Waking Up During Surgery: A Lesson in the Importance of Breath and Heart Rate

Years ago, I woke up in the middle of surgery. Intubated, extremities strapped down, and under-anesthetized, I opened my eyes and understood the true meaning of helplessness. Then, thankfully I had the wherewithal to recognize that my heart rate was my only mode of communication. At that moment I thought, if I can spike my heart rate (not too difficult when you are completely terrified and largely incapacitated) then I can let the doctors and nurses know I am awake when I certainly shouldn’t be. As I held my breath, I felt my heart rate skyrocket, heard the nurse say that my IV tube was kinked and then everything went black. It was only later, in the recovery room that I realized the impact of controlling my heart rate.

In competitive environments, awareness of and control over your heart rate plays a key role in managing high-stakes situations. During these pressure-packed moments, when the brain perceives threat, a danger message is sent to the rest of your body and the excitatory nervous system activates. Your heart and breath rate quicken in order to deliver more blood and oxygen to muscles needed in moments of survival. 

Fortunately, we can consciously slow our breath rate (the opposite of what I did in the operating room), signaling to the brain and body that we are not in danger. With training, you can learn to slow your breathing down in stressful situations, signaling safety and helping you remain calm under pressure. Devices like a Whoop band have been revolutionary in building an awareness of this brain-body connection. Ultimately, we have control of our breath, which means we have control of our heart, and if we have control of our heart, we have control of our experience, mentally and physically.

Do you notice your heart and breath rate in stressful moments? 

How do your heart and breath rate affect your performance?

The Jumbo Way: How making mistakes of action created a dynasty

When I played lacrosse for the Tufts University Jumbos (yes, the Elephants), we were good. Good enough to be ranked #2 in the nation at one time, but not exceptional. We did not win our conference and only appeared in the NCAA tournament once. We played a brand of lacrosse that was controlled, safe, and low-scoring, often winning games 6-5 or 9-7. 

A few years after I graduated, that all changed when my coach made the courageous decision to abandon his approach to play and adopt a much more aggressive, fast, and fun brand of ball. In the next five years, the Jumbos routinely led the country in goals, wins, and even championships (winning seven consecutive conference titles and three national championships in five seasons). They also led the country in turnovers, but who cares? What was the key? What was this winning recipe? Make mistakes of action, not inaction!

Interestingly, research has shown that regrets of inaction are far more common than regrets of action. We regret failures lacking boldness, failures in showing up, and failures of avoidance. When working with athletes and teams, I try to normalize a fear of failure, of making mistakes, of being judged and encourage them to, instead, approach the game more vulnerably. Playing vulnerably is embracing, accepting, and surrendering to the fact that mistakes will happen. With acceptance comes the realization that one must move forward bravely anyway. Bravery, after all, is not moving forward without fear, it is moving forward while afraid. 

If you were to embrace uncertainty, create comfort with making mistakes, and act more courageously in your performance pursuits, what would be different? 

What would (or wouldn’t) you regret? 

Wilt Chamberlain’s Catastrophic Case of FOPO (Fear of Other People's Opinions)

Most don’t know that, during the 1961-62 season, the year in which he scored 100 points in one game, basketball great Wilt Chamberlain shot all of his free throws underhand. Even fewer know that he precipitously stopped shooting underhand for one reason and one reason only: what others thought of him. Famed sports psychologist Michael Gervais termed this phenomenon FOPO: Fear of Other People’s Opinions. A notoriously bad free-throw shooter has his best-ever season from the strike, acquires a case of FOPO, and abandons a system that works (he promptly returned to his staggeringly low free-throw shooting percentage the next season). For a man who taught an endless number of helpful basketball lessons, this may have been his most valuable: Focusing on the wrong things can have a catastrophic impact.

It is completely normal and even evolutionarily beneficial to care about what others think (By looking over to gauge the speed of my fellow antelopes, I can decide to run faster and not get eaten by the predator on the prowl). BUT, we are not antelopes and are most often not in danger of being eaten, at least I hope so. So, whose opinion should we care about? I often have the athletes and executives I work with draw a small table with a limited number of seats to help them identify whose opinions truly matter to illustrate the relatively small number of people who’s opinion really matter. Additionally, in his book The Subtle Art of Not Giving a F***, Mark Manson highlights the notion that we have a limited number of F’s to give and thus must choose them wisely. Examples of better F’s: embracing uncertainty, investing in deep relationships, and taking ownership of your choices rather than focusing on what happens to you. 

How have you allowed what others think to negatively impact your life?

Whose opinions actually matter to you?

Which F’s do you choose to give moving forward?

We (are) Talking About Practice

In a 2002 interview, in what is now known as the “We talking about practice!” interview, Allen Iverson disparagingly mentioned the word practice a total of 22 times. “Not a game, practice!” he said. Most athletes despise practice and can’t wait until game time. The greats fall in love with practice, not just the game. It is, however, not just any old haphazard practice that counts; Instead, it is the purposeful, deliberate practice that matters.

Walk by any driving range in town and you will find the vast majority of golfers engaging in what is called, “Turn and Rake” practice. Mindless, rhythmic practice that lacks purpose not only does not lead to improvement but reinforces bad habits. Turn and Rake range time does not simulate a true competitive environment and leads to more frustration and confusion. This approach to practice lacks focus, purpose, and intention. To break these habits, one must identify specific technical skills to improve, enlist a quality-over-quantity approach, and enjoy the process of attempting to improve.

First, start by truly warming up (hitting balls without care or concern about any outcome other than getting your body warm/loose). Then, set a ten-minute timer and work on a specific skill with focus and intention, attempting to create muscle memory. Too often, golfers are thinking about the technical aspects of their swing while in competitive environments. Instead, make sure to leave the analytical thinking about your swing on the range. Finally, create a game/competition with yourself or others, be precise with your targets (instead of hitting aimlessly). You can repeat the technical/competitive portions for as many rounds as you’d prefer. When your practice becomes more purposeful, you will see commensurate improvements.

Are you practicing with purpose?

If not, what parts of your game do you want to work on with deliberate intention?

Know your Value(s)

If you had the opportunity to guess the top four values Steve Kerr (Nine-time NBA champion; five as a player and four as a coach) creates a culture around, you may guess toughness, persistence, hard work, confidence, or even discipline. Unfortunately, you would be completely wrong. Without further ado, here are the four core values Steve Kerr bases everything he does on: JOY, MINDFULNESS, COMPETITION, and COMPASSION. Yes, I said compassion.

Whether these would be your top four values or not is somewhat inconsequential, but the importance of identifying core values and organizing your behavior around them is something we can all agree upon. I will, however, admit that I love his four chosen values. If a team is not joyful, presumably they are not having fun doing what they do. If they are not mindful, they are liable to get caught in the past or overly focused on the future: both of which we do not have control over. If they do not compete with themselves or others, it makes succeeding and mastering their craft almost impossible. Finally, I believe that compassion, for self and others, is the antidote to shame, which can wreck individual and team experience perhaps more than any other emotion.

When building a team, whether athletic or professional, creating clarity around individual and team values is imperative. Doing so unifies the group, guides behavior, and constructs a clear vision for your group. After all, it’s no wonder that Steve Kerr has nine rings!

What are your core values and how do they guide your behavior?

The Difference is in the Details

As a teenager, I landed a job as a dental assistant to a well-respected dentist. I was able to get this sought-after assistantship because the dentist was my father. During the first dental procedure in which I assisted, he asked for a Scaler and I mindlessly handed it to him. He handed it right back to me. In that moment he taught me the importance of giving him the dental tool directly into his hand at exactly the angle he needed; he demonstrated that being haphazard or inattentive delays efficient treatment. This moment epitomized how the difference truly is in the details. 

Scottie Scheffler, the world’s #1 golfer warms up with a beginner’s grip aid on the range before every round. He has professed that, if the foundation of his swing, his grip, is not spot on, he cannot be a great ball-striker. Similarly, Steph Curry, the greatest shooter in NBA history, begins his pre-game shooting workout approximately one foot from the basket with one hand. He has learned that, if his fundamentals are not perfect, he cannot continue to be the best shooter in the game. These greats start each practice with basics and fundamentals. The difference is in the details.

           On the first day of each season’s basketball practice at UCLA, Coach John Wooden taught every player how to put on their socks and tie their shoes. I know this may sound ridiculous, but his thought was simple: If you do not put your socks and shoes on correctly, you could get blisters or, worse, get injured, which would have a negative impact on the team. Even the smallest detail matters and the difference is in the details.

If the greatest athletes in the world (and my dad - yes, I just put him on that level) are always working on these basic, fundamental, ground-level aspects of their craft to gain an edge, and perfect their performance, shouldn’t the rest of us too? When an individual creates muscle memory around these most fundamental skills, they then happen instinctively during pressure-packed moments. Increasing attention to the details yields great confidence. Not only in the best of athletes, but for all of us.

What are the most basic skills you can practice?

How is your performance impacted when you spend more time on them?

Writing this blog scares me… which is exactly why I am writing it.

In her viral TED talk “The Gift and Power of Emotional Courage,” Dr. Susan David shared on of my favorite quotes, “Discomfort is the price of admission to a meaningful life.” When asked about the most pervasive theme in my work, without hesitation I say it is our growing tendency to avoid that which makes us uncomfortable.

There is a trend in our society which is emblematic of this Comfort Trap; fewer and fewer 16-year-olds seize the opportunity to get their driver’s licenses. While there are several reasons why many may wait, the most persistent reported reason is fear: fear of failure, failure of making mistakes, fear of the unknown. Figuratively and quite literally, this avoidant response to fear shrinks the world of the developing teen.

Fear-based avoidance and remaining in one’s comfort zone deprives an individual of opportunities to be challenged, to learn, and to grow. This fear and avoidance pattern reverberates around our playing fields, classrooms, and workplaces and consequently prevents individuals and teams from reaching their full potential. 

Knowing that seeking comfort and convenience creates stagnation and stalls personal growth, we must, as Michael Easter writes in his book, The Comfort Crisis, “embrace discomfort as a powerful catalyst for change and self-discovery.” In fact, perceiving moments of stress as readiness, care, or excitement, can improve our performance! After all, fear is evolution’s most powerful performance enhancer.

In publishing this first blog post, I am choosing to interpret my fear, worry, and nervousness regarding sharing these insights in this public setting as excitement and a sign that I truly care about this work. Moreover, I believe that good questions are more valuable than good answers. With that in mind, I will conclude each post with what I hope will prove to be thought-provoking questions.

When have you allowed fear to inhibit you from taking action?

Looking back, what might you have done differently?

What uncomfortable experiences are you pursuing to create a more meaningful life?

Certainly, this piece was written to challenge your thinking and encourage positive change. I hope you enjoy this post and the others that will follow, but in the end, I am proud knowing that in writing this I have chosen courage over comfort, meaning-making over safety, and vulnerability over shame.