“Keep Calm And Carry Speed”

For a very long time, my favorite aphorism was “Don’t panic.”  I am a big fan of Douglas Adams, obviously.  My son and I often threaten his Mom that we’re going to get the phrase tattooed on the back of our right hands, which she no longer considers amusing.  It has always seemed an apt phrase and good advice for us both.  Certainly as a surgeon who specialized for a long time in trauma care, it served.  It also seems appropriate for my son, who is a percussionist.  It seems that unlike any other type of musician, percussionists are constantly coping.  A classical violinist or horn player, performing a difficult piece in a crowded concert hall, is rarely faced with an unexpected technical challenge. They play.  Percussionists, on the other hand, are frequently moving between multiple instruments, changing mallets on the fly, adjusting to alterations in tempo, tuning in mid performance. It makes me nervous just watching, but he loves it.  Every performance is a challenge in real time, every note played is heard without fail by everyone in the hall.  Certainly, “Don’t Panic,” has served him well throughout his career, as it has my own.cropped-156595748-alonso-ferrari-austin_custom-a3b7a8d98fcee01986148e35e0ef3b39c800a9c6-s4.jpg

“Don’t Panic” is good advice in difficult circumstances.  Whether you are faced with a patient bleeding out from a gunshot wound, a conductor who botches the crescendo, or a lethally morose robot (Hitchhiker’s reference), one must first cope.  But not panicking is not sufficient.  In life, as in surgery or musical performance, staying calm in the face of adversity is but the first step.  The real trick, as the famed Formula One driver, Kimi Raikkonen, so elegantly stated in the title of this post, is to keep moving. When faced with a difficult challenge, a sudden catastrophe, the realized mistake–it is necessary to move forward.  Carry speed.  It is almost never helpful or appropriate to stop suddenly, ruminate on why the illness has happened to you, regret the decision/marriage/investment.  In racing, a difficult situation is transformed into disaster by standing on the brakes, every time.  The host of Top Gear, Jeremy Clarkson, once said, “Speed has never killed anyone, suddenly becoming stationary…that’s what gets you.”  Carry speed.

Of course, just moving straight ahead is rarely sufficient to overcome difficult circumstances.  As you are moving through trouble, the driver must see further ahead, fighting the natural tendency to become too focused on what is immediately in front.  “The car goes where the eyes are looking.”  Look down the road farther.  Create space, change course, adapt, use a different technique–DO something.  In surgery, the experienced surgeon knows that the answer is almost always “Make a bigger incision.”  Better exposure, a wider approach, seeking control of the disastrous injury by extending into areas of normal anatomy is almost always the safest course.  Stopping, pausing to consider, trying to figure out why one’s usual techniques have failed; these things do nothing to stop the bleeding.  And there’s only so much blood one can lose before it really doesn’t matter any more.

There are a number of similarities between racing and surgery.  The need for constant focus is the most concrete.  In both pursuits, even a momentary lapse by the operator is often detrimental, and can at times be disastrous.  Team work, skilled colleagues, luck–all are paramount in both avenues of pursuit.  Even the aphorisms seem interchangeable:

“Slow hands in the fast parts, fast hands in the slow parts.”  The routine parts of the operation, opening and closing, can usually be accomplished by an experienced surgeon expeditiously.  Care must taken, however, when maneuvering around the pathology.

“Slow in, fast out.”  Approach the pathology deliberately, intelligently choose your position as you enter the critical phase of the resection–this will make the performance of the actual maneuver straightforward, allowing an easy, controlled exit.

“The fastest line is not always the quickest.”  In surgery, as in racing, it is sometimes much more efficient to take additional time in the approach, allowing the next maneuver to be performed more optimally.

“Drive your own car.”  You can only be responsible for your own actions.  What all the other guys are doing–the other drivers, the anesthesiologist, the other patients, the officials–is out of your control.  Do what you do to the best of your ability, let the others take care of themselves or the patient.

“Make room for trouble.”  Try to see the crisis developing ahead, rather than being forced to react once it happens.  Create space in anticipation, extend your line around a car that looks loose entering a turn–if he goes into a spin, the added space may get you past safely.  Same thing in surgery–anticipate that the infected artery may not hold your stitches, may fall apart as you try to clamp it.  Extend into another body cavity if you have to:  if you can’t get control of the bleeding infected aneurysm in the groin, go into the belly to get control.  Anticipate and extend.

Finally, Churchill (though not a racer or a surgeon, he managed to always say it best):  “When going through Hell, just keep going.”

Would It Kill You To Call Every Once In A While?

The other night, my wife got a call from a relative that she hadn’t spoken to in quite a while.  The woman called during dinner, of course.  Why people capable of calculating compound interest on their mortgage while separating two warring children armed with steak knives  and making dinner for a family of six can’t manage to wrap their heads around the entire concept of time zones is beyond me, but she was happy to hear from her.   When she hung up, my wife said, “I really should call her more often.”  Meaning, ever.northernlights_enl

This got  me to thinking about all the people I know and care about that I just don’t seem to hear from anymore.  Dinner was being reheated anyway, so I had some time to think about this.  It occurred to me that I really hadn’t had a good conversation with my Dad, for instance, in a very long time.  I love my Dad, and I remember when we used to talk pretty much every day.  My wife gave me a strange look when I brought this up with her, however, pointing out that my Dad had died almost twenty years ago.  Like this was a good excuse.

[Brief Aside:  One of my Dad’s favorite sayings was, “Man who trip over same rock twice, deserve to break his neck.”  He’d often admonish me with this gem told in a solemn fake Confucius  accent, in way of educating me about some mistake I’d made for the sixth or seventh time.  The frequency with which he used this aphorism prompted me to write a very short story in fifth grade about a dashing young knight who tripped over a rock in the road.  He was stuck, turtle fashion, by the weight of his brilliant armor, but helped back to his feet by a passing Good Samaritan.  The next day, however, when the incautious knight tripped over the very same rock, resulting in the same predicament, the next passer-by was a robber who killed the knight by breaking his neck and stole his money.  As I recall, Mr. Barno, my fifth grade teacher with breath so bad two students dropped out of school that year to pursue a life of crime, wrote in his comments something to the effect that I should seriously consider pursuing a career in accounting.  Thanks for that, Mr. Barno–hope you’re resting peacefully.]

There are dozens of good friends and beloved relatives with whom I’ve lost contact.  It’s inevitable, I guess, as we get older and get busy with our own, hectic lives, and these other folks just keep moving away or dying.  It makes it tough to keep in touch.  It’s probably my fault, to be honest.  I mean, I’m one of those folks that’s pitifully inattentive to maintaining contact with old friends and relatives.  I don’t think I’ve made a long distance call or attended a seance in a really long time.  And while I hate to admit it, there has been more than one occasion when I’ve returned from a long, tough day at work and looked at that little flashing red light on the answering machine and said, “No way.”  Then I just delete those suckers without even listening.  It’s true.  So it’s entirely possible that my Dad left some kind of message, just touching base, and I erased it.  It bothers me, now that I think of it, because if he left a call back number and I just deleted the thing, no wonder he’s so ticked off that he never called back.

On the other hand, it’s at least as likely that’s it’s their fault.  I know how tough it can be to pick up the phone.  My wife and I were recently traveling in Ireland, and we kept trying to use the cellphone to call back to a friend of hers here in the States.  But who can figure out whether to put the one in front of the number or not, do you include the 01 country code, and all that other jazz that makes it just about impossible if you’re over fifty to make these things work?  (Which is why we almost always travel with a child, just in case we have some technical issue.)  Most of these people are really, really old now.  A lot of them passed away before we even had cellphones or Skype.  What do we expect?

I like to think that they’re probably too busy to call, anyway.  Most of my parents’ friends are dead, and I wouldn’t be surprised if they’re so busy yelling at one another over how their partner screwed up the bidding for their great bridge hand that the subject of how the kids are doing just hardly ever comes up.  Or Samba lessons, or something.  Time just gets away from you, I know.  Dad’s probably still upset I moved so far away that’s he’s waiting till I move back into his neighborhood to stop by.  He hated that drive from Michigan to Long Island, no way he’s coming all the way back from the dead unless someone gives him a damn good reason.

Or maybe it’s just because they’re dead.  I don’t know.  Wouldn’t kill you to call, though.