High Performance Mindset | Learn from World-Class Leaders, Consultants, Athletes & Coaches about Mindset - 184: Fear, Courage and Stress from a Neurosurgeon’s Perspective, Dr. Mark McLaughlin, Neurosurgeon, Author & Speaker

Episode Date: June 5, 2018

Mark McLaughlin, MD is a neurosurgeon on a mission to use the lessons he’s learned in his career to help others courageously engage and wrestle with stress. Dr. McLaughlin believes everyone can take the core principles behind brain surgery and apply them to any of life’s problems. In his upcoming book, Outthinking Fear, Dr. McLaughlin discusses the lessons he learned in the operating room and how they can be utilized in everyday life to think and act move effectively. He is a board certified neurosurgeon, currently practicing neurological surgery at Princeton Brain and Spine Care. He has published over 100 articles on neurosurgery and spoken internationally about his field. A former NCAA Division I wrestler, Dr. McLaughlin was inducted into the National Wrestling Hall of Fame in 2016. He remains active in the wrestling world, coaching with the Princeton Wrestling Club. Dr. McLaughlin also served as medical director for Princeton Brain and Spine from 2005 to 2015 before focusing in on teaching and inspiring others.  You can find a full description of the Podcast at cindrakamphoff.com/drmark.

Welcome to High Performance Mindset with Dr. Sindra Kampoff. Do you want to reach your full potential, live a life of passion, go after your dreams? Each week we bring you strategies and interviews to help you ignite your mindset. Let's bring on Sindra. Welcome to the High Performance Mindset Podcast. This is Sindra Kampoff, your host, and I'm grateful that you're here, ready to listen to episode 184 with Dr. Mark McLaughlin. Now, the goal of these interviews is to learn from the world's best leaders, athletes, coaches, and consultants, all about mindset to help us reach our potential or be high performers in our field or our sport. In this interview,

I interviewed Dr. Mark McLaughlin, who is a neurosurgeon on a mission to use the lessons he's learned in his career to help others courageously engage and wrestle with stress. Dr. McLaughlin believes that everyone can take the core principles behind brain surgery and apply them to any of life's problems. In his upcoming book, Outthinking Fear, Mark discusses the lessons he's learned in the operating room and how they can be utilized in everyday life to think and act more effectively. So Mark is a board-certified neurosurgeon practicing neurosurgery at Princeton Brain and Spine Care. He has performed over 2,000 surgeries and he's published over 100 articles on

neurosurgery spoken internationally about his field. He's also, interestingly enough, a former NCAA Division I wrestler who was inducted into the National Wrestling Hall of Fame in 2016. So he's still active in the wrestling world coaching the Princeton Wrestling Club. Now in this interview, Mark and I talk about his top rules for surgery and how they can apply to everyday life, how the brain processes fear and courage, how courage is a learned behavior, and his five P's he uses to mentally prepare for surgery. Now my favorite parts of this interview is when we talk about courage and how courage is a learned behavior.

And the second thing that I really enjoyed about this interview is at the beginning we were talking about how one of his patients didn't recover as well as he expected. And I was talking about how that might be similar to my work in consulting in high performance. And he said something really powerful, that the struggle is the opportunity. So I know you're going to enjoy today's interview with Dr. Mark McLaughlin. And you can head over to Twitter to join the conversation there. You can tag myself at mentally underscore strong. And Mark's Twitter handle is mmclaughlinmd. We look forward to hearing

from you on Twitter. Now without further ado, let's bring on Mark. Welcome to the High Performance Mindset Podcast. This is your host, Cindra Campoff. And I'm really excited today to talk to Mark McLaughlin. So Mark, I'm just excited to talk to you more about neurosurgery and how you can teach us more about the applications to our everyday life. So welcome to the podcast. Hi, Sandra. Delighted to be here. Awesome. So Mark, tell us a little bit about your passion and what you do right now. Sure. So I'm a neurosurgeon at Princeton Brain and Spine in Princeton, New Jersey,

and I've been practicing almost 20 years now. I started way back when in Pittsburgh as a resident, got my training, and then did a fellowship in Atlanta at Emory University, and then started practicing. And I've moved around a little little bit and about maybe 15 years ago, settled in Princeton, New Jersey. So I've been practicing neurosurgery ever since. And I happen to coach a wrestling team at the same time. I love it. And you are a former division one wrestler, right? And got into the National Wrestling Hall of Fame. So I'm looking forward to talking to you about what lessons you learned even from

wrestling that you use today. I'd love to share them with you. And it's funny, that's how this whole thing started about sort of focusing on what are the aspects of neurosurgery that helped me perform not only in neurosurgery, but in other areas of my life. Okay. Yeah. So let's kind of dive into that because I think that's really fascinating. So tell us a little bit about, you know, how you first began, you know, being interested in neurosurgery and, you know, why is it something you chose to pursue? Well, I come from a family of doctors. I'm a third generation physician. And I don't know if you remember the black bag, but I used to carry my grandfather's black bag

on house calls. So it's literally in my DNA and my nephew is going to be a fourth generation physician. So it's been in my family for a long time. And I mean, I've known I've wanted to be a physician since I was five years old. So I'm very lucky that I've known that. Absolutely. And not a lot of people have that direction or maybe are introduced to those same kind of things in their family, you know, those same opportunities, or at least seeing that those are a possibility. Yes, I was given many, many opportunities.

I'm a lucky, lucky person. And so why neurosurgery in particular? Well, you know, I think it stemmed from my wrestling background. You know, wrestling is one of the harder, most challenging sports you can face. And I liked the challenge of it. It was sort of the Mount Everest of medicine for me. Neurosurgeons generally, you know, work the longest hours, have the most difficult and complex cases, endure the most stress. And in my experience, you know, they are looked at in the hospital as really, you know, one of the people that turn to in a crisis. And I saw that and wanted to be just like the great mentors that I was exposed to early on in my training.

You know, I think some people might say, well, I don't want to feel the pressure or I don't want to choose something, you know, that's going to have to work really hard at and long hours. So, you know, what do you think? Is it about you as a person or your personality that made you choose something that was going to be really difficult? Well, you know, I knew I wanted to be a doctor. I loved helping people and serving people. And then you have to match what fits your personality. So I've always had a lot of energy. And so, you know, I don't think I could ever sit still in a radiology department and read MRI scans and x-rays and things. God bless the radiologist, but I just could ever sit still in a radiology department and read MRI scans and x-rays and things. God bless the radiologists, but I just couldn't sit still at a desk like that.

And, you know, you want to, I'd like to see results quickly. And so surgeons' attitudes are generally, you know, like that. They like to see, you know, the work of their hands. So that's a nice feedback that you get from a surgical standpoint. And then you got to go with what really interests you. So I just was fascinated by neurosciences. I was fascinated by neuropsychology. I was very lucky early on in high school when I was a high school wrestler to be exposed

to Dr. Nate Zinser at the Center for Enhanced Performance at West Point. And, you know, he helped me very early on in my career to realize that, you know, that the link of the mind and the body and performance. So it all sort of came together in neurosurgery for me. I love that you were introduced to Nate Zinser because it's like he's one of us in terms of mental performance professionals. So I feel like it's such a small world, Mark. Yeah, it was neat. And I've had Dr. Zinser come to speak to my youth wrestling team, and we collaborate frequently on topics. And I get a chance to speak up at West Point for his class called the Psychology of Elite Performance. So it's been an amazing experience. He's my mentor,

he's a colleague, and he's a friend. So I'm very, very lucky to have been blessed to know him. Well, before we dive into the content, one of the questions I want to ask you is, you know, so we can get to know you a little bit more. Tell us a little bit about a time that you failed and what did you learn from it? Because I think that's a really important question to ask because I think, you know, we might hear about your accomplishments, but, you know, we all need to fail along the way for us to learn and for us to get on the course that we're intended to be on. So, Dr. McLaughlin, tell us a little bit about a time you failed. So, I just couldn't agree with you more on that. And it's, you know, when I'm in the office and I

see, you know, I could see 25 patients in a row that are doing great. And then I just see one person who's not doing well. And that's the one I drive home thinking about because, you know, you just, you want to, you know, you want to win them all in medicine. It's, it's hard. It's a hard thing to experience losses in medicine. And probably one of my greatest losses and failures in, in, in some way is, um, is a young boy who I operated on many years ago. And we did his surgery, he had a very difficult brain tumor. I did it with my partner. And we, we worked all day on him and did just a, we did a, it was technically a perfect operation. And unfortunately, he suffered some complications from the surgery that really were not related to the technical aspects of the surgery. But just because it was such a very difficult problem, he struggled and did not do well.

And I remember that time in my life. It was early on in my career. And I knew that we had done everything well, really perfectly, but he was not doing well after that surgery. And it was like a gigantic piano on my back to see him every day, to see him struggling. And it was an all-encompassing experience that over a few months to see him struggle, it was just, I felt like I had failed. And even though we had technically done the right thing and done it well, I still felt like a failure. And I remember just asking myself at that time, it was really the lowest point in my career, you know, why did I do this? Like, why did, why did I get into this? Like, I just want to,

I just want to go down to Key West and crawl under a rock or, you know, just, and, and then I just finally asked for forgiveness. I asked God for forgiveness and say, God, please, I did everything I could for this boy. And, you know, please let me let this pass. I mean, I got, there's got to be more for me here. And it was sort of that sense of higher purpose. And then that one day it was like a switch turned. I said, look, you did everything you could for him. You didn't give him his disease. It happened and you did everything you could. And that's the way it's going to be. And for some reason, you were, you were supposed to struggle through that as he was, and that's God's will

and move on. And I just was able to flip out of it. So that I've carried with that with me to this day. You never forget that. But it's something that I was able to really put in its own little shoebox and use it in the future when I needed it. So I'm hearing a few things that, you know, this higher purpose in terms of connecting to that helped you during that time of that you felt like you failed, right? And I'm also hearing, you know, that it's nice to hear that you struggle as well. You know, and I couldn't imagine, you know, that not everything goes perfectly within neurosurgery, right? So how do you feel, what did you learn from that situation in terms of like moving forward from, you know, patients that don't recover perfectly or, you know, knowing that you did

everything that you possibly could, how did that maybe change you? Well, it's, it's a demon of mine and I think it's a demon of, of all doctors. And some, some doctors, you know, unfortunately, they don't deal with it well, and they avoid it. And they maybe, you know, avoid talking to a patient that's had a bad outcome. And that just leads into more and more problems, as opposed to just saying, you know, up front, listen, you're not where you're supposed to be. I thought you'd be better at this point. And I'm, you know, I'm sorry, I did the best I could. And you know, unfortunately, not everybody comes out through surgery the way that we expected. So it's understanding that that's a demon knowing that that's never going to go away. But you can, you can put it in its cage and say,

okay, I saw that patient, I expressed my sorrow for their poor outcome. And now I'm going to move on to room two, which is another new problem. That person needs me just as much, and we're going to move on. So it's a delicate balance that you learn. Absolutely. And I think, you know, you're talking about neurosurgery, but we all have those situations that, you know, I think about my work in performance psychology, and I might meet with an athlete or performer, and, you know, 20 out of 21, like, there's, you know, these great outcomes, but then there's this one who you can't quite connect with, right? And so, I think we all have that in our lives where it's not always perfect.

Right, and that one that you can't connect with, if you look within, that's the person you're going to learn the most for and be the better clinician down the road, because you figured out a way to tap into that person. So that struggle is really the opportunity, isn't it? Yeah, it is the opportunity. I'm glad that you said that. Love it. The struggle is the opportunity. I think we can all take that. So, you know, one of the things I hear that you're really passionate about is helping people learn kind of life lessons from neurosurgery, even though that we don't, you know, do it. Tell us about, you know, your why behind that. Like, why is that important to you? And, you know, why is just

practicing neurosurgery important to you? Because I think when we know what our why is that important to you? And, you know, why is just practicing neurosurgery important to you? Because I think when we know what our why is, it can be really a powerful motivator. So this all started with my youth wrestling program when my boys were in it. And, you know, I coached it because I love wrestling, but I also had a chance to spend some time with my kids when they were young. Two of them were wrestlers all the way through college. And so what I started doing, you know, I do work during the day. I do my neurosurgery, and I'd come to the practice room, and I'd see these little kids, you know, wrestling

and have the same fear and struggles and trying to conjure up courage. You know, they'd step out on the mat in a ring with, you know, against another person and everybody be watching them and you could see the fear in their eyes. And so I started telling the kids, you know, listen, I'm going to tell you a story about what happened at work today. And I would boil that story down to a kid's level about how, you know, hey, I was in an operating room today and I got really scared for a minute. Let me tell you what I did about it. You know, I started telling myself, hey, just do a little step. Just do this step. Just do this step. Just stay close to where you need to

be. And I just kept saying that over and over again. And it got me through the surgery. And, you know, I heard this little voice that was, that was scaring me in my head and I, and I calmed it down. And I, you know, I tell them, Hey, listen, you're going to have those voices before you go out on the wrestling mat or before you take a test or before you have a job interview. Don't listen to it. Yes. Find ways to, to answer that with no, sir, not, not today. That's not what's going to happen today. And so I started telling the kids stories about my neurosurgery. And as the stories evolved, I realized, hey, these are great lessons for anybody. And I noticed that the parents started listening to my stories.

I realized they must be universal. Oh, that's wonderful. And what great experience for those, you know, the athletes to hear about neurosurgery, you know, and that everybody, no matter if you're highly educated, struggles with these kind of things, that voice inside your head or the fear. I think that's really helpful when I really learned that it's like, you know, it wasn't just me. It helped me just gain control of that a little bit more. Exactly. And then, so as things evolved, you know, I got invited up to West Point to be a guest speaker. And when I was going up there, I just said, oh my gosh, these are the finest, America's finest. I've got to bring my very, very best. So I worked on these stories more and it really, they came down to a bunch of rules that I had learned in

neurosurgery. And I took these rules that I had learned in neurosurgery, rules that are burned into your brain early on in your residency. And I expanded on them as in stories. And the rules are really universal laws that just translated into neurosurgery or translated into coaching or translated into life. And so those are the kinds of things I brought to West Point. And that's how everything evolved into this work that I'm working on this book called Outthinking Fear. Awesome. Awesome. Well, I can't wait to read it. So it's supposed to come out 2019. Is that right? Yes. Okay. Awesome. Can't wait. Because I do think that fear is the thing that holds us back. And one of the things that I was, you know, just as I listened to you,

I think about how, well, neurosurgery is a performance, right? It's so much like sport. It's so much like when I give a speech, right? Where I go in and talk in front of 500 people, you know, I need a routine to get mentally prepared. You know, I need to know what my best looks like and I need to work to get there. I need to calm that voice inside my head, right? I need to have courage to, you know, do what I know that I can do. So I see that, you know, what you're saying is that there's a lot of applicability to neurosurgery to our life.

It's absolutely true. And I think that, you know, we think that in the world, you know, stress is bad. We hear this, you know, stress can be bad. But, you know, in medicine, stress is really important. If you don't put stress on your bones, you get osteoporosis. If you don't put stress on your muscles, you have weak muscles going into old age is a bad formula for longevity. And if you don't stress your brain, you're not going to get smarter and take a higher IQ into old age, which again, is the number one deterrent for dementia. So I'm a believer that that stress, if you're armed with the right tools, is really critical and you need to engage the stress. Awesome. We need to engage the stress. Okay. So one of the things I wanted

to ask you a little bit about was your top tips to help us deal with stress. So what would your, as a brain surgeon, what would be your top tips related to that? So I would say, and again, I'm going to tell you three rules of neurosurgery, and maybe you'll be able to do a little surgery at the end of this thing. I love it. First is always place a drain. Second is never cut what you can't see. And third is never worry about a patient alone. Those are three rules that my mentors taught me along the way. And I'll share a little bit of a vignette with each of them. The first one is always place a drain. And that's a longstanding neurosurgical rule. And what it really means is, I don't know if people know

this, but your head, inside your head, there's a pressure inside your head, a normal pressure. But, excuse me, if you get a brain tumor, the pressure increases a lot. And so before we do any surgery on somebody with a brain tumor, we have to put a drain in the head to drain off the fluid and decrease the pressure. And that's sort of like a safety valve. It's a pop-off valve that makes the surgery safer. So just like, think about if you had a Coke can and you shook it up and then you opened up the tab of the Coke can, right? It would spray out all over you. Yes. Same thing if you operate, if you open somebody's head and you're working on somebody's head, they have a big tumor with a lot of swelling. It's not going to spray out at you, but it's going to swell out at you very rapidly.

So what we do is we put a tubing in just in front of the area and that allows to spill some fluid off and allows us to have a safer surgery. So always place a drain. But really, what is that in life? It's really what are your safety valves? What are your rules that can control the stress in your life? So, you know, if let's say you're going to go into a difficult conversation with somebody, you need to have a safety valve. You need to maybe say to yourself, listen, I'm going to talk to this person for 10 minutes. And if we're not seeing eye to eye or things start escalating, maybe we ought to just cool it and say, hey, let's talk to this person for 10 minutes. And if we're not seeing eye to eye or things start escalating, maybe we ought to just cool it and say, Hey, let's, let's talk about this later. You know, there's a safety valve for you.

Step away. Maybe you need to take a break and come back to that at a different time when it's a better time, or maybe you're more rested. If you're giving a lecture and you probably experience this sometimes, sometimes that you get a curve ball, you know, somebody before you speaks a little too long and then you go from like a 15-minute talk to a five-minute talk.

You have to have a safety valve. You have to have an escape hatch, a little short vignette that gets you out of your talk quicker. Those are the kinds of safety valves that I'm talking about. Always placing a drain means having a backup plan, really. Having a backup plan for

everything you do in life. Awesome. And what was the second one? Perfect. Second rule, never cut what you can't see. This was a great experience I had with Dr. Peter Giannetti. He was my mentor at University of Pittsburgh. And I first heard these six simple words while we were operating on somebody's brainstem, my first day at the University of Pittsburgh. And we were under a microscope and Dr. Gennetta was dissecting the blood vessels off of the brainstem under the microscope with just ease. He said to me, Mark, never cut what you can't see. As he was just about to make the maneuver that fixed this person's problem, he started humming. I was like, oh my gosh, here's this guy working on somebody's brainstem, and he has the calm coolness to actually be humming. How is this possible?

What I realized was, well, he had reduced microsurgery down to some basic rules. First one, which never cut what you can't see. If you never cut what you can't see, you're likely to not get into trouble. Yeah, for sure. And so zooming out, that's the biggest advances in surgery in the last hundred years are not new techniques or technology. It's simple illumination and magnification, bringing the microscope into the field and shining better light on our surgical field. So that's the greatest advance we've had. And again, that can really help us in life too. So when you're about to make an important decision, when you're about to do something that maybe has serious consequences,

ask yourself, have I shined a light on every area of this decision? Have I magnified this up to really see what I can see? And that's the second rule that I think is really important. I had an experience recently with my daughter was getting married and I had to prepare myself for the toast. And as I was getting the toast ready, I had this flood of emotions. And a lot of it was remorse that I hadn't spent more time with her when she was a child because I was a busy surgeon taking care of patients. And I kept asking myself, why am I feeling like this?

This is a happy occasion. Why are you getting so emotional? Why are you getting so emotional? And then I kind of realized, look, hey, this is what every father feels when their daughter gets married. This is the kind of thing that it's universal. And you can't have regret over this. This is something you can just have to pledge yourself

to be more present in the moments of her adult life. And that's all you can do. And plus, your toast isn't about you. Your toast is about them and your family and your grandparents and everybody welcoming them into your family and your grandparents and everybody welcoming them into the family. And sort of magnifying that up and illuminating that really helped me deliver a toast without too many tears. I love it. That's a great example, you know,

that you just looked at it from every different possible, like light, right? That you just didn't assume that it was about you, but you look, you were focused on other people and what you could give to other people in that, that talk and that speech. And then I think one thing that you said is like, you can't change the past, right? Like no reason to experience the regret instead, you know, commit to being more present in her adult life in those moments where you're with her. Exactly. Enjoy the moment and embrace all of it. It's all good. A third rule that I like to share with you is never worry about a patient alone. And this was another one of my mentors, Dr. Gail Rousseau, who's a neurosurgeon out in Chicago. And, you know, she taught me this years ago. And, you know, the same holds true for life. You know, by sharing our worries with others and getting

second opinions, we gain a lot of different perspectives and alternative solutions. So I always say when faced with something stressful, don't trust your gut reaction. It's not often right. Your gut reaction is usually a self preservation maneuver. And oftentimes it can, it can bring you to the wrong conclusion, reach out to others, turn to trusted colleagues and friends, get a third party assessment of your situation. And you're more likely to take, to make a decision a decision that has a lot more wisdom when you make that choice. Really thinking through the tough situations and asking for help from others, not just kind of going with what you think is best. Exactly.

All the time when I'm taking care of patients, if I have a patient who's not responding well to something, that's the first thing I do is I turn to my partners and say, hey, listen, I got this patient. This is what's going on. And I expected this to happen and it didn't happen. What are your thoughts? emotionally invested in a patient and you need to get another person's dispassionate evaluation to get, to get another view of what's going on. Absolutely. Really good advice. Never worry about a patient alone. Yes. Never worry about anything alone, really. Yeah, for sure. For sure. You know, one of the things that I wanted to ask you a little bit about, Mark, is, you know, your book, Outthinking Fear. So obviously, you know, these three rules of surgery apply to fear because I think when we think about fear, it's so future-based

and it's like, you know, what's going to happen? What if, right? And I think as a surgeon, if you're so focused on the future, you can't be at your best in the moment. You might make really poor decisions that are life-threatening to people. That's exactly correct. I use in my talks, and I've talked to my wrestlers about this, I use the Kipling poem, If. If you can meet with triumph and disaster and treat those two imposters just the same, because triumph and disaster are in the future or the past. Just be in the present and be focused on the present. I told the West Point class last time I was there that poetry is the world's first performance enhancement literature. That's awesome. It really is. If you go back and these are words that can

really pull you through. And that's what I'm excited about this book is, you know, surgeons don't like to talk about fear. And you would think on the surface, patients don't like to think that surgeons have fear. But the fact of the matter is we do. And just how you deal with it, how you cope with it, and how you engage with it is an important process. And I think it's something that I really would like to share with people because I think it can help them in their decisions. Absolutely. You know, so from a neuroscience perspective, what would you, where would you say that fear comes from? Well, it's a, it's a primitive, primitive part of our brain. I mean, the fight or flight response is the deepest part of our, you know, our amygdala and our hippocampus.

And these are the areas of the brain that, you know, that, that are triggered with emotion. And so that's, that's the area that we need to understand, uh, is, is, is the initial driving self-preservation, um, mode of our brain. And you know what, when a bus is screaming at you at 60 miles per hour and you stepped out on the street, it works really well. It works really well. But if you're having a difficult conversation with your son about making an important choice, it does not work well. And that's where the courage that comes in is really the frontal lobe override. That's the prefrontal cortex,

the part of the brain that has the planning and the executive function. And that's an area that we can develop. That's an area that we can actually train to override the primitive parts of our brain. Awesome. So do you think that, obviously we all experience fear because that it's, you know, this, this primitive reaction and part of our brain, right. That is natural. So do you think that courage is a choice or how would you describe that? So I think it's, I think it's a learned behavior and this leads into sort of the, the, the meat of the book is about a concept called cognitive dominance. And, you know, cognitive

dominance, it sounds like a very imposing word, like, you know, Darth Vader, I'm going to cognitively dominate you. It's not that kind of a term. It's a definition, it's defined, it's a word defined by the US Army, it was coined byS. Army, and it means enhanced situational awareness in order to facilitate rapid and accurate decision-making under stressful conditions with limited decision-making time. So that's a lot of words, but what it means is using your brain to come up with the best solution that you possibly can at the moment that you're faced with it. And that can be a learned behavior as long as you have the right building blocks. And I think, you know, concepts like your book, which is really exciting, and I'm looking forward to reading it.

You know, those are the kinds of things that we need to, you know, train our mind to have embedded as algorithms, and that'll help us make these decisions. Absolutely. So it's a learned behavior. Do you think it's sort of like courage? Do you think it's like a muscle? You know, when I lift weights, right, my muscle gets stronger, right? And I think like, at least from my perspective, I know when I choose to be courageous, right? And so like I think about, for me, I do a lot of public speaking. And so I remember the first time, man, I was super nervous, right? And sometimes I get nervous still, right? But typically it's because I'm thinking about the what ifs and what if they don't like it, right? But the more and more I do it, the more easier it becomes to be courageous

in that moment and show up as Cintra Kampoff, you know, because that's how we all shine when we're at our best. Do you think it's sort of like a muscle that you develop or, you know, tell us how we could be more courageous in our life. So it's absolutely something. It's a muscle that you can exercise. And it's really neat to see with the little kids in my wrestling program, it's almost like a little laboratory. I can see the little incremental, you know, development that these kids have, you know, even from, you know, not being able to do one pull-up to helping them do hanging pull-ups to helping them do pull-ups. It's exactly the same. So I would say, you know, A, it's good to have a coach. You know, you can't do this on your own. Having a mentor or a

performance or executive coach is important. I have one. I use it. I actually, I have several. I use coach Zinser and I use a guy named Jim Harsha, who's outstanding. And so having somebody to help you is good to kind of get you out of your comfort zone. Little incremental tries first. In other words, smaller discussions, practicing your presentation in front of your family. I'm sure you go over your talks with your kids first, and then maybe you try it on the office staff, and then you move on to a public venue, and then you move on to requesting, you know, a bigger venue to give your talk. So again, it's kind of inching that along and pushing yourself outside of your comfort zone. Absolutely. Yeah. And how would you say that, you know,

your brain processes kind of this fear and courage? Is there anything else you could tell us about the natural and normal response versus, you know, kind of what happens in our brain? really important. I think that reading and listening to books can very much strengthen your repertoire because, you know, I love the Andy Andrews quote, experience isn't the greatest teacher. Other people's experience is the greatest. That's awesome. And so the more you read, and I encourage all my kids and my wrestlers to read, that you're going to strengthen that. Inevitably, you're going to strengthen that. And then with respect to the second, your last question about courage, it's actually, I think it's a dopamine hit, just like everything else is in our brain.

We get a thrill out of finding a challenge, using the newly acquired skills that we have put into our armamentarium and successfully navigating that. And once you do that, and I'm sure you felt it after your talks, like I feel it after a surgery, you feel great. You feel it's euphoric. It's a euphoric feeling. It's a little hit of dopamine in your brain. It's the same chemical that, you know, people get when they inject heroin. But I tell you what, it's a heck of a lot better if you do it, you know, naturally and you do it by, you know, facing courageous events and overcoming them. Absolutely. You know, and I think as we age, we need to continue to have things that we're going to need to move towards, meaning like things that are going to take courage for us. You

know, I think what happens is people get really stagnant and then they maybe do things that aren't very courageous things that aren't very courageous that are out of their comfort zone. And I, at least for me, that's what I need. I need something, you know, maybe because of that dopamine hit, you know, that just for me to feel good about my life, I need, you know, goals to go after or, you know, new inspiring things, or I just get stagnant. Do you, Do you see that that's important in terms of like the brain? Yep. And my dad, who retired at the age of 69, went back to school and got a PhD in history, and then wrote a book at the age of 80. Wow. And then a second book at the age of 88. And he used to say, you know, never lose your curiosity for

life. Having that curiosity is going to push you into learning, continuously learning and being a lifelong learner. Absolutely. Absolutely. So what would you tell us in terms of, you know, I think about it as a neurosurgery, you have to really problem solve well under stress, you know, I think about it as a neurosurgery, you have to really problem solve well under stress, you know, and it can, it can feel like pressure moments, right? Where, you know, someone's life is, is in your hands. How do you think that we should operate in terms of under stress or in pressure situations? What could you tell us about how our brain kind of reacts and what should we do? Trust your, you know, trust your, be yourself, really be yourself. It's almost like the John Wooden poise, you know, be poised. It's

just being yourself. I think a lot of times we were faced with this, we faced with a decision and all of a sudden your mind starts thinking about like, oh, what are other people thinking about my decision? What are other people, other people, maybe they're looking at me right now, or this is going to, this could, you know, get, get outside of this area and other people could know. Really thinking about being in and of yourself, trusting your skills, mastering your skills. You need to master your skills. That takes many years. But really following, following what you've been trained to do.

And then if something is not going the right way, not being afraid of getting other people involved to give you other perspectives. Absolutely. And I'm thinking about the mental skills that are necessary in neurosurgery, right? Like the deep breath that, you know, you don't get too anxious or nervous, you know, tell us a little bit about how you might mentally prepare for neurosurgery. Sure. I have, I have my three R's, the rules, routines, and rituals. So I have the rules that I've learned through all my career. And then I have my routines, which are certain set things that I do every day before the surgery.

You know, I have to bring my own personal equipment in. It has to be placed in a certain area. The films have to be up. I have to have gone over the chart. My most common routine is I call my five Ps, and that's where I pause before any surgery. I think about the patient, the very specific parts of what's going on. This is a 39-year-old housewife with a severe right-sided sciatica, and she's had severe pain for three months, and she needs a perfect right L4, L5 discectomy today. Then I

make a plan. I go through the entire surgery in a quick 30 second to 60 second reel in my head of how exactly the surgery is going to go. Put out a positive thought. You know, you trained your whole life for this day. This is the most important day in this lady's life. Make it the best surgery you can. And then I say a prayer. So those are my five Ps. The prayer always helps me. Again, it's a higher purpose.

And I truly believe it's a part of my performance, you know, that helps me. And then lastly, I have rituals. I have things that I have absolutely no explanation for at all, but I'm superstitious and I make sure that they happen the same way every time. When I inject a medicine into the skin, I usually use a very specific amount every time. And that's more superstition than it is anything else. Yeah. Rules, routines, and rituals. Nice. And I liked your five Ps. So pause, patient, plan, positive thought, and prayer. Yes. Yeah. And I really liked your positive thought. I think we can each take this, you know, and apply it to our life. But you were like, you know, that you've trained your whole

life for this. And this day is the most important for that person, you know, that you've trained your whole life for this and this day is the most important for that person, you know, your patient. I like that thought because it's really giving you like confidence in yourself that, hey, this is what you've done your whole life, you know, no reason to doubt that you don't have the skills and knowledge, right? But then, you know, acknowledging that this might be your, you know, I don't know, how many surgeries have you done? Oh, several thousand. Right. So I was thinking this might be your 2000 and, you know,

25th surgery, but this is the most important person, the most important day in this person's life. So I think that helps you connect with the patient too. Absolutely. You have to have that balance of, you know, cool, calm, collected, and disattached, but you also have to be attached. And it's a fine balance. It was described by Sir William Osler as something called equanimitas. Okay. Yeah, so tell us a bit more about that. You need to be attached, but connected. Yeah. So he, you know, he talked about the doctor patient relationship and how,

you know, you, you, you have to care very, very deeply about your patients. And you have to understand that also there's a barrier that you need to keep so that you can deliver care without being, having a clouded judgment, without losing your perspective. And that's very, very important balance. And also, you know, so like, that's why doctors, you know, should never take care of a family member. You know, that's why, because your judgment is clouded by that relationship. So that's a very delicate balance. Yeah. I'm thinking about how even in my profession, that's an important balance where like you care about the person that you're working with, right? But you got to disconnect with also maybe how they perform because we can't control how they perform.

We can just give them the skills to help them. But, you know, really, ultimately, we can't control them when they're out on the field or when they're giving a talk or, you know, in surgery, like I couldn't control you, right? But I can help give them the skills necessary. Exactly. Yes. Awesome. Well, I have really, really enjoyed this interview. Me too. A lot to think about. And I love how just like easy it is to understand, you know, and how easy you are to connect with. So I appreciate that. You know, in terms of kind of wrapping up the interview, when you think about, you know, your experience in wrestling and being a really successful wrestler, did you wrestle at William & Mary? Is that right?

Yes, I wrestled at William & Mary for five years and was a captain of the team my senior year. Awesome, awesome. What do you think that in terms of kind of mental performance, what did you, what are the skills you used? Or how would you describe, you know, why you were successful in wrestling and how that's transferred to neurosurgery? I was lucky to have some amazing coaches along the way who really exemplified excellence and integrity. I think the greatest skill they imparted in me was persistence. That you don't, you know, when you don't know anything, you know, you can improve rapidly.

But then when you get really good at something, you improve very, very, very slightly. You improve in shades and those shades can be very subtle. And you have to just be persistent on that to really achieve greatness. It doesn't happen overnight. It happens multiple, multiple, you know, over days, weeks, years. And to be persistent, that was really, I think, the greatest lesson that wrestling taught me. And it brought me to medicine. And, you know, even in medicine, it's persistent. It's constantly asking yourself after every surgery, what could I have done better? How could this have gone smoother? You know, how can we improve outcomes? How could we figure out a way to get this person better in a less invasive way or even a non-surgical way if possible? Absolutely. Persistence and always learning and growing and that, you know, I like what you said about that even, you know, as you get really, really good at something, maybe the ways that you're improving are really small, but noticing those, maybe even celebrating those

and acknowledging those to keep you going. Yes, that's correct. Excellent, excellent. Well, Dr. Mark, could you tell us a little bit about how we might connect with you? So you have a book coming out in 2019, Overthinking Fear. And I know you also have a stress management quiz in 2019, Overthinking Fear. And I know

you also have a stress management quiz, a self-assessment we could take. So how could we connect with you and learn more from you and follow you? Sure. My website is markmclaughlinmd.com. And I write a blog that you can follow. I have created a stress decision-making assessment tool that you can access through the website and get a free evaluation. And it'll keep you up to date on, you know, book developments. I have a number of little segments that are on the website about the book. And so that would probably be the best way to connect. I'm also on Facebook, Mark McLaughlin, MD, and LinkedIn and Twitter is at M McLaughlin, MD.

So I'd love to hear your impressions of the folks that listened. Please send me a comment. The email is on the website and it. And it's really neat to hear other people, other high performers and people, you know, just struggling to be better and daily life activities. It's great to hear how they perceive these stories and how they reflect on their own life and how it helps them. Absolutely. Yeah. So I'd encourage you to reach out to Dr. McLaughlin. And I'm also on Twitter. What did you say your Twitter handle was? It's at M McLaughlin MD.

Okay. At M McLaughlin MD. So I'd encourage you to head over there and you could even share with us a comment. My Twitter handle is mentally underscore strong, and we'd love to hear what you got from today's interview. You know, Mark, the things that I really enjoyed, I liked what you talked about the three rules of surgery. So always place a drain, never cut what you can't see, and never worry about a patient alone. I thought what you talked about there was really applicable to our lives. And I loved our discussion about fear and courage

and how those are different areas in our brain and how they show up in our lives and how courage is really a learned behavior. I liked just your conversation about that and that we should continue to do things that are courageous because it's like this dopamine hit. We all need something like that. So we don't just kind of stay stagnant. And I also really enjoyed your five Ps. So pause, patient, plan, positive thought and prayer. And it makes me reflect on how you're very intentional with your focus and your energy before you go into

surgery, which is something I think we should do in all of our performances. So, you know, I appreciate you being here and giving us a little insight into your life and inspiring us to live a bigger vision of ourselves. My pleasure. Thanks for the opportunity. And I look forward to hearing everybody's impressions on Twitter. Awesome. Thank you again, Mark. Oh for the opportunity. And I look forward to hearing everybody's impressions on Twitter. Awesome. Thank you again, Mark. Oh, thank you. Have a great day. Thank you for listening to High Performance Mindset. If you liked today's podcast, make a comment, share it with a friend and join the conversation on Twitter at Mentally Underscore Strong. For more inspiration and to receive Sindra's free weekly videos,

check out DrSindra.com.