Here is the full transcript of neurosurgeon Alex Spiotta’s talk titled “Flow State: Taking Your Team To The Ultimate Level of Performance” at TEDxCharleston 2023 conference.
Listen to the audio version here:
TRANSCRIPT:
A Life-Changing Experience
Haley was just 20 years old, 20, at the prime of her life, when her boyfriend pulled over to the side of the road, pulled out his gun, pressed it right here, and shot her. He then pushed her out of the car and sped off. She’d been left for dead. Hours later, she was found and brought to my hospital.
This is the image that came across my phone at 2 in the morning. This is a CAT scan of her brain. That white diagonal band is the path of the bullet filled with blood, going from one side and crossing to the other. It was also this time that I was notified that Haley was pregnant.
So now I have to think about two lives. I thought about what could be done, what were the chances, and I came to this conclusion. Haley had just 5% chance of surviving, and she had 1%, only 1% chance of surviving well enough to have a meaningful life and maybe enjoy life with her baby, if the baby also were to make it. 1%.
But it was not zero. It was not zero. At that moment, I flipped a switch. I got in the car.
Coordinating the Team
I started calling all the various teams required to coordinate her care. I walked into the OR. The team was getting ready, but among the hustle and bustle, I could also sense some nervousness, apprehension. They may not have known all the details I knew, but they heard it was bad.
I got the team together and I said, “Today we have the opportunity to do something extraordinary. Today we’re going to save two lives.” I then stepped up to each of my teammates and I said, “Will, give me your best. I will give you my best.”
“We can do this.” I said, “Damien, give me your best. I will give you my best. We will do this.” But it wasn’t going to be easy. We had to repair the major artery of the brain that had been transected by the bullet, stop the bleeding, remove parts of damaged brain, and create room for the swelling that would take place. There were so many steps and we had to be perfect at every step. Perfect at every step.
Entering the Flow State
And for the next six hours, which went like that, for my team and I, nothing else in the universe existed other than the task of trying to help Haley and her baby. And every decision, every maneuver flowed seamlessly from one to the next. And even boundaries between individual teammates blurred. We had truly become one unit with this singular mission, Haley and her baby.
What is this experience I’m referring to? Some people call it being in the zone, in the moment, locked in. It’s called flow state. It’s an altered level of consciousness that unlocks peak human performance. And I believe and I’ll show that you can achieve it at a team level, team flow.
There are conditions that are right for flow state to take place. Consider increasing difficulty or challenge of the task, what you’re trying to do with your skill of preparation. If your preparation is very high and the challenge is low, you’re just bored. You’re not that into it. On the other hand, if the challenge is very high, your preparation is low, you’re in over your head and you know it. You’re stressed and you’re anxious. Flow can take place when there’s a matching between the challenge and the preparation.
And then you can enter what’s called the flow zone. Now there’s one very, very critical ingredient must be added in to the equation. The job you’re trying to accomplish must have meaning or impact to you. That could be for your own survival, for example.
It could be something for your child. In this case, my team and I, it was Haley and her baby. And what I’m most interested in what happens when you take peak preparation and peak challenge and merge those together. And then you have what I call amazing.
We can do extraordinary things on a regular basis. Flow state is the most remarkable state of the human mind. On the one hand, it’s a state of arousal, heightened sense of awareness, focus. Some senses are sharpened, others you don’t need are dulled. Explained by the neurochemical norepinephrine, think of adrenaline.
On the other hand, it’s a state of relaxation. Measure your heart rate, your breathing is slowed. Explained by the neurochemical serotonin, which acts like a tranquilizer.
The Brain During Flow
Time flies by like the six hours of Haley. Yet at other key moments, things appear to be in slow motion as your brain is processing more rapidly. Think of the quarterback scanning the field. The players are flying all across the field.
For the quarterback, things are in slow motion. He can easily pick out his target. Flow is a time of peak effort, yet the entire time feels effortless. And while you’re working and producing at your highest, it’s also a time of utter happiness. Explained by the neurochemical dopamine, which is involved in the reward centers of the brain.
This very unique combination of arousal, relaxation, and reward allows you to maintain flow state for hours if needed. There are two other amazing things that happen to your brain during flow. The first is your prefrontal cortex, which resides right behind your forehead here, is turned off. This part of the brain is extremely advantageous in every other walk of life except flow. This part of the brain helps with long-term strategic planning, thinking about options with consequences. But it has a dark side. It leads to your inner voice, which leads to your self-doubts, your insecurities.
Entering the Subconscious
What if we fail?
Think of a basketball player who’s fouled and must make the last shot to win the game. All that player wants to do is step up to the line, go through the routine, and not think about it, and sink the shot, which is easy when you’re on your own. If you’re the opposing coach, you’re going to call a timeout, make them think about that shot for three minutes.
Now when they step up to the line, that shot just became a lot harder. They’re thinking about, “What if I miss?” During flow, this part of the brain is turned off, and it unburdens you, unshackles you to perform at your highest without self-doubt and insecurities. The second amazing thing that happens to your brain is you enter a subconscious condition.
If we were to measure all of our electrical activity here, you’d all be awake and alert, I hope, and it would be very active waves. If you’re in deep sleep, it’s an inactive low wave. In between those two is the transition to subconscious condition. And this is the same electrical activity you can measure in a Tibetan monk during deep meditation, us lightly sleeping, and importantly, us with our eyes closed, rehearsing.
So mental imagery. With an appreciation and understanding of flow, we can enhance our entry and maintenance of flow. Rituals help. Here’s mine.
Rituals and Removing Distractions
I’m outside the OR, I’m scrubbing into surgery. Something I’ve done thousands of times, takes about three or four minutes. I can do it from muscle memory. I’m doing two critical things here.
One is I’m doing the surgery in my mind. I’m rehearsing the operation. Number two, I’m scrubbing away any distractions. Nothing in the universe exists other than what we’re trying to accomplish. My phone is literally always on me outside the shower, by the pool, birthday parties. These three minutes, it is in the room. I am untouchable. This is sacred time.
By removing distractions and rehearsing, I’m changing the electrical activity in my brain to enter the subconscious, and now I’m entering this flow zone where I can remain for hours if needed. These are the same strategies you can employ when you’re trying to complete a long-distance event, an endurance event, like an Ironman triathlon. Here I’m pictured coming through the finish line at the North Carolina Ironman 70.3. You can see I’m smiling, having just swam 1.2 miles in the ocean, biked 56 miles, and ran 13.1.
Functioning as a Team
I was able to enter and maintain flow. Those six hours went like that, just like Haley’s operation, and that can be the difference between having an enjoyable time and a horrible time, and I’ve had a couple of those too. But life is rarely, if ever, an individual sport. We almost always function in teams.
You can’t perform at your peak if the people right next to you are not right there with you. It doesn’t have to be a neurosurgery unit or a work unit, family units. My wife and I have four children. You better believe if we’re not working and flowing together, we’re going to be struggling.
So the skill of the superior leader and the challenge of the superior leader thus becomes how to bring others, as I call it, into your fold, under your umbrella of flow state. Here’s a selfie I took with three of my students after running a three or four mile run outside the hospital. Looks like I still got my scrub top on. These students are graduated doctors who, over seven years, are trying to become neurosurgeons.
You might ask, what does this have to do with our job in the hospital taking care of patients? It has everything to do with it, because we have to get to know our teammates. What are their strengths, their weaknesses, where are their breaking points? Anticipate their crisis points before they take place.
During a procedure, I may have to reach out to someone and say, “We’re good. You can slow down.” To someone else, I may have to say, “We need to speed up. I need to see more of a sense of urgency.”
“We need to turn things around.” Right before a critical portion of a surgery when I can feel the room tensing, I take a two-second pause. I lock eyes with all my teammates and I make physical contact. I extend a fist pound to all of them.
I’m telling them two things. Number one, we got this. Number two, more importantly, I have your back. Just give me your best. I will give you mine. I do not want them to start thinking about “What if we fail?” This picture here shows trust. And this team is my wolf pack.
The strength of the wolf is the pack. The strength of the pack is the wolf. So if you want to lead your team to do extraordinary things on a regular basis, listen carefully right now. At the individual level, you’re the leader.
Preparation and Focus
Preparation. There’s no shortcut to being ready to meet the challenge of the day. Put in the work. Focus. Remove distractions. That’s a precondition to all of this. Rehearse, then rehearse again. I show the importance of rituals, routines, into that self-conscious condition.
The concept of flipping the switch. Sometimes you must do it very quickly. Think of a police officer, fireman responding a call. In my case, it was Haley at 2 in the morning. At the team level, provide context. Provide that meaning or impact, that special ingredient. That day with Haley wasn’t just another surgery. I told the team she’d been left for dead on the side of the road and almost left for dead by the team before us.
Building Trust and Achieving Team Flow
But now she was in our hands. Set the tone. “Today we’re saving two lives.” Know your teammates. Invest the time and gain to know them so you can anticipate when they’re struggling and be able to reach out to them individualized. Most importantly, build that mutual trust. And that takes time and effort. And connect and reconnect throughout so you can bring them under your flow and then you can achieve team flow.
Are you wondering how Haley’s doing? Proud to say, for us on that day, Haley was our inspiration. She was our amazing on that day. And Haley’s here today. Haley, you’re a fighter. She’s a survivor. She’s an advocate against domestic abuse. She’s also a mom. And she’s here as a living example of the extraordinary things you can accomplish when you can lead your team and achieve team flow.