Snapshot · The School of Greatness
The iRISE protocol — Identify, Reject first impulse, Inventory alternatives, Stabilize and re-Evaluate — is McLaughlin's systematic framework for managing black swan moments in surgery and life.
Where this was said
At 6:55 · chapter starts 4:25
Lewis presses McLaughlin on how surgeons prepare for worst-case scenarios without spiraling into rumination. McLaughlin's answer is rooted in volume: where Anders Ericsson said 10,000 hours makes an expert, neurosurgery requires 50,000 hours of training plus another 50,000 of career practice. He brings out his kerrison rongeur — a bone-biting instrument he estimates closing 2 million times — to make a physical point about focus: every single bite demands total present-moment attention, because a millimeter of inattention can turn bone removal into nerve damage. His rule for West Point cadets crystallizes the principle: 'If you're casual, you create a casualty.'
McLaughlin has closed his kerrison rongeur bone-biting instrument an estimated 2 million times, requiring total focus on every single bite to avoid damaging a nerve.
When everything goes wrong mid-surgery, the worst thing you can do is what feels natural. McLaughlin's iRISE protocol — Identify, Reject first impulse, Inventory alternatives, Stabilize, re-Evaluate — is a replicable framework for any high-stakes crisis.
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