Updated: Mar 1, 2020
That’s a great move, but can you do it when you’re tired?
It’s the start of your shift in the ER. Your coffee is fresh, your mind is clear, and you’re ready to rumble as you pick up the chart for the first patient. Things are looking up.
10+ hours later though, when a truly critical patient comes in, the situation might look different. Your coffee is gone and your scrubs are bloodied. More that that though, you’ve been under significant cognitive and physical load for hours. Maybe, maybe you’re even a little bit tired.
When you’re stressed, and your resources are taxed, how well do your mental processes work? What algorithms keep functioning (or even improve!) when you’re tired, and what breaks down? What are your “tired moves?”
In Jiu Jitsu class recently we were drilling movements from the side control position when the coach paused from crushing me to explain the concept of tired moves:
“Look,” he said, “some things are great moves but you can only pull them off in the beginning of your match when you’re 100%- but you have to think about what you can do when you’re dead tired--your tired moves--and you have to drill those moves.”
No matter how good we are, during a crisis (in the ER, on a jiu jitsu mat, or elsewhere) we’re going to eventually face something that exhausts our normal resources. When that happens, the only thing that we have to work with is our tired moves.
So, if we want to function during emergencies, we have to train our tired moves.The challenge then is to invest the time and energy now, when we’re fresh, to train the moves we’ll rely on when we’re ground down.
Find your tired moves
Look back at the times you've really been in the thick of it. What physical or mental processes do you rely on most when the situation is beyond difficult? If something easily comes to mind--like an unwavering desire to support your teammates or a particular move you've trained so much it feels like an extension of your body--these could be your tired moves. Think through the concept and try to find patterns in what you rely on, or look at examples of people that have come before us and identify what they used when things became truly overwhelming.
When in doubt, your tired moves are often the most basic, fundamental skills in your arsenal. In the novel Siddhartha, by Herman Hesse, the main character Siddhartha says frequently that he has three key skills he can use no matter how hard the situation: he can think, he can wait, and he can fast. These are his tired skills. Pausing to reflect, not needing to rush, he can find his way in life.
Tired moves may not be the flashiest or the most fun to train, but they get the job done when the pressure is on. In the ER this might look like running and re-running our most basic algorithms - like the primary ATLS survey, high quality CPR and bag valve masking. On the Jiu Jitsu mat, it might mean drilling a basic escape over and over and over before moving to the more advanced versions.
So, what are your tired moves? What can you rely on when you’re exhausted?
Start Training your tired moves now
Whatever your tired moves are, now is the time to train them. To be really effective, they have to be rock solid, hard-wired in, and available when you need them the most. If your tired move is untrained and unpolished flailing, it is unlikely to be optimally effective.
One of the best ways to train your tired moves is to put yourself in the situation you think you'll be facing, get tired, and see what sticks. This is part of the logic behind sparring in martial arts classes--moves are best trained in situations as close as possible to the real thing. Alternating between training the moves in low-stress, calm environments when you're fresh and in higher-stress environments when you're tired can be particularly helpful.
If it is not possible to recreate the situation you're expecting exactly, either because it is rare (like a low frequency but must-not-miss procedure in the ER), or difficult or dangerous to access (like responding to equipment failures while deep sea diving), you can use mental visualization to train your tired moves. As I've written about before, visualization is a key tool for increasing high-quality repetitions of a skill and can involve simulating skills under tired conditions.
However you train them, the key thing is that you have to train those tired skills now, when you're fresh. When that 11th hour critical patient comes your way, you'll be happy you did.