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  • The Renaissance Surgeon

Activate the 'kill switch': Emotional Control in Sports and Surgery

Updated: Sep 30, 2022

Michael Jordan’s Bulls and Tom Brady’s Patriots are not in the top tier of sports dynasties? Tell me more! (Short answer: the 1974-1980 Pittsburgh Steelers and the 1956-1969 Celtics as well as the 1997-2016 San Antonio Spurs were more dominant.)


The captain

In his 2017 book, The Captain Class, Sam Walker explores the role of captains on the best sports teams in history. He started out by identifying the most freakishly successful sports dynasties in history. Having lived through some of the dynasties he studies made reading about them even more enjoyable. Of his sixteen best (‘Tier One’) teams, I can remember the World Cup victories of the USA women’s soccer in the late 1990s and the San Antonio Spurs dominance in the NBA from 1997-2016. Teams that just missed the cut are perhaps even more memorable for me: the Dallas Cowboys (1992-1995), the Aikman- and Emmitt-fueled frustration of my Philadelphia Eagles, the New England Patriots (2001-2017, but we got ya in Super Bowl LII, eh?), the Atlanta Braves (1991-2005) with whose fourteen division titles in fifteen years they were constantly (but not in ‘93!) suppressing the hopes of my beloved Philadelphia Phillies, and Michael Jordan’s Chicago Bulls (1991-1998).


This book reminded me that I should never feel sorry for Steelers fans, despite all the gripes that I hear from them. Their team is tied for the most Super Bowl victories in league history, and in Walker’s estimation, the 1974-1980 Steelers was the most dominant NFL team in history, edging out the San Francisco 49ers (1981-1995) and The New England Patriots (2001-2017), neither of which matched the feat of four Super Bowl wins in just six years.


I should also never feel sorry for Yankees fans (and never have). Yogi Berra’s Yankees won five consecutive World Series titles (1949-1953), earning them a spot in Walker’s Tier One, while the 1936-1941 and 1996-2000 versions of the Bronx Bombers also made it into Tier Two, with nine titles between them. Ironically, the man who everyone thinks of as a good captain, Derek Jeter, only won one title in twelve years as captain.


A ton of research went into building the dataset for this book. Walker considers every team sport (of five or more players playing at a time) in every country, competing at the top level of that sport, and uses the most objective and wide-ranging statistical metrics to evaluate them. Sports fans almost universally appreciate a good statistic, but one can get lost in the rabbit hole of sports stats. Walker somehow harnesses the power of sports statistics without bogging down his narrative. The book remains easy to read despite its treatment of a wealth of statistical data. (He also has a box of take-home points at the end of each chapter, so I didn’t even have to take notes while reading.) After amassing this mammoth dataset, he then set about digging into the details to try to find a common thread. That thread ended up being the captaincy, and Walker’s tug on that thread has produced an entertaining and thought-provoking read.


Stadiums fill and millions more tune in to watch elite athletes compete. We want to partake in the awe and beauty of humans capturing the upper limits of performance. Glimpsing what’s possible inspires us. The vast market for the attention of the sports-loving audience has made the sports industry ever more profitable. More than just individual achievement, however, team sports add another dimension to performance. Teams have a staying power with fan bases that eclipses affection for individual heroes. It is tantalizing to contemplate how great a team can be. At this time of year, American football teams are still ripe with possibility at the outset of the new season (the Eagles are undefeated!). Yet all fans have known the disappointment of collections of great players that did not turn out to be great teams.


Walker explores other theories about what creates dynastic teams (coaches, money, organizational culture, total team talent) and finds no consistency there. There are plenty of great teams without those resources and teams flush with them that did not produce. On the other hand, wildly successful sports dynasties almost always coincided with the presence of a captain. The end of their dominance was usually heralded by the departure of the captain.


Walker identifies seven methods of elite leaders that were common among the elite captains. These are: ‘doggedness,’ ‘playing to the edge of the rules,’ ‘leading from the back,’ ‘practical communication,’ ‘the power of non-verbal displays,’ ‘regulating emotion,’ and ‘the courage to stand apart.’


The bulk of the book consists of the exploration of these seven methods, so definitely check it out for the full treatment, but I’d like to highlight a few through my own lens. First, ‘doggedness’ – Walker notes that people tend to work harder as individuals than in groups (a phenomenon known as ‘social loafing’). The ‘antidote’ for this is the presence of one person who is clearly giving it their all on a consistent basis. This creates a performance pressure on teammates to perform up to their capabilities. I think this equates to what Angela Duckworth and modern psychologists would call ‘grit.’ This dedicated effort is the single strongest predictor of success, and Walker places it first in the list of seven methods of elite captains.


I found the chapter on practical communication to be particularly relevant as I reflected on teams I have captained. Walker notes that the sixteen elite teams he studied had vibrant, active communication within the team, but that the captains of these teams did not give rousing motivational speeches. Quite the opposite, they shunned the spotlight and were considered quiet. When I think back to my halftime talks to my soccer teams, they were brief, and not at all fiery. It couldn’t be further from the scene in the Mighty Ducks in which, inspired by Gordon Bombay’s words, the whole team and subsequently the whole stadium chanted ‘Quack, quack, quack!’


“Conventional wisdom tells us that the right words, delivered in the perfect moment, are the key to motivation. The captains in Tier One didn’t simply fail to prove this idea – they suggested that it’s patently false.”

Having never given a speech that left people roaring with motivation, I reflected that my hype-free leadership style was perhaps more of an advantage than disadvantage. (Another read that I found valuable for self-awareness of this type of personality is Susan Cain’s excellent book, Quiet: The Power of Introverts in a World That Can’t Stop Talking.) Communication can be effective without being Hollywood-ready.



‘Regulating emotion’ is another important method employed by elite captains that has special relevance for physicians and especially surgeons. People I work with in the operating room often tell me they are impressed that I don’t get upset when things go sideways. I don’t fly into a rage when someone or something appears to be doing its best to sabotage my efforts to produce the best surgical outcome for my patients. The camera that transmits the picture of the inside of someone’s joint to a viewing screen (critical, as you might imagine, for arthroscopy) might malfunction. The instrument I requested might not be in the room, or even sterile, when needed. My last case of the day could be canceled if there aren’t enough late-day staff to complete it with me.


Walker talks about the elite captains having a ‘kill switch,’ with which to shut off negative emotions as they arise. Despite the violence, I like the phrasing. Emotions are necessary and helpful. Surgeons are not robots. I still feel like my stomach drops down to the floor anytime the well-being of my patient’s life or limb appears in jeopardy. But negative thoughts and emotions don’t serve me, or my patients. No one on the operating room team wants or plans for things to go awry. We all need to simply identify the most important next step to move forward. “Cover and move.” as Jocko Willink would say. So anytime a negative thought or emotion shows up in the operating room, I activate the kill switch. (Negative thoughts, I suppose, are the only appropriate target for a kill switch in the operating room.)


Successful surgery requires a massive team effort, sending personnel ripples out much farther than most people realize. Nurses ready the patient for surgery in the preoperative holding area. Anesthesiologists and anesthetists, assisted by anesthesia techs, keep the patient safe and pain free during surgery. Operating room nurses coordinate the mechanics of the operating room flow. Scrub technicians ensure room readiness, sterility and instrument availability and functionality. Physician assistants or physicians in training assist with surgery and postoperative care. Staff in the sterile processing department sterilize surgical instruments for repeated use. Recovery room nurses guide the patient’s initial recovery. Radiographic technicians capture and transmit x-rays.


Photo: Unsplash

The list can expand on and on, depending on the needs and complexity of the case (e.g. pathology, blood transfusions, neurological monitoring, etc.). And that’s just on the day of surgery. Although there are many star performers among these groups of people, the surgeon remains in many ways the captain, having the longitudinal relationship with the patient that began outside the operating room and will continue afterwards. The surgeon is also the focal point for the purpose and goal of what’s to be accomplished by bringing the patient to the operating room at all.


I view elite performance in the operating room through many of the same lenses as elite performance on the athletic field. As important as surgical skills, training and competence undoubtedly are, the qualities of the elite captains Walker describes are a worthwhile consideration for anyone working in a surgical team. I guess I’m just more Tim Duncan than Michael Jordan.



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