Preparing for Opportunity

Photo Credit: Javier Allegue Barros

Preparation is critical. As the saying goes, failing to prepare is preparing to fail. This lesson is hardwired into individuals from the time of elementary school on, when projects requiring weeks or months of preparation are assigned with increasing frequency. In the early years of schooling, there is often little agency, a limited amount of initiative, that is required. Little, if any, homework is assigned and most projects take place under the direct supervision of the teacher or an assistant, often providing step-by-step prompts and instructions. As the years progress, assignments and projects become less and less supervised, allowing for, or requiring, a greater amount of individual responsibility and preparation. Yet even though high school and undergraduate years, the final goal, whether a presentation, a paper, a manuscript, a speech, a recital, a picture, or art installation, is due in a specific form on a specific day. This allows students to prepare over the course of many weeks or cram all the work into a few short days or even hours before this due date. Whether a better result occurs by playing the long game or whether the pressure of time provides the motivation for the best work continues to be hotly debated amongst students, with some swearing by one method whereas others maintain a strict adherence to the other. Regardless, the specific goal and day of reckoning is known from the start.

As one moves into the workforce, interviews, projects, and deadlines all continue, with deadlines or incentives encouraging a particular form of preparation by a specific deadline. Yet many of the greatest inventions, findings, teams, and results in history have been brought about not because there was a specific deadline everyone knew to prepare for, but because a select few prepared detailed contingencies should unlikely opportunities arise. Perhaps preparing for opportunities is just as important, if not more important than preparing for known deadlines. 

On the personal level, preparation for opportunity should start with some mundane but important basics. Whenever possible a base level of physical fitness and economic flexibility should be maintained. If there is an opportunity to go on an unexpected trip, help someone out, or even take a brief hiatus from the current occupation to pursue a once in a lifetime opportunity, one does not want these small but often binding constraints of a small amount of money or the ability to walk, hike, or jog to limit a new adventure. In every epic, the protagonists must have a baseline level of preparation from which to build. Imagine if Gandalf arrived and asked the hobbit for aid in a journey and it turns out he couldn’t walk more than a mile because of all the eating, drinking, and smoking for which hobbits are known? What a short story Lord of the Rings would have been. Or imagine if every time 007 was needed on a spy mission, he had to turn down the assignment because he needed his day job to cover the mortgage? This boringly basic preparation is the foundation for a broad range of future success. 

Everyone has great ideas, many of them simply need to be articulated and heard by the right people before being presented in final form to the public. Whatever one is passionate about, whatever gets one out of the bed in the morning, whatever raises one’s heart rate and gets the blood pumping, should be able to be articulated in a deliberate and thoughtful manner, with the natural enthusiasm to garner the support of others. There is no deadline to prepare for, and no guaranteed interview, but there is a high probability that given time, a chance meeting with someone who can help, someone excited about the same thing, a new collaborator or conspirator will occur and the preparation will pay off many times over. In a brief meeting, say the length of an elevator ride, one must be able to communicate a key idea as well as the enthusiasm to succeed. This elevator ride conversation is not of course the end, but rather the beginning, the entrance fee, the ticket to more discussions and further exploration. 

At a bare minimum one should be able to tap into the enthusiasm of another with one of two inquiries: 1) What do you do for work? or 2) What do you do for fun? These are open-ended conversation starters to allow the individual to tell you what they are excited about professionally or personally. Unfortunately many individuals either have no true enthusiasm in either of these categories or are unable to articulate this enthusiasm. These two questions invite the individual to pick the best part of any aspect of life, the thing that lights them up and share that with another individual. Whether this is their work, a particular project at work, their children, their hobbies, a trip they recently took, a restaurant they recently went to, or a personal project they are pursuing, they are being invited to share that passion. Everyone should be able to answer one or both of those questions in a succinct but impassioned manner as this is often the door to finding new collaborators, fellow sojourners, as well as new opportunities. The reason that communication is absolutely critical in every area of life, is that this allows for the preparation and dissemination of ideas and passions. However, great articulation of ideas is rarely if ever extemporaneous, but rather requires many repetitions before it has matured into a fully formed concept. By crisp, enthusiastic communication, new ideas are created, new plans are made, new resources are discovered, and progress is made. 

Unlike many of the projects of the early school years, the greatest things in life are rarely known and prepared for in a predictable and systematic fashion. Rather deliberate and detailed preparation is diligently conducted in hopes that an opportunity will present itself. As the saying goes “Luck is what happens when preparation meets opportunity1.” Diligently prepare for opportunity. 

  1. Often attributed to Seneca, although the certainty of this attribution remains low  

Repetition

Photo Credit: Sean Estergaard

At basketball camp growing up, one of the sayings that was imprinted in every campers’ head was “repetition, the mother of all learning”. At that stage, it was just something that was repeated, rote memorization for the sake of avoiding being yelled at or having to run extra sets of lines. At that time it was difficult to appreciate the importance of repetition, of muscle memory, of getting enough rounds in that one began to see the natural variations and contingencies involved with the exercise at hand. The goal is not to do it right once, to have a Dude Perfect trick-shot moment, but to be able to do the job correctly on command. Again. And Again. And Again. 

Do it until you get it right, keep doing it until you cannot do it wrong. The importance of repetition in every area of life is critical. Repetition is experience, and experience determines outcome. The goal of the new automobile driver is to change lanes without crashing, to park without hitting the curb. The experienced driver does not even have to think about either of those actions, they are little more than muscle memory after hundreds and thousands of repetitions. During medical training, there is a critical mass of patients that must be seen in order to gain proficiency. One of the criticisms of duty-hour limitations (i.e. limiting duty hours to 80 hours per week in the hospital) has been that this limits the number of repetitions seen during medical training. These repetitions are critical as each patient, each iteration is slightly different, and some are truly unique such that the presentation is only encountered a handful of times across a whole career. Training means getting these repetitions in, yet the end of training does not mean that there is an end to these repetitions, rather these repetitions repeat throughout the months and years and decades of a career, making medical practice, truly a practice. 

Repetitions are especially important for the critical aspects of any job. The more codes that one runs, the more experience one gains. Each code is different and requires both medical knowledge as well as team and resource management. Likewise, medical procedures may require as few as five repetitions until one is certified to perform the procedure independently. Yet it is often after the 20th, 50th, or 100th repetition when one is beginning to gain true mastery over the nuances of the technique and appreciates the variation between the anatomy of each individual as well as the clinical context in which one is appearing. 

Repetitions are not passively obtained but rather must be actively earned. Stepping up and volunteering, making sure that one is in the right place at the right time, making sure that others know that one is hungry and willing to get reps is critical to earning more reps. Repetitions can be earned in any capacity, perhaps as the learner, perhaps as the practitioner, perhaps as the instructor, or even as the assistant. There is a privilege to being in the room, to being allowed to participate in the repetition that must be earned. The snowball of experience allows those who start gaining repetitions to continue to gain repetitions as their experience is valued, they begin to know where to look for additional repetitions, and anticipate the way in which they can prove useful. Repetition begets experiences; experience begets the outcome. Put in the reps. 

The Red Queen

Photo Credit: Venti Views

In Lewis Carroll’s book, Through the Looking Glass, Alice encounters one of the most memorable characters of the books, the Red Queen. The Red Queen is incessantly running but appearing to get nowhere despite her best efforts. Upon inquiring about this peculiar set of circumstances, Alice and the Red Queen have a memorable exchange: 

…in our country,” said Alice, still panting a little, “you’d generally get to somewhere else- if you run very fast for a long time, as we’ve been doing.” 

“A slow sort of country!” said the Queen. “Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!” 

This concept of running just to stay in place, and sprinting in order to get ahead is a cultural phenomenon common back then and even more common today. The idea of 24/7/365, that is the idea of working every hour, of every day, of every year, and the push to take “no days off” are just some of the ways people boast of their hustle and grind. This is certainly not to say that hustle and grind are bad, but rather that the purpose of the hustle and grind must be to get somewhere meaningful, an extraordinary destination, not simply to show that one is running or moving. In one of his early vlog posts, Casey Neistat illustrates hustle to get ahead in a graphic depiction of the Red Queen principle. In the short video, he filmed himself walking in the reverse direction on a moving walkway in an airport like setting. As he was walking in the reverse direction, whenever he stopped moving he lost ground; simply to remain in a neutral position required him to walk. In order to get ahead, he had to run. 

Reverse walking on a moving walkway, is walking on a treadmill, something that millions of people do every day. This is not to say that running on a treadmill is in any way bad, in fact, it is a healthy and good behavior, but as a path to something greater. However, the activity of running in place can often feel defeating, pointless, demoralizing if not kept the larger picture. In the movie, Whiskey Tango Foxtrot, Kim, played by Tina Fey, is attempting to explain why she abruptly left her safe, well-paying job and exchanged everything to be a combat reporter. 

“I was at the gym after work one night….and stationary bike (sic), same bike every day and I noticed this indentation in the carpet. It was like a foot in front of my bike, and I realized it was from where my bike used to be. I have done thousands of miles on this bike, and I have gone backwards. I have literally gone backwards. I just, just wanted to blow everything up.” 

Often there is the perception of running in place, the sensation of a hamster on a wheel. Other affectionate or not so affectionate names by which this phenomenon is referred to include the rat race or keeping up with the Joneses. The feeling that one must run or sprint just to stay in place, like treading water just to stay afloat. As Tina Fey’s character notes, this realization can be deflating causing one to struggle with larger questions of purpose and meaning. The goal is not to simply demonstrate frenetic activity to be noted by others, nor to simply stay in the same place. There is the fear that something will pass one by if they stop running. Whether this something is others, opportunities, time, “life”, or another unspoken goal, the pressure to keep pace on the treadmill can be enormous. 

This realization, the pressure to run on the treadmill, to keep pace with the Red Queen, can cause many different reactions, from the need for radical change or the discovery of a new treadmill to join, dejection resulting in simply giving up to allow the treadmill to have its way, a desire to sprint to gain the applause of others, or a desire to run fast for a short period so perhaps a chance for a break will appear in the future. Many of these miss the point and simply exchange one treadmill for another. Instead, the running itself must be analyzed. The miles on the indoor bike are not a waste as the exercise improves the mind, strengthens the heart, lungs, and legs, boosts the immune system, and provides a chance for reflection. However, when viewed as a transportation device, of course the stationary bike is an utter failure and the hundreds of hours a waste. The act of running, the act of working, must focus not simply on the distance one is covering. Any idiot is able to find something easy to measure and then create an entire belief system around that single erroneous data trend. Far more difficult is the constant assessment and reflection about the true purpose, the greater game that is afoot. Then and only then can one truly pursue the goals that matter. Activity, in whatever shape or form, must be a moving meditation upon one’s place and greater trajectory. Without this intentional focus and direction, one assumes the status quo of joining the Red Queen on the treadmill to nowhere. 

Back To Normal

Photo Credit: Sigmund

Everyone is waiting for normal to return, to go back to the good old days, the times before the pandemic closed down the world, before millions of people had died, when a belief in one’s immortality could still be maintained, when a sense of innocence about the future permeated the present. Since the beginning of the pandemic the return to normal was always the hope. From “15 days to slow the spread” to mask mandates, school closures, and travel restrictions among many others, there has always been the lingering promise of a return to normal. The world began to identify with Orphan Annie looking to a brighter tomorrow when socializing, connecting with family, having meetings in person, and traveling to new destinations could return to that of pre-pandemic days. Even more, the desire to be able to do so without the fear of infection, hospitalization, intubation, and death. The pandemic robbed individuals of one of the greatest assets of humanity, trust in one another, as everyone began to eye one another with suspicion, the harbinger of disease. The air itself turned to poison as distance and masks became the new normal. All while everyone waited and hoped for a return to the old normal.

Yet with history as a guide, it becomes obvious that a return to a previous normal is rarely if ever possible. Even more, a return to a prior state is often not ideal. The world has changed in many ways as weeks turned into months which turned into years. Many things became worse, yet many beautiful things were also found. A return to the previous normal would negate all of these lessons, all of this progress, all the distance that had been traveled. Whenever struggle is endured the desire is not simply for it to stop, but even more so, that the struggle was worth it, that through the struggle something greater was born. As the world put itself together after World War II, it was abundantly clear that a return to the previous state was neither possible nor desirable. Instead, the only way was forward. In the same manner, every individual is radially different now compared with the start of the pandemic. Covid-19 has changed how people live, work, relate, and play. Many loved ones have been lost, and many struggles are only now becoming apparent. For better or worse there will be no return to normal, no reversion to the world that everyone once knew. Instead, there will only be slow progress forward. This slow progress forward is all that there ever has been, yet it remains the promise of a better tomorrow, a better normal. 

You

Photo Credit: Colton Sturgeon

What makes you, You? There is the story, the question rather, of a boat. Suppose there is a wooden boat on the shore. This boat is taken apart one plank at a time, with each plank replaced in such a way that over the course of time the entire wooden boat has been replaced with brand new wood, none of the old timber or nails, no piece of hardware from the prior boat is still present. The individual planks which were removed from the original boat are subsequently reassembled in form an entirely new boat. So now there are boats, identical to one another. One boat with all new wood, each plank and nail replaced, the other boat rebuilt from the replaced planks and nails. Which boat is the original boat?

The easiest answer to this problem is likely, “who cares?“ which is of course a valid point in and of itself. However, the point raised by this story brings about another series of issues which dives into deeper and more fundamental issues of the human condition. Over the course of the human lifetime, everything within the body is replaced. At the macro level, one can feel this as fluid enters and leaves the body, as nutrition is taken in and waste is removed. However on the cellular level, this also holds true as cells of the skin, hairs from the head, and linings of all of the inner passageways of the body are sloughed and replaced, sometimes multiple times per day. Of course, there are many cells that are rarely if ever, replaced including neural cells which may persist over the course of an entire lifetime. However, within even these cells, the individual atoms, the basic building blocks of the cells will be replaced as the cell takes up nutrients and goes through its cycle of disposing of waste and rebuilding itself within its environment. Does this mean that once all the atoms in the human body are replaced that the original person is lost? The You that had made that person themselves is absent? Or perhaps even before all the atoms are replaced, and only 50% of the atoms are exchanged? Or are there some other criteria?

Perhaps the person is not the sum of the parts, existence is not only the combination of many individual molecules but rather together these molecules, cells, tissues make up something entirely new. Perhaps it is the ideas that make someone themselves, their view of the world, their perspective of life, the concepts that they hoard within their head. Perhaps it is their beliefs, the things that they adhere to, the things they hold most sacred. Perhaps it is the community that they dwell in, the people surrounding them to who they give meaning and from whom they receive purpose. Perhaps it is the morals and values that they hold, the sense of right and wrong, of up and down, of good and evil. Perhaps it is their hopes and fears, the things that drive them on, the things they desperately wish to avoid. Perhaps it is their memories, the recollections of days gone by, perhaps it is their dreams for the future, their aspirations for a better tomorrow. Perhaps it is the memories of them that live on through others, the vision of the person that others see. Perhaps it is the soul and spirit, that which goes unseen and unmeasured, the intangible defining characteristic of the human existence. Perhaps it is all of these together, perhaps it is none of these. Perhaps all of these together create something not simply a sum of the individual parts and pieces but an entirely new entity and being, You. As Renee Descartes said, “I think therefore I am“. If they’re at is a You to think, to relate, to enjoy, to celebrate, to cry, to pursue, to dream, to help then there is a You. If there is a You to ponder, to debate right and wrong, to lay awake at night and tossed fitfully in bed, there is a You. If there is something to lose, memories, dreams, achievements, and progress, by definition there is a You, And while there is a You that is enough simply to celebrate, to revel in, to mourn, to ponder, and to share.

Don’t waste the opportunity of You.

Who We Are Becoming

Photo Credit Tom Barrett

What if the most important thing is not who we are now but who we are becoming?

What if it is not only what we do now but what we will do in the future that counts?

What if we started to care about the tides of change under the surface more than the splashes and undulations visible above?

Though actions speak louder than words, maybe the thoughts behind the actions speak loudest of all.

What if the hardest thing to build is oneself? the right self, the true self?

What if the default is a facade, passable in appearance but belying an empty reality?

Perhaps the smallest core of true metal is worth more than vast hoards of the artificial.

What if the stresses and strains placed upon us are not only changing us, but are also showing us what truly lies within?

What if our trajectory matters more than current position, the direction we are headed more than the speed at which we are traveling?

What if the most important thing was not who we are now but who we are becoming?

Flow

Photo by Solen Feyissa

A body at rest will stay at rest unless acted on by an external force. Likewise a body in motion will stay in motion unless acted on by an external force. This principle of inertia, as paraphrased from Newton’s first law, has many parallels with human motion, with human activity, as well. There is an energetic cost to enter any meaningful activity. This cost is analogous to shaking off the dust or warming up. Getting to the point where things are moving smoothly, a point where one falls into a natural rhythm takes time. There is no way to get rid of this warm-up period. Understanding this buy-in, the time sink required at the beginning of the activity, is critical for designing the day productively. 

Activities such as running require a period of acclimitization until one begins to feel the rhythm in their legs and their breathing begins to smooth. Initially every step is an effort, often the jolt of the road or track is jarring and unpleasant. But over the next several miles the collision of the foot and the ground becomes more fluid, the blood redistributes to key muscles and organs, and the mind begins to fall in line with the new rhythm. After two or three miles the mind slowly clears allowing focus on a single thought. The same is found in swimming where the a rhythm must be found that aligns with the movement of the water, a coordinated dance between the strokes, kicks, and breaths. It is critical to embrace this buy-in period, to push through this warm-up to get to the flow state. Too many workouts end just after the flow state is established. At least during a workout, the benefits to the cardiovascular and muscular skeletal system are still won during the warmup period. In other activities the buy in period is simply a period of time of low objective productivity, a preparatory period for things to come. 

Writing, true writing, not just putting words on a page, but communicating a complex idea with clarity and simplicity in a relatable and integratabtle fashion, is a difficult task to do well.  There is a high buy in cost in that there may be an extended period of time at the beginning of writing where there is little productivity as ones mind begins to craft arguments, meld world into sentences, and smooth sentences into paragraphs, all with a unifying theme. Writing, like coding, or complex data analysis, is difficult to pick up with small pieces of time. Writing with five minutes here or there will take longer and leave a worse product that writing in dedicated blocks of time. The cost of writing is then the exclusion of distractions for extended periods of time. 

The flow state, regardless of activity must be protected. Once this flow state is achieved, there should be few things, if any, that takes one from the flow state. The productive day should be designed around achieving and maintaining these flow states at predetermined times. One final cost of buying into the flow state bears mentioning. There are days, sometimes even weeks or months where the flow state is hard to achieve, where every foot strike is a physical and mental effort, where every sentence is achieved more with perspiration than inspiration. And that is okay. That is part of the game. That is part of life. There will come a time when the flow state comes easily again, and it will have been worth all of this effort.

Be purposeful about achieving flow. 
Guard the flow. 

Anti-Frenetic

Photo by Joshua Fuller

“At a cardiac arrest, the first procedure is to take your own pulse.” This oft quoted line from House of God is not unique to medicine, but applies across a wide swarth of life. The first question to ask when approaching an emergency is assessing the area for safety. Nothing turns a bad situation even worse as quickly as increasing the number of patients and decreasing the number of providers in an instant. After that, only two things are critical within the first handful of seconds. The first is to call for help and make sure that more assistance is on the way. The second is initiation of high quality CPR to keep key organs such as the brain perfused. After that keeping your own heart rate low, your mind clear, and your attention on the task at hand becomes the only concern. 

For teams that are well versed in running these codes there is often a feeling of calm, a rhythm that is rapidly ensues. Each person knows their role, the basics are covered with such precision that higher level thinking including methodical consideration of the underlying physiology can be done as the basic algorithms are already covered. The first time doing chest compressions, one of the attending physicians pulled out a pocket metronome to help me keep pace. For teams that are less familiar with codes or are not consistently working with high acuity patients, there is a frenetic pace to the code. A feeling of rapid movement, albeit with little forward motion, is tangible. Often very specific directions must be given to delegate tasks, ensure that proper medications are given, and to keep everyone on the same page. The frenetic activity results from the feeling of panic that those arriving may feel and the desire to do something, to do anything. 

Frenetic activity is the default. Often it even feels good. Activity provides a distracting sensation. In less urgent situations pacing, tapping on the desk, or other manifestations of frivolous activity may be permissible. In the situations which truly count, this frivolous activity is unacceptable. Steady hands and clear minds are inhibited by background motion and good communication is broken down by the cacophony of background noise. 

Rejecting meaningless motion, high paced but trajectory less activity, is essential. Being anti-frenetic in these moments is a choice, plain and simple. An anti-frenetic attitude does not mean that one is confident that a good outcome is guaranteed or that a serious problem is not present. In many cases a good outcome is far from guaranteed and a serious problem is definitively present. Freneticism is the antithesis of communication, teamwork and progress. Being anti-frenetic means recognizing that panic, high velocity flailing, is of little value and that the best chance for a good outcome is rejecting fear and the sensation of panic welling up in ones throat and choosing purposeful, meticulous activity with good communication and an emphasis on teamwork. 

Take your own pulse. Reject fear. Suppress panic. Do your job. 

Options

Photo by Jeremy Bishop

There are few things as daunting as endless choices and open opportunities. This is the struggle of a writer staring at a blank page. This is the struggle of a sculptor gazing at a block of marble. This is the conundrum of the undecided college major. On a much shorter time scale, this is the dilemma encountered when deciding what to eat or what to do on a day off of work. 

Options may be initially comforting. Having options provides the illusion of freedom in that if one does not like the current choice or selection one is able to bail on plan A and pursue plan B. Subsequently, if one finds plan B not quite to their taste, they will have no qualms about opting for plan C. As soon as there is a bump in the road with plan C, have no fear, there is always plan D. While some options may be beneficial, flitting from one option to another is the antithesis of digging deep, of going for the long haul, of feeling the struggle and ultimately the reward of any specific option. Freedom, true freedom, is not endless choices but enough agency to select and pursue a path of meaning and value. Collecting options, more often worded as “keeping my options open”, is similar to collecting happy meal toys. The options themselves are not useful in the long term, new options are constantly coming out, and in a matter of months, the options will be revert to being valueless. The freest life, the good life, then is not having infinite options but having a meaningful trajectory with the ability to navigate and steer through the obstacles ahead to a better destination. To achieve this, a flight plan, a structure is essential. 

Structure is freeing. Routine is comforting. Building independent structure is absolutely essential. When interviewing for medical school one of the common refrains was, “50% of what you will be taught in medical school will be wrong by the end of your career. The problem is no one knows which 50%.” The move in medical schools has broadly been away from teaching only discreet pieces of knowledge, facts and patterns, and towards learning how to incorporate new findings and studies into one’s clinical practice on an ongoing basis. Instead of having facts and figures spoon fed from lecturers and text books (have no fear, there are plenty of those still), there is a growing emphasis on how to ask questions, find new knowledge, evaluate the validity of new findings, and then incorporate those findings into clinical practice.

Broadly speaking, the goal is to learn more medicine. Yet that is both broadly intimidating and unhelpfully nonspecific. Instead an outline of what one hopes to gain, a question that one would like to explore must be defined. The process of recognizing weaknesses and working, in an organized and deliberate manner to turn them into strengths is always ongoing. Instead of “learn more medicine” a desire to learn more about the heart must be further refined into defined questions and goals. Instead of “learn more about the heart”, actionable goals could include “recognize patterns of ischemia on EKG” or “review the treatment of acute presentations of myocardial infarction.” The blank page of “learn more medicine” must be refined into a far more specific and useful structure for progress to be made. 

Structure to freedom 

There Is Always Something

Photo by Ethan Dow

There is always something. 

There is always something to be unhappy about. 
There is always something that could have gone better. 
There is always something that could be optimized, a more ideal way. 
There is always another option, something else that could be tried. 

There is always something. 

There is always more. 
There is always the next thing. 
There is always newer. 
There is always an upgrade. 

There is always something. 

There is always work to be done. 
There is always a project due.
There is always money to be made. 
There is always a deadline ahead. 
There is always a raise or promotion to be had. 
There is always a prize to be won. 

There is always something. 

There is always a faster mile to run. 
There is always a heavier weight to lift. 
There is always another race. 
There is always more fitness. 

There is always something. 

There is always a larger house. 
There is always a faster car. 
There is always a better phone. 
There is always a nicer vacation. 
There is always finer food. 

There is always something. 

There will not always be long conversations into the night. 
There will not always be lazy mornings around the kitchen table. 
There will not always be the familiar pot of coffee or the light on the porch. 
The chairs will not always be filled. 
The phone calls will not always be answered. 
Familiar disruptions will not always disrupt. 

There is not always someone. 
But there is always something.