No Oxygen, A Dying Patient, and the One Detail Everyone Missed
Books that changed my thinking, behaviors, and life
Hello,
During my first year as an attending emergency physician at Detroit Receiving Hospital, I learned something critical: panic is loud, but clarity whispers.
It was just another shift—until it wasn’t.
A patient lay before us in the resuscitation bay, sedated and paralyzed, ready for intubation. Everything was textbook. The resident moved into position, laryngoscope in hand, trying to identify the vocal cords. A few seconds go by, then almost a minute. He was struggling.
Then the patient’s oxygen started dropping.
95%.
90%.
85%.
I felt the shift in the room. That unspoken change in energy when control starts slipping through your fingers. The steady hum of organized chaos was unraveling, thread by thread.
I told the resident to stop and bag the patient—get the oxygen level back up. We had time. Or at least, we thought we did.
84%.
83%.
82%.
The oxygen level kept dropping.
81%. 80%.
Something was wrong.
The resident was bagging perfectly. Seal was tight. Chest was rising. There was no trauma to explain this. The nurses glanced at me. The other residents looked nervous. This was the moment. The moment when all eyes land on you, when you’re supposed to have the answer.
79%.
78%.
Panic, I’ve learned, is like a virus. It spreads fast. It feeds off uncertainty. And the worst thing you can do when things are unraveling is add to the chaos.
I took a breath. Then I heard the voice of one of my mentors, Dr. Robert Hoffman: When things go south, check the basics first.
I forced myself to step back—not physically, but mentally. To speed up, I had to slow everything down. The solution couldn’t be complicated. It had to be right in front of us.
And it was.
The bag-valve-mask used to deliver oxygen to patients is connected to tubing. That tubing then connects to an oxygen source. It’s one of the simplest things we do in hospitals. But in this case, it was the very thing causing the problem. Someone had connected the bag tubing to the wrong valve.
The green valve delivers oxygen. The yellow valve delivers room air.
I traced the tubing from the oxygen mask to the source. It was connected to the yellow valve.
I felt the weight lift instantly. “Hey, we’re bagging with room air. Switch the tube to the oxygen outflow.”
The resident’s eyes widened. He turned, made the swap, and within seconds, the numbers started climbing.
85%.
90%.
100%.
Crisis over. The resident intubated successfully on the second attempt. No harm done—except maybe to my blood pressure.
That moment stuck with me.
Because this wasn’t just about a misplaced tube connection—it was about how easily we overlook the obvious, especially in moments of stress. When things go wrong, our instinct is to jump to complex solutions, to troubleshoot the big picture. But more often than not, the solution isn’t complicated. It’s something simple, something fundamental, something we take for granted.
We think our exhaustion means we need a biohacking routine when really, we just need more sleep. We assume we’re stuck in a rut and need a career change when maybe, we just need to log off social media and focus on the work in front of us. We believe our relationships need elaborate interventions when sometimes, they just need our genuine, undivided attention.
We chase complexity when the solution is almost always simpler than we think. The fundamentals matter. They matter in medicine, they matter in life, and they matter when everything is on the line.
Consider this: what if the answer isn’t out there somewhere, waiting to be discovered? What if it’s right in front of you—something simple, something foundational, something you’ve overlooked?
Before you chase complexity, check your connection. The solution might not be a radical change.
It might be as simple as making sure you’re breathing the right air.
Welcome to this week’s Three Book Thursday.
1. Decision making
Nudge: Improving Decisions About Health, Wealth, and Happiness
Summary
In our daily lives, we often believe we’re making choices based solely on our own free will. In Nudge, Thaler and Sunstein break down something so simple yet so powerful: the way choices are presented to us matters just as much as the choices themselves. We like to believe we’re logical, rational beings, carefully weighing options and making smart decisions. But the truth? We’re creatures of habit, influenced by defaults, subtle cues, and tiny bits of friction we don’t even notice.
Thaler and Sunstein explore the dichotomy between our two modes of thinking: the rapid, instinctual “Automatic System” and the deliberate, analytical “Reflective System.” Understanding this interplay is crucial. Recognizing when we’re on autopilot versus when we’re engaging in reflective thought can profoundly impact our decision-making processes.
Take something as simple as retirement savings. In companies where employees have to sign up for a 401(k), participation is low. But in companies where enrollment is automatic unless you opt out, the numbers skyrocket. The difference isn’t the options—it’s the design. The same principle applies everywhere. Countries that make organ donation the default save more lives. Cafeterias that put healthy food at eye level see better eating habits. Even Google, a company built on data, realized that putting lids on candy jars led to employees eating significantly fewer sweets.
That’s what makes this book so compelling. It’s not about forcing better decisions—it’s about designing choices so that the best option is the easiest one.
Want to read more? Leave a book on your nightstand instead of your phone. Trying to drink more water? Keep a glass within reach. Hoping to cut down on mindless scrolling? Move social media apps off your home screen.
The biggest lesson? Change doesn’t have to be a battle. You don’t need to rely on willpower or some massive act of self-control. More often than not, the key to making better choices isn’t about trying harder—it’s about making the right path the path of least resistance.
Favorite Quote, Insight, & Principle
Quote: “A good way to increase people's fear of a bad outcome is to remind them of a related incident in which things went wrong; a good way to increase people's confidence is to remind them of a similar situation in which everything worked out for the best..”
Insight: If you are a doctor and must describe the alternative treatments available to a patient, you are a choice architect.
Principle: Meetings that occur every week are easier to remember than those that occur every other week.
Author: Richard Thaler and Cass Sunstein
Themes: Decision making, Human psychology, Running a business, Marketing
2. Biography
Buffett: The Making of an American Capitalist
Summary
If there’s only one person to study when it comes to finance, decision-making, and the long game of life, it’s Warren Buffett. I’ve been a serious Buffett fan for years—not just for his investing genius but for the way he thinks. His ability to cut through noise, to see what truly matters, and to play the game on his own terms is something I deeply admire. And at 94, he’s still shaping the conversation, still influencing markets, still proving that wisdom, discipline, and patience will always outlast hype.
Roger Lowenstein’s Buffett: The Making of an American Capitalist is the book that gets closest to understanding how Buffett became, well, Buffett. It’s not just about his billions—it’s about his mindset, his principles, and the way he systematically built his empire. The book takes you inside his early years, his obsession with numbers, his mentorship under Benjamin Graham, and how he evolved from a strict value investor to something even more formidable: a business owner who sees stocks not as tickers on a screen, but as living, breathing companies with stories, leadership, and long-term potential.
What struck me most is how Buffett has always played a different game than everyone else. While others chase trends, he chases value. While others panic, he stays rational. While others overcomplicate, he simplifies. His entire approach is built on patience, on letting compounding do the heavy lifting, on understanding that time is the most powerful force in wealth-building—not timing.
And that lesson extends beyond investing. Buffett’s life is a study in disciplined decision-making, in cutting out distractions, in focusing on what actually moves the needle. He’s famous for saying, The difference between successful people and really successful people is that really successful people say no to almost everything. He understood long before most that the hardest choices in life aren’t between good and bad—they’re between good and great.
This book isn’t just about stocks. It’s about clarity. About trusting your process. About playing the long game in a world addicted to shortcuts.
Favorite Quote, Insight, & Principle
Quote: “You won't encounter much traffic taking the high road in Wall Street.”
Quote: “It takes twenty years to build a reputation and five minutes to ruin it. If you think about that, you'll do things differently.”
Insight: Buffett's genius was largely a genius of character–of patience, discipline, and rationality.
Principle: His talent sprang from his unrivaled independence of mind and ability to focus on his work and shut out the world.
Author: Roger Lowenstein
Themes: Biography, Investing, Personal finance
3. Patient care
Incidental Findings: Lessons from My Patients in the Art of Medicine
Summary
Incidental Findings: Lessons from My Patients in the Art of Medicine hits a little closer to home for me. Danielle Ofri writes from Bellevue Hospital—the same place where I trained, where I learned how to be a doctor, where I saw medicine in its rawest form. Bellevue isn’t just a hospital; it’s an institution, a place where every imaginable human experience converges. And in this book, Ofri captures the weight of that experience with honesty, humility, and an unflinching look at what it really means to care for people.
What makes Incidental Findings so powerful is that it’s not about the medicine—it’s about the moments between the medicine. The conversations at the bedside. The hesitation in a patient’s voice. The quiet doubts that creep in after a tough case. Ofri writes not as an expert handing down wisdom, but as a doctor still learning, still questioning, still being shaped by every patient she encounters.
That’s what makes this book resonate beyond medicine. Because in any field—whether you’re leading a business, raising a family, or just navigating the chaos of life—the real work is in those in-between moments. The ones where you don’t have a perfect answer, where you have to make a decision despite uncertainty, where you have to show up fully even when you’re not sure you’re ready.
Bellevue has a way of teaching you that medicine isn’t just about fixing things. It’s about bearing witness. About standing in the discomfort of not knowing. About understanding that presence is sometimes more powerful than action.
Incidental Findings is a reminder that the best lessons don’t come from textbooks. They come from experience, from failure, from the willingness to admit you don’t have all the answers. And most importantly, they come from the people right in front of you—if you take the time to listen.
Favorite Quote, Insight, & Principle
Quote: “Medicine at its core is about relationships—the ones we build with our patients, with our colleagues, and ultimately with ourselves.”
Insight: There is a vulnerability that comes with putting on the white coat, one that is rarely acknowledged but deeply felt—the fear of not knowing enough, of making a mistake, of failing those who have placed their trust in us.
Principle: Medicine is fundamentally a human endeavor. Despite all of our technological advances, it is still a person caring for a person.
Author: Danielle Ofri
Themes: Patient care, Residency training, Medical school
There’s a moment in every crisis where the noise peaks—when stress, fear, and urgency collide, and everything feels like it’s spiraling out of control. It’s in those moments that our instincts push us toward action, toward doing more, toward searching for a complex fix. But as this week’s stories reveal, the most effective response isn’t to rush forward—it’s to step back, breathe, and check the basics.
That’s what saved my patient when his oxygen levels plummeted. It wasn’t some extraordinary medical maneuver. It wasn’t cutting-edge technology or a high-stakes intervention. It was catching a simple mistake—one that had been hiding in plain sight. When the pressure was on, the right move wasn’t to panic or overcomplicate—it was to return to first principles.
And that’s a lesson that stretches far beyond medicine.
Nudge shows us that small, simple shifts in how choices are structured—defaults, environments, nudges—make a greater impact than sheer willpower. Buffett reminds us that success isn’t built on chasing trends but on discipline, patience, and filtering out the noise. Incidental Findings reveals that the heart of medicine—and of life—is in the small, everyday moments of human connection, not in grand gestures or heroic efforts.
The theme is clear: when faced with complexity, don’t look for bigger solutions. Look for better fundamentals.
Feeling overwhelmed? Maybe the answer isn’t a complete life overhaul—it’s fixing your sleep, turning off notifications, or simply stepping outside for some air. Struggling with a big decision? Maybe the solution isn’t another round of analysis—it’s getting quiet enough to hear your own instincts. Stuck in a rut? Before assuming you need a drastic change, ask yourself: have I mastered the basics?
The hardest moments in life don’t always require extraordinary solutions. They require clarity. And clarity begins by stripping things back, simplifying, and making sure—before anything else—that you’re breathing the right air.
Always ❤️📚💡
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Loved this one Adam!