WEBVTT

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Raise your hand, and be honest,

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if you've used the phrase "crazy busy"

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to describe your day,
your week, your month.

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I'm an emergency-room doctor,

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and "crazy busy" is a phrase
you will never hear me use.

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And after today,

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I hope you'll stop using it, too.

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Here's why you cannot afford
to use "crazy"

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to describe your busy.

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Because when we are
in what I refer to as Crazy Busy Mode,

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we are simply less capable
of handling the busy.

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Here's what happens.

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Your stress hormones rise and stay there,

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your executive function
in the prefrontal cortex declines.

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That means your memory, your judgment,
your impulse control deteriorate,

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and the brain areas for anger
and anxiety are activated.

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Do you feel that?

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Here's the thing.

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You can be as busy
as an emergency department

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without feeling like you're crazy busy.

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How?

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By using the same tactics that we use.

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Our brains all process stress
in similar fundamental ways.

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But how we react to it

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has been shown by research
to be modifiable,

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whether it's emergencies
or just daily, day-in, day-out stress.

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Now contrast Crazy Busy Mode

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with how I think of us
in the ER -- Ready Mode.

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Ready Mode means whatever comes in
through those doors,

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whether it's a multiple-car pileup,

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or a patient having chest pain
while stuck in an elevator,

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or another patient with an item
stuck where it shouldn't be.

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When you're know you're dying to ask.

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(Laughter)

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Even on those days when you would swear
you were being punked,

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we're not afraid of it.

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Because we know that whatever comes in
through those ER double doors,

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that we can handle it.

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That we're ready.

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That's Ready Mode.

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We've trained for it,

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and you can, too.

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Here's how.

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Step one to go
from Crazy Mode to Ready Mode

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is to relentlessly triage.

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In Crazy Mode, you're always busy,
always stressed,

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because you're reacting to every challenge
with the same response.

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Contrast that with Ready Mode,

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where we triage,

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which means we prioritize
by degree of urgency.

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This isn't just a nice way
to get your to-do list done.

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Work by Dr. Robert Sapolsky

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shows that individuals who cannot
differentiate threat from non-threat

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and react to everything
with the same response

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have double the level of stress hormones.

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Which is why this
is the first skill to learn.

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You can't take care of them all at once,

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but you don't have to.

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Because we triage.

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Red -- immediately life-threatening.

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Yellow -- serious, but not
immediately life-threatening.

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Green -- minor.

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And we focus our efforts
first on the reds.

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Now hear this.

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Part of the problem in Crazy Mode

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is that you are reacting to everything

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as if it is red.

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So start by triaging correctly.

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Know your reds.

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They're what is most important
and where you can most move the needle.

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Now it's easy to be confused by noise,

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but what it noisiest
is not always what is most red.

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In fact, my severe asthmatic patient
is most at risk when he's quiet.

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But my patient over here, demanding
that I bring her flavored coffee creamer,

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she's noisy, but she's not red.

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I'll give you an example from my own life.

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Last spring, my house flooded,

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my one-year-old was in the ER,

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I was supposed to do a fundraiser
for my four-year-old's school

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and the final chapter of my book
was beyond late.

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Maybe not ironically,
that was the chapter on stress.

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(Laughter)

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My red tasks were getting
my one-year-old better

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and finishing my book.

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That was it.

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Remember, relentlessly triage.

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The house flood repair?

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Well, once we had stopped
and stabilized the damage,

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it was no longer a red.

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It felt red,

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but it was in fact just noise.

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No, no really, it was quite noisy,

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this picture on the far right
is me wearing earplugs

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to focus on my book,

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while the floor is being
mechanically dried around me.

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Know your reds,

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and do not let your non-reds
distract you from them.

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By the way, it is liberating
with a green task

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to, every once in a while,
be able to remind yourself,

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"That's a green task.
No one's going to die."

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(Laughter)

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It's OK if it's not perfect.

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Now there's one last triage level
that we use in the worst scenarios.

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And that is black.

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Those patients for whom
there is nothing we can do.

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Where we must move on.

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And although it is gut-wrenching,

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I mention it,

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because you each have your own equivalent
black tasks in your life.

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These are items
that you must take off your list.

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And I think many of you
know what I'm talking about.

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For me, this was the fundraiser.

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I had to step down.

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Because as we in the ER know,

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if you try to do everything,

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you have no hope of saving your reds.

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Step two to go from Crazy Mode
into Ready Mode

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is to expect and design for crazy.

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Half of handling crazy
is how you prepare for it.

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So if step one we triage,

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step two, we design to make
those tasks easier to do.

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Science shows us
that the more options we have,

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then the longer each decision takes.

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And the more decisions we have to make,
the more exhausted our brain gets

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and the less it is capable
of making good decisions.

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Which is why this step two

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is about finding ways to reduce
your daily decisions.

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Here are four easy examples
you can use in your daily lifestyle.

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Plan.

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Plan your entire week's meals
on the weekend,

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so that when it's Wednesday at 6pm

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and everyone's hangry
and requesting pizza,

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you have no decisions to make
to get a healthy meal on the table.

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Automate.

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Never leave anything to remember
that you could automate,

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whether it's scheduling it as recurring
or saved list, or recurrent purchases.

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Colocate.

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When it comes to exercise,

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store all the equipment that you need
for a certain activity together,

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charged and ready,

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so you don't spend energy looking for it.

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And decrease temptations,

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for anyone driven by sugar cravings.

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Anyone?

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Say aye, go ahead.

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That itself is its own form of Crazy Mode

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and self-medication for Crazy Mode,

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but stop working your willpower.

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Design differently.

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If a food is out of immediate reach,

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such that you have to use
a stool to reach it,

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even when it's chocolate,

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study participants ate 70 percent less
without thinking about it.

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I know.

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Let that sit for a second.

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(Laughter)

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Design to make the choices
you wish to make easier.

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Which bring us to the third step
to go from Crazy Mode to Ready Mode,

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and that is to get out of your head.

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Come with me.

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Different story.

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I'm working in a small, satellite ER,

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when a woman comes in in labor.

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I realize that the cord
is wrapped not once

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but twice around the baby's neck.

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And I'm the only doctor.

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I was scared.

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But I couldn't let it derail me.

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Because, you see, we all get nervous.

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We all get scared,

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but it's what you do next that matters.

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That first feeling isn't the problem.

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It can be an important sign.

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The problem comes
when we let it derail us.

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When that internal monologue starts

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and we catastrophize
and we start to get that tunnel vision.

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That's how you think
when you're in Crazy Mode,

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and you cannot solve anything that way.

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Now I promise to come back to the story,

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but first, how do I get out
of my own head?

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There are many tactics that you may hear,

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but for me, I find it best in the moment
to actively put my focus on someone else.

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To deliberately make myself
see the person in front of me,

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see myself in the arena with them --

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what do they need, what do they fear

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and how can I help?

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This may sound like a whole lot
of warm and fuzzy to you,

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but it's not.

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In fact, research shows
that when you prime your brain

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with what is, essentially, compassion,

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we disrupt that tunnel vision
and internal monologue.

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You widen your perception,

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so your brain can actually take in
broader information,

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so you see more possibilities
and can make better decisions.

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Try it.

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Know that your internal
monologue can derail you.

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And realize that when you get out
of your own head,

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you get out of your own way.

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Now what happened to that baby?

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I focused not on my fear,

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but on the mother and the baby
and what they needed me to do.

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And got the cord off of the baby's neck,

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and a healthy screaming,
kicking baby arrived,

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just as the dad ran in
from the parking lot,

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"Hi, you have a son, I'm Dr. Darria.

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Congratulations,
you want to cut the cord?"

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(Laughter)

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And for a moment,

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the strong cries of a newborn

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drowned out the beeps and the sirens
that are the normal sounds of the ER.

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But there was also something else.

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Because when I walked back
out of that mother's room,

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I saw several of my other patients
hovering nearby.

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I suddenly realized
that despite their own problems

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that had brought them
to the emergency room,

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they had all come together
to root for this baby.

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And they now together shared in the joy.

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Because that is what happens
when you go from Crazy Mode to Ready Mode.

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Others notice.

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They want it too,
they just don't know how,

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they just need one example.

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Which could be you.

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Own the busy.

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But stop calling it crazy.

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You've always had that ability.

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But now ...

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you're ready.

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Thank you.

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(Applause)