Stay calm when you know will be stressed

A few years ago, I found myself breaking into my own house. I had just driven home, and it was around midnight in the middle of a bitter Montreal winter. I had been visiting my friend Jeff across town, and the thermometer outside read minus 40 degrees—no need to ask if it's Celsius or Fahrenheit, since that’s where the two scales meet! It was freezing.

As I stood on the porch, searching through my pockets, I realized I didn’t have my keys. I could see them through the window, sitting on the dining room table where I had left them. I quickly ran around to check all the other doors and windows, but they were all locked. I considered calling a locksmith, but it was late, and I didn’t want to wait in the cold. I couldn't go back to Jeff's house either since I had an early flight to Europe the next day, and I needed my passport and suitcase. So, desperate and freezing, I found a big rock, broke the basement window, cleared out the glass shards, crawled through, and taped a piece of cardboard over the hole. I figured I could call my contractor the next day to fix it before heading to the airport. It was going to be expensive, but probably less than a locksmith at midnight, so I felt like it balanced out.

I'm a neuroscientist, so I understand how the brain works under stress. Stress causes the brain to release cortisol, which increases heart rate, stimulates adrenaline, and clouds thinking. So, the next morning, after a poor night’s sleep and with a million things on my mind, I didn't realize that my thinking was foggy because of the cortisol. It wasn’t until I got to the airport check-in counter that I realized I had forgotten my passport!

I rushed back home in the snow, grabbed my passport, and rushed back to the airport, but by the time I arrived, my seat was given away, and I was stuck in the back of the plane by the bathrooms in a non-reclining seat for an eight-hour flight. I had plenty of time to think during that flight, and I started wondering whether I could put systems in place to avoid or minimize the damage of future mistakes.

It wasn’t until about a month later that my thoughts really started to come together. I was having dinner with my Nobel-winning colleague, Danny Kahneman, and I awkwardly told him about breaking my window and forgetting my passport. Danny shared with me something called "prospective hindsight," which he learned from psychologist Gary Klein, also known as a "pre-mortem." While a postmortem is when experts investigate what went wrong after a disaster, a pre-mortem involves looking ahead and imagining all the things that could go wrong, then coming up with strategies to prevent them or minimize the damage.

So, what I want to talk about today are some things we can do as part of a pre-mortem, some obvious and some not so obvious. Let's start with the obvious ones. Around your house, designate a specific place for things that are easily lost, like your keys, reading glasses, or passport. There’s a part of your brain called the hippocampus that helps track the locations of important things, but it works best for items that don't move around much. It’s why we often lose things like car keys or glasses. By setting designated spots for things, they’ll always be where you expect them to be.

When traveling, take a picture of your credit cards, passport, and driver's license with your phone and email them to yourself so they’re stored in the cloud. If these items get lost or stolen, you’ll be able to replace them more easily. These may seem like simple things, but when under stress, cortisol affects your ability to think clearly, so it's important to put systems in place ahead of time.

There’s no situation more stressful than facing a big medical decision. All of us will eventually face the need to make important decisions about our own or a loved one’s health care. So, let's consider a scenario. Suppose you go to the doctor, and they tell you that your cholesterol is a bit high. They might recommend a statin, a common drug used to lower cholesterol. Statins are widely prescribed, but you should ask a key question: the "number needed to treat" (NNT). This statistic tells you how many people need to take a drug before it helps one person. For the most commonly prescribed statin, the NNT is 300. That means 300 people need to take the drug for a year to prevent one heart attack, stroke, or other serious event.

Now, you should also ask about the drug’s side effects. For statins, side effects affect 5% of people, including things like muscle pain and gastrointestinal distress. So, if you do the math, 300 people take the drug, and 15 people experience side effects. That means you’re 15 times more likely to be harmed by the drug than helped by it. It’s important to have this conversation with your doctor, as part of the informed consent process.

This isn’t an isolated case—many medical decisions have similar statistics. For example, for prostate cancer surgeries in men over 50, the NNT is 49, meaning 49 surgeries are performed for every one person who benefits. The side effects for this procedure are severe, including erectile dysfunction and incontinence. The point is to think ahead about these kinds of decisions and have conversations with your doctor and family about the risks and benefits before you’re under stress.

Remember, stress messes with your thinking, and we need to prepare for these moments. It’s essential to think ahead, put systems in place to avoid mistakes, and make sure we’re asking the right questions in stressful situations. Back to that cold Montreal night—I later had a contractor install a combination lock near my door, with a key to the front door, just in case. While I’m not perfectly organized (I still have piles of mail and emails to sort), I’m gradually getting there.