Overview
- Professionals in any arena focus on learning and repetition to attain the highest skill level.
- Why not focus this level of energy for developing life skills – processing stress and nurturing joy?
- Efficienting overcoming challenges is critical to for success. Yet we often are upset by adversity.
- Embrace adversity as an opportunity to practice your skills. Challenges never stop.
For decades, I was an orthopedic spine surgeon specializing in complex redo and deformity surgery. The mindset that got me there was that I was tough, and my attitude was, “bring it on.” I did not know what the word anxiety meant until I had a panic attack while driving in 1990. That was the beginning of a severe personal decline that no amount of medical training could fix, nor could anyone explain what happened. I was trapped in an abyss of chronic pain, manifesting in seventeen different physical and mental symptoms that felt inescapable. I didn’t emerge from this abyss by fighting or “fixing” the pain through traditional means, although I made heroic efforts. Somehow, I stayed on my feet. Instead, I learned, through fifteen years of trial and error, how to lower my nervous system’s activated threat physiology. As I emerged, I still had little idea of what had happened and why. From that day in 1990, I embarked on a relentless search for answers, and I am still on that path.
Chronic illness
As I learned the principles of chronic mental and physical illness, I implemented them into my practice and helped hundreds of people out of their versions of the abyss. The worst part of my ordeal was fighting off unwanted thoughts and being socially isolated. Today, having helped hundreds escape the same abyss, I realize that the worst part of any ordeal is often not the physical sensation, but the unwanted thoughts and social isolation that follow. The brain cannot distinguish between the pain of a surgical wound and the pain of a mental burden. However, as you fight adversity, mental and physical, or to fix them, you are giving it more power. The key is learning to quit fighting; the reactions abate, and healing happens as you move forward towards what you want.
I have been out of this hole for over twenty years, with resolution of all my physical and mental symptoms. I now understand that I induced deep healing by creating safety physiology, where the body regenerates and heals. So does the brain. It is the fundamental shift in thinking that allows this to happen, and it is deeper than just a series of interventions.
Cognitive fusion
To understand how to heal, we must first understand the problem. It originates in our biological hardware. Our unconscious survival brain operates at lightning speed, unable to tell the difference between a physical predator and a modern mental stressor like financial worry or intrusive thoughts. Both trigger the same fight-or-flight cascade. Most of us live in a state of “cognitive fusion,” where we are our thoughts, concepts, and ideals. This fusion is our default biological state. Thoughts can’t physically hurt us, so why are we fused with them? It is because the fight-or-flight response occurs first in the presence of physical danger, and humans have language to interpret it. That happens one to ten seconds later, and we label it anxiety. It is just an alarm signal.
We now have a thought connected to our physiology. Then the thought can set off the physiology. As we fight negative thoughts, we become entangled with them. We don’t fight positive thoughts, and why repetitive positive thoughts are not problematic. Fighting against these “RUTs”—the repetitive unpleasant thoughts—only serves to fuse them more deeply into our physiology.
The performance formula
There is a two-step sequence of healing: you must first down-regulate threat through somatic safety signals. Only then does space open for joy, play, and growth. You cannot outrun threat physiology with willpower or forced “positive thinking. This is a dynamic, daily process that eventually becomes second nature.
In the operating room, I learned that a simple formula defines performance:
Performance = Skill – Interference.
The desired outcome is a consistent performance regardless of the circumstances. To become a professional in any performance arena, one must relentlessly practice correct skills. Why not take the same approach with life skills – processing adversity and nurturing joy?
The adversities in the OR parallel life; I observed five categories of interferences.
- Anxiety: fight-or-flight hyper-arousal physically decreases the blood flow to the neocortex or the thinking brain.
- Anger: keeps the brain active but narrows focus, so we lose perspective, can’t see the bigger picture, and compromises creativity needed for solutions.
- Rushing: urgency that often causes many complications in the final quarter of a case. In modern life, rushing seems to be the baseline state for many of us. Where are we rushing to?
- Distraction: It is common to have conversations occurring in the OR that have nothing to do with the case. Not a good idea.
- Complacency: You are not completely connected to the next move. Sometimes the worst complications occur in the easiest cases.
It is a common saying amongst surgeons, “Complications happen.” What I learned is that every complication happens for a reason. You have interference that you don’t recognize or respond to. The solution is easier than you might think, and it is centered around a word – awareness. This is both a cultivated state and tool.
There is a real-time reset that brings you back into focus. It happens with every move, every time, with full connection to it. Awareness is the link. Each move is a fresh one performed in the “safe zone.”
The reset involves three steps that we call the AIR technique: Awareness, Intention, and Response. You become aware that you are in an interference and pause by taking a deep breath. As you breathe in, you identify the active interference. As you breathe out, you visualize your next move in the safe zone, and respond. There are clear parallels to life.
In surgery, the “Safe Zone” is characterized by three pillars.
- First is Visual: taking the extra time to perceive the “anatomy” of a problem accurately.
- Second is Tactile: maintaining a light grip on the instruments, which translates in life to a light touch of awareness and listening.
- Finally, there is Kinetic Safety: making every move in a calculated, safe manner.
It sounds daunting, and initially it is challenging. However, being in the safe zone becomes so habitual that you would have to make a conscious decision to have a complication. It is also more enjoyable to be safe, and surgery becomes an art form. Additionally, as you fully connect to each move, racing thoughts are pushed out of the way. Instead of operating to avoid complications, I focused on what I could do to perform at the highest level, which included everyone in the room.
There were four categories of unsafe moves that we called complications, whether one occurred or not.
- Type 1 events are minor awarenesses—a tight grip or a move in an unsafe direction that has zero chance of causing harm. In life, these are the unpleasant events with no consequences, like a moment of anger that you successfully stepped back from.
- Type 2 events carry potential consequences where we simply got lucky. Maybe we were “white knuckling” the instrument in a difficult part of the case or had the instrument slip towards a vital structure, but no damage occurred.
- Type 3 is clearly out of the safe zone where actual damage occurred that was repairable. An example is a small tear in the lining of the spinal canal that contains the cerebrospinal fluid. It is easily repaired without sequelae.
- Type 4 represents a major complication with long-term damage—a torn nerve, massive dural tear, or a punctured blood vessel.
We encourage ourselves to look for type 1 events. There should be at least 10-15 per case. As you note them, it allows you can adjust back into the safe zone. It is impossible to stay fully connected to a whole case, and it is important to be aware that you are not at optimum performance. However, it is possible to stay connected to every move by creating space and moving into the safe zone.
Type 2 events may occur a few times in a case, although you would like them to be zero. Again, you just take note, and re-engage with the next move.
Type 3 and 4 events should not happen, but they occasionally do. The chances drop dramatically by being aware of the type 1 and 2 events.
In life, regardless of the level of adversity from type 1 to 4, it is critical to embrace it with the only question being, “what can I learn?” When we are angry about having to experience challenges, our capacity to avoid and solve future problems is significantly compromised.
“I don’t want to become a professional”
Why? You may not become a concert pianist or major league baseball player. But why not focus your energy on living life? Everyone has access to the concepts. There are no resources needed. Not only can you be a better performer at life, but why not take it to the highest level? You have chances to practice all day long.
One factor is that professionals recognize that the deepest learning happens by making mistakes, understanding them, and then adjusting to the situation. In other words, they embrace adversity and love a challenge. In real life, we view adversity negatively and feel victimized by it. You are a victim, but instead of running from it or avoiding it, ask the question, “What can I learn, and what is the opportunity?”
Professionals treat interferences not as emotional drama, but as neutral performance data. By embracing adversity as feedback rather than a personal failing, you can create safety where true healing happens. Professional living isn’t about achieving a perfect, pain-free performance; it is about the consistent, skilled execution of a life well-lived, one safe move at a time.
Let’s Wake Up and embrace life, for better or worse, one moment and move at a time!