BREAKING IN

Picture this: it's a frigid midnight in the heart of Quebec City, the air biting at a staggering minus 40 degrees—where Celsius and Fahrenheit converge into a chilling cocktail of cold. I had just returned from a friend's house, celebrating a cozy evening filled with laughter and warmth, only to discover my keys were nowhere to be found, taunting me from the dining room table through the frosty glass of my front window. Locked out in the dead of winter, with an early flight to catch the next morning, I found myself in a predicament that felt like a scene out of a dark comedy.

Desperation set in as I circled my house, trying every door and window, but they were all sealed tight against the merciless cold. The thought of calling a locksmith flickered through my mind, but I quickly dismissed it—who knew how long they’d take in this weather? Instead, I opted for a more drastic solution: a hefty rock. With one swift motion, I smashed the basement window, crawled through the jagged opening, and patched it up with a piece of cardboard, thinking it might save me some cash compared to a midnight locksmith's fee. Little did I know, this impulsive act was only the beginning of a night filled with regret, reflection, and lessons learned.

As a neuroscientist, I’ve spent years studying how our brains react under stress. When faced with pressure, cortisol floods our systems, clouding judgment and heightening anxiety. The next morning, I awoke groggy and panicked, battling a whirlwind of thoughts: the gaping hole in my basement window, the freezing temperatures, and the pressing need to pack for my flight. But the kicker? I forgot my passport. A panicked sprint back home through the icy streets followed, only to arrive at the airport just in time to find my seat had been given away, leaving me cramped in the back of the plane, next to the restrooms, on an eight-hour flight filled with discomfort and contemplation.

During that lengthy journey, I couldn’t help but ponder: how can we prevent such chaos in our lives? A month later, over dinner with the brilliant Nobel laureate Danny Kahneman, I shared my tale of woe. To my surprise, he introduced me to the concept of “prospective hindsight,” also known as the “pre-mortem.” This powerful technique allows us to anticipate and mitigate future mishaps. Unlike a postmortem—which examines failures after they occur—a pre-mortem encourages us to look ahead and devise strategies to avoid disaster before it strikes.

Today, I want to share some practical and insightful strategies that you can implement in your own life to safeguard against chaos. Let’s begin with the basics: designate specific spots for items you frequently misplace. This may sound like common sense, but research supports this approach. The hippocampus, a structure in our brain responsible for memory, helps us track important locations. When we assign a specific spot for our keys or passport, we increase our chances of finding them—no more frantic searching in the freezing cold!

Now, let’s shift our focus to travel. One simple yet effective strategy is to take a photo of your important documents, such as your passport, driver’s license, and credit cards. Store these images in the cloud or email them to yourself. If misfortune strikes and these items are lost or stolen, you’ll have quick access to crucial information that can facilitate replacements. Such proactive measures are vital during stressful moments when rational thinking tends to go out the window.

Speaking of stress, let’s delve into the realm of medical decisions—arguably some of the most critical choices we make. Picture this scenario: you visit your doctor, who informs you that your cholesterol levels are high and suggests a statin. Naturally, you know that high cholesterol is associated with an increased risk of cardiovascular disease, heart attacks, and strokes. The doctor’s suggestion might seem like a no-brainer, but it’s essential to ask one crucial question: What is the “number needed to treat” (NNT)?

The NNT is a statistic that reveals how many people must take a medication or undergo a procedure before one person benefits from it. This figure is vital for informed decision-making. You might assume that the number is one—that is, if a medication is prescribed, it must help you. However, the reality is often different. For many common medications, that number can be surprisingly high. For statins, for instance, the NNT is about 300. This means that 300 people need to take the drug for one person to see a benefit.

Now you might think, “Okay, so it’s one in 300 for lowering my cholesterol. Why not just take the prescription?” But here’s where it gets interesting: you should also inquire about the potential side effects. Statins have been linked to adverse effects in about 5% of patients, including debilitating muscle pain and gastrointestinal distress. While you might be tempted to brush these risks off, it’s crucial to consider them when you’re not under the pressure of an immediate medical decision.

Let’s do some quick math. If 300 people take the drug and 5% experience side effects, that translates to 15 individuals who will face adverse reactions. In other words, you’re 15 times more likely to be harmed by the drug than to benefit from it. This is not to suggest whether you should take the statin or not, but rather to emphasize the importance of having these conversations with your healthcare provider. Medical ethics requires informed consent, and you have the right to access information that can guide your decisions.

The same principle applies to various medical interventions. For example, consider the most commonly performed surgery for men over the age of 50: prostate removal for cancer. The NNT for this procedure is 49, meaning 49 surgeries must be performed for one person to benefit. The side effects for this surgery are significant, occurring in about 50% of patients and including impotence and urinary incontinence. Understanding these statistics can help you navigate your healthcare choices more effectively.

But it’s not just medical decisions that benefit from a pre-mortem approach. Reflecting on life choices in general can be enlightening. Ask yourself questions like: What do I want my life to look like in ten years? Am I prioritizing the right things? Would I prefer a shorter, pain-free existence or a longer life that might involve suffering? Engaging in these conversations with family and loved ones allows for deeper understanding and preparation.

As I navigated that chaotic night in Quebec City, I learned the importance of anticipating potential pitfalls and devising strategies to minimize the fallout of our inevitable human flaws. Today, I have a combination lock installed next to my door, ensuring I won’t get locked out again. While my email inbox and the mountain of unopened mail might still resemble a chaotic mess, I view organization as an ongoing journey, and I’m steadily working towards it.

In summary, embracing the idea that we all stumble from time to time is liberating. It allows us to approach life with a sense of humility and preparedness. By thinking ahead and considering what our failures might be, we can create systems that help minimize damage and prevent chaos before it happens. So, the next time you find yourself in a stressful situation, take a moment to reflect on the strategies you’ve set in place. Remember, a little foresight can go a long way in navigating the unpredictable journey of life.

Thank you for joining me on this exploration of chaos and clarity. Let's strive to make informed decisions, anticipate our challenges, and create a more organized, thoughtful life together!