“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.”

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