Suitcases, Constraints, and Where Possibility Lives

Last week, I wrote about a familiar moment in medicine: when you’ve used every skillful form of influence you have (data, stories, coalitions, reframing) and nothing moves. When effort stops matching outcome, (high importance, low control, and your influence stalls), there are a few ways forward. Last week, we discussed redefining success.

This week, I'll highlight something else.

A small moment brought it into focus. I had to pack for an important grant announcement in Chicago, with a stop in Central Washington for Thanksgiving. Different airlines, tight turnarounds, and the need to step off the plane and head straight into meetings meant one thing: carry-on only.

I wanted to pack more. (Chicago- windy, snowy, cold, formal setting). I needed to pack more. But no amount of wishing it were different was going to shrink my boots. And trust me, I have no influence with the airlines, even as much as I travel. Arguing my case to the airline for a bigger bag was, literally and figuratively, not going to fly.

It wasn’t a problem to solve. It was a constraint to navigate.

At some point the question shifted from “How do I make this work?” to “Given the fixed limits of this carry on, what’s the next-best combination I can take?”

That shift, the one Edith Eger describes as moving from “Why me?” to “What now?” opens just enough space to see possibility again and gives a bit of ease.

And that’s the heart of inside-the-box problem-solving. https://www.youtube.com/watch?v=dxFoae8Or5A&list=PLZWrCbJ7Bukuwek8D2y-6QAyGFAiuiB9a&index=8

Where This Shows Up in Medicine

Years ago, when we were helping launch a start-up indigent care clinic in Florida, we hit a set of constraints we absolutely could not influence:

Volunteers needed malpractice coverage. Insurers weren’t extending physicians' private policies to this type of setting. We didn’t have the budget to buy coverage. And asking volunteers to purchase another policy wasn’t reasonable, they were already giving so much.

The community needed the clinic. Patients were falling through the cracks. The barrier was real. And none of the usual strategies were workable.

It would have been easy, and understandable, to walk away and assume the idea wasn’t feasible after all.

But instead we shifted the question:

“Given the fixed constraints, what option already exists that we haven’t considered?”

We didn’t invent a new insurance product. We didn’t dismantle policy barriers.

Our State DOH liaison simply knew the corners of the box better than we did. She uncovered a state statute, helped us enroll as official volunteers, and that step made the providers in the clinic eligible for Federal Tort Claims Act coverage.

Same constraints. Same box. New pathway.

That one reframed question made the entire clinic possible.

And today, over 22 years later, that clinic provides millions of dollars in free medical and dental care each year to individuals who still fall through the cracks despite the ACA, powered by hundreds of volunteers serving more than 2,000 patients annually. The long-term impact is far bigger than anything we imagined in those early conversations.

All because someone we committed to thinking inside the box, and one uncovered where possibility lived in there.

Why This Matters When Influence Has Stalled

Inside-the-box problem-solving isn’t resignation. It’s not giving up on bigger change. It’s the step that often keeps people grounded, resourced, and effective while the larger systems stay immovable.

It helps us ask:

• What are the real, non-negotiable constraints in front of me?
• Within those constraints, what pathways already exist that I haven’t considered?
• Who may know the “edges of the box” better than I do?
• What becomes possible when I stop fighting the limits and start navigating them?

This is where creativity lives when the room to maneuver is small. It’s also where energy gets preserved instead of drained.

And for many physicians and leaders, this is the move that keeps them oriented toward impact rather than burnout.

Reflection Questions

1. What are the fixed constraints in the situation you’re facing right now, the ones you didn’t choose and cannot change?
2. Inside those constraints, what existing resource, structure, or pathway have you not considered? (Remember, I always say - if you point your brain in the direction you want it to go and get out of it's way, it'll often find new answers).
3. Who might know the box better than you do and what would you learn if you asked?

I'd love to here what you uncover. We will continue this series next week.