When Difficult Gets Interesting

I was recently talking with a leader who had navigated a complex, high-stakes situation. We discussed the stress she had experienced. I asked if in the midst of it, she had also felt energized by the challenge. I saw a little twinkle in her eye as she said, “a little.”

And so, no surprise, that got me thinking about people I've known who, even during extraordinarily difficult circumstances, find energy and satisfaction in solving complex problems. Of course they don’t enjoy the circumstances themselves and wish they didn’t have to face them. But they do enjoy the problem-solving aspect.

It reminded me of Kelly McGonigal's book, The Upside of Stress, and her discussion of how our bodies can respond differently to stress. Most of the time, many of us go into fight or flight. When we perceive a threat, the sympathetic nervous system activates, adrenaline and cortisol kick in, and we're primed to respond.

But we have access to a couple other neuroendocrine responses – the challenge response, and the tend and befriend response. Today, I’m focused on the first. When we appraise a demanding situation as one we have the capacity to meet, rather than a threat that may overwhelm us, the balance of neuroendocrine and physiologic responses is different.

The balance of cortisol to adrenaline, and DHEA is different. DHEA is associated with adaptation and recovery; and emerging work suggests dopamine may play a role in motivation and cognitive flexibility under stress. The key idea is that how we interpret stressful situations can influence physiological responses. Cardiovascular research has demonstrated distinct patterns, with greater cardiac output and lower vascular resistance during challenge, compared to threat.

We don't pick the circumstances, but we can choose to reframe them and approach them as problems we can work through. That choice can shift how it feels. And even the knowledge that the stress-physiologic response is helpful –  priming us to respond well – builds our belief in our capacity to strategize and problem solve.

I’ve seen that shift from threat to challenge over the years.

I once worked with an attending physician who was feeling overwhelmed by having to teach while in the midst of the higher acuity of patients on inpatient service. They questioned whether they were up to the responsibility. Every new admission and resident interaction seemed to reinforce that uncertainty.

They talked about how their heartrate would go up the minute they walked in the hospital. And how they kept playing the soundtrack of “What’s going to happen today? Maybe I’m not the right person to be here,” in their head.

As we talked, they began to see the situation differently. Their racing heart and nervous sensations weren't necessarily signs that they couldn't handle the work. They were signs of heightened alertness preparing them to respond. The patients weren't any less sick... They started reframing these as multiple challenges and a sort of prioritization puzzle. They looked at their resources – including the boost their stress response gave. That allowed them instead of focusing on whether they were the right person, to approach the challenge, knowing they could draw on their clinical knowledge and experience, involving specialists, look things up, and lead their team. Inpatient went from a source of dread, to a place where they were “nervous-cited” and enjoyed modeling for their residents how to accept discomfort, figure things out and utilize resources effectively.

I've seen a similar perspective modeled in residency leadership. During COVID, a program director I knew was responsible for incident command. Every decision involved competing priorities: protecting patients, keeping residents and faculty safe, maintaining educational quality, and making sure patients continued to receive care. The circumstances were extraordinarily difficult, as we all recall, yet he had genuine satisfaction in working through complex problems, mobilizing his team, and figuring out what to do next.

Teams often come together under pressure, including residency programs navigating SOAP, and navigating new consequential priority changes and relationships with C-suite turnover. The circumstances were nothing to celebrate, but there was genuine satisfaction, team cohesion, and enjoyment in problem solving together.

When something difficult happens, our initial response defaults often to seeing it as a threat. But we can pause and decide, ‘I’m going to approach this as a challenge I can figure out.’

I've never read Marie Forleo's Everything Is Figureoutable, but I've always loved that title. I've borrowed those three words countless times in my own work. There's something empowering about approaching a daunting situation with the belief that a way forward can be found.

That doesn't change the circumstances or guarantee success, but it can change how we respond. And sometimes we may discover that we actually enjoy the challenge of figuring out what to do next.

Reflection

1. How can you see a difficult situation you’re facing as a challenge to figure out?

2. Can you recall a time when you found yourself genuinely enjoying the process of working through something difficult? What made that experience different?