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Hard places teach hard lessons. As a military doctor in Afghanistan, as an expedition medical officer in sub-Saharan Africa and in the Arctic, in the cockpit of an aircraft, and inside the complex world of today’s corporate healthcare system, my failures in these extreme environments have taught me that you cannot stop chaos. You can only manage it.

Managing every single emergency comes down to just four steps.

1) Identify the team

• Focus: Identify and protect your team; capitalize on their strengths and weaknesses

2) Prioritize your immediate needs

• Focus: Focus strictly on what needs to be done immediately, and within the next 60 minutes. Triage everything else.

3) Keep your plan simple

• Focus: Communicate your plan with the team but keep it simple because complex plans fail under pressure.

4) Empower your team to make decisions

• Focus: You cannot win by doing everything yourself. Trust your team to make good decisions with the information they have, and support them at all cost even if they are occasionally wrong.

by Jon Solberg, MD

Fellow, American College of Emergency Physicians

Fellow, Academy of Wilderness Medicine

Diploma in Mountain Medicine

An Excerpt from the book:

“…the nearest anyone can come to finding himself at any age is to find a story that somehow tells him about himself.”

—Norman Maclean, Young Men and Fire

Thirty high school juniors shuffled through the classroom door after lunch. For those in the back row, the agenda included a quick snooze—but that never occurred on Mr. Liebelt’s watch.

A bit of a savant, slightly overweight, and looking somewhere between 35 and 85 years old, Mr. Liebelt sported a pressed, faded, slightly yellowed dress shirt and dark slacks. He could have worn the exact same outfit yesterday; his wardrobe very likely contained a dozen of them. A left-breast pocket protector carried a black and a blue ballpoint pen, various highlighters, and a small, metric pocket ruler.

Many in our class suspected he was a former NASA rocket scientist whose first career had failed to achieve liftoff, landing him in this high school physics room with the same predictable lesson plans, textbooks, and labs year after year. One classmate claimed to know for a fact that Mr. Liebelt lived with his mother, won a fortune counting cards in Las Vegas, and woke up at 0600 to a homemade Rube Goldberg machine that automatically fried an egg, brewed coffee, and launched two slices of toast perfectly onto his breakfast plate.

Even in their post-lunch, insulin-induced stupor, the students noticed the stack of crisp, new twenty-dollar bills fanned out in a perfect arc on his desk planner.

The bell rang. The murmur quieted. Mr. Liebelt waited for absolute silence, then coughed.

“Who would like to become twenty dollars richer today?” he asked.

A few front-row hands shot up. He smiled, undeterred. “All you have to do is convince me you listened to yesterday’s lecture. I’m so confident you did, in fact, that I’ll bet you twenty dollars against five points on your final grade. Follow me into the hallway, stand with your back and heels against the wall, and I’ll place a twenty on the floor. If you can bend over and pick it up without losing your balance or moving your heels away from the wall, you keep the money and the bonus points. If you can’t, I keep my cash and you lose five points on your final grade.”

Brain cogs started chugging around the room. A gymnast laughed, boasting she could do it on one foot. A basketball player claimed his wingspan gave him a heroic advantage.

But when I looked back to the front, Mr. Liebelt and the cash were already gone. One by one, the class shuffled into the hallway to find him.

“All right, line up tallest to shortest,” Liebelt commanded. “Butts and heels flat against the wall.”

After minor rearrangements, we formed a satisfactory line of physics cadets. Mr. Liebelt walked down the row, placing a fresh twenty-dollar bill at each student’s feet. He pointed to the basketball player first. The boy's false confidence shattered the moment he bent at the waist; his center of gravity instantly threw him forward, and he stumbled onto his hands.

“What the heck?” he exclaimed.

“I’m sorry,” Mr. Liebelt said smoothly, marking a minus five in his gradebook. “You lose. Next!”

One by one, the result was identical. Students bent forward, tumbled, and caught themselves on outstretched fingers, completely unable to fight the laws of physics.

Finally, Mr. Liebelt pointed to the last kid in line—the smallest, scrawniest runt of the back row, and the least likely to have ever listened to a lecture. Liebelt presumptively began writing a minus five in his book already.

The runt stretched his hands over his head, cracked his neck, and yawned. Then, keeping his heels glued to the wall, he bent at the waist, effortlessly scooped up the bill, and slid it into his pocket. With a cocky grin, he shuffled past his stunned classmates and back into the room; we all followed.

Mr. Liebelt stood by the chalkboard, hands on his hips, shaking his head. “I’ve been doing that demonstration for fifteen years,” he muttered, reluctantly handing over the cash. “I’ve never lost.”

The short kid leaned back in his desk, snapping the crisp bill proudly between his fingers. He stuck his legs straight out into the aisle. On his feet were the longest, most cartoonish pair of size 13 athletic sneakers any of us had ever seen, the laces drawn so tight they looked ready to burst.

“My brother took this class three years ago,” the runt boasted. “I’ve been shopping the clearance racks for size 13s for months. I stuffed the toes with tissue paper so they wouldn't flex, and I checked your desk calendar to see when the lesson was coming. They were a hundred-and-fifty-dollar shoes, but I got 'em for forty! Who’s the smart one now?”

Mr. Liebelt cocked a half-smile, pleasantly surprised to be out-bluffed by a back-rower. He turned to the chalkboard to explain the science behind the trick.

He drew diagrams of a second-class lever—where the load sits between the fulcrum and the effort, like a wheelbarrow. He explained how the human Achilles tendon acts as this exact machine, multiplying mechanical force to lift a 200-pound person or propel a sprinter.

“Think of the tremendous force exerted through the Achilles tendon as a runner accelerates,” Liebelt opined, chalk flying across the board in another drawing. “One thousand pounds of force generated by the calf muscle, allowing early humans to out-run predators on the ancient Savannah! Incredible!”

Mr. Liebelt stood back, redeemed in his own eyes. The class drifted back into their afternoon daze.

Thirty years had passed and I had never given that physics lesson another thought until today. I forgot about the levers, I forgot about the runt's giant shoes, and I forgot about Mr. Liebelt.

Until this morning.

Because on this morning, the lever, my own trusty Achilles tendon, it tore right in half leaving me stranded on the floor of the pickle ball court where I had been squaring off against two men twice my age.

Why would I ever have given it a second thought? My tendon had worked just fine. It had carried me to the summit of Mt. Rainier, through Army basic training, and onto the Marine Corps helicopters that delivered me to Southern Afghanistan. It had endured an expedition across the entire length of Greenland to within a few hundred miles of the North Pole. It had seen me through flight training and into the cockpit of my bush plane, where most aeronautical student conundrums can be fixed by the instructor simply yelling: “More right rudder!”

Today, however, I am staring at my right foot, propped up on a pile of hospital blankets, completely unable to wiggle my foot.

I knew the exact moment it happened. It wasn’t even in pursuit of some worthy, heroic endeavor. It was a simple game of doubles pickleball at the YMCA, directly across the street from the emergency department where I work. The game was hot, the adrenaline was up, and I was just about to smash the ball right into the face of my double-my-age opponent.

SNAP!

I crashed to the floor. People on the far side of the gym heard what sounded like a gunshot and ran over to see who had been rolled. I wasn’t in pain, but my ankle was offline. Bystanders scrambled to grab a wheelchair, track down my 80 year old dad who had just been playing with us moments ago, and find a young guy from the front desk to help me get up.

“I think I just tore my Achilles tendon, and I don’t have time for this; not today. I’m going to get a wound infection, wind up on antibiotics and get C diff diarrhea, and probably a blood clot, then I’ll be on blood thinners for the next two years!” was all that I could think of…

Discover what lessons can be learned when a logistical control freak is forced to surrender the reins, and learn the elite leadership principles that can help you bring calm to your own chaos.