"Take a deep breath, count to ten..."

I came across an article in Forbes magazine earlier this week, entitled "7 Ways Leaders Maintain Their Composure in Difficult Times".  There is no question that we are faced with perpetual, constant, and at times, rapid change.  In many ways, both health care and society at large are changing in ways that make it more and more difficult to navigate our way around.  During these difficult times, we look to our leaders for guidance and inspiration.  We want - and in many cases, we desperately need - leaders with grace, composure, and poise.  It's interesting to me that Webster's Online Dictionary defines the word "poise" in two ways.  In the first definition listed, "poise" is defined as a "graceful or elegant bearing in a person."  More relevant in the current context is the second definition.  Here, "poise" is defined as "balance or equilibrium."  We want our leaders to remain balanced - they don't necessarily need to be in 100% control of their emotions all the time, but we certainly don't need our leaders to "lose it" when times are tough.


So, here are the 7 recommendations to help leaders maintain their composure in difficult times, at least according to the article in Forbes magazine:


1. Don't allow your emotions to get in the way.
2. Don't take things personally.
3. Keep a positive mental attitude.
4. Remain fearless.
5. Respond decisively.
6. Take accountability.
7. Act like you have been there before.


Grace.  Composure.  Poise.  There are three examples of grace, composure, and poise that immediately come to my mind, and I would like to share them here.


Example #1 (from my own personal files!)


I remember when I was a Pediatric Critical Care Medicine fellow, and while I don't remember the exact time (it probably was during my second or third year), I remember almost every single detail.  In fact, I am almost 100% positive that if I started to talk about the case now with the physician who was my attending physician at the time, he would immediately remember the specifics of the case as well.  I can't share specific details of the patient, but suffice it to say that we were called upon to place what is known as a central line (basically, a larger intravenous catheter that is placed in a large, so-called central vein, such as the internal jugular vein, subclavian vein, or femoral vein, as opposed to a normal "IV" which is placed in a small, peripheral vein in the arm or foot) in a critically ill infant who did not have vascular access.  The patient was not doing particularly well, so this was an emergency and time was of the essence.  We were using a commonly employed technique known as the Seldinger technique, in which a guidewire is used to help place the catheter through the skin and into the vessel (the guidewire is removed after the catheter is placed).  We are always taught to never let go of the guidewire!  The attending physician was standing right behind me as I successfully placed the guidewire into the subclavian vein.  As I was withdrawing the dilator from the patient, I accidentally pulled out the guidewire too - in other words, back to square one!  My attending dropped his head, slowly walked away to the corner of the room, sat down, buried his face in his hands, and muttered what I think (though I can't be 100% sure), "Derek.  Derek.  Derek."  We really needed that line.  The patient really needed that line.  My attending physician was obviously very frustrated, but he took a deep breath, stood up, walked back towards me, smiled, and said, "You got it once, you can do it again."  He nodded his head, and I successfully placed the central line.  Rather than yelling at me or criticizing me in the middle of a very busy Intensive Care Unit, he took a deep breath, waited a few moments, and came back to positively encourage me to do my job.


Example #2

One of my favorite movies (of all time even) is the movie, Gettysburg based upon the novel, The Killer Angels by Michael Shaara.  There is a scene in the middle of the movie when General Robert E. Lee has to speak with one of his generals, in this case General J.E.B. Stuart.  Stuart led the cavalry for the Army of Northern Virginia, and at times, was guilty of being too overly confident and too self-gratified.  During the few days leading up to the battle, General Stuart was nowhere to be found (an army's cavalry was often its "eyes and ears"), and several other officers in the Army of Northern Virginia were probably correct to say that General Stuart had left them "high and dry" while he was off enjoying his celebrity status and seeking fame.  Lee has a fairly "crucial conversation" with Stuart - in private - in which he reprimands General Stuart for not doing his duty.  As you watch the video clip, notice that General Lee (played by Martin Sheen) starts to lose his temper, quickly retreats ("take a deep breath, count to ten"), and redirects the conversation back to his original point.  He then tells General Stuart that "you are one of the finest cavalry officers that I have ever known," and that "your services to this army have been invaluable."  Lee tells Stuart that he is confident that he will learn from his errors and that "it will never happen again."  It is a fairly minor scene in the movie, but it is an excellent example of grace, composure, and poise in a leader during a very stressful time.


Example #3

Another example from the Battle of Gettysburg.  In this case, the example involves the Union Army of the Potomac, and the main characters are President Abraham Lincoln and General George Meade.  General Meade was given command of the Army in the days immediately prior to the Battle of Gettysburg (he actually tried to refuse command, so he was a reluctant leader for sure).  The battle is fought for three days.  The Union Army of the Potomac wins the battle, and the Confederate Army of Northern Virginia finds itself in a full-scale retreat.  More importantly, the Army of Northern Virginia gets caught on the wrong side of the Potomac River and is trapped.  The river was overflowing due to heavy rains, and the Union Army, or so it is believed, had a golden opportunity to fight the Army of Northern Virginia and rout them.  The Civil War could have ended there and then.  Instead, General Meade delays his advance, the river subsides, and the Army of Northern Virginia escapes a disaster.


Lincoln was furious with Meade.  He wrote a letter to General Meade that follows:

Executive Mansion,​

Washington, July 14, 1863.​

Major General Meade​

I have just seen your despatch to Gen. Halleck, asking to be relieved of your command, because of a supposed censure of mine. I am very--very--grateful to you for the magnificent success you gave the cause of the country at Gettysburg; and I am sorry now to be the author of the slightest pain to you. But I was in such deep distress myself that I could not restrain some expression of it. I had been oppressed nearly ever since the battles at Gettysburg, by what appeared to be evidences that yourself, and Gen. Couch, and Gen. Smith, were not seeking a collision with the enemy, but were trying to get him across the river without another battle. What these evidences were, if you please, I hope to tell you at some time, when we shall both feel better.

The case, summarily stated is this. You fought and beat the enemy at Gettysburg; and, of course, to say the least, his loss was as great as yours. He retreated; and you did not, as it seemed to me, pressingly pursue him; but a flood in the river detained him, till, by slow degrees, you were again upon him. You had at least twenty thousand veteran troops directly with you, and as many more raw ones within supporting distance, all in addition to those who fought with you at Gettysburg; while it was not possible that he had received a single recruit; and yet you stood and let the flood run down, bridges be built, and the enemy move away at his leisure, without attacking him. And Couch and Smith! The latter left Carlisle in time, upon all ordinary calculation, to have aided you in the last battle at Gettysburg; but he did not arrive. At the end of more than ten days, I believe twelve, under constant urging, he reached Hagerstown from Carlisle, which is not an inch over fifty five miles, if so much. And Couch's movement was very little different.​

Again, my dear general, I do not believe you appreciate the magnitude of the misfortune involved in Lee's escape. He was within your easy grasp, and to have closed upon him would, in connection with our other late successes, have ended the war. As it is, the war will be prolonged indefinitely. If you could not safely attack Lee last Monday, how can you possibly do so South of the river, when you can take with you very few more than two thirds of the force you then had in hand? It would be unreasonable to expect, andI do not expect you can now effect much. Your golden opportunity is gone, and I am distressed immeasurably because of it.​

I beg you will not consider this a prosecution, or persecution of yourself. As you had learned that I was dissatisfied, I have thought it best to kindly tell you why.​

Abraham Lincoln​

Surprisingly, Lincoln never sent the letter!  The letter was not discovered until after the end of the War, shortly after his assassination.  It was found in an envelope in his desk that was endorsed by Lincoln himself, stating "To Gen. Meade, never sent, or signed."  Apparently, Lincoln often wrote letters that he never sent.  It was his way of venting his anger and frustration without offending or attacking the person who had caused his frustration.  In other words, he took "a deep breath and count to ten."

Grace.  Composure.  Poise.  We, as leaders, need these skills, especially in times of difficulty.  So whenever you find your temper starting to flare, whenever someone on your team triggers your frustration, "take a deep breath, count to ten" and re-direct and re-focus.