0:00:01.182,0:00:04.198
Raise your hand, and be honest,

0:00:04.222,0:00:08.135
if you've used the phrase "crazy busy"

0:00:08.159,0:00:13.273
to describe your day,[br]your week, your month.

0:00:14.441,0:00:17.386
I'm an emergency-room doctor,

0:00:17.410,0:00:22.390
and "crazy busy" is a phrase[br]you will never hear me use.

0:00:23.539,0:00:25.459
And after today,

0:00:25.483,0:00:28.340
I hope you'll stop using it, too.

0:00:29.166,0:00:33.315
Here's why you cannot afford[br]to use "crazy"

0:00:33.339,0:00:35.328
to describe your busy.

0:00:35.847,0:00:39.379
Because when we are[br]in what I refer to as Crazy Busy Mode,

0:00:39.403,0:00:44.137
we are simply less capable[br]of handling the busy.

0:00:44.844,0:00:46.035
Here's what happens.

0:00:46.059,0:00:48.336
Your stress hormones rise and stay there,

0:00:48.360,0:00:52.069
your executive function[br]in the prefrontal cortex declines.

0:00:52.093,0:00:55.919
That means your memory, your judgment,[br]your impulse control deteriorate,

0:00:55.943,0:01:00.306
and the brain areas for anger[br]and anxiety are activated.

0:01:00.825,0:01:01.975
Do you feel that?

0:01:03.950,0:01:05.211
Here's the thing.

0:01:05.235,0:01:08.887
You can be as busy[br]as an emergency department

0:01:08.911,0:01:12.005
without feeling like you're crazy busy.

0:01:13.204,0:01:14.362
How?

0:01:14.386,0:01:16.244
By using the same tactics that we use.

0:01:16.268,0:01:20.425
Our brains all process stress[br]in similar fundamental ways.

0:01:20.449,0:01:22.664
But how we react to it

0:01:22.688,0:01:25.323
has been shown by research[br]to be modifiable,

0:01:25.347,0:01:29.719
whether it's emergencies[br]or just daily, day-in, day-out stress.

0:01:30.633,0:01:33.394
Now contrast Crazy Busy Mode

0:01:33.418,0:01:36.552
with how I think of us[br]in the ER -- Ready Mode.

0:01:37.243,0:01:39.980
Ready Mode means whatever comes in[br]through those doors,

0:01:40.004,0:01:41.871
whether it's a multiple-car pileup,

0:01:41.895,0:01:45.377
or a patient having chest pain[br]while stuck in an elevator,

0:01:45.401,0:01:49.609
or another patient with an item[br]stuck where it shouldn't be.

0:01:50.498,0:01:53.076
When you're know you're dying to ask.

0:01:53.100,0:01:54.474
(Laughter)

0:01:54.498,0:01:59.403
Even on those days when you would swear[br]you were being punked,

0:01:59.427,0:02:01.838
we're not afraid of it.

0:02:02.664,0:02:06.474
Because we know that whatever comes in[br]through those ER double doors,

0:02:06.498,0:02:08.029
that we can handle it.

0:02:08.053,0:02:09.339
That we're ready.

0:02:09.887,0:02:12.011
That's Ready Mode.

0:02:12.800,0:02:14.339
We've trained for it,

0:02:14.363,0:02:16.531
and you can, too.

0:02:17.236,0:02:18.386
Here's how.

0:02:18.736,0:02:20.863
Step one to go[br]from Crazy Mode to Ready Mode

0:02:20.887,0:02:23.506
is to relentlessly triage.

0:02:23.530,0:02:25.948
In Crazy Mode, you're always busy,[br]always stressed,

0:02:25.972,0:02:29.840
because you're reacting to every challenge[br]with the same response.

0:02:30.307,0:02:32.950
Contrast that with Ready Mode,

0:02:32.974,0:02:34.495
where we triage,

0:02:34.519,0:02:38.151
which means we prioritize[br]by degree of urgency.

0:02:38.763,0:02:41.508
This isn't just a nice way[br]to get your to-do list done.

0:02:41.532,0:02:43.492
Work by Dr. Robert Sapolsky

0:02:43.516,0:02:47.654
shows that individuals who cannot[br]differentiate threat from non-threat

0:02:47.678,0:02:50.218
and react to everything[br]with the same response

0:02:50.242,0:02:52.975
have double the level of stress hormones.

0:02:53.393,0:02:56.313
Which is why this[br]is the first skill to learn.

0:02:56.337,0:02:58.284
You can't take care of them all at once,

0:02:58.308,0:02:59.680
but you don't have to.

0:02:59.704,0:03:00.926
Because we triage.

0:03:01.474,0:03:03.823
Red -- immediately life-threatening.

0:03:03.847,0:03:07.245
Yellow -- serious, but not[br]immediately life-threatening.

0:03:07.269,0:03:09.031
Green -- minor.

0:03:09.490,0:03:12.610
And we focus our efforts[br]first on the reds.

0:03:13.245,0:03:14.800
Now hear this.

0:03:15.149,0:03:17.926
Part of the problem in Crazy Mode

0:03:17.950,0:03:20.547
is that you are reacting to everything

0:03:20.571,0:03:22.769
as if it is red.

0:03:24.332,0:03:28.037
So start by triaging correctly.

0:03:28.639,0:03:30.194
Know your reds.

0:03:30.616,0:03:34.417
They're what is most important[br]and where you can most move the needle.

0:03:34.870,0:03:37.179
Now it's easy to be confused by noise,

0:03:37.203,0:03:40.932
but what it noisiest[br]is not always what is most red.

0:03:41.472,0:03:47.551
In fact, my severe asthmatic patient[br]is most at risk when he's quiet.

0:03:48.212,0:03:52.375
But my patient over here, demanding[br]that I bring her flavored coffee creamer,

0:03:52.399,0:03:55.775
she's noisy, but she's not red.

0:03:56.736,0:03:58.752
I'll give you an example from my own life.

0:03:58.776,0:04:00.522
Last spring, my house flooded,

0:04:00.546,0:04:02.522
my one-year-old was in the ER,

0:04:02.546,0:04:05.601
I was supposed to do a fundraiser[br]for my four-year-old's school

0:04:05.625,0:04:10.315
and the final chapter of my book[br]was beyond late.

0:04:11.682,0:04:14.777
Maybe not ironically,[br]that was the chapter on stress.

0:04:14.801,0:04:16.535
(Laughter)

0:04:17.150,0:04:20.222
My red tasks were getting[br]my one-year-old better

0:04:20.246,0:04:22.172
and finishing my book.

0:04:22.196,0:04:23.370
That was it.

0:04:23.394,0:04:26.579
Remember, relentlessly triage.

0:04:26.950,0:04:28.466
The house flood repair?

0:04:28.490,0:04:32.252
Well, once we had stopped[br]and stabilized the damage,

0:04:32.276,0:04:33.809
it was no longer a red.

0:04:34.125,0:04:35.791
It felt red,

0:04:35.815,0:04:38.127
but it was in fact just noise.

0:04:38.543,0:04:40.392
No, no really, it was quite noisy,

0:04:40.416,0:04:43.196
this picture on the far right[br]is me wearing earplugs

0:04:43.220,0:04:44.646
to focus on my book,

0:04:44.670,0:04:47.756
while the floor is being[br]mechanically dried around me.

0:04:48.458,0:04:50.315
Know your reds,

0:04:50.339,0:04:54.140
and do not let your non-reds[br]distract you from them.

0:04:54.974,0:04:57.688
By the way, it is liberating[br]with a green task

0:04:57.712,0:05:00.256
to, every once in a while,[br]be able to remind yourself,

0:05:00.280,0:05:03.459
"That's a green task.[br]No one's going to die."

0:05:03.483,0:05:04.594
(Laughter)

0:05:04.618,0:05:07.824
It's OK if it's not perfect.

0:05:10.118,0:05:14.331
Now there's one last triage level[br]that we use in the worst scenarios.

0:05:14.355,0:05:15.555
And that is black.

0:05:16.347,0:05:20.160
Those patients for whom[br]there is nothing we can do.

0:05:21.165,0:05:22.631
Where we must move on.

0:05:24.188,0:05:26.125
And although it is gut-wrenching,

0:05:26.149,0:05:27.299
I mention it,

0:05:27.323,0:05:32.243
because you each have your own equivalent[br]black tasks in your life.

0:05:32.854,0:05:36.390
These are items[br]that you must take off your list.

0:05:36.700,0:05:39.233
And I think many of you[br]know what I'm talking about.

0:05:39.716,0:05:42.176
For me, this was the fundraiser.

0:05:42.526,0:05:43.882
I had to step down.

0:05:44.542,0:05:46.476
Because as we in the ER know,

0:05:46.500,0:05:48.736
if you try to do everything,

0:05:48.760,0:05:52.426
you have no hope of saving your reds.

0:05:53.942,0:05:57.053
Step two to go from Crazy Mode[br]into Ready Mode

0:05:57.077,0:06:00.664
is to expect and design for crazy.

0:06:01.188,0:06:05.043
Half of handling crazy[br]is how you prepare for it.

0:06:05.877,0:06:07.321
So if step one we triage,

0:06:07.345,0:06:11.054
step two, we design to make[br]those tasks easier to do.

0:06:11.901,0:06:14.807
Science shows us[br]that the more options we have,

0:06:14.831,0:06:16.569
then the longer each decision takes.

0:06:16.593,0:06:20.141
And the more decisions we have to make,[br]the more exhausted our brain gets

0:06:20.165,0:06:23.077
and the less it is capable[br]of making good decisions.

0:06:23.530,0:06:25.006
Which is why this step two

0:06:25.030,0:06:28.767
is about finding ways to reduce[br]your daily decisions.

0:06:29.482,0:06:33.395
Here are four easy examples[br]you can use in your daily lifestyle.

0:06:33.832,0:06:34.999
Plan.

0:06:35.023,0:06:37.467
Plan your entire week's meals[br]on the weekend,

0:06:37.491,0:06:39.313
so that when it's Wednesday at 6pm

0:06:39.337,0:06:42.451
and everyone's hangry[br]and requesting pizza,

0:06:42.475,0:06:46.170
you have no decisions to make[br]to get a healthy meal on the table.

0:06:47.392,0:06:48.550
Automate.

0:06:48.574,0:06:52.503
Never leave anything to remember[br]that you could automate,

0:06:52.527,0:06:56.963
whether it's scheduling it as recurring[br]or saved list, or recurrent purchases.

0:06:57.670,0:06:58.820
Colocate.

0:06:59.122,0:07:00.479
When it comes to exercise,

0:07:00.503,0:07:04.250
store all the equipment that you need[br]for a certain activity together,

0:07:04.274,0:07:05.971
charged and ready,

0:07:05.995,0:07:08.153
so you don't spend energy looking for it.

0:07:08.558,0:07:11.875
And decrease temptations,

0:07:11.899,0:07:14.312
for anyone driven by sugar cravings.

0:07:14.336,0:07:15.526
Anyone?

0:07:15.550,0:07:17.101
Say aye, go ahead.

0:07:17.125,0:07:19.320
That itself is its own form of Crazy Mode

0:07:19.344,0:07:22.172
and self-medication for Crazy Mode,

0:07:22.196,0:07:24.545
but stop working your willpower.

0:07:25.077,0:07:27.085
Design differently.

0:07:27.800,0:07:29.934
If a food is out of immediate reach,

0:07:29.958,0:07:32.948
such that you have to use[br]a stool to reach it,

0:07:32.972,0:07:35.266
even when it's chocolate,

0:07:35.290,0:07:41.004
study participants ate 70 percent less[br]without thinking about it.

0:07:41.028,0:07:42.178
I know.

0:07:42.202,0:07:43.688
Let that sit for a second.

0:07:43.712,0:07:45.252
(Laughter)

0:07:45.276,0:07:50.193
Design to make the choices[br]you wish to make easier.

0:07:50.495,0:07:54.574
Which bring us to the third step[br]to go from Crazy Mode to Ready Mode,

0:07:54.598,0:07:57.965
and that is to get out of your head.

0:07:58.455,0:07:59.621
Come with me.

0:07:59.645,0:08:00.795
Different story.

0:08:01.199,0:08:04.191
I'm working in a small, satellite ER,

0:08:04.215,0:08:06.281
when a woman comes in in labor.

0:08:06.754,0:08:10.818
I realize that the cord[br]is wrapped not once

0:08:10.842,0:08:13.651
but twice around the baby's neck.

0:08:14.842,0:08:17.135
And I'm the only doctor.

0:08:18.889,0:08:20.039
I was scared.

0:08:20.643,0:08:23.381
But I couldn't let it derail me.

0:08:24.207,0:08:27.651
Because, you see, we all get nervous.

0:08:27.675,0:08:29.548
We all get scared,

0:08:29.572,0:08:33.325
but it's what you do next that matters.

0:08:34.022,0:08:36.101
That first feeling isn't the problem.

0:08:36.125,0:08:38.005
It can be an important sign.

0:08:38.411,0:08:40.577
The problem comes[br]when we let it derail us.

0:08:40.601,0:08:42.424
When that internal monologue starts

0:08:42.448,0:08:45.283
and we catastrophize[br]and we start to get that tunnel vision.

0:08:45.307,0:08:47.736
That's how you think[br]when you're in Crazy Mode,

0:08:47.760,0:08:51.734
and you cannot solve anything that way.

0:08:52.791,0:08:54.760
Now I promise to come back to the story,

0:08:54.784,0:08:57.815
but first, how do I get out[br]of my own head?

0:08:58.648,0:09:00.601
There are many tactics that you may hear,

0:09:00.625,0:09:06.386
but for me, I find it best in the moment[br]to actively put my focus on someone else.

0:09:06.410,0:09:09.674
To deliberately make myself[br]see the person in front of me,

0:09:09.698,0:09:11.507
see myself in the arena with them --

0:09:11.531,0:09:13.618
what do they need, what do they fear

0:09:13.642,0:09:16.134
and how can I help?

0:09:16.952,0:09:20.372
This may sound like a whole lot[br]of warm and fuzzy to you,

0:09:20.396,0:09:21.815
but it's not.

0:09:21.839,0:09:24.768
In fact, research shows[br]that when you prime your brain

0:09:24.792,0:09:27.014
with what is, essentially, compassion,

0:09:27.038,0:09:30.419
we disrupt that tunnel vision[br]and internal monologue.

0:09:30.443,0:09:31.776
You widen your perception,

0:09:31.800,0:09:35.609
so your brain can actually take in[br]broader information,

0:09:35.633,0:09:39.986
so you see more possibilities[br]and can make better decisions.

0:09:41.336,0:09:42.486
Try it.

0:09:43.241,0:09:46.820
Know that your internal[br]monologue can derail you.

0:09:47.955,0:09:52.535
And realize that when you get out[br]of your own head,

0:09:52.559,0:09:55.518
you get out of your own way.

0:09:57.503,0:09:59.177
Now what happened to that baby?

0:10:00.156,0:10:01.982
I focused not on my fear,

0:10:02.006,0:10:05.672
but on the mother and the baby[br]and what they needed me to do.

0:10:06.355,0:10:09.704
And got the cord off of the baby's neck,

0:10:09.728,0:10:12.228
and a healthy screaming,[br]kicking baby arrived,

0:10:12.252,0:10:14.561
just as the dad ran in[br]from the parking lot,

0:10:14.585,0:10:16.478
"Hi, you have a son, I'm Dr. Darria.

0:10:16.502,0:10:18.672
Congratulations,[br]you want to cut the cord?"

0:10:18.696,0:10:20.077
(Laughter)

0:10:20.101,0:10:21.744
And for a moment,

0:10:21.768,0:10:24.307
the strong cries of a newborn

0:10:24.331,0:10:29.751
drowned out the beeps and the sirens[br]that are the normal sounds of the ER.

0:10:30.942,0:10:33.209
But there was also something else.

0:10:33.823,0:10:37.093
Because when I walked back[br]out of that mother's room,

0:10:37.117,0:10:41.958
I saw several of my other patients[br]hovering nearby.

0:10:42.941,0:10:46.250
I suddenly realized[br]that despite their own problems

0:10:46.274,0:10:48.353
that had brought them[br]to the emergency room,

0:10:48.377,0:10:52.179
they had all come together[br]to root for this baby.

0:10:52.203,0:10:55.000
And they now together shared in the joy.

0:10:56.215,0:11:00.325
Because that is what happens[br]when you go from Crazy Mode to Ready Mode.

0:11:00.739,0:11:02.135
Others notice.

0:11:02.159,0:11:04.253
They want it too,[br]they just don't know how,

0:11:04.277,0:11:06.358
they just need one example.

0:11:06.684,0:11:09.215
Which could be you.

0:11:11.494,0:11:13.128
Own the busy.

0:11:13.787,0:11:17.088
But stop calling it crazy.

0:11:18.299,0:11:21.164
You've always had that ability.

0:11:22.021,0:11:23.886
But now ...

0:11:23.910,0:11:25.060
you're ready.

0:11:25.878,0:11:27.029
Thank you.

0:11:27.053,0:11:29.714
(Applause)