Defending the Lob, Managing the ICU and Emotional Intelligence

The lob shot.

As a goalie, it’s my nemesis. It was my major weakness in college and even more so today. Standing (or more appropriately treading) 6’3″ tall, with an even longer wingspan, I have always been eager and ready to explode up and out of the water, my arms outstretched, to intimidate a shooter. My height, along with my gangly arms and a quick first reaction, are great tools to disrupt, alter and ultimately block my opponents’ shots.

But my kryptonite is the lob shot. It turns my strength against me. A patient opposing player, by waiting a split second, lets my aggressiveness work against me. By allowing me to rise up and out of the water first, a shooter can then release an agonizingly slow arcing shot, up and over my now sinking self, to then drop into the opposite corner of the net. I react. They wait. And I’m beat.

When I correctly anticipate the lob, it’s demoralizing for the shooter. With minimal effort, the ball is not so much blocked as “caught” in humiliating fashion, usually deterring the shooter from another. But when my legs have already committed to a direct shot, all I can do is swivel my head and watch as the ball takes its time, teasing and taunting me, just out of arms reach, and lands in the net.

In college, it took a while to develop patience. To dial back my brashness, my impulsivity. Wait that extra split second. Take in the arm angle and the eyes of the shooter. Trust myself and my abilities to make the block even if I delay for a brief moment. My teammates challenged me with lobs over and over again in practice, until finally a change occurred. Thinking, instead of just reacting. Using my frontal cortex, instead of my primitive brain. And for a while, I had the upper hand against my nemesis, and my opponents as well.

Tempering my first reaction has never been easy, either in or out of the water. My initial response to life’s challenges tend to be more reactionary and visceral. In one’s college years, that lack of patience and emotional intelligence is somewhat expected, if not the norm. Not so much when in mid-life and caring for the critically ill or teenage children.

The ICU will never be mistaken for an Olympic sized pool. And my children, despite how it may feel, are not opponents on a challenging team. But the unique nature of an ICU and family dynamics make both areas ripe with opportunities for a battle between my brash, impulsive tendencies and my more mature, deliberate and thoughtful side.

The space that exists within the confines of the ICU is awash with challenges. Rooms are filled with the tension that accompanies the acuity and intensity of critical illness. ICU physicians are tasked with navigating multiple health care professionals, who frequently have honest differences in opinions, and sometimes supercharged egos and attitudes as well. Families and surrogates of patients, residents, nurses and students all operate in this landscape, within their own sphere of swirled thoughts and emotions. There are a multitude of relatively quick decisions that need to be made. Do I intubate or not? Do I send them on a road trip for a CT or stay in the more stable confines of the critical care unit? Do I commit a patient to an invasive procedure with potential complications or hold off and continue with the status quo?  But it’s not just the decisions themselves. There is a qualitative component as well. Do I take the extra time to explain my thought process to the nurse, resident or student at the cost of delaying decisions for the next patient? Do I provide more than a cursory update to a family as I exit a room, or do I sit down and invite them to share their angst and fear. Do I do so at the cost of delaying the start of my office and the patients waiting there? Do I share my inner head voice and its whispers of fear, concerns and self-doubt? Or do I project unwavering confidence and certainty? Challenges lie not just in making decisions, but in the manner they are carried out and executed. To grow, not just as a competent clinical doctor, but as an empathic physician as well, one needs emotional intelligence to navigate such complex waters.

These days, back in the pool, I find my old nemesis is back to taunt and haunt me. My height and wingspan may be unchanged, but the same cannot be said about my explosive move up and out of the water. Over-eager and anxious to defend a shot on goal, I now have the added challenge of being a bit slower and quite lower out of the water. I don’t have the luxury of waiting that split second anymore.

I find history repeating itself, with my current teammates showing the way. They challenge me in practice, frustrating me with lob after lob. But they are not content to stop there. They let me know that I may be the only one in the net, but I am not alone in defending it. Through their efforts in games, fighting for position, and playing a team defense, they buy me back the time I have lost. They remind me to trust them. And in turn, trust myself, allowing me to tap into my thinking brain in order to defend the lob.

My experiences with the team continue to parallel my life. Just like success in the net is a result of a team effort, so it goes in the ICU. I’d be lying if I said the years have not affected the excitement and enthusiasm of the young attending physician I used to be. There is now a component of fatigue and burnout that I often need to shake off before rounds. Some days it feels that I am on an island when dealing with a crisis or challenge. That is neither true nor accurate. The nurses, residents and students, along with my physician partners are teammates too. Together, the challenge of taking care of the critically ill seems less daunting, giving me the time and space to harness my thinking brain.

There are moments when instinct and gut reactions are critical for success. But when I am able to bring both parts of my brain to a challenge, the enthusiasm that comes with  impulsivity and brashness along with the wisdom that accompanies maturity and thoughtfulness, good things happen. Not just in the pool or ICU, but in life as well.




It is September 2012, a bit chilly out, a mist of rain that night, and I find myself a few feet from the stage, packed amongst several hundred others at the Metro. Bob Mould comes out with his new band and promptly starts playing the first song from Copper Blue, “The Act We Act”. Even if the 15 foot speakers were not 10 feet from my ears, the music is felt more so than heard. I am there at the Metro, but I’m also 21, just graduating college. I’m at my desk plodding thru organic chemistry and physics questions with Copper Blue playing on repeat in the background. It’s a warm summer night, but cool in my car with the top down and the stars dancing above, on the road to Michigan City or Fond Du Lac or Madison, with “Changes” on the CD setting the tone. The album is played that night start to finish at a frenetic but absolutely familiar pace. My heart pounding a half-tick ahead of the tempo as I am here, 42 years old, at the Metro, but also 22 years of age with my life ahead of me.

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Building Blocks


buildong blocks WaterPolo

Its 9am Sunday morning and I’m standing on a humid pool deck staring across at the  blank faces of thirteen high school water polo players. Most of them I have never seen before and don’t have a clue as to their names. They are  looking back at me.  Sort of.  At least those that are not looking at their iphones or zoned out listening to music with their earbuds.  But they are MY players.. My team!  At least for today.  And I am wondering how I got myself in this situation.

About 18 hours earlier, the email came across my iphone.  “High School Water Polo Tournament Tomorrow!!!!!! Players Needed! Please respond ASAP!”  My son plays sporadically for a club team based out of a neighboring high school run by my friend Claire.  We have known each other for a few years having played on the same Master’s team.  I let her know my son is available if needed. The text that comes back says:

“yes needed! Also short a coach. Interested?”

I reflexively reply:

“NP” (text speak for No problem…learned that from my kids being the hip Dad that I am)

With visions of Bobby Knight or Phil Jackson swirling thru my head, I see myself challenging these currently “faceless” kids to play  above their ability. I’ll share my  years of knowledge, wisdom and love of the game, and they will  play beyond their years and bring home victory!

But what I see right now is nothing like the visions I had the day before. The team in my head was tall…REALLY TALL….and ripped!…Kind of like a bunch of Michael Phelps.   Lets just say this team was a bit more diverse.  From freshman to seniors,  5″3 to 6 feet tall the team was quite a mix of shapes and sizes. Three goalies (Three? How do I find playing time for three goalies?) And I don’t know the names of more than half the kids.  I had some sort of pre-game pep talk loosely planned in my head but right now I can’t get the attention  of the two kids listening to music.  With three minutes left to go before game time, I’m still trying to figure out a starting line up (when in doubt, go with seniority and the kids that have been there the longest) when the whistle blows to start..

Game 1 : As soon as the game begins, I’m in over my head. I’m trying to figure out who will be the first subs. Easy…first three on the bench (if only I knew their names).  Now I’m trying to figure out who will come out.   Figuring out who people are with a water polo cap on and half under water is hard enough, but when you don’t know their name to begin with, it becomes comedic. “you in the speedo…no..the other one..yeah you…sub out”  Not to mention there are two brothers Leo and Rodrigo who look quite similar and I will continue to confuse them for the rest of the tournament.  I find myself spending minutes figuring out substitutions instead of watching and offering any type of strategy (which seems to be desperately needed as we are quickly losing by quite a lage margin) It’s not till the half, that I have a chance to collect my few thoughts.  Now I have thirteen tired, frustrated and short of breath players looking at me for direction.  No zen like observations come to mind (thanks for nothing Phil) and yelling at them (coach Knight) doesn’t seem quite appropriate right now. Three…Three things. Somewhere I heard that the most a team can focus on are three things.

Ok guys…rough start…One, we are going to play a press defense.  Play them tight. Two, first option on offense, we go to the hole set. Three, get back on D quicker. Don’t watch the turnover..just get back on defense and help the goalie! Lets go.!”

Final Score 5-15.  Names memorized on team: 7 of 13 (but I knew four of them already)

GAME 2: Starts right after game 1. Starting line up is easy. Same as last game. I’ve got some sense of what my team can do. Who are the fast swimmers (or not so slow). Who can shoot, who is not playing defense.  I try to figure out how to keep at least 3-4 stronger players in while peppering in some of the more novice kids.  I’m still hampered by the “name” thing but at least I’m able to watch the game and finally able to offer some specific advice by the fourth quarter. We lose the game, but play them even for the last 6 minutes. And a bonus, I get to see my son score two goals!

Final Score 7-13  Names memorized: 10 of 13

Game 3:   After a 50 minute break, the team is ready for one last hurrah.  3 kids have left leaving me with 10 (unfortunately the three whose names I have not figured out are all still here…including Leo and Rodrigo).  A slight modification to the starting line-up and we are good to go.  Our defense is having some trouble with their huge hole set.  I modify to a foul and crash defense to adjust and it seems to work. Our counterattack is working and going into the last quarter we are down only  one goal.  I rest the strongest players for the first minute of the 4th. And when they come in, they are swimming hard.  We trade some goals and with 1:30 left  still trailing by one, I call time out.  The team swims over and now they are looking at me…I mean really looking at me, waiting for me to tell them what to do!  But this time, I know what to say.

We need the ball back! Switch back to a straight press defense.  No drop on the hole.  I want the defenders on the crown ready to counter.  They are tired. We are not!”

The defense holds, and Denilio has broken early for the counter. Our goalie makes a great pass to him and on the breakaway scores to tie the game!  Our defense holds up for the next minute and the game ends.

Final Score 12-12. Players names memorized 10/10.

The kids leave exhausted but excited to have improved and played a great competitive game and I’m feeling quite a bit better about my coaching prospects. My record is still 0-2-1 but ended on a positive note. Even better, I got to watch my son score 3 goals for the tournament.  And as I drive home to try and catch the second half of the bears game with my son, I think about how this fits with the big picture of BALANCE.

I wanted to be this dynamic coach who could teach, challenge and motivate right out the box. Just like I want to have this BALANCE. Now! Today!  I want to be that dad who has the boundless energy,  always knows the right thing to say to his wife and kids.  That team player at work but still home in time for an hour run before dinner.  I frankly sucked as a coach for the first game, just like last weekend was pretty horrible for any  BALANCE.   But after using the first two games as BUILDING BLOCKS,  I’ll leave it to the kids to say what kind of coach I was by the end.   And as I reflect back on THIS  weekend as a whole, it was certainly better than the prior.  There were some BUILDING BLOCKS here as well.  Family yoga on Saturday despite a bad back, making progress on redoing the upstairs bathrooms, coaching my son in the tournament, watching together the Bears lose to Detroit.  No major drama. In fact mostly mundane. But those are the BUILDING BLOCKS for sustainable balance. Not every weekend can be a family hike in Moab Utah or surfing in Hawaii.  Those don’t sustain BALANCE. They are fun and exciting and add flair and a dramatic backdrop. But its the smaller moments, that build off each other that add some depth and can act as an anchor. It does not happen in one game,  and as I’ve said before, not one weekend. But some of the pieces are already here and its time to start building off of them.