How to stay calm when you know you'll be stressed

Several years ago, I found myself in a rather unusual predicament—I had to break into my own house. Picture this: it was midnight in the heart of a frigid Montreal winter. I had just returned from visiting a friend named Jeff across town. The thermometer on my front porch ominously displayed minus 40 degrees, a temperature that coincidentally aligns in both Celsius and Fahrenheit at that extreme point. As I stood on my front porch, shivering and fumbling through my pockets, a sinking realization hit me—I didn't have my keys.

My keys were mocking me from inside, visible through the dining room window where I absentmindedly left them. Panicking, I rushed around the house, testing every door and window, but they were all securely locked. The thought of calling a locksmith crossed my mind, but the combination of midnight hours and bone-chilling temperatures made that less appealing. Complicating matters, I couldn't retreat to Jeff's house for the night because of an early morning flight to Europe, requiring my passport and suitcase.

Faced with the urgency of retrieving my essentials and the biting cold, I resorted to desperate measures. Spotting a large rock, I made the impulsive decision to break through the basement window. After clearing away the shards of glass, I crawled through the improvised entrance and, in an attempt at a temporary fix, taped a piece of cardboard over the opening. The plan was to call my contractor in the morning, en route to the airport, and have the window repaired. While I knew this was an expensive solution, it seemed justified compared to the potential cost of a middle-of-the-night locksmith.

Being a neuroscientist by training, I was acutely aware of how the brain responds under stress. Cortisol floods the system, elevating heart rate, modulating adrenaline levels, and clouding rational thinking. The next morning, with too little sleep and a mind preoccupied with the broken window, I grappled with a mental note to call my contractor amidst freezing temperatures and impending European meetings. My thinking, clouded by cortisol, remained oblivious to its own foggy state.

It wasn't until I reached the airport check-in counter that the full extent of my lapse became evident—I didn't have my passport. Racing back through the snow and ice, I managed to retrieve it, but my seat on the flight had been given away. Consequently, I found myself relegated to the back of the plane, next to the bathrooms, in a non-reclining seat for the duration of an eight-hour flight.

During those long, sleepless hours, I pondered whether there were systems I could implement to prevent or, at the very least, minimize the impact of such chaotic situations. The crystallization of these thoughts occurred about a month later during a dinner with my colleague, Nobel Prize winner Danny Kahneman. I sheepishly recounted my escapade of breaking into my own house, and Danny introduced me to the concept of prospective hindsight or the pre-mortem.

The pre-mortem involves looking ahead and identifying potential pitfalls, allowing for the development of strategies to prevent or mitigate their impact. This proactive approach to problem-solving became the focus of my reflections. I delved into the idea of implementing pre-mortem strategies, starting with practical tips for everyday situations and gradually transitioning to more critical decision-making scenarios.

At home, designating specific spots for commonly misplaced items was emphasized, leveraging the spatial memory supported by the hippocampus. Whether it's a hook for keys, a particular drawer for passports, or a dedicated table for reading glasses, having designated places can save time and prevent unnecessary stress.

For travel, a simple yet effective strategy involved taking pictures of essential documents—credit cards, driver's license, passport—and emailing them to oneself, ensuring easy access for replacements in case of loss or theft.

Recognizing the impact of stress on clear thinking, I stressed the importance of putting systems in place, particularly in situations as stressful as making critical medical decisions. Using the example of statins prescribed for high cholesterol, I introduced the concept of the number needed to treat (NNT). Inquiring about the NNT reveals the number of individuals who need to take a drug before one person benefits. This statistic, often overlooked, provides valuable insight into the efficacy of a treatment.

Continuing with the statin example, I urged individuals to inquire about side effects. Understanding that under stress, logical thinking becomes compromised, I encouraged pre-thinking through potential scenarios. By considering the number needed to treat and the likelihood of side effects, one can make more informed decisions in collaboration with their healthcare provider.

Transitioning to more profound decision-making scenarios, I explored the challenging choice of prostate removal for cancer. The number needed to treat for this surgery is 49, meaning 49 surgeries are performed for every one person helped. Additionally, 50 percent of patients experience side effects, including impotence, urinary incontinence, and rectal tearing.

The overarching theme was to encourage individuals to engage in conversations about potential medical decisions, fostering informed consent and open communication with healthcare providers. The pre-mortem approach allows individuals to anticipate questions and scenarios, preparing them for critical decision-making moments.

In conclusion, the importance of recognizing our inherent flaws and proactively addressing potential failures was highlighted. The journey towards better organization and decision-making is presented as a gradual process, acknowledging that perfection is a continuous pursuit.

Returning to the snowy night in Montreal, I shared the postscript of having a combination lock installed next to the door, with an easy-to-remember code and a spare key inside. Acknowledging my ongoing struggle with mail and emails, I embraced the idea that organization is a work in progress. The key lies in cultivating a mindset that values preparedness and continuous improvement.