1
00:00:01,182 --> 00:00:04,198
Raise your hand, and be honest,

2
00:00:04,222 --> 00:00:08,135
if you've used the phrase "crazy busy"

3
00:00:08,159 --> 00:00:13,273
to describe your day,
your week, your month.

4
00:00:14,441 --> 00:00:17,386
I'm an emergency-room doctor,

5
00:00:17,410 --> 00:00:22,390
and "crazy busy" is a phrase
you will never hear me use.

6
00:00:23,539 --> 00:00:25,459
And after today,

7
00:00:25,483 --> 00:00:28,340
I hope you'll stop using it, too.

8
00:00:29,166 --> 00:00:33,315
Here's why you cannot afford
to use "crazy"

9
00:00:33,339 --> 00:00:35,328
to describe your busy.

10
00:00:35,847 --> 00:00:39,379
Because when we are
in what I refer to as Crazy Busy Mode,

11
00:00:39,403 --> 00:00:44,137
we are simply less capable
of handling the busy.

12
00:00:44,844 --> 00:00:46,035
Here's what happens.

13
00:00:46,059 --> 00:00:48,336
Your stress hormones rise and stay there,

14
00:00:48,360 --> 00:00:52,069
your executive function
in the prefrontal cortex declines.

15
00:00:52,093 --> 00:00:55,919
That means your memory, your judgment,
your impulse control deteriorate,

16
00:00:55,943 --> 00:01:00,306
and the brain areas for anger
and anxiety are activated.

17
00:01:00,825 --> 00:01:01,975
Do you feel that?

18
00:01:03,950 --> 00:01:05,211
Here's the thing.

19
00:01:05,235 --> 00:01:08,887
You can be as busy
as an emergency department

20
00:01:08,911 --> 00:01:12,005
without feeling like you're crazy busy.

21
00:01:13,204 --> 00:01:14,362
How?

22
00:01:14,386 --> 00:01:16,244
By using the same tactics that we use.

23
00:01:16,268 --> 00:01:20,425
Our brains all process stress
in similar fundamental ways.

24
00:01:20,449 --> 00:01:22,664
But how we react to it

25
00:01:22,688 --> 00:01:25,323
has been shown by research
to be modifiable,

26
00:01:25,347 --> 00:01:29,719
whether it's emergencies
or just daily, day-in, day-out stress.

27
00:01:30,633 --> 00:01:33,394
Now contrast Crazy Busy Mode

28
00:01:33,418 --> 00:01:36,552
with how I think of us
in the ER -- Ready Mode.

29
00:01:37,243 --> 00:01:39,980
Ready Mode means whatever comes in
through those doors,

30
00:01:40,004 --> 00:01:41,871
whether it's a multiple-car pileup,

31
00:01:41,895 --> 00:01:45,377
or a patient having chest pain
while stuck in an elevator,

32
00:01:45,401 --> 00:01:49,609
or another patient with an item
stuck where it shouldn't be.

33
00:01:50,498 --> 00:01:53,076
When you're know you're dying to ask.

34
00:01:53,100 --> 00:01:54,474
(Laughter)

35
00:01:54,498 --> 00:01:59,403
Even on those days when you would swear
you were being punked,

36
00:01:59,427 --> 00:02:01,838
we're not afraid of it.

37
00:02:02,664 --> 00:02:06,474
Because we know that whatever comes in
through those ER double doors,

38
00:02:06,498 --> 00:02:08,029
that we can handle it.

39
00:02:08,053 --> 00:02:09,339
That we're ready.

40
00:02:09,887 --> 00:02:12,011
That's Ready Mode.

41
00:02:12,800 --> 00:02:14,339
We've trained for it,

42
00:02:14,363 --> 00:02:16,531
and you can, too.

43
00:02:17,236 --> 00:02:18,386
Here's how.

44
00:02:18,736 --> 00:02:20,863
Step one to go
from Crazy Mode to Ready Mode

45
00:02:20,887 --> 00:02:23,506
is to relentlessly triage.

46
00:02:23,530 --> 00:02:25,948
In Crazy Mode, you're always busy,
always stressed,

47
00:02:25,972 --> 00:02:29,840
because you're reacting to every challenge
with the same response.

48
00:02:30,307 --> 00:02:32,950
Contrast that with Ready Mode,

49
00:02:32,974 --> 00:02:34,495
where we triage,

50
00:02:34,519 --> 00:02:38,151
which means we prioritize
by degree of urgency.

51
00:02:38,763 --> 00:02:41,508
This isn't just a nice way
to get your to-do list done.

52
00:02:41,532 --> 00:02:43,492
Work by Dr. Robert Sapolsky

53
00:02:43,516 --> 00:02:47,654
shows that individuals who cannot
differentiate threat from non-threat

54
00:02:47,678 --> 00:02:50,218
and react to everything
with the same response

55
00:02:50,242 --> 00:02:52,975
have double the level of stress hormones.

56
00:02:53,393 --> 00:02:56,313
Which is why this
is the first skill to learn.

57
00:02:56,337 --> 00:02:58,284
You can't take care of them all at once,

58
00:02:58,308 --> 00:02:59,680
but you don't have to.

59
00:02:59,704 --> 00:03:00,926
Because we triage.

60
00:03:01,474 --> 00:03:03,823
Red -- immediately life-threatening.

61
00:03:03,847 --> 00:03:07,245
Yellow -- serious, but not
immediately life-threatening.

62
00:03:07,269 --> 00:03:09,031
Green -- minor.

63
00:03:09,490 --> 00:03:12,610
And we focus our efforts
first on the reds.

64
00:03:13,245 --> 00:03:14,800
Now hear this.

65
00:03:15,149 --> 00:03:17,926
Part of the problem in Crazy Mode

66
00:03:17,950 --> 00:03:20,547
is that you are reacting to everything

67
00:03:20,571 --> 00:03:22,769
as if it is red.

68
00:03:24,332 --> 00:03:28,037
So start by triaging correctly.

69
00:03:28,639 --> 00:03:30,194
Know your reds.

70
00:03:30,616 --> 00:03:34,417
They're what is most important
and where you can most move the needle.

71
00:03:34,870 --> 00:03:37,179
Now it's easy to be confused by noise,

72
00:03:37,203 --> 00:03:40,932
but what it noisiest
is not always what is most red.

73
00:03:41,472 --> 00:03:47,551
In fact, my severe asthmatic patient
is most at risk when he's quiet.

74
00:03:48,212 --> 00:03:52,375
But my patient over here, demanding
that I bring her flavored coffee creamer,

75
00:03:52,399 --> 00:03:55,775
she's noisy, but she's not red.

76
00:03:56,736 --> 00:03:58,752
I'll give you an example from my own life.

77
00:03:58,776 --> 00:04:00,522
Last spring, my house flooded,

78
00:04:00,546 --> 00:04:02,522
my one-year-old was in the ER,

79
00:04:02,546 --> 00:04:05,601
I was supposed to do a fundraiser
for my four-year-old's school

80
00:04:05,625 --> 00:04:10,315
and the final chapter of my book
was beyond late.

81
00:04:11,682 --> 00:04:14,777
Maybe not ironically,
that was the chapter on stress.

82
00:04:14,801 --> 00:04:16,535
(Laughter)

83
00:04:17,150 --> 00:04:20,222
My red tasks were getting
my one-year-old better

84
00:04:20,246 --> 00:04:22,172
and finishing my book.

85
00:04:22,196 --> 00:04:23,370
That was it.

86
00:04:23,394 --> 00:04:26,579
Remember, relentlessly triage.

87
00:04:26,950 --> 00:04:28,466
The house flood repair?

88
00:04:28,490 --> 00:04:32,252
Well, once we had stopped
and stabilized the damage,

89
00:04:32,276 --> 00:04:33,809
it was no longer a red.

90
00:04:34,125 --> 00:04:35,791
It felt red,

91
00:04:35,815 --> 00:04:38,127
but it was in fact just noise.

92
00:04:38,543 --> 00:04:40,392
No, no really, it was quite noisy,

93
00:04:40,416 --> 00:04:43,196
this picture on the far right
is me wearing earplugs

94
00:04:43,220 --> 00:04:44,646
to focus on my book,

95
00:04:44,670 --> 00:04:47,756
while the floor is being
mechanically dried around me.

96
00:04:48,458 --> 00:04:50,315
Know your reds,

97
00:04:50,339 --> 00:04:54,140
and do not let your non-reds
distract you from them.

98
00:04:54,974 --> 00:04:57,688
By the way, it is liberating
with a green task

99
00:04:57,712 --> 00:05:00,256
to, every once in a while,
be able to remind yourself,

100
00:05:00,280 --> 00:05:03,459
"That's a green task.
No one's going to die."

101
00:05:03,483 --> 00:05:04,594
(Laughter)

102
00:05:04,618 --> 00:05:07,824
It's OK if it's not perfect.

103
00:05:10,118 --> 00:05:14,331
Now there's one last triage level
that we use in the worst scenarios.

104
00:05:14,355 --> 00:05:15,555
And that is black.

105
00:05:16,347 --> 00:05:20,160
Those patients for whom
there is nothing we can do.

106
00:05:21,165 --> 00:05:22,631
Where we must move on.

107
00:05:24,188 --> 00:05:26,125
And although it is gut-wrenching,

108
00:05:26,149 --> 00:05:27,299
I mention it,

109
00:05:27,323 --> 00:05:32,243
because you each have your own equivalent
black tasks in your life.

110
00:05:32,854 --> 00:05:36,390
These are items
that you must take off your list.

111
00:05:36,700 --> 00:05:39,233
And I think many of you
know what I'm talking about.

112
00:05:39,716 --> 00:05:42,176
For me, this was the fundraiser.

113
00:05:42,526 --> 00:05:43,882
I had to step down.

114
00:05:44,542 --> 00:05:46,476
Because as we in the ER know,

115
00:05:46,500 --> 00:05:48,736
if you try to do everything,

116
00:05:48,760 --> 00:05:52,426
you have no hope of saving your reds.

117
00:05:53,942 --> 00:05:57,053
Step two to go from Crazy Mode
into Ready Mode

118
00:05:57,077 --> 00:06:00,664
is to expect and design for crazy.

119
00:06:01,188 --> 00:06:05,043
Half of handling crazy
is how you prepare for it.

120
00:06:05,877 --> 00:06:07,321
So if step one we triage,

121
00:06:07,345 --> 00:06:11,054
step two, we design to make
those tasks easier to do.

122
00:06:11,901 --> 00:06:14,807
Science shows us
that the more options we have,

123
00:06:14,831 --> 00:06:16,569
then the longer each decision takes.

124
00:06:16,593 --> 00:06:20,141
And the more decisions we have to make,
the more exhausted our brain gets

125
00:06:20,165 --> 00:06:23,077
and the less it is capable
of making good decisions.

126
00:06:23,530 --> 00:06:25,006
Which is why this step two

127
00:06:25,030 --> 00:06:28,767
is about finding ways to reduce
your daily decisions.

128
00:06:29,482 --> 00:06:33,395
Here are four easy examples
you can use in your daily lifestyle.

129
00:06:33,832 --> 00:06:34,999
Plan.

130
00:06:35,023 --> 00:06:37,467
Plan your entire week's meals
on the weekend,

131
00:06:37,491 --> 00:06:39,313
so that when it's Wednesday at 6pm

132
00:06:39,337 --> 00:06:42,451
and everyone's hangry
and requesting pizza,

133
00:06:42,475 --> 00:06:46,170
you have no decisions to make
to get a healthy meal on the table.

134
00:06:47,392 --> 00:06:48,550
Automate.

135
00:06:48,574 --> 00:06:52,503
Never leave anything to remember
that you could automate,

136
00:06:52,527 --> 00:06:56,963
whether it's scheduling it as recurring
or saved list, or recurrent purchases.

137
00:06:57,670 --> 00:06:58,820
Colocate.

138
00:06:59,122 --> 00:07:00,479
When it comes to exercise,

139
00:07:00,503 --> 00:07:04,250
store all the equipment that you need
for a certain activity together,

140
00:07:04,274 --> 00:07:05,971
charged and ready,

141
00:07:05,995 --> 00:07:08,153
so you don't spend energy looking for it.

142
00:07:08,558 --> 00:07:11,875
And decrease temptations,

143
00:07:11,899 --> 00:07:14,312
for anyone driven by sugar cravings.

144
00:07:14,336 --> 00:07:15,526
Anyone?

145
00:07:15,550 --> 00:07:17,101
Say aye, go ahead.

146
00:07:17,125 --> 00:07:19,320
That itself is its own form of Crazy Mode

147
00:07:19,344 --> 00:07:22,172
and self-medication for Crazy Mode,

148
00:07:22,196 --> 00:07:24,545
but stop working your willpower.

149
00:07:25,077 --> 00:07:27,085
Design differently.

150
00:07:27,800 --> 00:07:29,934
If a food is out of immediate reach,

151
00:07:29,958 --> 00:07:32,948
such that you have to use
a stool to reach it,

152
00:07:32,972 --> 00:07:35,266
even when it's chocolate,

153
00:07:35,290 --> 00:07:41,004
study participants ate 70 percent less
without thinking about it.

154
00:07:41,028 --> 00:07:42,178
I know.

155
00:07:42,202 --> 00:07:43,688
Let that sit for a second.

156
00:07:43,712 --> 00:07:45,252
(Laughter)

157
00:07:45,276 --> 00:07:50,193
Design to make the choices
you wish to make easier.

158
00:07:50,495 --> 00:07:54,574
Which bring us to the third step
to go from Crazy Mode to Ready Mode,

159
00:07:54,598 --> 00:07:57,965
and that is to get out of your head.

160
00:07:58,455 --> 00:07:59,621
Come with me.

161
00:07:59,645 --> 00:08:00,795
Different story.

162
00:08:01,199 --> 00:08:04,191
I'm working in a small, satellite ER,

163
00:08:04,215 --> 00:08:06,281
when a woman comes in in labor.

164
00:08:06,754 --> 00:08:10,818
I realize that the cord
is wrapped not once

165
00:08:10,842 --> 00:08:13,651
but twice around the baby's neck.

166
00:08:14,842 --> 00:08:17,135
And I'm the only doctor.

167
00:08:18,889 --> 00:08:20,039
I was scared.

168
00:08:20,643 --> 00:08:23,381
But I couldn't let it derail me.

169
00:08:24,207 --> 00:08:27,651
Because, you see, we all get nervous.

170
00:08:27,675 --> 00:08:29,548
We all get scared,

171
00:08:29,572 --> 00:08:33,325
but it's what you do next that matters.

172
00:08:34,022 --> 00:08:36,101
That first feeling isn't the problem.

173
00:08:36,125 --> 00:08:38,005
It can be an important sign.

174
00:08:38,411 --> 00:08:40,577
The problem comes
when we let it derail us.

175
00:08:40,601 --> 00:08:42,424
When that internal monologue starts

176
00:08:42,448 --> 00:08:45,283
and we catastrophize
and we start to get that tunnel vision.

177
00:08:45,307 --> 00:08:47,736
That's how you think
when you're in Crazy Mode,

178
00:08:47,760 --> 00:08:51,734
and you cannot solve anything that way.

179
00:08:52,791 --> 00:08:54,760
Now I promise to come back to the story,

180
00:08:54,784 --> 00:08:57,815
but first, how do I get out
of my own head?

181
00:08:58,648 --> 00:09:00,601
There are many tactics that you may hear,

182
00:09:00,625 --> 00:09:06,386
but for me, I find it best in the moment
to actively put my focus on someone else.

183
00:09:06,410 --> 00:09:09,674
To deliberately make myself
see the person in front of me,

184
00:09:09,698 --> 00:09:11,507
see myself in the arena with them --

185
00:09:11,531 --> 00:09:13,618
what do they need, what do they fear

186
00:09:13,642 --> 00:09:16,134
and how can I help?

187
00:09:16,952 --> 00:09:20,372
This may sound like a whole lot
of warm and fuzzy to you,

188
00:09:20,396 --> 00:09:21,815
but it's not.

189
00:09:21,839 --> 00:09:24,768
In fact, research shows
that when you prime your brain

190
00:09:24,792 --> 00:09:27,014
with what is, essentially, compassion,

191
00:09:27,038 --> 00:09:30,419
we disrupt that tunnel vision
and internal monologue.

192
00:09:30,443 --> 00:09:31,776
You widen your perception,

193
00:09:31,800 --> 00:09:35,609
so your brain can actually take in
broader information,

194
00:09:35,633 --> 00:09:39,986
so you see more possibilities
and can make better decisions.

195
00:09:41,336 --> 00:09:42,486
Try it.

196
00:09:43,241 --> 00:09:46,820
Know that your internal
monologue can derail you.

197
00:09:47,955 --> 00:09:52,535
And realize that when you get out
of your own head,

198
00:09:52,559 --> 00:09:55,518
you get out of your own way.

199
00:09:57,503 --> 00:09:59,177
Now what happened to that baby?

200
00:10:00,156 --> 00:10:01,982
I focused not on my fear,

201
00:10:02,006 --> 00:10:05,672
but on the mother and the baby
and what they needed me to do.

202
00:10:06,355 --> 00:10:09,704
And got the cord off of the baby's neck,

203
00:10:09,728 --> 00:10:12,228
and a healthy screaming,
kicking baby arrived,

204
00:10:12,252 --> 00:10:14,561
just as the dad ran in
from the parking lot,

205
00:10:14,585 --> 00:10:16,478
"Hi, you have a son, I'm Dr. Darria.

206
00:10:16,502 --> 00:10:18,672
Congratulations,
you want to cut the cord?"

207
00:10:18,696 --> 00:10:20,077
(Laughter)

208
00:10:20,101 --> 00:10:21,744
And for a moment,

209
00:10:21,768 --> 00:10:24,307
the strong cries of a newborn

210
00:10:24,331 --> 00:10:29,751
drowned out the beeps and the sirens
that are the normal sounds of the ER.

211
00:10:30,942 --> 00:10:33,209
But there was also something else.

212
00:10:33,823 --> 00:10:37,093
Because when I walked back
out of that mother's room,

213
00:10:37,117 --> 00:10:41,958
I saw several of my other patients
hovering nearby.

214
00:10:42,941 --> 00:10:46,250
I suddenly realized
that despite their own problems

215
00:10:46,274 --> 00:10:48,353
that had brought them
to the emergency room,

216
00:10:48,377 --> 00:10:52,179
they had all come together
to root for this baby.

217
00:10:52,203 --> 00:10:55,000
And they now together shared in the joy.

218
00:10:56,215 --> 00:11:00,325
Because that is what happens
when you go from Crazy Mode to Ready Mode.

219
00:11:00,739 --> 00:11:02,135
Others notice.

220
00:11:02,159 --> 00:11:04,253
They want it too,
they just don't know how,

221
00:11:04,277 --> 00:11:06,358
they just need one example.

222
00:11:06,684 --> 00:11:09,215
Which could be you.

223
00:11:11,494 --> 00:11:13,128
Own the busy.

224
00:11:13,787 --> 00:11:17,088
But stop calling it crazy.

225
00:11:18,299 --> 00:11:21,164
You've always had that ability.

226
00:11:22,021 --> 00:11:23,886
But now ...

227
00:11:23,910 --> 00:11:25,060
you're ready.

228
00:11:25,878 --> 00:11:27,029
Thank you.

229
00:11:27,053 --> 00:11:29,714
(Applause)