Hi,

'He/she's such a flapper'.

This is a label you always want to avoid in medicine. 

Over the years, I've learned it's a trait that nurses hate to be around. 

It describes a maladaptive response to stress. In a time where cool composure is most valued, some 'flap around' in a state of heightened anxiety and panic. 

Flapping is infectious.

Shrill voices put others on edge, consume bandwidth, and instill panic. 

I love Dan Dworkis' antithesis to this:

"Sangfroid—translated literally as “coldblooded”—is the ability to be calm under significant pressure."

Although some are cooler than others under pressure, it's a skill that can be trained. It won't necessarily develop passively as a by-product, but has to be consciously cultivated. 

Flapping just wastes energy, and worsens things anyway.

The ability to acknowledge circumstances, and consciously remain calm and composed, is a skill that can be learned and improved. 

Having a word or phrase that helps acknowledge the situation can re-train our felt response. Dan uses "well, this is sub-optimal". The fact this can be deployed when all hell is breaking loose brings some levity and a state shift for him. 

"...sangfroid is intensely personal...No one can teach you sangfroid, it is up to you to choose to study it."

Developing sangfroid, or cold-bloodedness, is useful across all areas; whether it's someone cutting you off in traffic, spilling your coffee, or something truly life-upsetting unfolding. 

Better than flapping, anyway. 

Clinical Things I've Learned

One big meaty learning this week.

I wrote a new article on the fundamentals of acid-base. 

I explored the Stewart approach, which flips all of my understanding of metabolic acidosis upside down.

From Elsewhere

Our idea of what a thing is, is often only 1% of the actual thing:

“If the only thing you really enjoyed was whipping around Earth in a spaceship, you’d hate being an astronaut. The ratio of prep time to time on orbit is many months: single day in space.”

- Chris Hadfield

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Maybe we need more of this in our current climate:

“Someone new who doesn’t know much, has little believability, or isn’t confident in his views should ask questions. On the other hand, a highly believable person with experience and a good track record who is highly confident in his views should be assertive.

Everyone should be upfront in expressing how confident they are in their thoughts. A suggestion should be called a suggestion; a firmly held conviction should be presented as such. Don’t make the mistake of being a dumb shit with a confident opinion”

- Ray Dalio