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  • Raise your hand, and be honest,

  • if you've used the phrase "crazy busy"

  • to describe your day, your week, your month.

  • I'm an emergency-room doctor,

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

  • And after today,

  • I hope you'll stop using it, too.

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

  • to describe your busy.

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

  • we are simply less capable of handling the busy.

  • Here's what happens.

  • Your stress hormones rise and stay there,

  • your executive function in the prefrontal cortex declines.

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

  • and the brain areas for anger and anxiety are activated.

  • Do you feel that?

  • Here's the thing.

  • You can be as busy as an emergency department

  • without feeling like you're crazy busy.

  • How?

  • By using the same tactics that we use.

  • Our brains all process stress in similar fundamental ways.

  • But how we react to it

  • has been shown by research to be modifiable,

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

  • Now contrast Crazy Busy Mode

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

  • Ready Mode means whatever comes in through those doors,

  • whether it's a multiple-car pileup,

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

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

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

  • (Laughter)

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

  • we're not afraid of it.

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

  • that we can handle it.

  • That we're ready.

  • That's Ready Mode.

  • We've trained for it,

  • and you can, too.

  • Here's how.

  • Step one to go from Crazy Mode to Ready Mode

  • is to relentlessly triage.

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

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

  • Contrast that with Ready Mode,

  • where we triage,

  • which means we prioritize by degree of urgency.

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

  • Work by Dr. Robert Sapolsky

  • shows that individuals who cannot differentiate threat from non-threat

  • and react to everything with the same response

  • have double the level of stress hormones.

  • Which is why this is the first skill to learn.

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

  • but you don't have to.

  • Because we triage.

  • Red -- immediately life-threatening.

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

  • Green -- minor.

  • And we focus our efforts first on the reds.

  • Now hear this.

  • Part of the problem in Crazy Mode

  • is that you are reacting to everything

  • as if it is red.

  • So start by triaging correctly.

  • Know your reds.

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

  • Now it's easy to be confused by noise,

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

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

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

  • she's noisy, but she's not red.

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

  • Last spring, my house flooded,

  • my one-year-old was in the ER,

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

  • and the final chapter of my book was beyond late.

  • Maybe not ironically, that was the chapter on stress.

  • (Laughter)

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

  • and finishing my book.

  • That was it.

  • Remember, relentlessly triage.

  • The house flood repair?

  • Well, once we had stopped and stabilized the damage,

  • it was no longer a red.

  • It felt red,

  • but it was in fact just noise.

  • No, no really, it was quite noisy,

  • this picture on the far right is me wearing earplugs

  • to focus on my book,

  • while the floor is being mechanically dried around me.

  • Know your reds,

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

  • By the way, it is liberating with a green task

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

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

  • (Laughter)

  • It's OK if it's not perfect.

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

  • And that is black.

  • Those patients for whom there is nothing we can do.

  • Where we must move on.

  • And although it is gut-wrenching,

  • I mention it,

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

  • These are items that you must take off your list.

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

  • For me, this was the fundraiser.

  • I had to step down.

  • Because as we in the ER know,

  • if you try to do everything,

  • you have no hope of saving your reds.

  • Step two to go from Crazy Mode into Ready Mode

  • is to expect and design for crazy.

  • Half of handling crazy is how you prepare for it.

  • So if step one we triage,

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

  • Science shows us that the more options we have,

  • then the longer each decision takes.

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

  • and the less it is capable of making good decisions.

  • Which is why this step two

  • is about finding ways to reduce your daily decisions.

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

  • Plan.

  • Plan your entire week's meals on the weekend,

  • so that when it's Wednesday at 6pm

  • and everyone's hangry and requesting pizza,

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

  • Automate.

  • Never leave anything to remember that you could automate,

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

  • Colocate.

  • When it comes to exercise,

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

  • charged and ready,

  • so you don't spend energy looking for it.

  • And decrease temptations,

  • for anyone driven by sugar cravings.

  • Anyone?

  • Say aye, go ahead.

  • That itself is its own form of Crazy Mode

  • and self-medication for Crazy Mode,

  • but stop working your willpower.

  • Design differently.

  • If a food is out of immediate reach,

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

  • even when it's chocolate,

  • study participants ate 70 percent less without thinking about it.

  • I know.

  • Let that sit for a second.

  • (Laughter)

  • Design to make the choices you wish to make easier.

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

  • and that is to get out of your head.

  • Come with me.

  • Different story.

  • I'm working in a small, satellite ER,

  • when a woman comes in in labor.

  • I realize that the cord is wrapped not once

  • but twice around the baby's neck.

  • And I'm the only doctor.

  • I was scared.

  • But I couldn't let it derail me.

  • Because, you see, we all get nervous.

  • We all get scared,

  • but it's what you do next that matters.

  • That first feeling isn't the problem.

  • It can be an important sign.

  • The problem comes when we let it derail us.

  • When that internal monologue starts