What keeps you up at night?

What do you fear? In your quiet moments.


In ancient Rome, when the conquering generals would return to Rome following their victory in battles, they would typically be in a chariot, which was a ritual procession, the highest honor bestowed upon a general in the ancient Roman republic. This was the summit of the career of a Roman aristocrat and the opportunity for the general to tell his story of victory.


Crouching unseen in the chariot was a slave who would whisper into the victorious general’s ear: Memento mori (translated as “remember you will die”). Meaning: Despite the greatness of your achievement, this will end.


We humans are hard-wired to air our fears and share our stories. This point came home at a recent dinner with two colleagues whom we had not met for several months as COVID was surging. Each had a need to share with us their professional and personal challenges, how they dealt with life as it unfolded. Maybe you are finding yourself hungry for face-to-face time once again. Here is my story.


The Unexpected Guest


On a gray, bitterly cold April morning, yes, this is Minnesota, our two dogs, Stevie and McKenna, were with me when we heard a polite knock on the door. Our remodeling carpenter stopped by to finish up some work. I remarked that he was a magician, an artist who took pride in his profession and was a joy with whom to work.


As he was finishing up, I wished him a good day and was curious about his world.

I asked, “This must be stressful work. What keeps you up at night? What is your biggest concern in this business?”


He was dumbfounded because no one had ever raised this question. He then explained that his biggest concern would be to disappoint his clients. There was no comment about lost revenue, no comment about the finances of the business, but a sense of sadness that his clients would not be satisfied.


But then he shared something profound: “I worry what my kids . . . what they think about me.”


We each then talked about adult children, how their world is very different from that of us baby boomer parents. And how we need to be respectful of each other’s position and to recognize that the world of the parent is very different from that of the adult children.


Curiosity about the Human Spirit


I have occasionally asked friends and others (and some of my patients) what keeps them up at night. I have a natural curiosity about the human spirit. And their responses, like that of our carpenter, provide a snapshot of the human soul.


One prominent businessman now in his late sixties grew up on a farm in the upper Midwest, earned a bachelor’s degree at a state college, bought a failing farm, and turned around and sold it for a hefty profit. He parlayed those finances into a series of businesses and became a wealthy “simple country boy.”


We met at a fundraiser golf tournament and I asked what kept him up at night. In so many words, he disclosed that he was not a financial wizard. His investments were by gut feeling, intuition, “seat of the pants,” and not based on some algorithm by a Wall Street analyst. He was generally fearful if people found out that his success was essentially a roll of the dice.


Dr. W, an iconic surgeon who speculated that with careful technique cancers could be teased out of the liver and perhaps these patients would live longer than without surgery. The liver had been viewed as the “seat of the soul” and should not be violated by the surgeon’s scalpel. Dr. W had a quiet confidence, a reserved swagger, that said, “Yes I can do this,” in a field where others had not.


And he became world renowned for his expertise. What kept him up at night? The reality that the cases that he initially operated on were straightforward. He was now expected to be the miracle worker, to resurrect complex patients with multiple medical conditions. The complications increased, our surgeon lost his confidence, and he gently bowed out of the operating theater.


A scenario familiar to me from high school. My friend “Billy” had a growth spurt and a weight gain ahead of the other players. He became the master of the turnaround jump shot. With his back to the basket, he would receive the ball from one of the guards, take a step away from the basket, pivot, shoot, and drain the shot. He was unstoppable.


What kept him up at night? He knew that he was a one-trick pony. Other teams realized that his shot was the same, he was easily defended, and his career came to an unceremonious closure.


Of Tigers and Fears


I became acquainted with Siegfried and Roy, two performers who were the first of the big shows in Vegas, Masters of the Impossible. Backstage, I asked what kept them up at night: The palpable fear that a 600-pound tiger might lose his focus and create mayhem on the stage. Their worst fears were realized.


Here’s a familiar story. A super-star golfer leaves college in his junior year. Told by everyone that he “cannot miss” and he is destined for the PGA tour where he would be among the top 125 golfers in the world. The difference between #1 and #125 is about one stroke a round.


During his first couple of tournaments, his competitors were in awe, he had the touch of a sorcerer around the greens. Wins major tournaments within the first two years. But what keeps him up at night? The recognition from history that present performance, as in stocks, does not predict future performance. He lost that confidence, lost his panache and drifted into the nether world of those who had great promise but for some reason could not hold it all together.


My friend, the pilot of a sophisticated passenger airliner, with thirty years of flying experience. There is no situation that he has not seen and handled from the flight deck. His fearful night? “There but for the grace of God go I.” He questions an experienced flight crew with a full complement of passengers aboard, ideal weather, picture perfect takeoff—then the plane falls into the apocalypse. Unexpectedly. A vertical plummet into a mountain. No survivors. That’s what keeps your airline pilot up at night.


What keeps me up at night?


It’s relatively easy to paraphrase the nightmares in the anxieties of others but when we turn the lens on our cells, there is an element of self-disclosure and an element of vulnerability. But in the interest of literary honesty, here goes.


I have been blessed in myriad dimensions. A wonderful spouse, three adult children, two grandchildren—each with their own issues, but at the end of the day there is a respect and a supportive culture among us. Professionally, a career that some have called transcendent and iconic at one of the premier medical institutions in the world.


But during those quiet reflective moments such as on a cold, windy and rainy April in the upper Midwest when I am the only one home, there is that nagging angst, that existential uneasiness that the gift to write reasonably intelligibly, the gift to stand before thousands in an audience as an “entertainer,” the gift to play the piano somewhat clumsily may evaporate.


What if I awake some morning and that confidence, that reserved swagger, that quiet voice that says, “Yes, I can do this”—what if all these things disappear as if taken away by some vengeful god. Have I seen this happen to others? Absolutely.


Several months ago, while playing “My Way” on the magnificent piano in the lobby of our medical institution, I was stunned by a gentleman standing by my right shoulder and singing the words to the song. I had never heard such energy, such power, such vocal presence.


As we finished up the lyrics, I turned around and what did I see?


A gentleman in his forties who bore the look of a hard life: multiple facial scars, a nose that had been broken and poorly set, tobacco-stained fingers, a shirt missing three buttons, and the aura of alcoholism and a life of poor choices and decisions.


Without exaggeration he shared with me that he was destined for the Big Time, the Big Stage and then the wheels came off because of alcoholism. His parting words: “Doc, can you give me a couple of bucks for a bus ticket to get back to Chicago?”


This reminded me of the mythical “boulevard of broken dreams,” which certainly can be the final resting place for any one of us. As John Greenleaf Whittier eloquently stated, “For all sad words of tongue and pen, The saddest are these, ‘It might have been.’”


Bottom line: We have a need to tell our story. A hidden servant whispering in our ear about reality. We have a need to be acknowledged and recognized. We have a need for someone to listen. No judgment, no critique, no interruptions. Just be present.


We can do our homework. We can be prepared, but at the end of the day, situations will arise over which we have no control. So, we show up, we suit up, and we give life our best shot.



Unsplash image, David Brooke Martin.


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