"Count backwards from one hundred for me."
I've said that sentence thousands of times. It's the last thing a lot of people hear before the medication reaches them, and here's a piece of trivia from my side of the drapes: almost nobody makes it past ninety-four.
They're mid-number, mid-thought, planning to show me how far they can get, and then they're simply gone, somewhere I'm in charge and they aren't.
It is the purest act of surrender most people will ever perform while sober. You hand a stranger your breathing, your heartbeat, your consciousness, every system you've spent a lifetime believing you operate, and you trust that he'll hand them all back.
I've watched people do this every working day for years. And I've noticed something about how they do it.
Two patients
A while back I had two patients in the same week who I still think about as a matched set.
The first was an executive type in his fifties. Ran everything in his life, and tried to run my operating room too. He wanted to negotiate the timing of the drugs. He asked if he could keep his phone "until the last possible second."
He told me, genuinely, not joking, that he was going to "try to stay awake a little longer than most people" as if unconsciousness were a deal he could work.
His blood pressure on the monitor looked like a mountain range.
The second was a retired farmer in his eighties, in for something bigger and riskier. When I finished explaining what was about to happen, he nodded once and said, "Son, I've been getting up before the sun for sixty years and the sun never once asked my opinion. You do your job. I'll do the sleeping."
Out by ninety-seven. Vitals like a calm lake.
Same surrender. Two completely different prices paid for it.
The part I didn't expect
Here's where the story turns on me, because for a long time I told it smugly, from the head of the bed, the one place in the room where I am in control.
Then one night it occurred to me that outside those doors, I'm the executive.
I white-knuckle things I have no vote in. My kids' choices as they get older. Other drivers. The schedule. Whether the thing I'm worried about at 2 a.m. happens or doesn't.
I run mental negotiations with outcomes that were never negotiable, exactly like a man asking to keep his phone until the last possible second.
And my job, of all jobs, should have taught me better. Because the secret an anesthesiologist learns early is this: even at the head of the bed, with every drug and every monitor, I control far less than it looks like.
Bodies do what bodies do. Surprises come. The actual skill of my profession was never control. It's staying calm and useful inside of uncertainty, preparing hard for what I can influence, and holding steady through what I can't.
The farmer figured that out in a field decades before I figured it out in an OR.
Control was never really on the menu. The only thing on the menu is how you hold yourself while things happen.
Where the peace actually comes from
I want to be precise here, because "let go of control" is one of those phrases that's been hugged to death.
The farmer wasn't passive. He'd worked land his whole life: a lifetime of fixing what could be fixed, patching what could be patched, and getting up the next morning regardless.
His calm wasn't resignation. It was accuracy. He had a lifetime of practice at telling the difference between his job and the sun's job, and he wasn't going to waste his last minutes awake doing the sun's job for it.
The executive's suffering came from the opposite place: an inaccurate map. He believed his vigilance was load-bearing, that his grip on things was the thing holding them up. So handing over the grip felt like the building might fall.
The building was never resting on his grip. It isn't resting on yours, either.
I think about the two of them now when I feel my own knuckles going white, over a delayed case, a teenager's attitude, a future I'm trying to pre-live from bed.
I ask myself the farmer's question, which I've adopted with the seriousness of a prescription: Is this my job, or the sun's job? Prepare like a professional for my part. Then let the count run out on the rest.
The bottom line
I don't want to oversell serenity, because I haven't achieved it, and because some fear of losing control is just love wearing a disguise. You grip hardest on the things that matter most, and I won't pretend that's a flaw.
But here's what thousands of inductions have taught me. Every single day, ordinary people, anxious, controlling, terrified people, successfully surrender everything for a few hours, and wake up fine on the other side.
The capacity is in all of us. Most of us just save it for the operating room, when the truth is we need a working version of it every single day, for all the smaller anesthetics of life: the outcomes we can't run, the people we can't steer, the futures we can't pre-approve.
You will spend your whole life handing things over. The only choice you actually get is whether you do it like the executive or like the farmer.
So here's my question for you this week: What's the thing you're currently gripping that was never actually your job to hold up?
Reply and tell me. I can't write back to everyone, but I read every single one.
That's all for this week.
See you next Saturday.