 So what's my other unique qualification? Well, it's this. I wouldn't cut out for this at all. I'm an inherently anxious person. I have a fragile psyche and I'm overly empathetic. I saw someone give a course on self-defense once and they said, whenever you're watching a movie and there's a fight scene, regardless of whether it's the good guy or the bad guy that's dominating in the fight scene, you should always try to identify with a person that's given the beating and not the person that's receiving the beating. I'm not that guy. I become overly empathetic. Even when I was in middle school, I remember some kid got sick at school and puked. It freaked me out so bad. I empathized with it so bad. I became incredibly fearful of becoming sick and vomiting to the point that I made myself sick any time that I thought about it. It was insane. My first ER experience, when I was in college, I thought, I want to go to medical school. This is what I want to do. And part of that was you had to demonstrate some curiosity about the medical field. So I volunteered at the University of Texas Health Science Center emergency department. And my very first experience as a volunteer, I was useless. So they did what they could do with a useless volunteer. We had this little Vietnamese guy, spoke no English, who was schizophrenic, who was being held to be admitted to the psychiatry unit. But he's being held in the ER and he needed a sitter. So they sat me down in a chair. And this little Vietnamese guy was sitting there and talking to himself. And he smiled at me. And I smiled at him. And he opened his mouth, stuck his tongue out, and he had a single-edge razor. And I froze. He just took it out. And I thought, oh, my God, he's going to kill me. And then he took this single-edge razor and he shoved it in full depth into his wrist. And then he went vertically with the full depth of the razor up like this. And I remember feeling the sensation of ants crawling on my forehead. And my vision was like I was looking through a paper towel roll. And then there was nothing. And when I came to, there was this huge ruckus of people stepping over me as they were wrestling with this guy and trying to get in control. And they sent me home. It was the most humiliating experience. And it clearly, and I mean, it was even said to me, you are not cut out for this. Don't even think about it. Medical school was a similar experience. It was the most miserable four years of my life. I got into medical school by being the ultimate anal retin of study year. I studied from dusk till dawn. I always made sure that I was going to get an A on every test so I could get into medical school, which I did. But once I got into the medical school and the volume of the material was so great, I didn't know how to scale back and quantitate my effort. So the way I compensated for that was I woke up at five in the morning. I studied until one in the morning for two solid years because the only way I knew how to do it, I did not know how to calibrate getting a B or getting a C or any of that. When I got to my clinical years, I knew I would be seeing sick people. I had no conception of how sick people could actually be and how overwhelming that was. And you had this sense of you had to manage or fix something that was completely unmanageable. So I would vomit frequently every morning before going in for rounds, if not vomit diarrhea. At night when I would finally get to sleep, and these were on rotations where you have every other night calls, so you're awake for 36 hours, you get to sleep for six or seven hours and then you wake and do 36 hours again over and over. But when I would sleep, I would have night sweats and soak the bed sheets. That's how terrified I was through the whole process. So I clearly was not cut out for this but I wanted to not feel fearful anymore. So why did I choose emergency medicine if all of this is true? Well, I was tired of being scared. I didn't want to be afraid of anything. I was tired of that feeling of not knowing what to do or not being able to deal. And I wanted to be in control of the chaos or I at least wanted to contribute to the chaos in a way that put me as part of the process rather than someone being acted upon. And I didn't want to be afraid of anything in any specialty. So how'd I do this? Well, in a word stress inoculation, I sucked it up. I faced my worst fears by provoking them and I lived through it. When I was in middle school, I told you about the whole fear of throwing up kind of thing. I finally got to where I was just sick of this. I was just so fearful I was going to catch a bug and start vomiting and then it would be so traumatic. I ate a really big meal. I drank a lot of milk. I went out to the track and I ran as fast as I could as long as I could until I puked and then I got over it. Literally in that moment got over it. Sometimes you just got to find an alternative and then fake it. You got to act like the guy that you want to be and just fake it until you make it. And then the lastly is get some skills. Read books, find role models, look, seek out a mentor, get educated and study like hell. Get mastery of something so that you can be confident in a situation. And in the medical aspect, emergency medicine was facing my worst fear. Throughout medical school, I did see circumstances where different specialists, when they were actually encountered with those center of the pie scenarios that we had talked about earlier, literally came unglued. I could see it happen and I did not ever want to be that. And I didn't want to be that under any circumstance in medicine and that's why I chose the specialty that I did. That's another, and that brings us to Dr. Doug McGuff. Let's bring it home. Great to see you. Thanks for having me. First time I remember having it, we were at the end of shift and I was coming on and we were talking about the patients. The ambulance rolled between us with this well-dressed, middle-class looking guy, curled up on the stretcher, moaning and groaning and acting dramatic. And I thought, oh, brother, that guy rolled between us and my attending said, keep a close eye on that guy. He's got mesenteric ischemia, meaning one of the arteries to his bowels is blocked and he's dying. I'm like, shit, how did he do that? Well, two and a half hours later after multiple testing in an angiogram of the gut, he was right. And I realized because this guy was well-dressed and he was acting dramatic, I made an assumption about him and I latched on to that for normal C-bias. I see it with nurses. They'll bring back a patient that, and if you ever show up in an ER, kind of look a little scrungy, my friends. Don't wear your clean underwear because the more normal you look, the more normal C-bias will kick in for the people taking care of you. We can believe that some derelict that we pulled out of the gutter is going down the drain. But you come in, you know, with your, you know, khakis on and a nice pressed shirt and you're doubled over. It's kind of like, whatever. Because your brain seeks normalcy. I see them bring someone that's actively dying and put them in a non-acute room. And if you're seeing a really sick patient in a room that's designated for not sick people, your brain will run to normal C-bias and you have to protect against that. And then finally, we want to be able to bend the curve. And what we're looking at here on this curve is you have performance on the y-axis and heart rate on the x-axis. And what you'll see is as heart rate goes up, you reach this optimal performance zone here at the top, okay? If you get too stressed out, you start to go into that realm where everything starts to go to pot. Well, there is a way of performing stress inoculation to bend that curve. So you go from condition red. Instead of going into condition black, you just extend condition red out further. And think in terms of breathing, self-talk. Actually do all those things.