Finding Mastery with Dr. Michael Gervais - Wiring Your Brain for Performance Under Pressure | ER Physician, Dr. Dan Dworkis

Episode Date: January 5, 2022

This week’s conversation is with Dr. Dan Dworkis, an attending emergency physician and professor at USC’s Keck School of Medicine, where he works at the Los Angeles County+USC Medical Center (one of the largest and busiest emergency departments in the country).Before that, he did his training with the Brigham and Women’s Hospital / Massachusetts General Hospital Harvard Affiliated Emergency Medicine Residency.ER doctors or not, we all face emergencies in our lives– times when we are called on to make a decision to act, or not act – with skill to meet the demands of the moment – whether that’s in an environment of uncertainty, pressure, or even intimacy.Dan believes deeply that all of us can improve how we function under pressure and in doing so perform at our best when we are needed the most. He’s the founder of The Emergency Mind project which helps individuals and teams perform better under pressure both in and out of the emergency department – and that sets the tone for this conversation._________________Subscribe to our Youtube Channel for more powerful conversations at the intersection of high performance, leadership, and meaning: https://www.youtube.com/c/FindingMasteryGet exclusive discounts and support our amazing sponsors! Go to: https://findingmastery.com/sponsors/Subscribe to the Finding Mastery newsletter for weekly high performance insights: https://www.findingmastery.com/newsletter Download Dr. Mike's Morning Mindset Routine! https://www.findingmastery.com/morningmindsetFollow us on Instagram, LinkedIn, and X.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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better. And where that confidence comes from is me knowing that I have trained and continue to train to be able to bring all that humanity has to bear to that patient. Hey, welcome back or welcome to the Finding Mastery Podcast. I'm Michael Gervais. And by trade and training, I'm a sport and performance psychologist, fortunate to work with some of the most extraordinary thinkers and doers across the planet. And the whole idea behind these conversations, behind this podcast, is to learn from the extraordinaries, to pull back the curtain, to explore how they have committed to mastering both their craft and their minds. Now, our minds are our greatest asset.

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with Dr. Dan Dworkus. He's an attending emergency physician and professor at USC's Keck School of Medicine, where he works at the Los Angeles County and USC Medical Center. This is one of the largest and busiest emergency departments in the country. Before that, he did his training with the Brigham and Williams Hospital, Massachusetts General Hospital Harvard-affiliated emergency medicine residency. Be our doctor or not, we all face emergencies in our lives, times when we are called on to make a decision to act or to not act, and to be able to meet the demands of the moment with skill, whether that's an environment of uncertainty or pressure or even intimacy.

Dan has spent years working on how to refine his ability to perform with pressure. He's deeply thought about what it means to be his best in those moments. And then subsequently, what are the best practices that have helped him so that they can help you as well? That's what we talk about. That sets the tone for this conversation. With that, let's jump right into this week's conversation with Dr. Dan Dworkus. Dan, how are you? I'm great.

I'm happy to be here. Thanks for having me. Oh, for sure. Okay, good. So let's jump in. Let's get a bit of context. How did you and why did you want to become an ER doc? And I kind of feel like once you're in medical school, you get exposed to all of these different ways of being a doctor.

And usually for all of us, there's some moment of kind of like a bolt out of the blue, unquestionable. This is the shape that I am cut out to be in. And so for me, I have this really vivid memory of it being, I don't know, three or four in the morning. And I'm wandering around in the hospital on one of my rotations, which was not an ER rotation. I was like, Oh, I wonder what's, I wonder what's going on down there and wandered down and just this absolute palpable sense of being home. Like this was home. This is where I'm supposed to be. This is what I'm supposed to be doing. And that, um, you know, that was maybe six, 15, 16 years ago now. And it's basically always felt like that in one form or another.

Wow. Okay. So was that a gut response? Was that a felt embodied response? Was that some sort of intellectual stimulation? No, that was like a full body, like you're just grabbing a live wire kind of moment. Like you're just sort of lit up. Like this is unquestionably like what the right shape for you is, which is interesting

because I'm not sure I really believe that for everything. Right. I'm not, I'm not sure I believe that we're cut out to be a certain shape or have some sort of predetermined destiny for it. But this was one of these, like, you know, every signal is pointing towards this being, this being what you want to do, what I want to do. And like looking at it backward, I can sort of contextualize that a lot better and understand, well, here are some elements that probably contributed to that for me, right? Like I love the fact that emergency doctors don't say no to anybody, right? It doesn't matter what your insurance is. It doesn't matter who you are, where you're from, what your details are. If you show up, whether you need a sandwich and a pair of socks, or whether you are shot in the chest and about to die, whatever that thing is you need, I and my team are going to do the best we can to take care of you.

And I love that. I love that idea of what I've come to learn about what it means to really hold the line in that moment and to be part of humanity that's sort of up there holding the line in that minute. I didn't really understand that at the time. I just had this feeling of like, wow, this is crazy and chaos and the grit and dirt and blood of what's happening. And this is where I want to be. Very cool. Now, have you had other experiences like that, this lightning rod moment prior to walking into the ER? Is this a familiar response? That's a good question. I think that's one of the most vivid versions of that in my life. I think there are certainly signals, positive and negative, as you learn to, I don't know,

I guess you could call it hear and feel the inner landscape of what's going on, things that you're more drawn towards or less drawn towards and spaces that feel more important or less important to explore. But that's probably one of the most vivid versions of that I've ever had. You are the first ER physician that we've had on. And so I want to understand the, you know, what is it like when somebody comes in and they're in bad shape and it's obvious that decisions need to be made quickly. Can you bring me into maybe your first moment like that, or one that is dramatic that you remember that really captures the internal experience of a physician in an emergency setting? Yeah, there are, there are a lot. And those moments are, many of them are burned into us,

and they don't go away. Right? So there are times that that I can look back and sort of snap back with perfect vividness into details of the moment of a particular patient or a particular case. And I'm sure we'll come to a lot about this, but I think one of the big open questions of what it means to function in emergencies is what do you do with that? What do you do with the chaos and the emotional charge of being in those moments? And how do you transcend that and leverage that and bring that back into the rest of your life? And in some sense, we're talking about Joseph Campbell's hero's journey here. You're dropping down into the underworld of existence, and you're going to come back and

bring that back to society somehow. So there's a lot of richness in that. But I think, you know, to give you a little context, so let's imagine that you're the doctor on call in a small hospital. And depending on where you work, you might be the only emergency doctor. You might even be the only doctor in the entire hospital at that point in time. And so there's really just you. Now you have a team of nurses and techs and pharmacists and everybody, but you're it. You're not only the point of the spear, you are almost the entirety of the spear. And you get a call on the radio, EMS is five minutes out, code three, meaning they're coming in lights and sirens and they're coming in hot. And this is a high level trauma.

So somebody has just been shot in the chest or they fell off of something and they're not breathing. In fact, let's do that one. That's a pretty good one. So they fell off of something. They have seriously injured their head. It's quite obvious. And they're not breathing. And you have three minutes, go.

And you know, in three minutes that you're going to be in a room set up, that they're going to bring in this person, that you're going to not really have any idea what's actually coming in. And then in three minutes, you're going to have to make life or death decisions that alter this person's life, that alter every person who's in that person's life, that alter maybe the entire community that that person's a part of, and also that alter your life and everybody else in that room. And you're going to have to do it to the best of your ability, no matter what else is happening. If you're sick, if your family's sick, if you're hungry, if you're tired, if you've been on for 12 hours,

if you've been on for one hour, whatever it is, you're going to be called upon in that moment to hold the line. And there's some depth in that, obviously, right? When you think about it from the good sense, you realize, okay, well, hey, I'm the human right now that's called upon to hold this line. I'm also in a broader sort of more metaphorical sense, I am the representation of all the other humans who have ever held a line for anybody else in society at that moment. And I can look to the left and right of me and see every other person that stepped up and tried to make a difference for humanity. Some days it feels like that successfully, right? And some days it doesn't feel like that at all. And it just feels like a pile of chaos and a dumpster fire going on. Right. But whatever it is, you're going to have to be in there and make those decisions.

And that's just the minute before all this happens. So all this is swirling around your head. You're, you know, your sympathetic drive is going up. You're learning it. You're employing all the tools and coolants you have to slow yourself down and slow your heart rate down. You're getting ready. You're thinking about possibilities. You're thinking about backup possibilities. You're sort of readying your mind for the

moments that are going to happen. And then this person comes in and then you have that one moment to use everything you've studied your whole life to learn, to try to save that person. So it's a little heavy. And how did, yeah. I mean, I see why you're attracted to it. Yeah. And yeah, like that's right on the edge. And it is. And sorry. And it's an edge that you get to go up to bat against over and over and over again. And that to me is one of the most beautiful, deepest pieces of it, right? Most of us get to go up to bat against life and death once or twice in our entire existence, right? Maybe we feel it ourselves. Maybe one of our family members feel it. But what I do, what we get to do in the ER is go up to bat against the

edge of that existence over and over and over again. And as a result, you get to experiment, you get to iterate, you get to try things. You get to come back and talk to each other and be like, hey, this is what I did when I was in this circumstance. What do you do? How do we get better at this? And try to sort of share that moment. And because I think all of us, right, ER doctors or not, we all face emergencies in our lives in one form or another. And I think we all want to be better when we're called upon to act in that moment. I just get more practice at it. So I do want to understand the preparation and the readiness, you know, but pin that for just a moment.

And you're talking about, you know, birth and death and life in, you know, that, that space between birth and death, when life flashes before you, but you have some of those folks that are in barely conscious in and out, whatever it might be. How has that shaped your understanding of birth and death, your understanding of life? Yeah. I feel really,

really grateful to be able to experience versions of that moment over and over again. Now, I would never wish that suffering on anyone on either side of that equation, right? Either the person who's coming in suffering or the person who's standing there trying to absorb that suffering. I don't want anybody to feel that, but if it has to happen, I'm grateful that it's me there. And I'm grateful that I get to experience it because I hope that when I come out of that, I can have learned something that I can turn around and give back to the people around me. And that as a result, all of us can end up better. And so, so this is the thing that sort of got me down this whole path on the Emergency

Mind Project and on thinking about how to get better under pressure and all of this, was this understanding that if my patient suffers and dies, which happens, right? It doesn't matter how good you are as a doctor or how good you are as anything else, people are going to suffer and die. But the question is, what do you do with that? You let it sort of dissipate in the universe or do you try to use it as fuel to get better for the next thing? And so this concept of sort of never wasting the suffering that you're exposed to tends to be one of the biggest pieces of it. And I think that being exposed to that over and over again has shaved me and polished me and hopefully made me a better human as I go through.

Never waste the suffering that you're exposed to. Yeah, never waste suffering. So for you, are you talking about the pain that you feel from maybe a mistake or being there too late or being part of somebody's passing or is, or is the suffering your witness of the family suffering? And it's probably a yes and, but I'm wondering, like when you say never waste the suffering, I just want to pull apart suffering for you. And then I want to pull apart the never waste. Yeah, absolutely. I think the suffering is, is all of it, right? It's the person being sick and feeling that experience and that that's where they are in life right now.

How is that suffering for you? I, Mike, I don't know enough about your life to know which version of that you've been in, but I think when you're standing next to somebody that is in horrible pain or being put in a circumstance that would for many of us be only encountered in a horror movie, right? Like that's the level of stuff that we're talking about that some of our fellow humans unfortunately have to go through. And when you feel the compassion and empathy and sort of the reflection of that pain and anguish that they're going through, you suffer with them in that moment and you're exposed to that suffering. Yeah. That's what I wanted to get to because I don't know about in your profession, but definitely in my profession,

I cried a lot more early on with my clients. I cried a lot more. And like as a full rookie, you know, as a practicing psychologist, like I was just getting, when I was still being supervised and pre-licensure if you will like I I was gripped by every word and I'm trying to figure it out with him and I'm trying to feel and figure it out I didn't know what I was doing right I'm trying to

find the right theory to apply and okay so be a rookie for me with just a moment yeah but there was a lot of feeling that was attached to it. And then there was maybe like, I don't know, 10, 12 years in, I tugged on a mentor's shirt of mine and I was like, I don't cry anymore. I don't know what's going on. Like, I don't know what's changed, but I'm not feeling the same way. It's like I was like this, almost like this early career crusty, you know, like, I've seen it, I've seen it, I've seen it. Okay. I'll be here with you. And, but there was, I wasn't callous, but I wasn't fully embodied as I once was. So that's why I was asking about the suffering bit for you is, are you still now suffering in the way that you once did? And I wanted to understand,

is that suffering? Because it doesn't have to be suffering. When you see someone else suffer, it doesn't mean that you have to suffer. And just witnessing suffering does not mean that I'm a person or you are experiencing suffering. So those are two parts underneath that question. For sure. And I think in some sense, we're sort of exploring the edge here between the difference of empathy and compassion, right? Empathy being in some sense, I see an emotion and I feel the mirror of that emotion. Okay. And compassion in some sense being, I see something and it produces within me something different, usually some desire or impetus to change or improve something that I'm seeing. And an interesting line that I think is worth exploring, both from my hat and your hat and a

lot of other people that have been on the Finding Mastery podcast, thinking about the idea of like, well, how much are we embodying being a human and how much are we being something else? So am I approaching this as a human? Am I approaching this as an ER doctor? What does that even mean to ask that question about like the tools and parts of my brain and everything that I bring to bear for this other person? I certainly don't feel the same way that I did when I first started. Right. And I think a great example of that is, you know, I have this very vivid memory of the first time I ever did CPR for somebody. Right. And, you know, there's this person and their heart stopped and I'm the one closest to them. So I'm going to start doing the chest compressions and I will never forget what it feels like to break that man's ribs when I'm doing CPR

and to feel that just sort of crush under my hand and to know that that was human to human, the best thing I could possibly bring to that person was to crush his ribs and do CPR. And I don't even remember how many years ago that was, but I never forgot that. I never forgot the color of his skin or the color of the glove I was wearing or all this burned into me. Now, when I do CPR, I don't absorb that level of detail from it. I do think about that question of, am I bringing the best I have to bear, the best humanity has to bear for this person in this moment? But they probably don't need me to feel the same way about it. Finding Mastery is brought to you by Momentus. When it comes to high performance, whether you're leading a team, raising a family, pushing physical limits, or simply trying to be better today than

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Just good design, great science. And if you're ready to feel the difference for yourself, Felix Gray is offering all Finding Mastery listeners 20% off. Just head to FelixGray.com and use the code FindingMastery20 at checkout. Again, that's Felix Gray. You spell it F-E-L-I-X-G-R-A-Y.com and use the code FindingMastery20 at FelixGray.com for 20% off. Okay. And then when you're watching other people have incredible suffering, family members, and it's the most traumatic or one of the most traumatic experiences in their life is to see a loved one slipping right through their grasp. What do you take from that? I haven't seen a fraction of what you've seen. So what do you take? Yeah. On the best days from that, I'm able to think about and to bring together this idea of kind of a fierce optimism. This sort of reality that suffering and death is part of existence, that they go through

it. I watch them go through it. I know it's going to be my turn on the table at some point and the turn of everybody that I love. And if that's true, if that's part of the inevitability of what we're doing, then we're left with this question of sort of what is the purpose, right? And man, does that drop you into what is the purpose really quickly to watch that level of chaos and suffering. And to be able to approach that with a joy of, and this fierce optimism of, okay, well, I'm going to do what I can. And I'm going to try to stand here and hold the line. Well, and I'm going to try to do it tomorrow better than I do it today. And I'm going to try to do it because I think it's right. And because it's my way of honoring that other person as they're going through it. And, you know, you sort

of, uh, you get to feel connected to all of the other people that have been in that moment. I think there's this deep sense of connection, both the ones that are physically near you and then the other people that have gone through that before, right? Every human goes through this part of our journey. I just get to be there and help shepherd some of them as it goes. Can you recall a time when you were there in an eloquent way? And can you recall a time when you fumbled? Oh my God. Yeah. You want to, you want to just talk about yesterday or you want to talk about like the entirety of the career? Like, like, I think this is like a constant, constant thing that goes on, right? Like, you know, you try to bring the best that you have to bear to everything, but I'm also a human, right? Which means that I am an imperfect human. I practice an imperfect science of emergency medicine and I practice it imperfectly. And that's the reality of everything that we do. And I think I can always aspire to be my best at it and to bring everything I have, but

man, you know, it's hard. It's hard and it's chaotic. And geez, I had a couple of weeks ago, one of the most difficult human interactions I've ever had with a patient as a physician. And it got to the point where at the end of it, I was saying, look, I'm really struggling to bring compassion into this argument. And this person told me maybe I shouldn't be a doctor. And man, just every button you could possibly think of pushed about this. And still you, okay, well, how do I do anything for this person?

And how do I come back tomorrow and do it better? But yes, are there times when I can show up fully with everything that I want and that myself and my team are polished and oiled and doing the best we have to offer. Yeah. And are there times when we are knocked out of it, when we struggle to recover from mistakes? Absolutely.

So you've got a couple of first principles that are apparent. Empathy and compassion are first principles for you. And then working towards being your best is are first principles for you. And then working towards being your best is a first principle for you. Can you maybe explain why empathy and compassion are important for helping you be your best? And then double click underneath of like, what does that phrase mean to you? Be my best. Like, what does that mean? And I tell you, I have a sense, like when I say it it there's two things that happen i'm like i know exactly what that means for me yeah and then i almost have for

i almost have like i want to i want to there's a nauseous that comes with it because it's so almost cheese like really like oh god did i just say that out loud but i really like that is really what i want for people is for them to understand the mechanisms for them to be their best. So there's a double part here. Okay. One is why empathy and compassion to help you be more skilled, to help you be your very best. And then what does that phrase mean to you? Yeah. You know, I, I think that my understanding of the value of, this is going to sound weird, but my understanding of the value of, this is going to sound weird, but my understanding of the value of empathy and compassion is a relatively newer piece of me as a human.

And that's maybe part of, I don't know what I'm on, Dan 4.0 or something as I look back at my life. And maybe that's something to talk about too but but i actually um i think that when you go through medical training uh often you come out or many of us come out feeling like a bit of a robot because in order to um in order to do what you have to do, you can't bring to it sort of the normal human skill sets and the normal human interactions, right? In normal life, it is inappropriate to stab somebody in the chest and cut their chest open, right? In my life, in certain times, that's the most humane, wonderful, giving thing you could possibly do. That's a really weird disconnect, right? Hey, welcome.

I don't know you. I'm going to cut all your clothes off and stab a hole in your chest. Oh, that's weird, right? That's really outside the normal realm of human experience. So to get to the point where you're like, yeah, not only is that what I'm going to do, I'm going to do it right now. And I'm going to do it smiling and be like, hey, I'm here for you, right? Like to actually sort of like cross that gap, you have to really reprogram the way you understand

how you interact with other people. And that gets to this idea of, well, what is compassion? What is empathy for most of us that turns off at the beginning, because that's the safer way to do it and safer and enormous air quotes here, right. That feels safer to just not handle any of those deeper pieces and instead to act a little bit robotic. And a friend of mine put this really eloquently. She's also an ER doctor and said, I used to go to work and think all I want to do today is robot so hard. And that's the way that I could serve people the best. Now there's always undercurrent of like, of like, I'm doing it because I think it's the right thing for folks.

Maybe, maybe I'm also just running away from the pain and suffering that I'm feeling from it, but there's some of that undercurrent. And I think the more experience I get and the more, frankly, that I do therapy and start to look into, hey, what have I been feeling this whole time and not really realizing it, the more I understand that harnessing the empathy and compassion and the human pieces of myself really are how I get to be the best doctor, really how I do get to be the best version of myself to bring to people. I have an index card that's off to the side of the screen over here that literally says, you are not replaceable by a Dan-shaped robot. Because sometimes I need to think about that and I need to say that and be like, you know what? I wouldn't be better if you could drop a Dan-shaped robot into my life and have them do the doctoring instead. Because that compassion, that humanness that I bring to it is such a crucial part of my ability to be there for people. Yeah. What an interesting note to have. Where does that come from? It's almost like there's a battle,

like an internal civil war between being a robot and being compassionate and empathetic. It's as if, if I were to extrapolate just a bit, it's as if there's a tax that you're paying to be compassionate and to have high empathy in the job that you're in. I would if there's a tax that you're paying to be compassionate and to have high empathy in the job that you're in. I would say there's a tax for most people, period, on that. And that's early days. Once you get your arms around compassion and empathy, it's as if like, oh God, life just got so much easier because it's no longer about me managing me, me presenting me in a certain way, but I'm spending my energy on understanding and conveying what it must be like or what it could be like to be you. And so the

whole thing gets so much easier. But I say that and I'd love to know like maybe where you are on that arc or even wave me off if my hypothesis is wrong here. No, I think you're right. I think I'm in the early exploring fun phase of sort of figuring that out and learning how to bring all of the pieces of me to it, which the sister problem of that is how to come home from work in a way and still be a human. Right. And I think that's something that a lot of people that serve on one front line or another. I would say the hard part is to come home and not be a physician and not be a doc. Yeah, absolutely. A shot caller, not be a head coach.

That's what I think would be the more challenging. Are you in an intimate relationship? Yes. Yeah. Okay, cool. So let us talk about that in a minute. I want to stay with what is best self mean to you? So you talked a little bit earlier about some of, you know, sort of getting at what are some

of my first principles? Like, what do I think like the deepest operating system principles are in terms of, of being me? And there's always been two that have stood out for me, or at least the way that I sort of conceive of myself. Like if I had to answer today, like if I blinked out of existence and something or someone or whatever was like, Dan, how did you account for your time? How would you judge what you've done? Well, so I would put these two things forward, which is that I tried to master myself and I tried to serve the universe. And that dichotomy of like mastering myself and I tried to serve the universe. And that's like that dichotomy of like mastering myself and serving the universe has been sort of my

guiding star through everything else that I'm doing. How about it? I mean, okay, cool. Like when you say universe, what, what's, yeah, I don't know. The word universe is like the least stable part of that phrase for me. Like sometimes that serve the world. Sometimes that serve humanity. Sometimes I wonder about like, how do you balance like, you know, the, the fate of the planet versus the fate of humanity and some other stuff in there. So, so, so to be of service is maybe a better way to put that, like to master myself and to be of service. And then what do you do to work on mastering yourself? I get this service part is actually quite simple. I do want to understand the service part when you come home, like we're going to get to that in a minute, but

what do you do to work on mastering your inner self or yourself, period? Yeah. Everything I can possibly think of. And I think that's something that I am very lucky to have been given that idea from a very young age from my family. My parents, my brother are really deep thinkers and really driven people. And we sort of always had this idea, even from the time of growing up that like, you know, sort of one, you can change and grow and two, it's your job to change and grow. And so you should learn and take in other ideas and practice things and constantly strive to make yourself better tomorrow than you are today. For what aim?

Well, in some part for its own sake, right? Which is that some part that's the reflection of being human is that you can change and improve and grow, but also that you have this responsibility to figure out who you are and how to, you know, like what is your own user manual, right? Like how to use yourself as a human. And part of that is that idea of understanding like what it means to master myself, which some of which is, you know, reflection and deep thinking and meditation and trying to say, okay, well, how does my, how does my, how does like, you know, the pile of chemicals that is me work? And then how does that interface with the rest of existence? And what does that edge look like? You know, It gets somewhat abstract relatively quickly, the sort of longer you go down that rabbit hole. Yeah, no, I love it. You've hinted in maybe five different ways

an influence of your spiritual framework. And it sounds very Buddhist. But yeah, you haven't concretely said that. Sure. So, so I grew up, I grew up doing martial arts and I was exposed. Which art? Chungda Khan Taekwondo is what I started doing. But it was really the, the person that taught me from the time I was a little kid really was also had this spirit of self-mastery, not as a sense of, hey, here is a canon. Here are X number of things that you have to master, but more of you are a constant student of yourself and of your relationship with everything. So I watched him

go out and learn different techniques from different people and bring them back and sort of then teach us and explore that framework together. So even the people that were at the highest level of what I was doing, I watched them be students and I watched them continue to learn and grow. And so I really got that from an early age from there. And along the way, got exposed to a lot of different pieces of Eastern thought and certainly some Buddhist frameworks. And then as I kept going, a lot of the Stoic philosophy has been a really real, a huge influence on me. I have a tattoo on my right arm over here that essentially is the idea of amor fati, of love the hand of cards that you're dealt and try to play it with joy. That's definitely a guiding principle for me as well. Okay, cool. Do you have mentors in your life? Yeah, absolutely. Yeah. Across a wide variety of fields. I wonder if you feel this way too. I think

that's one of the joys of getting to do a podcast where you get to reach out to people that are so different and varied and so far in what they're doing is that you get these vast abilities to argue across these like really deep life questions with people from a wide variety of things. Right. So, you know, my, my current martial arts instructors and I studied jujitsu now. So, you know, my, my current martial arts instructors and I study jujitsu now they are, you know, enormous mentors for me in terms of how they train their body and their mind to be at the edge of what they do. I'm, I'm constantly surrounded not only by other, you know, attending level ER doctors who are advancing the field, but also like some of the

best students in the entire universe who get to, who I get to mentor and get to mentor me at the same time as we all sort of struggle with this. Okay. So let's, it sounds like you have mentorship in your life. You like being a student. That's been something that's probably started around the dinner table. It was informed by some of your early martial arts, your student, professional student for a long time, you know, in a formal sense, you're still a student, both of life of self and craft. And so how do you identify a good mentor? You know, what are the right questions for folks to ask? I i found a mentor accidentally it has been one deep long mentorship for 20 years actually longer uh more like 30 no 30 35 years oh my god and so it's been an amazing kind of i'll tell you i will i'll start this by saying he knows me he knows every he knows me and um what gift because his his whole role in my life

is for that and so it is there is no ask and return there it is an honor in his words to to be a mentor and so i don't know how to help somebody find it. He found me, it was an accident. We kind of bumped into each other at a event, you know, where he was supervising kids and, um, I was one of the kids and it was, it was amazing. So how do you, how do you help identify a mentor? You know, I, I don't think there's a person in my life like that. I don't think I have one mentor that's been with me through all of these different pieces. I think at various stages of my life, there's been people that have occupied part of that role in one form or another. And I've tried to cobble it together here and there from different relationships with different folks.

But I don't know that I have that. I'm not sure how to answer that question. So then you've taken more of a openness to mentorship on a regular basis from multiple people. So then is that correct? Yeah, I've certainly taken that. You said earlier, I identify as a student. I think that's very true. I think I certainly identify as a student of myself and as a student of life. And that's a vulnerability required there. And then the other side of vulnerability is like, and being a student is like really knowing something and having conviction and confidence. So there's the learner and the doer. Okay. And so learning you're soaking in and sometimes you're doing it by doing, but I don't want to overcomplicate this idea. But the idea that I'm trying to understand for you is the vulnerability learner part, and then the required skill of command and confidence when you've got your white coat on.

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slash finding mastery and use the code finding mastery at checkout for 20% off your first order. That's calderalab, C-A-L-D-E-R-L-A-B.com slash finding mastery. Okay. So then you never take the learner approach off. Never. Okay. How could you? I don't think there's a universe where I'm a finished product. Well, I think you're one of the first MDs that I know that would say that. And I'm slamming an industry. How is that possible, right? We don't know everything, not at all. And I think we're constantly exposed. How is that possible? Right? Like we don't know everything. Not at all. No. And I think like we're constantly exposed to the changing, growing face of humanity and what we have to get through.

Right? There is a course you guys take. You guys take a course. I don't know. It's like a 606 level or something. And I think it's like it's the arrogance of the white coat. Like there's a thing that happens. Now, I don't get any of that from you. And listen've got plenty of friends right now. They're like, oh dude,

we're going to have to have a talk because they're like, are you talking about me? And so there is, I, would you disagree with that as a, as a, a broad stroke, almost grotesque in what I'm saying about the medical profession? I think ER doctors are a different breed. Okay. Let's not do ER. I did ER. Yeah. I did all white coats, not all white because as researchers wear white coats too, but you know, the MD profession. Yeah. I gotcha. I think we are vulnerable to expertise creep, let's call it, where maybe I'm really good at X and I think that makes me really good at X plus Y and that I need to tell you everything about X plus Y. And I think that's probably not true. We should call it expertise creep.

Yeah. Expertise creep. Yeah. You know what? So here's the rub. I've been in ER plenty of times growing up in action sports. And so I got to tell you a funny story in a second, but I want my physician and or surgeon, or I want the practitioner in front of me to demonstrate that they are credible, to demonstrate that they know they've seen it. They've got frames of reference and they have shared options with me. And if there's not enough time to share options that I want to know that they know how to reduce the options to get to the action. So there is, there is something very safe in that that I think people want from the white coat. And I want to get at like this idea of you having confidence.

You're a great learner. You've got the openness and the vulnerability, but sometimes when we demonstrate too much vulnerability, we lose credibility. Okay. So I'll give you a case in example. In my world, a coach says, Mike, what do you think? Lays out a scenario and it's real time we need to take some action and i say you know coach i don't know and the eyes go up and they kind of their head you know kind of turns a little bit and then they start walking that's just kind of how it works they just start start walking. Like that is no good. That doesn't, this is not the time to not know. So, so how do you develop the right type of confidence?

What do you do? And Mike, what a great question. What a fun thing to explore in there. I think there's a lot in that. And so first off's certainly, there are times in space, especially in emergencies where action is paramount, where you have to move, where it is not the appropriate time to talk about probabilities or to talk about different alternatives or options. Like it's life or death, you move and you do it and you do it well. As a great example of that, when I'm called upon to come into a room where somebody is in a critical situation, they're in a cardiac arrest or something, and I don't know the person, I don't know the people in the room, I don't know what's happening. I just know, hey, Dan, you need to get to room three.

Like, let's go. What we train to do and what I train my teams to do is to run into the room and say very quickly, who's in charge? Oh, so that's first frame. Who's in charge. So who's in charge in case there's somebody better informed and better put together than I am, who's already got the show. Now I will tell you that really rarely happens unless there's already another ER doctor or

occasionally an ICU doctor, like already running that show. And then most of the time there's this moment of like frazzle of like, everybody's looking around. And so the very next sentence that comes immediately after who's in charge. Okay. I am in charge. My name is Dan. You do this and then you move and then you go and then you go and you structure that. So you can run that first couple of seconds. And literally we practice this with your eyes closed. You can run it on one foot. You can run it when you're out of breath. So when I go running, there's this hill outside my house. And when I charge up that hill at the end of it, I practice that sentence at the

end of it when I'm out of breath. I practice running through skill sets in my mind about intubating people, about dropping chest tubes in people, about doing these skills. I practice it when I'm out of breath so that I can walk in that room and have every single thing ready to bear. And I come with the weight of everything that humanity has ever invented about medicine, all behind me, every other person whose shoulders I stand on. I run in that room and I do everything that I can to make that person better. And where that confidence comes from is me knowing that I have trained and continue to train to be able to bring all that humanity has to bear to that patient. I love it. That's fire. I mean, that's, that's fine. Wait, wait, wait, wait, wait, wait, wait, wait, wait, hold on, hold on. Before you get to the even better part, like, I love that.

There's, there's not a word out of place. And, and what I really appreciated is that you are practicing in context of the conditions that you might be in at some point where you are out of breath, where your nervous system is over activated for that moment, or literally you just sprinted upstairs. Oh, I look like a crazy person at the end of my run, right? I'm sitting there at the top of this Hill and I'm hyperventilating at the end of it. And I'm like, I'm like mentally going through procedural skills. Like I look like a total crazy person. Are you doing it? Eyes open, eyes closed. Depends on the day. It depends on what I'm trying to practice. And are you moving your hands? Sometimes. Right.

Are you speaking out loud or to yourself? Sometimes. Yeah. Yeah. It depends on, it depends on what I'm trying to drill through that particular, that particular day of it. But I think that, you know, practicing under conditions of, of applied graduated pressure like that is a really key component to delivering a skill under pressure. Where'd you learn that? I probably, you know, I don't know. It's hard to look backward and decide what comes from martial arts training and what comes from medical training, which is sort of a weird thing to say, because I think like those, those edge principles of applying something under pressure, I think are really best done mixed up. And I think that each has a real ability to inform the other one of

them, right? So when you learn a skill in jujitsu, right, you learn, here's how you do, you know, a side control escape, and we're going to do it really slowly. We're going to break it down. Then we're going to put you positionally with a little bit of extra pressure and a little extra resistance. Then we're going to throw you into a match and see if you can apply it. When I'm learning a medical skill, like putting a central line into the neck, right? I learned it on a skills trainer.

Then I learned it on a skills trainer under pressure. Then I do it on a easy patient as an assistant. Then I do it on a really challenging person in a full-fledged thing. That graduated pressure is a pretty universal concept in terms of knowledge under pressure. How would you translate that to somebody practicing vulnerability, somebody practicing intimacy, somebody practicing empathy? How would you translate that over to the other skills that we've talked about? Yeah. Yeah.

So we tend to visualize it as a wedge, right? So low wedge practice is easier, friendlier environments. High wedge practice is unfriendly, maybe even antagonistic things. And a couple of truths that come out of that is basically you're not better at a high wedge than you are at a low wedge, generally speaking. So if there's a thing that you need to practice, and maybe that thing is instead of putting a central line in, it's how to talk to your partner when you're angry and when you're upset, how to communicate hurt. Not something I'm always particularly good at, but I'm trying to get better at. And I know I won't be better at it this, how can I find low wedge ways to practice things? Whether that's a side control escape or a central line or talking to my partner. And then how do I do that consciously as a student, as a scientist and be like, well, I don't know, did this work?

How do I know if it worked? What am I going to do differently tomorrow to try it again? And is when you are using the wedge, I'm going back to like a carpenter wedge. Is that what you're using as well? Yeah. So high wedge, there's more leverage. There's more tension on the joint or the stability of the, whatever you're working with. So in a low wedge, there's less tension. Okay. Yeah. That's a cool frame. I've never heard that. Yeah. It's also easier to slip into something, you know, the low wedge part, you can find easy places to do it. Yeah. Okay. Yeah. And what are the different types of pressure that you face as an ER physician?

Uh, yeah. Um, um, a good way to break that question down is to think a little bit about like cognitive load theory, right? So the idea of intrinsic versus extraneous cognitive load. So like if I'm trying to do a task, like put a central line in or intubate is usually the one I think about, right? Which was, you know, you put somebody to sleep, you put a breathing tube in. The intrinsic cognitive load is what it takes to actually execute the skill. So the physical parts of putting a tube in somebody, the thinking through the thought process of what medicine I'm going to use and why, how do I map this huge knowledge

base onto this patient right here to do the best I can, understanding probabilistic things and running multiple different scenarios in terms of what might or might not happen and planning for backups and things like this. And then there's the extraneous part of the cognitive load, which is all of the stuff that it takes that's not directly related. So the patient is screaming and coughing blood everywhere. The person who is their family member is trying to punch you. The all of these are real, right? The, you know, there's like, seriously all the time. Yeah. Yeah. People try to punch all of us on a regular basis. It's actually not funny. It's really terrible and sad. And there's this sense of like, actually this gets to a really fascinating question, which is as somebody who tries to serve people, what do you owe them? And what do you owe yourself as a human? So I'm in

this situation where I'm trying to provide good to somebody and they respond by trying to punch me. Okay. Well, you know, what do I owe them? Do I, do I owe them to stand there and try to take it and still try to help them? Well, in certain circumstances, right? Like what if they're a, yeah, my, my first response was like, you, you, you don't, we are taught in my profession, like you don't have to accept a client, you know, like, you know, so it's like, no, but maybe you owe it to yourself to see it through one more frame, one more heartbeat, one more sentence. You know, you might owe it to yourself in that scenario. was the physician not too long ago for a man in his, probably was in his thirties and he had very severe cerebral palsy. And so his brain had not developed in what you'd call the normal manner. And he was nonverbal and he bit me. And this scenario feels a little different than the one I had in my head, by the way. Well, sure.

Right. But what do you do? Do I, this person, this human didn't have the capacity to interact with me in what I would consider a normal and acceptable way. And so he bit me. And was I upset about that? Hell yeah, that hurt. I don't want to get bit.

Right. Nobody wants to get bit, but does that mean that I, like, where do you draw that line? Like what part of yourself are you willing to put in there to serve this person? And what part are you willing, are you not willing to, and man, how do you even answer those types of questions? I know this is what keeps me up at night sometimes thinking about this kind of stuff, right? Like, what does it mean to be a good human and to serve the universe versus to protect myself from getting bit by people? What a weird thing to think about. Totally. And you'd recognize that as a lifeguarding analogy holds up here. Of course. Absolutely. Yeah. What many people miss in ocean lifeguarding is that if we're near rocks or pylons or, you know, barnacles with pylons on it of a pier and waves are crashing, a person's drowning and you've got to go out, you're instructed. If the wave is coming and they're floundering, you have to push them off.

Absolutely. And sometimes that means, you know, that you might lose them. And the other frame is that if you're holding them and you've got them, you know, in a secure lock, but you're being pushed into the, to the barnacles of the, of the pylon, you have to put their body between the pylon and you. Sure. That, that, that is an absolute mind bender, you know, because every, every part of your DNA is to go out and help and save and rescue and, you know, be that person's advocate when they can't. And then all of a sudden you got in an instant, got to flip it and put them in even worse

situation that they were in. Like that is, this is your dilemma on a regular basis. So a person is in a room and they have really severe COVID and they start, they stop breathing. You got to put your own protective gear on before you go in the room, which means you have to slow yourself down to put your own protective gear on. And you have to do it so well that you don't screw it up. Even as you're watching this other human choke to death in front of you. Oh my God. How do you do this? You do it over and over again. And somehow you wake up the

next day and you try to do it better. And okay, man, let's jump right into this, right? Because that moment, let's take that a little bit farther out there. So that moment of this person's dying, and let's say I can't get there in time, or I get there in time, but no matter what I deeply, deeply value is to say this, is to put your hand on this person's body after they've gone and to say some version of, thank you for teaching me, sir. I'm sorry. All I could do for you today is to learn. I'm sorry. All I could do for you today is to learn. I'm sorry all I could do for you today is to learn. Because sometimes that's all we can do for each other. We can't stop the suffering. We can't stop the chaos. We can't protect them from the barnacles and the reefs or the COVID or whatever it is. Sometimes all we can do is learn and come back and be like, well, what did I learn from this? And that's never waste suffering. That's that

commitment to say, what I'm going to do is learn from this. I'm going to be better tomorrow for the next person that comes in. That's the most important thing I know about being human. Yeah, that just changed me. Thank you. Yeah. I don't want to leave this place that you just brought me to right now. Yeah, right? Yeah. now yeah right yeah because the words that I'll use will fall far below here but the brilliant truth and the painful truth is that we're gonna we're all

gonna die and you are part of that death experience for so many. And you say it intellectually. And I heard it at the top of the, the, the conversation here where you're like, listen, yeah, I make mistakes. I'm imperfect. But then you just go, Oh my God, I put my hands on this person. Who's, you know, I don't know a certainty where this person just went to where the soul went if you're even so we'll put an asterisk there but and i i wasn't enough i wasn't able to do what i hoped i could do yeah that's dude that haunts me um that haunts me with like the way that i i parent the way that i love my wife the way that i love my friends the way that i lead the way that I parent, the way that I love my wife, the way that I love my friends,

the way that I lead, the way that I show up for, of course, clients. That haunts me. So that practice, I got to sort out in my head, how can I adopt that practice with somebody that I haven't been enough for?

There was probably about 10 years of my life when people would say, how you doing? I'd say, you really want to know? And most people would be like, yeah, come on, dude, lighten up. And so, okay, that's a no. But those who say, yeah, no, seriously, I want to know. I would come home every day feeling as though I had let many people down.

And it was a condition of saying yes to too much. It was a condition of trying to do too much. It was a condition of caring maybe too much. And I would feel exhausted at the end of the day about all the calls I didn't return and all of the people I didn't say the right things to and whatever. And it was early, it was an early career condition for me. I don't have it anymore. It was kind of that thing that we're talking about as well. I don't have it because I'm, it's not that I'm caring less. It's that I'm managing the care appropriately, but you just, you just offered a depth to the experience for me.

And I got to figure out how now to apply it. So I just want to say thank you, dude. That was awesome. Yeah, man. And that's the joy of honoring every single patient that I've had that I wasn't able to bring back. We just honor by having this conversation. When you go and talk to other people about it and take that sense of purpose and meaning and that sense of the scope of humanity, that's honoring them too. And I think there's a lot of depth in that, to put it mildly,

right? You asked in some sense, how do you handle that? How do you handle knowing that there are times when you're going to do the best you can and it's not going to be enough. Part of my answer to that is that you have to, in some sense, consider the integral of your effort over time, right? Are you bringing good things to the rest of humanity over time? Are you winning on net? Because you can't win every time. Nobody can win every time. And what does winning mean to you? Yeah. Right. So to me, in some sense,

it's bringing the best that I have to bear in that moment. Right. So I talked recently to Rich Devaney, who wrote the book, The Attributes, former Navy SEAL, really interesting dude. He talks a lot about the difference between optimal and peak performance, right? So for him, peak performance is like an Olympian peaking at a particular moment of time. Optimal is given the constraints of the universe that you exist in at that moment, did you do the best you could? And that's in some sense what I mean by that. Given the constraints of the universe i live in in that moment did i dan dorcas step forward and bring the best of what i have to bear so in that there are micro choices that we make it's not like it's a it's not a binary in most cases you know there's

these little micro choices that we're making and do do you, what are your, what are your backstops for risk? Because there's risks that are required, right? And so it's a risk of, in some respects, making sure that you put on all of your gear properly for this COVID patient we're talking about. And there's a risk to going in without your gear and there's a risk to taking your time and kind of taking care of yourself. So what are some of the backstops that you have to mitigate, manage, work with the risks that you take? Well, you said a second ago, there's all these micro choices, right? So I think first off, you understand that what you can bring to bear on any day is influenced enormously by all of the choices you make on the

days before that. And so what you do on your day off influences what you can do when you're on your day on. It's a little bit of a clumsy construction, but I think you get the idea. Right. And so part of my backstop against risk is trying to make really intelligent choices when I'm not under pressure and setting up systems that support me to perform better, uh, that are capable of supporting me despite my shortcomings. So what are your shifts? I know that the medical professional at ER included, like the shifts are crazy. They're all over the place. It totally depends on the day. I mean, they'll overnights or morning you know, morning shifts. Sometimes you get off at 3 AM. Sometimes it's just all over the place. I worked about midnight last night. Are you on call? Not today. No. So there's days that you're on call. There's days that you're in, in the ER world,

there's days where you're the backup person. So if anybody else can't make it for one reason or another, you come in to backup. Got it. Okay. So one of the backstops are making choices about health, about recovery, about making sure you're adding to the bucket rather than depleting. What about the legal? What about the moral backstop? I think the moral one we've covered pretty well. But what about the legal backstop? think the moral one we've covered pretty well but what about the legal backstop because you've got to make choices too where yeah from a legal standpoint

like i'll tell you examples just the other day it was um i was driving and um caught out of the corner of my eye that there was a car pulling into a gas station but it was kind of hovering over the or resting over the sidewalk it's just a weird place for a car to be parked and i looked down and there's a person face down like an elderly person face down and i was like i think someone just got hit or passed out. I'm not sure. So I looped around to see if I could be of any assistance. And there was a woman that obviously knew what was up. And she grabbed him, flipped him over. She looked like a nurse.

Actually, she was taking his pulse. Then flipped him over and immediate CPR. Blood was kind of all over his face. And so my impulse was go to help. And I was pulling around to go do so. And at the same time, there was a better suited medical profession that I know that was in the parking lot behind me. And so I went and grabbed him as well. And they're like, no, no, no, I'm good.

Because I could see they're like, this is a legal nightmare for me. So it's like a real life story happening on the street. And the Good Samaritan thing, I don't know where that falls. Maybe you can advise because the horror stories that you try to help somebody out, you break their rib, you do something that it's super dangerous from a legal standpoint. More covid mouth-to-mouth and or whatever i don't know so that's maybe more moral there's a little bit of legal but if we stay in the er room for just a moment what do you struggle with legally like what are the calls you have to make to cover your ass when it's sometimes putting a patient at risk. I want to make sure I understand this, the spirit of the question you're asking, right? Cause I'm,

you know, we talked about expertise creep and I'm, I'm not a legal expert by any stretch of the imagination and wouldn't provide legal advice, but, but are you asking about the difficulty of making decisions on these edge cases about where do you balance what you think the right thing to do is versus what the safe thing to do is? Is that what we're talking about? Yes, exactly that scenario. Yeah. You asked earlier about what are some of the sources of pressure we face or what are the things that make our environment really challenging to make high quality decisions under pressure. And I think that this tension is certainly one of them. the underlying principles of autonomy and doing good for people, or sometimes called non-malfasance, right? Not doing bad for people, right? So if somebody comes in and they are very intoxicated and they are very belligerent, and they've obviously been in an accident and they're injured, it's quite common that they're like,

F you, I'm out of here and want to leave. And at this point, we run into this issue of balancing the autonomy. The person has the right to refuse care versus wanting to do good or prevent ill, which is they seem to be injured. And maybe they're wanting to leave is actually a reflection of a serious head injury that we're not sure about. And so what do you do? Do you let them leave because autonomy is important or do you sedate them and strap them down to the bed and say they can't leave because not doing ill is more important. And that's like every shift I faced that give or take. Oh, you do. Oh, constantly. Oh, we all face it, right? People come in and they're intoxicated on one substance or another, or they in their, in the depth of their illness,

whatever that illness is, they respond by wanting to hurt or kill themselves or wanting to hurt or kill someone else. And you're on these edges of like, well, is this a case where the net good is for me to take away their rights to leave? Or is the net good for me to protect their autonomy as a human and let them go, even though I think it's against their own good interest. Isn't that like the conversation for our country right now? Yeah. Oh my, and you're making the micro choices there. Goodness. Okay. And like everything, like whether it's that micro choice or whether it's a micro choice of all of the stuff we're seeing unfold at a larger scale, right? What we know is that pressure makes nothing

easier. Everything's harder under pressure. And if we want to get better under pressure, we have to practice low on the wedge, right? We have to practice at things that aren't super high stress and super high pressure, because that's what's going to inform us as we get better at this stuff. You know, I would hope, I don't hope I find myself in an ER situation, uh, for the rest of my life, but, um, I would hope that I ran into you. Yeah, no, I would hope I run into you. And, um, like there's this, there's just a thanks man, I appreciate discerning, uh, expertise that is really warm and thoughtful. And I, I know that you take, I can feel and hear that you take your profession seriously. And, um, on the lighter side, what's a sure way, what's, what's the most

common way to find yourself in, um, in an ER room, you know, like how do you find yourself? And then like, like what are some of those trends that you're seeing? Oh man. Yeah. You know, we see a ton of people that, that. Give me a couple that you just can't make up and that probably happened this week for you. Oh, where do you even want to start? I mean, you know, I mean, I think that there's a lot of these electric scooters. People tend to want to fly down hills on them, jump over things and or fight each other with them like they're swords. I'd probably not recommend doing that. Avocados are particularly dangerous. Interestingly. It is one of the most dangerous fruits to try to cut. People end up impaling themselves with avocados on a non-zero basis.

Meaning with a knife? Oh, yeah. Yeah, yeah. Like hand, avocado pit, knife. Totally. Bad outcome. What else? In New England, we would always say when I was training up in Boston,

the snowblower is always on. Don't put your hand in it. That's a pretty good. Yeah. Oh God. Yeah. Fireworks. Don't sit on fireworks. You'd think I wouldn't have to say that, but don't sit on fireworks. Don't put fireworks down your pants. Any variation of that sentence you want to come up with, don't do it. They're not designed for that. And neither are the parts of you that you're putting fireworks next to. How much is alcohol and drugs involved with just about every diagnosis that you have? Oh, no, no, no. I mean, I think that the vast majority of people that come into the ER are people who are suffering from appendicitis or a sprained ankle or pneumonia. Not stupidness. Sometimes all of us humans do not act in our best interest especially when alcohol and drugs are

involved you couldn't even say it yeah that's funny okay you know um tell me if i'm way off on this but uh one of my friends who's an er physician um he's like it's awful mike but i'm trying to deal with it properly right now but we've got a code in the er and i can't remember what it was. It was like lunch on aisle four and something like that. And it was like, somebody put a vegetable into a place that a vegetable is not supposed to go and it's stuck. And they've got, you know, right. And so there's a code because people just actually couldn't believe it, you know? And so it was like an alert thing to the other physicians and nurses. Like you've got to go to aisle four.

Somebody had lunch. And so you've seen that plenty of times. Sure. I think it's always like, you know, you don't want to add to like, this is a human and they made a dumb choice and they're suffering enough being there. Right. You don't want to, you don't want to heap suffering on their suffering but also like that was a dumb choice and uh yeah you know if you're wondering don't do it that's my public if you're wondering if you're concerned about it if you're like man yeah you know should this go there no

that's perfect the answer is no he just he was like mortified by it he's like i he goes i'm new to the the art this er and he goes it is like this weird mash type humor where people are so stressed out and this that and the other and yeah yeah yeah for sure but i but that humor that that dark humor is such an important part of surviving these really challenging moments, right? And if you were to come in and watch us in those two minutes before some really critical case comes in, man, we are just laughing at each other. We're having a great time. We're loose and friendly and cutting it up. And then you come out of the room after and you've made some really hard life and death

decisions. And you're joking with each other because like, oh, it looks like you got a, you look like a Jackson Pollock painting. You got sprayed with so much blood. You're just sort of like really sort of tearing into each other like that. Because I think that that's part of being a human. That's part of surviving this nonsense and making it through. Okay. So let's kind of pull on this just a little further because the average tenure for a running back in the NFL is 2.57 years. The average tenure for somebody, you know, all positions aggregated in the NFL is 3.3 years.

So that means most, you know, the average is 3.3 years in the NFL. Suicide for physicians, ER physicians, like it's really high, alarmingly high. And the mortality rate, is it like 65? Age 65? It's know those offhand? But I know the suicide rate for you guys and the mortality rate is really high. It's high. Maybe you can speak to that. particularly in the last couple of years, it's gotten a lot higher as we've all sort of struggled handling the pandemic and watching the enormity of the human suffering that comes through that.

I mean, I know for me, that was the thing that finally got me into actively doing therapy myself was waking up for the whatever number night in a row with the same image of this one woman choking to death in front of me on repeat over and over again. And PTSD. Yeah. You know, I mean, it wasn't the first by any stretch of the imagination, the first patient that I'd lost. It wasn't the, you know, I mean, it wasn't, wasn't the newborn twins in Haiti. I couldn't save. It wasn't the, I mean, it wasn't the newborn twins in Haiti I couldn't save. I mean, it wasn't all of the things that have happened that are just the vast number of humans and their families that I talk about when I talk about honoring those who have passed by getting better. Right. But man, it was a lot. And I am very lucky. I have an incredible group of friends around me and an incredible family and the resources and ability and self-knowledge to know that,

I need help. And not all of us have been that lucky. From the Emergency Mind Project, when we talk about performance, we talk about this cycle of prepare, perform, recover, and evolve. And when I was coming up, when a lot of us were coming up, that cycle was perform, perform, perform, perform, kind of prepare, perform, perform some more. And there wasn't this focus on, Hey, well, what does it mean to successfully come home? Right. What does it mean to, to, to find your way through a lot of the suffering and death and come out a human on the other side? And if you do not pay attention to that, you will break period. And I think we're just starting to really pay enough attention to that kind of thing to be like, well, what, what do we need

to support ourselves as humans? You know, I'm glad you brought that up because I, I said, put a pin in it and we never came back to it, which was how do you come home? Do you have a best practice that you use when you come into your home? That is an active area of experimentation for me. I'm practicing that a lot. So there's this, I take, I purposely park sort of in a far away spot from the entrance to the ER because it allows me to walk back and forth across this one bridge. And it's this really long bridge to the parking structure. And it's a space, and I did this in residency too, there was this long hallway that leads in sort of to the ER and Mass General. And it has these old bricks that are there and they've been there forever. And you sort of like feel the weight of the people as you walk through it. And I use it as a sense of, okay,

when I'm going in, it's this sense of leaving the outside world behind me as I'm walking in. And it's an idea of I'm setting my intention. I'm moving closer to my intention. I'm getting ready to be there. Now I'm going to be the one on the line. And then on the way out, you know, it used to be, I'd get out and I'd be on my phone. I'd be talking to people. I'd be sort of like just pretending none of that ever happened. And now I try to be a lot more conscious about stepping down from it, especially as I walk over that bridge. And I try to think about, you know, like every pillar of the bridge I pass is like me getting scrubbed a little bit from what happened. And then whatever is still there at the end of that scrubbing process.

Okay, well, how am I going to think about that? And part of that is, all right, well, I sit down with my therapist and I talk about it. Like, hey, this is what I'm chewing on. This is what I'm thinking about. I've learned over the years about how to be more open with my friends and family about some of the stories. And I've also learned about which ones not to tell to anybody that's not an ER doctor or that sits in this circumstance. Because if you don't have the training, then you don't want to hear some of these things. You're not prepared to hear some of these things. I was talking to a colleague of mine who is a retired Navy SEAL.

And he was talking about how sometimes people come up to him and be like, oh, how many people did you kill? And he's like, man, that's such a different version of reality, which is usually my answer when somebody asks me, what's the craziest thing you've ever seen? And my answer is, it's so bad, you wouldn't even understand how to listen to it. So, okay, ignoring that for a second, right? So what can I share with people? Because the more I can share, the more I can share my struggles and my understanding and what I'm working on and what I'm experimenting with, which maybe is saying the more open and vulnerable I am about how my life is going, the better that I can interface with folks and process that. And I've gotten a lot more conscious about that as I've gotten older and hopefully better at what I do.

Awesome. I mean, I would go back to like what I said earlier, like I'm stoked that you're out in the world doing what you're doing and you know, like, yeah, like the, the, the bedrock that you're working from is awesome. Like that's, it's not like the sturdy foundation. It's like the bet you're working from bedrock is like, and I don't want to sound jaded by any means, but like, I've got, I don't, I think the, the healthcare system in the United States is so far from caring for health. It is like. Oh yeah. We got work to do. it is like, Oh yeah. Oh, it is like, like if I'm not, if there's, if there's one clear message right now, which is like, if I could speak to, um, to our community right now is be an advocate for yourself, like be a real advocate for your health today. And because once you enter into this system,

it's not good. And so there are people like you out there, Dan, I'm stoked to know you. But overall, the system is really complicated and not necessarily set up by any means for the patient wellness. And so we got to take it in our own hands. Can you, are we too far gone? Like, is this strongly in the U S no, I strongly agree that like, you need to be out there advocating for yourself and for your family and, and that our system is not to say that it's not perfect is a massive understatement right yeah and what i'm saying yeah i'm saying advocate by like advocate get your sleep advocate by hydrate oh sure sure by you know get your heart rate up you know like from fitness and like advocate that way which is all the front loading of of readiness for vibrance and health

and aliveness, you know? So yeah. So that, when I was going to advocacy there and the second part of advocacy is if you find yourself in the healthcare system, like, Oh goodness, you know, and I think most of us will. And, but we got to be strong, like really strong. Yeah. You have to set yourself up for success. Right. And that, that prepare, perform, recover, evolve. That's not just me getting into a shift or me putting a breathing tube in that's all of us for anything we want to do. Right. We prepare to get ready to do the best that we can. We do it. We come home and recover. And then if we really want to spin the cycle, we sit down and ask what the hell just happened and what does it mean? And how do I get better at it? And what am I going to do differently? And that cycle over and over and over again is

like, I mean, that's where the magic comes from, whatever that is that you're trying to do. But yes, we all have to own our own health. We have to own the health of as much as we can, we have to own our health right now. Sometimes all of us, or some of us get hit by a disease that we cannot manage on our own. Of course. And that's what we are here for, right? That's what we're here for. We're here to help.

And when I do my job correctly, I want it not to feel like you are here and I'm on the opposite side of the table from you looking against you, but rather I am right next to you facing whatever the hell this problem is together and bringing the best that we can put into it from it. And I want it to feel like that because that's what it should be. That's what we should be doing as physicians. That's what our job is, is to help people heal and get better. Yeah. So I just, you're just bringing me right back to that story I wanted to share with you is that I was like 15 probably, and I borrowed my friend's wetsuit.

It was great conditions, a little bit edgy. You know, it was surfing. Sorry. I was surfing. I borrowed a friend's wetsuit. The conditions were tricky and it was shallow. And I found my fin was like sticking out of my leg. It's so nice, oh God.

So it's about four inches down from my hip. Right in the kind of the meat of my thigh. And I was like, oh, damn it. And so I pulled it out and I've got a wetsuit over it and it didn't cut through the wetsuit. And so I pulled it out and I swam to the sand. I was like, ooh, this aches. And I look and there's blood, like kind of a lot of blood coming from the bottom of my wetsuit.

And I look and I go, okay, good. The wetsuit's okay. I got to get this thing fixed though. Like I got to figure this out. And the lifeguard, there happened to be a thing fixed though. Like I got to figure this out, you know, and the life guard, there happened to be a life guard there and he saw it. And so he comes over, takes a look at it. He's like, Hey, I got to cut your life, your, your wetsuit off. I was like, no, no, no, no, no. I go, listen, I need to go to the doc though. I need to go to the ER. And so lights

gone. Okay. We're sent off. I to the um emergency room and um the physician comes over and he goes okay well i have to i have to cut your wetsuit so um this is gonna kind of feel weird i go no no no you understand like i just needed i had no money okay yeah i was like i'm i'm bleeding all over the shop and i have no money. And how am I going to pay my friend back? This was 15 years old. And so it was an awesome moment for your profession because he, he put his hand on my leg, my other leg.

And he goes, he goes, I understand. He goes, but I do need to take this off. I have to cut it off because pulling it off, I think might damage, you know, whatever is underneath here. So I do need to cut it off. And I understand. And I was like, oh, fuck, cool. You know, like he gets it, you know, he totally gets it. Okay. If

that's the best decision. Yeah. All right. All right. Let's do it. And so he cut it off. And as soon as he kind of, you can imagine like the constriction from the the wetsuit as soon as he gets near it i'm like oh wait wait wait wait like and then all of a sudden he cuts it open and then you just see the whole thing kind of my skin just split open you know i'm like damn it and so um yeah but the the moment where he put his hand on my leg and he got me he got got this, you know, I could barely rub two nickels together and he totally got it. And I was like, I think you're probably, your whole heart is swelling right now. Like, yeah, that's one of the good ones. And so I want to share that because it's funny, like, you know, part of it. And the other part is like, nice job, dude. Really nice job.

Okay. Switching gears really quickly. Can you share the emergency mind and the project that you've put together here? We'll link it all up so people can take a look at just be a reductionist right now. Top of mind, one thing that you would hope people could do to be their best self. You have to study yourself. We talked about advocating for yourself, but you really have to study yourself because I can point you towards the direction of mental models and frameworks that historically function well under pressure. And I can give you ideas, but the ideas rot on the page unless you put them to practice. You have to study and experiment with yourself to get better at pressure, under pressure. The corollary to that is that you can't

expect just to jump into the deep end and have everything work. You have to practice it if you want it to be well when you need it. Mindfulness, meditation, journaling, introspection work. There is no rival to introspection. There is no comparison to that work. I love that you went there. And so what is your practice? Is it daily? In one form or another, yes. And there's this beautiful sort of like fractal nature to everything we do in emergencies, right? So there's a microcosm of, okay, so like last night I was supervising a resident who was about of putting a breathing tube in. Okay. So here's what we're going to do. Here's my plan. I'm thinking ahead about what's going to happen. We're going to deliver the anesthesia. We're going to put the breathing tube in. Great. We're going to take a moment to pause and recover and make sure everybody's okay. Now we're going to reflect on that moment. How do you think that went? What do you think we could do better next time?

What do you think would have happened if this happened instead? And in that moment, we're doing that cycle, prepare, perform, recover, and evolve, and we're running these little mini experiments. Over the course of the shift, we're doing that. Over the course of the day, you're doing that. And then personally, I do it at that micro level for every hard case and every serious moment. And then I take a broader sense, which is over the course of a week, I might spend several days on and off journaling or writing about things that I'm dealing with and running through and then present those either to a group of trusted peers, to my therapist, to a group of other peers in the ER and be like, yeah, this is what I'm sort of wrestling with. What do we think about this? And then we're just about to hit, we're recording this in, what is it?

Mid-December, something like that. And I tell you, ear doctors never know what day it is. We never know what time it is. I like the only reason that I have a good sense of what day it is during the week is usually the jujitsu schedule, because that's when I know when I'm going to go to jujitsu. But if you take that away, I've got no idea what day it is. But anyway, it's mid-December. And so we're getting to the point of the year where we're closing out like another larger cycle. So I'm going to spend a

bunch of time over the next couple of weeks doing a deep dive backward into the year and mapping out a bunch of goals and things. I want to do this next year. I'm not a big believer in resolutions. I don't think that's really the right way to do it in part, because I hope that whatever I decide right now will be obsolete as I get farther in the year, as my understanding of it gets better and more in depth and changes. And so I want that, I want that moving target, um, because I want to have that, that constant cycle of prepare, perform, recover, evolve running in my life. So good. I, um, the natural cycles to reflect are really important. And certainly at this time of the year, you know, we're at one.

Yes. So we talked, we talked earlier about this, you know, this sort of tension between how do you project confidence and, uh, command and control of a complex situation and also hold a vulnerability at the same time. And I think there's, there's two really important pieces in that, that are, that are worth poking at. Um, one is that obviously there's timeframes for pieces in that that are worth poking at. One is that obviously there's timeframes for this.

There's times to be in command and control. And then when you're doing that, you have to also set up the other half of that. You have to purposely carve out time to question if you did the right thing and how you could do it better, which again is that cycle, prepare, perform, recover, and evolve. The other thing is that I think that we carry this implicit notion that masters are perfect, which I think is just wrong. I don't think a master is perfect at what they do. I think a master is a really, really deep student of what they do, and that they understand how to ask the right questions and the better questions to push forward. And some of that comes from my lineage of doing martial arts, right? There's always this story you hear that a white belt becomes a black belt. And then when you wear

a black belt for a long enough time, it frays and it becomes a white belt again, because you realize you never stopped that cycle. There is no pinnacle where you are the absolute perfect, you know, structured, crystallized piece of knowledge that, that is everything. In fact, you're just learning how to be a better and deeper student all the time. And to me, that's part of what it means to master myself. So it's really good. Yeah. Okay. Brilliant, Dan. Thank you. You know, um, I've appreciated your readings, your reflections, your stories here, your insights, and just one last quick hit. It all comes down to. And there's so many different ways to go with that. It all comes down to learning who you are.

Very cool. Appreciate you, Dan. Yeah. Thank you so much for sharing and the time and um all of the insights and wisdom that have been availed in this conversation i really appreciate it uh it's a total pleasure to talk to you and thank you for what you guys are building i've benefited from it hugely awesome okay all and and if you to find you, if folks want to follow and find you, what's the best place to send them? Yeah, absolutely. So they can go to the website, emergency mind.com. And that sort of is the jumping off point for everything else. There you go. All right, Dan, all the best to you. My pleasure, man. Thank you. All right. Thank you so much for diving into another episode of Finding Mastery with us.

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