
Which is why this step two
is about finding ways to reduce
your daily decisions.
Here are four easy examples
you can use in your daily lifestyle.
Plan.
Plan your entire week’s meals
on the weekend,
so that when it’s Wednesday at 6pm
and everyone’s hangry
and requesting pizza,
you have no decisions to make
to get a healthy meal on the table.
Automate.
Never leave anything to remember
that you could automate,
whether it’s scheduling it as recurring
or saved list, or recurrent purchases.
Colocate.
When it comes to exercise,
store all the equipment that you need
for a certain activity together,
charged and ready,
so you don’t spend energy looking for it.
And decrease temptations,
for anyone driven by sugar cravings.
Anyone?
Say aye, go ahead.
That itself is its own form of Crazy Mode
and self-medication for Crazy Mode,
but stop working your willpower.
Design differently.
If a food is out of immediate reach,
such that you have to use
a stool to reach it,
even when it’s chocolate,
study participants ate 70 percent less
without thinking about it.
I know.
Let that sit for a second.
(Laughter)
Design to make the choices
you wish to make easier.
Which bring us to the third step
to go from Crazy Mode to Ready Mode,
and that is to get out of your head.
Come with me.
Different story.
I’m working in a small, satellite ER,
when a woman comes in in labor.
I realize that the cord
is wrapped not once
but twice around the baby’s neck.
And I’m the only doctor.
I was scared.
But I couldn’t let it derail me.
Because, you see, we all get nervous.
We all get scared,
but it’s what you do next that matters.
That first feeling isn’t the problem.
It can be an important sign.
The problem comes
when we let it derail us.
When that internal monologue starts
and we catastrophize
and we start to get that tunnel vision.
That’s how you think
when you’re in Crazy Mode,
and you cannot solve anything that way.
Now I promise to come back to the story,
but first, how do I get out
of my own head?
There are many tactics that you may hear,
but for me, I find it best in the moment
to actively put my focus on someone else.
To deliberately make myself
see the person in front of me,
see myself in the arena with them –
what do they need, what do they fear
and how can I help?
This may sound like a whole lot
of warm and fuzzy to you,
but it’s not.
In fact, research shows
that when you prime your brain
with what is, essentially, compassion,
we disrupt that tunnel vision
and internal monologue.
You widen your perception,
so your brain can actually take in
broader information,
so you see more possibilities
and can make better decisions.
Try it.
Know that your internal
monologue can derail you.
And realize that when you get out
of your own head,
you get out of your own way.
Now what happened to that baby?
I focused not on my fear,
but on the mother and the baby
and what they needed me to do.
And got the cord off of the baby’s neck,
and a healthy screaming,
kicking baby arrived,
just as the dad ran in
from the parking lot,
“Hi, you have a son, I’m Dr. Darria.
Congratulations,
you want to cut the cord?”
(Laughter)
And for a moment,
the strong cries of a newborn
drowned out the beeps and the sirens
that are the normal sounds of the ER.
But there was also something else.
Because when I walked back
out of that mother’s room,
I saw several of my other patients
hovering nearby.
I suddenly realized
that despite their own problems
that had brought them
to the emergency room,
they had all come together
to root for this baby.
And they now together shared in the joy.
Because that is what happens
when you go from Crazy Mode to Ready Mode.
Others notice.
They want it too,
they just don’t know how,
they just need one example.
Which could be you.
Own the busy.
But stop calling it crazy.
You’ve always had that ability.
But now …
you’re ready.
Thank you.
(Applause)