I was a bit puzzled because I thought I was well aware of these facts. What I realized during the following conversation was though, that I seemingly was suffering from a delusional time perception I haven’t been fully aware of. Because apparently, all the other things I am doing or planning or about to be doing - and was telling her about - seemed to demonstrate that I had either forgotten about these facts or a serious issue with time perception.

Jobs had his reality distortion field. Musk has his. I am not them, and I don’t intend to be. But their results fascinated me enough to ask: what would it look like to build that mechanism for myself?

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But I often get asked about how I am able to do all of the things I do - running a surgical department, in-depth academic work, teaching, hosting a podcast, building a speaking career, making music and being a passionate father and husband in a family of five. I have started writing this newsletter to identify the answers to this question.

And after that conversation with my wife, it became clear to me that one of these traits that help me with everything I do, is this:

I am delusional.

Not so much in the clinical sense, but close enough to be useful.

Psychiatry has a precise definition for delusion.

ICD-10 code F22 describes delusional disorder as a fixed belief system maintained with full conviction despite contradictory evidence, while the individual’s general cognitive function remains intact.

That last clause is the interesting one.

The person reasons logically, plans effectively and acts in the world without impairment.

Except for one thing: they live in a reality others cannot see.

The clinical definition describes a disorder. What I am about to propose is the deliberate practice of the same mechanism, pointed at your own potential instead of away from reality.

I call this Deliberate Delusion - a self-constructed belief about what is normal for you, maintained despite evidence to the contrary, while your reasoning and execution remain intact.

The belief is not there to describe reality accurately. It is there to help you decide direction and optionality. Reality still corrects the path.

What is normal?

We think normal is what everybody else thinks normal is. Everybody is eyeing the others to find out what is acceptable and adjusting to stay part of the group.

These definitions are fluid and differ widely — historically, culturally as well as geographically.

But they are all regressions to the mean.

Normal is not reality. It is the average of other people’s limits.

Deep inside we know that “normal” doesn’t really exist as it is a social construct, and thus it doesn’t serve our very personal needs. But as long as we don’t challenge our need for belonging, it will influence our every decision and action.

Everything you can see around you right now, the device in your hands, the chair you sit on, came to life through someone’s thought. It didn’t exist before. Someone was delusional enough to imagine it and persistent enough to make it real.

This is nothing new. Every religion, every nation, every currency is a shared delusion that enough people decided to treat as real. Every company is this. The difference is that you don’t need to warp anyone else’s reality. You only need to do it for an audience of one - yourself.

I have developed a delusional view about what I consider normal for myself. In that view I consider myself as much a single person as I see myself as a family father. I can hold opposing perceptions simultaneously - a form of compartmentalisation that lets me treat each identity as fully real, even when they contradict each other in terms of time, energy and attention. I consider my day job that objectively takes 8–9 hours each day as only filling about 20% of my time.

It is a perceptual mechanism I have built - partly deliberately, partly not - that makes the impossible feel normal. I am still fully present while I do what I do and when I am where I am.

I just don’t see why it would prevent me from doing everything else as well.

If I were to draw an “objective” outside view of a standard day time allocation, it would look like this:

If I were to draw my internal perceived daily time allocation, it would look like this:

Which brings us back to reality distortion fields, because this is what it is. A distortion of reality.

We all distort reality. The question is not whether, but how deliberate that distortion is. And it touches something deeper: what your definition of normality - and thus reality - actually is.

Human history is filled with people who held delusional beliefs for decades and turned them into reality. It is also filled with billions of delusional ideas that failed. Survivorship bias is real and this is not a framework for predicting success.

It is a framework for expanding what you consider possible for yourself.

But Deliberate Delusion has an Achille’s heel , and it is worth being honest about.

I recently watched a portrait of Joe Alexander. He desperately wanted to become a professional NBA basketball player. Coming out of high school, he wasn’t on anyone’s radar.

What followed was by his own account a state of Deliberate Delusion. He decided to hold two very firm beliefs.

#1 If he outworked every other player on earth, he could reach the NBA.

There was absolutely no evidence for this. The belief was, by any reasonable standard, delusional.

#2 The only thing that matters in life is basketball.

That if he failed, his life would be miserable. It was a deliberate axiom, where he decided to stay away from anybody who believed otherwise. He explained, that you cannot spend time with people who question your belief. You cannot even think it once. Because the moment you do, the belief loses its strength, and without it, you cannot produce the work that closes the gap.

Through that fixed conviction and relentless work, he transformed himself and was drafted 8th overall in the 2008 NBA Draft.

And then? His NBA career lasted roughly two seasons. He went on to play professionally overseas for over a decade, in Russia, Israel, Italy, Turkey and France. A real career, but not the one the delusion promised.

The delusion got him in the door, which alone was extraordinary. But the isolation it required, the refusal to let anyone question the belief, also made him lonely. When reality pushed back, there was no community around him to absorb the shock.

This is the difference between what I call lonely delusion and Deliberate Delusion.

Lonely delusion demands that you cut off anyone who doesn’t share your belief. It produces intense short-term output at the cost of sustainability, relationships and the ability to adapt when the world doesn’t match your delusion.

Deliberate Delusion, as I practice it, works differently. You hold the fixed belief about what is normal for you. But you don’t isolate. You communicate it, you let it pull others in, and you stay embedded in the life you are building across all its dimensions.

You can also make an argument for a delusional belief you first buy into yourself, but then communicate it so strongly that others can’t help but follow along and help you build towards that goal together.

It comes down to aligning your inner and outer communication.

What to do with this?

You have been rational and realistic your whole life - you know how that feels.

How about trying to be delusional for a while and see how that feels.

Here is what I want you to do:

Create a current realistic time allocation bar.

And then create one where you allocation more time to the areas you want to have more of in your life - despite “better knowledge”. For a week pretend that that is how your time is allocated and see what happens.

My wife asked me if I knew I was a father of three working full-time as a professor and department head. I do. I just refuse to let that define the boundary of what is normal for me.

To more in life,

Nicco

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This wasn’t a testament to love’s triumph. It was a quiet indictment of what happens when someone mistakes avoidance for transcendence. He had not risen above anything. He had simply sealed a living part of himself in the basement of his psyche, and there it waited — patient, undigested, unresolved — until the door cracked open.

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I relate to him more than I’d like to admit. I can explain Kriya mechanics, I’ve sat hundreds of hours in Vipassana silence, I’ve taught meditation to rooms full of people. And yet I still experience anger, pettiness, resentment. There are domains of my life that have genuinely loosened their grip on me — alcohol, nightlife, certain forms of validation — and there are other domains, like wealth, where I can feel the old contraction still alive and active.

Not because I’m failing at spiritual practice.
Because I haven’t resolved that pattern yet — not through repression, not through indulgence, but through genuine, embodied understanding.

This distinction is the heart of what I’m exploring here.

Suppression is a Disguised Form of Attachment

Suppressed desire does not disappear. It simply relocates. It moves from conscious awareness into a part of the nervous system that doesn’t use language, and from there it shapes behavior, emotion, and fantasy. It becomes a background vibration influencing everything — the tone of a conversation, the way you interpret a message, the decisions you make without quite knowing why.

Buddhist phenomenology, modern psychology, and Jungian shadow work all circle around this same observation: whatever you refuse to face directly ends up steering you indirectly.

We see the consequences everywhere.
In religious scandals.
In spiritual communities where people claim purity while their unresolved urges leak out in twisted forms.
In “ascetic” people whose entire identity depends on convincing themselves — and the world — that they are above desire.

These are not failures of morality.
They are failures of contact with reality.

And after teaching, practicing, and observing for long enough, I’ve come to recognize three broad ways people respond when a domain of life pulls on them: money, sex, status, pleasure, power, comfort, ambition, beauty — whatever their particular magnet happens to be.

The Three Modes of Relating to Desire

There are many sub-variations, but the essential structure is surprisingly simple:

1. Supression

You declare yourself “beyond” something, not because you’ve resolved it, but because you don’t want to feel its pull. You cut yourself off prematurely. You climb the metaphorical mountain. You pretend the longing isn’t there, even though your body knows better.

2. Unconscious Indulgence

You give in to the desire without paying attention. You repeat the cycle automatically, learning nothing. You wake up years later in the same place, slightly more tired, slightly more bruised, still confused about why the satisfaction doesn’t hold.

3. Lives Resolution

You turn toward the desire rather than away from it.
You observe it without collapsing into it.
You allow the full arc to reveal itself: the anticipation, the high, the crash, the subtle aftertaste that remains once the thrill evaporates.

And eventually — not through rejection but through understanding — the charge weakens. The grip loosens. The desire flattens into something uninteresting, not forbidden.

This third mode is messy. It doesn’t offer the aesthetic appeal of renunciation or the dopamine of indulgence. But it is the only approach that reliably dissolves the underlying attachment.

Ancient Initiations and the Modern Equivalent

Ancient cultures understood this challenge long before we had psychological language for it.
Some confronted fear and craving through controlled ordeals:

• Egyptian initiates spent days in darkness, sealed inside a sarcophagus.

• Tibetan practitioners practiced solitary retreat in caves, exposed to the raw material of their own minds.

• Native American rites involved fasting, isolation, and vision quests.

• Tantric traditions used carefully structured encounters with pleasure and discomfort.

The purpose was not punishment.
It was contact with what the individual avoided, compressed into an accelerated environment.

Did every ritual work? Probably not. Many were simply attempts at forced transcendence — suppression dressed up as spirituality. But the underlying principle is worth keeping: human beings require direct experience to understand themselves. Not theory. Not moral framing. Not spiritual performance.

Today we don’t get a cave or a ritual burial.
We get inboxes, bank statements, relationship tensions, aging bodies, career disappointments, unexpected losses, subtle humiliations, fragile egos, persistent cravings, and the uncomfortable reminders of our own limits.

These are the initiations now.
Not elevated or symbolic — painfully ordinary.
But no less transformative if approached with the same seriousness.

The Seven Ordinary Initiations

Over the next letters, I will explore seven domains that consistently shape the inner architecture of a person’s life. These are not arbitrary. They are the terrains where human attachment tends to root itself most deeply:

1. Family

The earliest blueprint — the emotional loyalties, unmet expectations, patterns of guilt and belonging that shape us long before we choose anything consciously.

2. Wealth

Money functions as a mirror, reflecting whatever meaning we project onto it. Safety, freedom, worth, revenge, recognition — rarely the number itself.

3. Social Status

Recognition feels like nourishment until you realize it binds you to external evaluation in ways that quietly suffocate inner autonomy.

4. Health, Sickness, and Death

Aging is an unsparing teacher. The body becomes the curriculum nobody can skip.

5. Romantic Relationships and Sex

Most longing in this domain is projection; we chase aspects of ourselves we haven’t met, packaged in the form of another person.

6. Spiritual Life

Meditation, when misused, becomes escapism wearing sacred clothing. Avoidance disguised as depth.

7. Indulgence: Food, Pleasure, Stimulation

These behaviors reveal patterns of emotional regulation. When observed without numbing or shame, they burn themselves out through simple clarity.

My Own Case Study: What Has Resolved, What Hasn’t

Some domains have truly completed their arc for me.

I no longer drink — not because alcohol became morally unappealing, but because I finally saw the entire cycle so clearly that the appeal evaporated. The anticipation, the short-lived lift, the flattening afterward, the way it pulled me away from myself. I repeated this pattern enough times with awareness that the desire simply thinned out.

It was the same with nightlife, with casual sex, with status games inside academia. Observing the mechanisms long enough stripped them of their glamour. They lost their spell.

But wealth is different.
It still activates something.
I still project meaning onto it — security, potential, maybe even proof. I still feel a subtle charge when I look at numbers. That charge is evidence that I am not done here. The pattern is not complete.

This is why I can write about this honestly: I am not reporting from a perfected state. I am writing as someone in the thick of his own curriculum.

What Resolution Actually Involves

Resolving a desire — allowing it to lose its charge through lived understanding — is not a neat process. It is not indulgence, not abstinence, not rationalization, not moral superiority.

It looks more like this:

• You allow yourself to feel the pull without acting blindly.

• You notice the full arc of the experience rather than the peak.

• You stay present for the aftermath rather than distracting yourself from it.

• You stop narrating the experience with morality — neither elevating nor condemning it.

• You let the pattern reveal itself in its entirety.

Over time, the intensity lessens.
Not because you fought it, but because you understood it from the inside.
Understanding removes the mystery, and without mystery, the compulsion fades.

When a desire truly loses its power, it doesn’t become forbidden — it becomes boring. Not intellectually boring. Somatically boring.
The nervous system stops responding because it finally knows the outcome.

That is the real resolution.

Conclusion: Ordinary Life as the Real Initiation

We don’t need caves, or rituals, or extreme deprivation.
We need a willingness to stay in contact with life as it is, especially in the domains that still catch us off guard. The uncertainty — “has this dissolved or am I lying to myself?” — is not a flaw. It is a safeguard against delusion.

In surgery, every practitioner knows the feeling of the patient they hesitate to confront — the case that seems more complex, more delicate, more demanding. But avoidance has never closed a wound. Resolution comes from engagement, not distance.

The same principle applies internally.

So the real question becomes:
Which domain is yours?
Which “patient” is waiting for you to stop avoiding?

To more from life,
Nicco

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They quit because the shoes are in the wrong cabinet.

Top shelf. Behind the winter boots. You have to move two items, something will fall, and by the time your brain has simulated this obstacle course, it has already whispered: not today.

We usually blame discipline. But is it really discipline? The culprit is embarrassingly small: a missing charger, a dead laptop, shoes in the attic. One irritating step, and that energy-hoarding beast in your skull calls it a day.

This is the physics of friction applied to human behavior. Once you see it, you can’t unsee it.

And once you can’t unsee it, quitting the wrong battles becomes much easier.

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Your Brain Is a Cheapskate (And That’s Not a Bug)

Like every living system, we are wired for one thing: conserve energy.

Every decision costs cognitive resources. Every initiation moment — every “startup” — feels expensive. Anything requiring “extra” activation gets flagged as unnecessary expenditure.

We all know the theory: healthy habits promise compounding returns — longer life, more muscle, smaller belly, fewer surgeries, less pain. You’d think that alone would motivate change.

But your brain doesn’t calculate in decades.
It calculates in seconds.

And right now, that cabinet friction with your running shoes feels like a threat to the system.

This isn’t weakness. It’s rational energy economics operating on incomplete information.

Every doctor has a truckload of stories where patients choose short-term comfort over long-term consequences. Instant gratification often wins, not because of ignorance, but because of friction stacked at every behavioral step.

It’s why a patient with a lifestyle-induced lower-leg amputation might be smoking outside the hospital entrance the next day. Incomprehensible — until you look at the layers of friction in their life that make their choices feel rational, without actually being rational.

Physics has known this forever: static friction is highest at the start. Once something moves, momentum is cheap. Your body mirrors it — initiating muscle activation costs more effort, maintaining it costs far less. Even your neural circuits follow the same pattern. The first sentence you write? Maximum cognitive load. The tenth? Flow state.

This is why “just do two minutes” works when it works. You’ve paid the activation toll. Quitting now costs more energy than continuing.

But productivity gurus still praise willpower as fuel.

Willpower is wet matches in a storm.
It sparks, then dies.

Architecture is what holds.

Why Surgeons Thrive on Low Friction

In the operating room, nothing is left to chance.

Instrument setup, team positioning, lighting, temperature — everything set up to minimize friction. No “where’s the clamp?” mid-incision.

I don’t want to decide where the scalpel is. Ideally, it finds my hand because the environment was designed for that outcome.

We eliminate microdecisions because in surgery, as in every other field, decision fatigue has a cost.

Contrast that with daily life:

High-friction writing:
Laptop in another room, password expired, forty tabs open, notifications bombarding your senses.

Low-friction writing:
A dedicated device, pre-loaded doc, single purpose, specific chair. Nothing else is possible.

One demands intense amounts of willpower every time.
The other requires one structural decision upfront.

Identifying these friction points — or bottlenecks — is central to leadership in any field.

The art isn’t fixing every bottleneck.
It’s fixing the ones that actually constrain flow. The ones with a clear return on effort. If fixing the friction costs more than the friction itself — don’t fix it.

Some friction doesn’t matter if the workflow doesn’t matter.

Recently, we noticed insufficient quality in our electronic health-record coding. A friction analysis revealed a maze of buttons and forms that required a precise order. The solution was a semi-automated click-guided questionnaire that moved the doctor through the process without friction — and now coding in that area is nearly flawless.

The Part Where You’re the Problem

Here’s the uncomfortable truth: sometimes the friction is real, but the reason it’s there is buried deeper. Because often, we built it ourselves.

If you say you want to write but never charge your laptop, that’s not an accident.
If you “plan to run” but your shoes keep migrating to the attic, that’s not inconsistency.

It’s avoidance dressed as nuisance.

We construct elaborate obstacle courses around things we don’t truly want. Call it self-sabotage, call it subconscious protection — the result is the same.

You’re not doing what you said you’d do. Not because you can’t, but because you secretly don’t want to.

I’ve done this. I have a trove of buried startups, abandoned languages, countless projects rotting in digital graveyards. Each one teaching the same lesson:

When I truly want something, I remove friction. When I don’t, I build excuses and call them obstacles.

I’ve learned that this is okay — as long as I admit it to myself. That I don’t want it anymore. That I said yes because I didn’t have the guts or experience to say no.

The hardest move in personal growth is also the most liberating:

Honesty with yourself.

Don’t want it? Stop saying you do. Kill the guilt, let it die.
Do want it? Stop expecting future-you to be a hero. Remove every barrier you can.

Both demand truth.
Only one demands courage.

The Three-Audit Protocol

Think of yourself as the CEO of your own life. Not in the hustle sense — in the self-mercy sense. Helping future-you spend energy where it actually matters.

Run your frictions through these filters:

1. The Relevance Audit

Is this workflow even important?
Some bottlenecks don’t deserve your energy. Fix only the constraints that shape your life.

2. The Honesty Audit

If friction keeps recurring, ask: Do I truly want this?
If no, drop it. This single move frees more capacity than any productivity system.

3. The Design Audit

If you do want it, map the real chain from intention to action.

Not “go to gym.”
The actual path:

Find clothes → check if clean → locate water bottle → find keys → drive → park → change

Count every bail-point.
Then eliminate the first three:

Lay out clothes.
Pre-pack the bag.
Put the keys on top.
Stack your phone on the keys.

You haven’t increased discipline.
You’ve decreased activation energy.

One Example From the Mess

I wanted to draw more again after an on-and-off relationship with it. Over almost ten years — zero drawings.

The friction diagnosis was simple: it was a solo project competing with family time.

The solution was just as simple: my son loves drawing too. So we started a joint online class. We put it on the family calendar. Shared accountability, shared joy, and suddenly I had drawing time and time with my kid.

One structural decision.
Problem solved.

This is core to how I manage my different renaissance identities — surgeon, researcher, father, musician, writer, artist. I’m constantly hunting friction thieves.

Your Move

Pick one area this week. Work. Health. Parenting. Creativity.

Where’s the quiet friction stealing disproportionate energy?

Maybe it’s your running shoes in your cabinet, maybe it’s something bigger.

Remove one obstacle today and watch the stream flow again.

If you’re willing to share:
What’s the friction point you’re eliminating next?

Hit reply or post it below.
Your insight might unlock mine or someone else’s.

To more in life,
Nicco

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In oncology, I’ve learned something far more uncomfortable:

The old “normal” is gone — and trying to restore it, is what causes the real suffering.

The Body You Remember, The Life You Lost and the One You Have to Build

Every week in my clinical practice I see the same pattern: patients who have survived cancer, completed treatment, undergone reconstruction — and are still devastated with the result.

Not because the surgery failed.

Not because the outcome is poor.

But because they are grieving a version of themselves that no longer exists.

For years I assumed this was a communication problem. Then an expectation management problem.

Now I see it as identity grief.

And it shows up far beyond medicine — in burnout, divorce, career collapse, aging, and every major rupture that separates the self we remember from the self we own now.

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The Case That Made the Pattern Impossible to Ignore

Recently a patient came to me after years of reconstructive procedures: failed implants, expansions, complex reconstruction, multiple revisions.

From a technical point of view, the final result was good.

But she was devastated.

Not only because of the complications.

But because the reconstructed breast did not match the internal breast memory she had carried — a sensory imprint of a body of a time before her illness.

She asked me:

“What can you do to give me my breast back?”

“Will I ever be like before?”

“When will I feel normal again?”

These are not surgical questions.

They are grief questions.

What she truly meant was:

“Who am I now, that the old version of me is gone?”

No operation — no matter how skillful — can answer that. No operation can solve that.

A Lesson From Early in My Career

As a junior doctor on a burn ward, I witnessed a moment I didn’t understand at the time.

A young woman survived a severe car fire and lost one leg below her knee. When she woke up, she was terrified and disoriented. She demanded to see a senior attending.

He was a former navy officer. Direct, uncompromising. A die-hard christian.

He walked in and said:

“You have lost the idol that was your body.

The body you remember is gone.

Your life is not over — but that version of you is.”

She screamed. She broke. Everyone in the room thought he had gone too far. I thought to myself “You can’t say something like that at this moment.” Apparently you can.

Months later she thanked him.

Because he named the truth she was coming to fight long before she could face it.

He ended the bargaining — the mental loop where the mind tries to reverse time instead of moving forward.

I have never forgotten that moment.

And I see the same mechanism in breast reconstruction, in high performers after burnout, in founders after collapse, in anyone whose old identity is no longer accessible.

The Expert Wisdom Triad

There’s an old surgical triad:

The good surgeon knows how to operate.

The better surgeon knows when to operate.

The wise surgeon knows when not to operate.

I used to think this was about anatomy and risk.

Now I understand it’s also about identity.

Operating on someone who is still psychologically anchored to their pre-cancer self — still worshipping the idol of their former body — is not surgery.

It is enabling a fantasy that the past can be restored.

And that guarantees dissatisfaction, revision spirals, repeated disappointment, sometimes even conflict.

This is because the psychological contract is impossible.

Now most patients after cancer adapt quickly. But not all do, and identifying these, is important. For them, as much as for ourselves.

The same applies outside medicine:

• Trying to “save” a relationship that has already ended

• Forcing a return to a pace of life that burned you out

• Attempting to reclaim youth instead of aging into a new identity

Sometimes the wisest intervention is naming what is already gone. And then re-construct from there.

The Restoration Fallacy

After any major rupture — cancer, trauma, burnout, divorce, status loss — the mind gravitates to the same trap:

The belief that the old self can be restored.

That you just need the right intervention, the right recovery protocol, the right timeline — and you’ll be “back.”

But the old baseline is gone.

This is the Restoration Fallacy — the mistaken belief that wholeness comes from reclaiming what was lost.

It doesn’t.

It never has.

The Reconstruction Path

There is only one path that leads to real stability:

Building the next self — not resurrecting the old one.

Forward, not backward.

New, not restored.

This is the line I use with patients and anyone facing irreversible change:

“You cannot rebuild the old self. You can only build the next self.”

Instead of resignation it is more an alignment with reality and the foundation of actual healing.

Why High Performers Struggle Most

There are many groups other than cancer patients that are especially vulnerable to the Restoration Fallacy.

High achievers are especially vulnerable to the Restoration Fallacy.

A burned-out executive tries to return to their old pace.

An athlete tries to reclaim their old body.

A founder tries to recreate the confidence they had before collapse.

They’re not rebuilding, they are trying time-traveling.

Burnout, illness, loss, aging — these things don’t just change your performance abilities - they actually change your identity.

And identity cannot be restored.

The Tool We’re Building

In my department, we are beginning piloting a brief clinic-based screener to detect when a patient is still anchored to their pre-cancer body identity — still trapped in the Restoration Fallacy.

Because no amount of surgical excellence can help someone who is fighting the wrong battle.

Reconstruction only works when someone is ready to build forward, not reach backward.

And I suspect this applies far beyond oncology — to any domain where a former self has been lost.

The Real Work

You cannot return to the version of yourself that existed before a major rupture.

But you can build forward from there.

In surgery we do not reconstruct the past.

We assess what remains, accept what is missing, and build from there.

Identity works the same way.

Wholeness is not the restoration of the old self, it is probably more the construction of the next self, a new self where you can feel whole again.

The moment you stop bargaining with the old story, you can finally begin writing the new one.

In surgery as in other areas in life, the work is not really figuring out how to get back. But to decide what kind of future you can build from where you are at this moment.

To more from Life

Nicco

The Renaissance Protocol reflects on identity, performance, and building a life that integrates across domains.

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So there we were, crammed into the ICU kitchen — me and 15 surgery residents and consultants — trying to have a “crucial conversation” about the state of the union and training fairness. The kind of meeting that in any functional institution would happen in a conference room with a whiteboard and decent lighting.

Instead: fluorescent overhead buzzing, the smell of reheated hospital food, a microwave beeping every 90 seconds.

Dr. S started it: “Why does Dr. X get three flap cases this month when I only got one?”

Then Dr. M: “The schedule isn’t balanced. You promised equal rotation.”

Then Dr. K: “This whole system is unfair.”

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I tried to explain. That the goal was to provide equal distribution. But that the schedule depends on a million little things — which patients come through the door, who calls in sick, which skill levels are available. In a system under strain, distribution becomes a secondary matter to ensuring patient safety and keeping the boat afloat.

Not merit. Not fairness. Not divine justice.

And then I said it: “Life isn’t fair.”

The room went cold.

A nurse walked in to warm up a patient’s dinner. Microwave beep. She squeezed past us, clearly annoyed we were taking up her workspace.

I kept talking: “The sooner you accept that life isn’t fair, the sooner you can focus on—”

The head nurse — the one who’d been tolerating our presence — finally had enough:

“Gentlemen, we need the kitchen. Patients need dinner. You’ll have to continue this elsewhere.”

Three residents stood up, walked out mid-sentence, mumbling: “Yeah, yeah. Life is not fair.”

We filed out. Everyone angry. Me questioning whether I’d just made everything worse. Nobody got what they came for.

The Suffering of Non-Acceptance

Looking back, I realized that I had that same sense of entitlement when I was younger. It was actually one of the reasons why I opted against an academic surgical career right after med school — because I was sure the system was flawed and unfair.

I also overestimated my skills and ignored the fact that surgery — by definition a craft — requires a step-by-step apprenticeship that compounds over time and experience, and can only partially be sped up.

The underlying problem though was something else.

It was the fight against reality itself.

Expecting the world to operate according to a principle — fairness — that simply doesn’t govern how things run. And fairness by itself is highly subjective — fair is where I feel treated fairly.

So when reality refuses to comply with expectations, we have three options:

Option A: Keep fighting. Keep scorekeeping. Stay angry that the universe isn’t delivering what you’re “owed.” Option B: Accept reality as it actually is, then figure out how to act on it. Option C: Quit.

Most of us are stuck in Option A without realizing it’s a choice.

And boy, is Option A exhausting.

The Buddha’s equation for suffering:

Obviously, we’re not the first to figure out that there’s a problem. The Buddha already described this brilliantly in this little formula:

Reality - Expectation = Suffering

The bigger the gap between how you think things should be and how they actually are, the more you suffer.

You end up expending enormous energy trying to change something that isn’t changeable — how things already are at any given moment. And things like the fundamental randomness of how life distributes opportunities.

Often we focus on how things were and are — tracking who got which cases, calculating “fairness” metrics, building resentment toward colleagues who “got lucky,” or waiting for someone to fix the system.

None of this made us better surgeons. All of it made us miserable.

So while we’re litigating fairness, we’re missing the things — or cases for that matter — we actually did and do get.

When we’re so focused on what we weren’t getting, we can’t extract maximum value from what we have.

That’s what fighting reality actually does:

It doesn’t change reality — it just blinds you to the opportunities within it.

What I Was Trying (Badly) to Say

I wasn’t trying to tell my residents to give up and resign.

I wasn’t telling them to accept exploitation or stop advocating for better training.

I was trying to free them from an unwinnable mental battle that was paralyzing their growth.

What I should have said: “Accept reality as it is, not as you want it to be. THEN you can change your position within it.”

But I didn’t use those words then.

I was standing there as senior consultant, no longer subjected to the randomness they were experiencing, telling them to accept being subjected to randomness.

Of course they walked out.

They thought I was saying: “Life is unfair, so stop complaining.” What I meant was: “Life is unfair, AND you can still win — but only after you stop fighting the unfairness itself.”

That distinction matters.

My buddhistic meditation retreats helped me a lot with that. And life wasn’t stingy with opportunities to put my learnings into practice. I learned that lesson a lot through constraint.

I learned it, for example, from being parked — twice. And when I learned it, I was the one being parked, not the one doing the parking.

Right before certification, staff shortages meant I spent six months in outpatient clinic instead of the OR.

Wound checks. Suture removals. Minor procedures. Post-ops. Pre-ops.

Not exactly the complex reconstructions I’d trained for, not the microsurgery I wanted.

I could have spent those months resentful — counting the cases I was “owed,” calculating how far behind this set me.

Instead, I decided to act as if I were already independent.

Not a frustrated resident serving time, but a consultant running that part of the department. That single mental shift changed everything. I began managing patients like I was the attending — documenting, communicating, and triaging with full ownership.

Additionally, I used every gap to write or analyze data for my research papers and academic career. I found myself sitting at the top of the staircase for lack of rooms before my clinic started, generating boxplots.

Those minutes added up. On the longer timeline, all of this gave me leverage. I wasn’t behind — I was ahead. My gift was hidden inside the constraint.

But I only found it after I stopped waiting for someone to rescue me from it.

Different year, similar frustration: I found myself parked in burn surgery.

Burn debridement after burn debridement. Skin graft after skin graft. Repetitive. Monotonous. Not exactly intellectually thrilling.

I found myself complaining to one of my mentor attendings. What he said stuck with me ever since:

“Look for opportunity in every little case. There’s gold to find everywhere for your surgical skill. Any necrosectomy can be turned into an exercise to identify and preserve perforators.”

He was essentially teaching me to accept the case I had, not to mourn the case I craved.

So I began treating every (burn) case with strategy: primary plan, backup plan, danger zones, anatomical structures to preserve.

I even built custom “surgicards” — case-prep index cards assessing these items — that served me and others I shared them with very well.

This pushed me extremely forward, not because the cases changed, but because I did. Those burn months taught me more about tissue handling and three-dimensional thinking — and system thinking in surgery — than any “exciting” microsurgery rotation.

These parkings were valuable not because they were secretly great opportunities disguised as setbacks, but because accepting them as reality forced me to create my own opportunities within the constraints.

That’s what I was trying to tell my residents in the kitchen.

Not to “accept unfairness and give up,” but to “accept unfairness and find the gold inside the constraint.”

It’s something like an acceptance paradox: accepting unfairness gives you more power, not less. It feels like resignation — but it’s actually the starting point for change to come.

But there’s actually more going on. If you thought ‘life isn’t fair’ was hard to hear, this one cuts even deeper:

Nobody Owes You Anything

Nobody is obligated to make life fair FOR you.

Not your partner. Not your mentor. Not your department. Not the universe.

For unknown reasons, we think we’re entitled to things. Just because we are. Or we did certain things.

“I did my time, I deserve the good cases.” “I sacrificed my life, the system owes me.”

That thinking destroys you. It will make you resentful.

And you can wait forever for fairness.

Once you start accepting that nobody owes you anything, you become appreciative of the things you do get.

Now, I’m not saying that you should accept systemic injustice.

Fight for better work-hour regulations, demand safer conditions, advocate for structural reforms.

But do it from a place of accepting the current reality, not denying it.

Acceptance isn’t resignation. It’s the prerequisite for effective action.

Landing

I still don’t know if my residents took with them what I had intended. When I left, they gifted me a book with the title Life isn’t fair — so I guess something stuck.

But I can’t teach acceptance anyway.

Only life can. And boy, isn’t it a great teacher. You get lesson after lesson delivered straight to your door.

And a hospital is essentially a high-speed pressure chamber that beats that lesson into your bones until fairness stops making sense as a framework.

There is often not much to do about the circumstances at any given moment. But there is often much to do about how you decide to deal with them.

I can stop reinforcing the illusion that fighting reality is productive.

Accept reality as it is. Not as you wish it were. Not as it “should” be. Not as it would be if things were fair.

As it is.

Only then do you stop suffering and can start moving.

My kitchen meeting was a disaster — but maybe that was the point.

Maybe you can’t teach acceptance in comfort.

Maybe it only lands when the nurses kick you out, the microwave keeps beeping, and reality refuses to cooperate.

Maybe that’s when you finally stop arguing — and start living.

To more from life,

Nicco

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I didn’t grasp how much this would limit me. Three decades later, I’m still paying interest on that shortcut.

Charlie Parker said, “Master your instrument. Master the music. And then forget all that bullshit and just play.” Somehow I went from A to C while skipping B entirely.

My play-by-ear ability carried me through 25 years in a wedding and party band—enough to have fun, enough to get paid. But that deep understanding? Still missing. Still nagging.

For years I tried composing, both conventionally and with computers. Always hit the same wall—the music inside me couldn’t get out because I’d skipped the foundations.

AI eventually gave me a workaround, let me develop different skills to become the composing artist I’d wanted to be.

But there’s a pattern here I’ve watched play out in my own life and in countless others I’ve met: that urge to cut corners. Skip the hard part, jump to the fun part.

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The Plateau Trap

We all know how learning works. Early progress is intoxicating. Visible gains, rapid improvement, constant dopamine hits.

Then you hit a plateau where progress stalls and the fun evaporates.

That’s when three options appear:

a) Quit and start something new.

b) Develop grit and push through.

c) Try to jump over the plateau.

I kept choosing c). Every time I tried to skip it, I paid for it later.

Medical school: I decided—based on probability and time efficiency—to skip hand anatomy details. Too complex, statistically unlikely I’d need it.

A decade later I was working in hand surgery, painfully grinding through anatomic textbooks every morning and evening for months to make up for that “strategic” decision of my younger self.

The pattern holds across domains: skip the boring fundamentals, pay compound interest later.

The Truth About Talent

I used to wonder if talent was real. Watching my kids grow up, I see what psychology and neuroscience describe: innate inclination meeting environment.

Talent brings you curiosity for something - sometimes physical dexterity - and enough energy and motivation to stick through that first plateau. The new height brings the next boost of motivation for the next plateau. Success breeds success. And it’s compounding.

Talent often happens when your environment fosters curiosity early and helps you through that first plateau at a young age. The grandfather playing chess with you. The mother taking you to dance classes. The family that lets the three-year-old play with instruments freely.

These are pedagogues meant in its original sense—someone who guides a child.

Then it becomes a game of compounding effort. It’s hard to catch up with someone who has ten years of deliberate practice from childhood. We dismiss it as “just gifted.” But it’s not magic - it’s a head start, and you’re fighting uphill carrying basics they automated years ago.

Still possible, though.

What This Means for You

First: get honest about your innate inclinations. We all have them—maybe just not in the areas we think we should.

Second: develop grit. It’s the decisive differentiator. And it’s a muscle you can train.

In most conversations, especially with personnel I try to find out: “What are you unexpectedly good at outside work?”

I don’t like that classical “what are your strengths” too much. I want the thing they do for fun that they’re oddly skilled at.

The product manager who DJs weddings and intuitively reads crowd energy. The engineer who restores vintage motorcycles and has mechanical empathy most designers lack. The nurse that’s sailing and accustomed to quickly changing (weather) environments.

These aren’t soft skills—they’re transferable pattern recognition capabilities sitting dormant because we thought they didn’t belong at work.

I’ve held parts of myself back for years because I thought they wouldn’t be beneficial—or worse, wouldn’t be allowed in my environment, in my position. I’m gradually learning to integrate my own goofy extracurricular skills into my work.

And learning from my own blocks I can now try to ask “what boring fundamentals are you trying to skip?”

Including myself. Especially myself.

I spent years trying to compose without theory, lead with insufficient information, diagnose without mastering anatomy. The pattern still holds: you can’t shortcut mastery.

But you can build systems where admitting “I skipped the basics” isn’t career suicide—it’s the first step to getting unstuck.

Where we help each other develop that necessary grit.

Where we hold each other accountable not through pressure but through genuine support.

Master the fundamentals. Then forget them and play.

By the way, I’m still learning scales. Thirty years later, some lessons finally land.

To more from life,

Nicco

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It has done so — uninterrupted — for more than 500 years. Without electronics. No fancy software or smart algorithm. Just pure craftsmanship built on first principles — deep knowledge about mechanics, precision and physics.

On the way home I thought about my ten-year-old espresso machine that still pulls perfect shots, and my Italian boots I’ve worn almost every day for a decade. All of them still work — not because I care for them obsessively, but because they were built to last. They were built with me the customer in mind, not the company building it.

It made me reflect: How much of what we build today — in medicine, in business, in life — is designed to last? Maybe even outlast us. How much is built to keep working when we’re no longer there to fix it?

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The Leadership Parallel

We talk a lot about innovation, rarely about sustainability. Yet leadership, when looked from this perspective is the art of building clocks, not alarms. The craft of building sytems that keep ticking because they’re built on principles, not personalities.

The best teams don’t need constant supervision.The best departments don’t collapse when a leader is away. The best organizations don’t rely on adrenaline and pressure to function.

In healthcare especially, we’ve built too many alarms — urgent, reactive, human-dependent. And that has it’s place in high-stakes acute situations. But even there medicine works better, when it has been built like a clock: reliable, self-calibrating, graceful under pressure.

Constraints Are the Compass

Every system has at least one bottleneck. As do our own lives.

Professionally, mine currently is clear: too few consultants to meet surgical demand. But that’s only the superficial bottleneck, there is a tighter one hidden underneath — it’s in the system itself.

In Denmark, referrals and patient flow are centrally governed and this defines how cases loop between providers, how inefficiencies compound. Parts of these constraints have to be solved with policymakers.

So I’ve been working at the political level to change what’s possible. But that takes time. Meanwhile, we need all hands on deck in the OR, in the clinic.

Which means, that I can’t delegate parts of my workload. And suddenly I have become the bottleneck.

The question isn’t how to remove all constraints. It’s which one to optimize for right now.

Identifying where the bottleneck actually is, and what to do about it - that is already half the equation.

But here’s what I learned the hard way: If you want things to work like a clock, you have to built them without yourself as the coo-coo jumping out of your little black forest hut every other minute.

I inherited a microsurgical unit built around deep specialization — one surgeon, one approach, one way of knowing. It worked brilliantly while that structure held. But the moment it changed, the system faltered.

So from day one, I started re-building like a clock — teaching, assisting, rotating with my colleagues, creating as much redundancy as possible. Not because the old way was wrong, but because I wanted to build a clock that ticks whether I’m in the room or not — a system that survives transitions.

I see that as the biggest test of my leadership: not having the answer, but having the patience to build a system that can find it.

And there’s more to that: building a system that doesn’t depend on you or any particular person means building one that doesn’t isolate either. Often when we build pinnacles we remove these people from the “herd”. Yet we are all social beings and despite differences in personality can neither we nor the group thrive in isolation.

I’ve been thinking about the etymological difference between loneliness and being all-one - alone. One isolates, the other integrates.

The same is true for systems. A healthy department, like a healthy human, needs solitude and connection —focus and exchange.

And to foster that we need to create joint routines, create places for communication and sharing. In ultra-optimized healthcare and remote work, this becomes both more important and harder.

One of the few fix points we cling to almost religiously is our joint morning routine. The team gathers for handover from night shift, we look at the day ahead, the next day. We discuss cases, rotate through educational pieces and mini journal clubs.

It’s persistent in its rough structure — the ritual itself is sacred —but we’re constantly evolving and adapting within it.

That’s the clock: reliable rhythm with built-in flexibility to adjust for timezones.

Another lesson I learned while improving systems: Start with gratitude and appreciation. Every system has been set in place originally because it helped a problem at that point in time. Usually not everything is bad. It means appreciating what currently works while improving what can be improved.

It helps to accept the status quo as is and take everyone with you on the journey of change.

Kindness and Clarity

And doing so with kindness is key. The people and mentors who have impressed me most were the kind ones. The ones that have reached the top but stayed humble. That talked to the housekeeping personell the same way they talked to administration. I recently watched Alex Hormozi - successful entrepreneuer - diagnose a failing business in an hour with ruthless precision, but absolute kindness.

That combination stayed with me. This is what we need, not only with our patients - diagnosing and treating with ruthless precision and absolute kindness. It is the same for leadership and change management.

We serve nobody when sugarcoating essential flaws. And we serve everyone when pointing it out with loving kindness. And the go do something about it.

Like a clock, marking every hour ruthlessly, but with a sort of loving kindness.

That’s what I want to build — in my department, in my work, in my life.

Not alarms that scream for attention every hour, but clocks — quiet, elegant, enduring clocks — that keep time long after I’m gone.

What in your world still runs beautifully — simply because it was built right? And what would change if you led today with a craftsman’s patience instead of a sprinter’s urgency? Where are you currently the bottleneck, and what one constraint, if addressed, would let your team move without you?

to more from life

Nicco

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I was actually trying to shove in the second fork of a limp salad from the cafeteria while standing. “Surgeons don’t need to eat!” I was waiting for a hint of a smile, a smirk, anything indicating that he was joking. But nothing, just cold grey eyes. The second time I was “caught” was in a different hospital, exiting the elevator heading for lunch when I was tapped on my shoulder and stopped by my chief attending: “If you have time to eat we obviously have too much staff in our department,” she said.

For years I was peeking nervously over my shoulder when having lunch, if I dared to have it at all.

Back then I was a fifth-year surgery resident, a father, and a grown man. And I was afraid to have lunch. Clearly there is something wrong.

This absurd reality reflects a deeper problem in our profession - a fundamental misunderstanding of what it means to be a physician. The solution lies in distinguishing between two fundamentally different approaches: the Old School physician mindset that glorifies suffering, and what I call the New School physician mindset that prioritizes our wellbeing as the foundation for excellent patient care.

To the basics: ASICS - anima sana in corpore sano - a healthy soul in a healthy body - this is an eternal truth that we preach our own patients day in day out. But we are not able to apply it to our own lives. On the contrary.

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Becoming and being a doctor is no walk in the park. Everyone knows that, and I knew that, and after all, it was my free choice. The long hours, the responsibility, the administrative and legal burdens, the at times abominable working conditions and environments have been pointed out time and again. The stress can be enormous.

The statistics tell a sobering story. Burnout among physicians remains high worldwide. A comprehensive COVID-era meta-analysis found an overall prevalence of ≈55%, with significantly higher odds among frontline clinicians and regional variation (Macaron M.M. et al., Frontiers in Psychiatry, 2023; https://doi.org/10.3389/fpsyt.2022.1071397).

The statistics tell a sobering story. Burnout among physicians remains high worldwide. A comprehensive COVID-era meta-analysis found an overall prevalence of ≈55%, with significantly higher odds among frontline clinicians and regional variation (https://doi.org/10.3389/fpsyt.2022.1071397).

In emergency medicine, pooled international prevalence reached ≈43% (95% CI 32–54%), underscoring that high stress is a global, not regional, phenomenon (https://doi.org/10.3390/healthcare11152220).

In the United States, the most recent Mayo Clinic Proceedings data show physician burnout falling from 62.8% in 2021 to 45.2% in 2023, returning to pre-pandemic levels yet remaining alarmingly high (https://doi.org/10.1016/j.mayocp.2024.11.031).

We are one of the professional groups with the highest rates of illicit substance and drug abuse, suicide rates and premature deaths. And this is no longer only affecting physicians themselves - physician burnout directly correlates with increased patient safety incidents, decreased professionalism, reduced patient satisfaction, and higher turnover intentions, as demonstrated in comprehensive BMJ meta-analyses (https://doi.org/10.1136/bmj-2022-070442).

A particularly insidious contributor to modern physician burnout is electronic health record (EHR) fatigue. We spend more time documenting care than providing it - studies show physicians spend 2 hours on EHR tasks for every hour of patient contact. This administrative burden represents a form of moral injury, forcing us to prioritize documentation over healing. The ICD-11 now formally recognizes burnout as an occupational phenomenon resulting from chronic workplace stress, acknowledging that systemic factors like EHR burden require organizational-level solutions alongside individual interventions (https://doi.org/10.2147/JHL.S389245).

But one of the root problems lies somewhere else. It is a force that at times opposes change for good from within.

It is our common mindset. The mindset that defines how we think we as physicians have to act and interact within this system.

This is what I call the Old School physician mindset.

The practice of medicine is often associated with that of a selfless practice. A term that has been badly misunderstood. Selfless in the sense of no ego, no personal agenda driving the practice, yes. But it never was intended to deprive us from our natural physical, emotional, spiritual and social needs, that we - human beings after all - have, too.

I oppose the implicit and explicit suggestion of physician martyrdom as the only way of practicing medicine.

Neither the Hippocratic oath, nor Lasagna’s modern interpretation of it or Inman’s “First do no harm” indicate at any point that our profession should go at the expense of our own wellbeing.

Yet the Old School mindset has often created a toxic culture where suffering becomes a badge of honor. As a collective, we take some sort of sick pride in suffering, comparing who works and harms himself more. It leads to a twisted form of false, perceived heroism, where a delusional mind fights its very own body.

I lost one great grandfather physician to morphine and one grandfather physician to myocardial infarction. I have seen colleagues smashing trash cans, kicking holes in walls when the pressure got too high and their underdeveloped coping strategies failed. I saw them literally smoke themselves to death, or get admitted to their own ICU in a diabetic coma.

I have seen way too many near accidents such as wrong surgery site markings, faulty prescriptions and other concentration deficit derived mix-ups. And I have seen a patient die because of a catastrophic cascade of decisions made by physicians trapped in ego-ridden decision making. This should not be.

The prospect of working the rest of my life in such self-wrecking conditions made me quit medicine for good twice.

Only one mentor’s reminder to “focus on changing what is within your reach. Change from within” kept me coming back.

This mentor’s wisdom points toward a different path - one that acknowledges the reality of systemic problems while empowering us to take control of what we can change. The problem is not that these things happen, but that we shrug them off as something inevitable, as the status quo. This is what I call the old school physician’s mindset which puts a skewed idol image of our profession first.

In contrast, a New School Physician mindset puts ourselves as doctors first.

Not the profession. Not the patient, but ourselves.

Safety first. We know that from first aid guidelines and airplanes - make sure you don’t endanger yourself, it helps no one.

We can’t give if we have nothing to give, if we get consumed in the process.

We must stop postponing it to some indistinct point in the hazy future.

To be clear, this is not about creating a medical la-la land for physicians. And it is definitely not about jeopardizing patient care because of petty personal issues.

The New School approach is actually about becoming better physicians through conscious self-care. It is about acknowledging one’s personal needs. It is about building up the strength and courage to express those needs, even against implicit or explicit threats from our peers or more importantly against imagined threats of our minds.

It is about taking responsibility for your own life. It is about actively deciding how to spend our time; how to do what we do. It is about making conscious choices for ourselves.

The moment we become true and honest about ourselves to ourselves, we become better doctors as well.

So what does this look like in practice? How would this look like? Take one step back and take a bird’s-eye view on your current life.

And then examine your life’s situation as you would with your own patients.

What are the most pressing issues?

What would you recommend to a patient under those kinds of circumstances?

I believe there are many things we can do in the realm of mindset, organization, lifestyle and communication to help us feel better again.

And most likely, every single one of us already knows exactly what that would be in our case.

When we embrace this New School approach, the benefits extend far beyond our personal wellbeing. If we know our truth and can stand up for it, we become independent from other people’s conflicts of interest. We then can start treating our patients to our best knowledge.

And we can be truthful and honest with our patients as well, without having to be afraid to disappoint them or make them feel bad.

And most importantly without risking harming them by harming ourselves.

This would also reduce pressure and stress, and foster wellbeing far more significantly than any external health reform ever could.

It doesn’t and shouldn’t take away the responsibility to improve structural and institutional conditions - but it is an important pillar to tackle this multifaceted challenge.

This is the future of medicine I envision - one where healthy physicians provide the best possible care because they’ve learned to care for themselves first. This is what a New School Physician would look like.

The choice is ours. We can continue perpetuating a culture that glorifies suffering and ultimately harms both physicians and patients, or we can choose to become New School Physicians - one conscious decision at a time. The transformation of medicine begins with transforming ourselves.

I wrote this piece in 2016. Back then I was too afraid to publish it.

I have slightly adjusted the text and updated some references - which haven’t fundamentally changed, what is telling in itself.

Since then I have moved through the ranks to be now in a position where I see this problem perpetuating itself also on the administrative side. And realizing that I have become part of the problem myself - and to a certain extent - hopefully part of more structural solutions as well.

The challenge requires both individual and systemic approaches. While evidence shows that interventions targeting medical residents yield only modest benefits when implemented in isolation, combined approaches show greater promise (https://doi.org/10.1186/s12909-024-06195-3). This reinforces the need for what I call the CARE framework - a practical approach for New School Physicians:

The CARE Principles

Consciousness: Developing awareness of your own needs, limits, and warning signs. This means regularly checking in with yourself: Am I hungry? Tired? Overwhelmed? Start with simple daily check-ins.

Advocacy: Building the courage to express your needs and set boundaries. This includes saying no to excessive overtime, requesting adequate break times, and speaking up about unsafe working conditions. Practice starts with small assertions.

Responsibility: Taking ownership of your wellbeing through concrete actions - overhauling diet, exercise and sleeping habits one at a time, getting up earlier to experience the feeling of “having time” again, and seeking professional help when needed.

Expression: Opening up about your challenges to colleagues and superiors, and fostering honest collegial check-ins. Taking microbreaks in the OR and using scrubbing-in times for genuine connection. Creating psychological safety in our teams.

While I don’t think that magic AI tools will make all our problems - or jobs for that matter - suddenly disappear, I see the potential to ease some of our burdens.

A lot of creative thinking, openness and persistence is required to move the needle on many other areas.

Let’s reflect and create change in the way we interact with ourselves, our colleagues as well as our system - one day at a time.

To more in life,

Nicco

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“Dude, you have to try this. Really, she’s the best, I swear.”

Forty‑eight hours later, I was on a mat, eyes watering—part pain, part relief. What blindsided me were the unexpected challenges: relentless pressure wringing my muscles like a sponge, sharp jolts up my spine with each strike, and the sheer will it took to stay still while my body screamed for mercy.

Had I known, I might have hesitated.

Six brutal double‑fist hits on my back. “Finiiiished,” she whispered. And with that, my first‑ever no‑oil martial arts-like thai-bodywork session on my skinny doctor’s frame was over. I felt great—painful but great. I had to wince a little again once I paid, but I figured the short‑ and mid‑term effects were worth that pain, too.

I felt like a pirate with a wooden leg walking home, and my whole physique felt kind of off the next couple of days. It took me a while to realize, that this was actually how aligned and normal should feel. Two days later I felt awesome.

The athlete’s unfair advantage

Watching the Olympics or the FIFA World Cup, it’s obvious: high‑performing artists—masters of their field—are surrounded by professional supporters who keep their bodies, minds, and spirits at their best so they can give their best. Massage therapists, nutrition pros, stress managers, dieticians, prescribed rest plans—you name it.

But look at two top‑performing areas where this logic often breaks down: healthcare professionals and C‑suite executives.

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For some reason, we accept that people who run around a field for 90 minutes chasing a ball need full‑stack support. Yet the people who run multi‑billion‑dollar companies—and people who literally have your health in their hands—are somehow expected to figure out elite performance solo, maybe with the occasional foot massage from a spouse.

We can complain about salaries and systems, but that won’t move us forward. What we can do is steal the gladiator mindset: a fierce, proactive approach to self‑preservation, where you treat your body and mind like the ultimate arena weapon and invest in them relentlessly to outlast and outperform.

We can acknowledge the investment, build our own support group, and share the nuggets of gold with each other. Looking back, consciously and subconsciously, that’s exactly what I did.

How I built my support team

Over the years, partly by design and partly by necessity, I assembled exactly the kind of high-level support network that elite athletes take for granted:

Structural care

A physiotherapist who regularly cracked my motion apparatus—spine and all—back into place after 6–8‑hour surgeries and long stretches in unnatural positions.

Recovery and bodywork

- A highly skilled Kalari Ayurvedic therapist for 72‑hour rejuvenation system reboots: herbal‑infused oil massages, sweat boxes, sinus clearance, and sense‑grounding food and environment.

- Massage therapists in every city I moved to. I spent a fortune on all of them—and I’m 100% sure I’m above where I’d be without them.

Nutrition and planning

Regular assessments of my diet and practical ideas to meal prep, including for crazy clinic days.

Mobility and mindset

Hundreds of hours in yoga classes and meditation retreats. Another fortune spent—and I’m 100% sure these are major reasons why I’m in better physical shape at 42 than at 22.

I don’t need epigenetic testing to see how much better off I am than many of my same‑aged colleagues. I quit smoking and drinking decades ago. I spend a large part of my salary on taking care of myself. I can complain that it had to be me who paid for it. At the end of the day, it’s me who has to live in this body. While it would be nice if someone else paid, I’m happy to do it myself.

And I’ve also seen the cost of not investing.

Stress‑induced psychosis that leaves a colleague found completely incapacitated, with their car inexplicably discovered burned out kilometers away—and neither they nor anyone else can remember what happened. Being admitted to your own ICU because of ignored diabetes. The extreme emotional and monetary costs of a failed marriage when you’ve prioritized everything except the relationship that matters most.

These aren’t abstract warnings. These are people I know. These are versions of myself I narrowly avoided becoming.

Where leaders fall behind

We normalize 14‑hour days, ignore ergonomics, and skip planned recovery. We treat ourselves like amateurs and then expect elite output.

You can’t perform like an elite athlete if you treat yourself like someone who just started.

So take an honest inventory:

Strip down and face the mirror. Look at your physique. Not with judgment—with curiosity. What does this body tell you about how you’ve been living?

Sit down, close your eyes, and scan inward. Feel where your body is tight or in pain. Notice what you’ve been ignoring.

Open your fridge and see what’s actually in there. Not the aspirational meal prep from three weeks ago—what you actually ate this week.

Ask yourself: Is this what you’d recommend to top performers if they asked for your professional advice?

If yes, congratulate yourself. You’re in the top 1%.

If not, don’t be hard on yourself. Nobody taught us this. We weren’t taught it in medical school, business school, or at any step in our careers. We have to learn it and take care of it ourselves.

The good news: it can be done. It’s not impossible. And while not everyone has equal resources, most of us have more capacity than we’re currently using.

Good / Better / Best: make it accessible

Not every season permits the “best” stack, and not everyone starts from the same place. The goal is progress, not perfection. Small, consistent upgrades compound dramatically over time.

Good (low cost, low time commitment)

- 10 minutes of daily mobility work—even just a simple down-dog or a basic stretching routine

- Evening screens‑off wind‑down starting 30–60 minutes before bed

- Sunday meal prep for 2–3 weeknights so you’re not choosing between skipping meals and drive-through at 9 PM

Better (moderate investment)

- Monthly bodywork session—massage, chiropractic, or whatever modality works for your body

- Dietitian consultation once per quarter to reality-check your nutrition against your actual schedule

- Basic sleep protocol: caffeine cutoff by 2 PM, light management - dimming lights after sunset, blackout curtains - consistent bedtime within a 30-minute window

Best (full stack)

- Integrated care plan with 2–3 key providers who communicate and adjust based on your specific demands

- Quarterly assessments and metrics—sleep quality, HRV, regular relevant lab work based on your health picture

- One to two immersive recovery retreats per year—whether that’s a meditation retreat, an ayurvedic panchakarma, a structured wellness program, or simply a week with zero connectivity and plenty of movement

A note on access: Not everyone can afford everything, and financial or time constraints are real. Start where you are. A free YouTube mobility routine done consistently will outperform an expensive program you never use. The key is to stop treating professional support as indulgent and start treating it as essential infrastructure.

ROI you can feel

Pick your measures, but the trend lines matter more than any single data point:

Physiological:

- Better sleep efficiency and steadier mood

- Lower resting heart rate and higher HRV

- Fewer overuse injuries and fewer sick days

Performance:

- More surgical stamina and clarity in hour six of a complex case

- Clearer decision‑making under pressure

- Consistent energy through afternoon meetings instead of the 3 PM crash

Relational:

- Actually present when you’re with your family, not just physically there while mentally reviewing the day

- Patience with your team when things go sideways

- Capacity to mentor junior colleagues instead of just surviving your own workload

Creative:

- Mental bandwidth at 8 PM to actually work on that project - that thing - instead of scrolling

- Saturday mornings where you wake up with energy to create, not just recover

- The cognitive space to think about your art, not just your to-do list

You probably didn’t sign up for The Renaissance Protocol just to optimize your quarterly reviews. You’re here because there’s a creative part of you that’s been on hold—maybe for years—and you want it back.

But here’s what nobody tells you: you can’t reclaim that dormant passion by just “making time for it.” That’s a very important first step. But your photography hobby doesn’t just need more calendar slots. It also needs you to not be physically depleted when those slots arrive.

Renaissance living isn’t about cramming creativity into an already maxed-out system. It’s about building the infrastructure that makes the full life—the one with both performance AND passion—actually sustainable.

The support team isn’t optional. It’s the foundation.

Start now

Pick one area where professional help could elevate you to an elite support level. Not three. Not “I’ll think about it.” One.

Research it this week. Find a provider, read reviews, ask colleagues who seem to have their act together.

Make an appointment now. Put it in your calendar before you close this email.

Protect one hour a week. Treat it like a board meeting or a surgical case—non-negotiable unless there’s a genuine emergency.

Iterate. After 4–6 weeks, assess what’s working and adjust. Add a second support pillar when the first becomes routine.

You didn’t hesitate to invest years and six figures into your professional training. Your body and mind are the platform that training runs on.

Thank me later.

Your support team isn’t just about performing better at work. It’s about having enough left over for the parts of life that make you feel alive. That’s what Renaissance living actually means.

To most from life

Nicco

-----

What’s one area where you need better support? Hit reply and let me know—I read every response, and I’m always collecting recommendations to share with the community.

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“What are you doing there?” Utter disbelief rang in the voice of my attending, as if I were spraying communist slogans on his house.

I was actually trying to shove in the second fork of a limp salad from the cafeteria while standing. “Surgeons don’t need to eat!” I was waiting for a hint of a smile, a smirk, anything indicating that he was joking. But nothing, just cold grey eyes. The second time I was “caught” was in a different hospital, exiting the elevator heading for lunch when I was tapped on my shoulder and stopped by my chief attending: “If you have time to eat we obviously have too much staff in our department,” she said.

For years I was peeking nervously over my shoulder when having lunch, if I dared to have it at all.

Back then I was a fifth-year surgery resident, a father, and a grown man. And I was afraid to have lunch. Clearly there is something wrong.

This absurd reality reflects a deeper problem in our profession - a fundamental misunderstanding of what it means to be a physician. The solution lies in distinguishing between two fundamentally different approaches: the Old School physician mindset that glorifies suffering, and what I call the New School physician mindset that prioritizes our wellbeing as the foundation for excellent patient care.

To the basics: ASICS - anima sana in corpore sano - a healthy soul in a healthy body - this is an eternal truth that we preach our own patients day in day out. But we are not able to apply it to our own lives. On the contrary.

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Becoming and being a doctor is no walk in the park. Everyone knows that, and I knew that, and after all, it was my free choice. The long hours, the responsibility, the administrative and legal burdens, the at times abominable working conditions and environments have been pointed out time and again. The stress can be enormous.

The statistics tell a sobering story. Burnout among physicians remains high worldwide. A comprehensive COVID-era meta-analysis found an overall prevalence of ≈55%, with significantly higher odds among frontline clinicians and regional variation (Macaron M.M. et al., Frontiers in Psychiatry, 2023; https://doi.org/10.3389/fpsyt.2022.1071397).

The statistics tell a sobering story. Burnout among physicians remains high worldwide. A comprehensive COVID-era meta-analysis found an overall prevalence of ≈55%, with significantly higher odds among frontline clinicians and regional variation (https://doi.org/10.3389/fpsyt.2022.1071397).

In emergency medicine, pooled international prevalence reached ≈43% (95% CI 32–54%), underscoring that high stress is a global, not regional, phenomenon (https://doi.org/10.3390/healthcare11152220).

In the United States, the most recent Mayo Clinic Proceedings data show physician burnout falling from 62.8% in 2021 to 45.2% in 2023, returning to pre-pandemic levels yet remaining alarmingly high (https://doi.org/10.1016/j.mayocp.2024.11.031).

We are one of the professional groups with the highest rates of illicit substance and drug abuse, suicide rates and premature deaths. And this is no longer only affecting physicians themselves - physician burnout directly correlates with increased patient safety incidents, decreased professionalism, reduced patient satisfaction, and higher turnover intentions, as demonstrated in comprehensive BMJ meta-analyses (https://doi.org/10.1136/bmj-2022-070442).

A particularly insidious contributor to modern physician burnout is electronic health record (EHR) fatigue. We spend more time documenting care than providing it - studies show physicians spend 2 hours on EHR tasks for every hour of patient contact. This administrative burden represents a form of moral injury, forcing us to prioritize documentation over healing. The ICD-11 now formally recognizes burnout as an occupational phenomenon resulting from chronic workplace stress, acknowledging that systemic factors like EHR burden require organizational-level solutions alongside individual interventions (https://doi.org/10.2147/JHL.S389245).

But one of the root problems lies somewhere else. It is a force that at times opposes change for good from within.

It is our common mindset. The mindset that defines how we think we as physicians have to act and interact within this system.

This is what I call the Old School physician mindset.

The practice of medicine is often associated with that of a selfless practice. A term that has been badly misunderstood. Selfless in the sense of no ego, no personal agenda driving the practice, yes. But it never was intended to deprive us from our natural physical, emotional, spiritual and social needs, that we - human beings after all - have, too.

I oppose the implicit and explicit suggestion of physician martyrdom as the only way of practicing medicine.

Neither the Hippocratic oath, nor Lasagna’s modern interpretation of it or Inman’s “First do no harm” indicate at any point that our profession should go at the expense of our own wellbeing.

Yet the Old School mindset has often created a toxic culture where suffering becomes a badge of honor. As a collective, we take some sort of sick pride in suffering, comparing who works and harms himself more. It leads to a twisted form of false, perceived heroism, where a delusional mind fights its very own body.

I lost one great grandfather physician to morphine and one grandfather physician to myocardial infarction. I have seen colleagues smashing trash cans, kicking holes in walls when the pressure got too high and their underdeveloped coping strategies failed. I saw them literally smoke themselves to death, or get admitted to their own ICU in a diabetic coma.

I have seen way too many near accidents such as wrong surgery site markings, faulty prescriptions and other concentration deficit derived mix-ups. And I have seen a patient die because of a catastrophic cascade of decisions made by physicians trapped in ego-ridden decision making. This should not be.

The prospect of working the rest of my life in such self-wrecking conditions made me quit medicine for good twice.

Only one mentor’s reminder to “focus on changing what is within your reach. Change from within” kept me coming back.

This mentor’s wisdom points toward a different path - one that acknowledges the reality of systemic problems while empowering us to take control of what we can change. The problem is not that these things happen, but that we shrug them off as something inevitable, as the status quo. This is what I call the old school physician’s mindset which puts a skewed idol image of our profession first.

In contrast, a New School Physician mindset puts ourselves as doctors first.

Not the profession. Not the patient, but ourselves.

Safety first. We know that from first aid guidelines and airplanes - make sure you don’t endanger yourself, it helps no one.

We can’t give if we have nothing to give, if we get consumed in the process.

We must stop postponing it to some indistinct point in the hazy future.

To be clear, this is not about creating a medical la-la land for physicians. And it is definitely not about jeopardizing patient care because of petty personal issues.

The New School approach is actually about becoming better physicians through conscious self-care. It is about acknowledging one’s personal needs. It is about building up the strength and courage to express those needs, even against implicit or explicit threats from our peers or more importantly against imagined threats of our minds.

It is about taking responsibility for your own life. It is about actively deciding how to spend our time; how to do what we do. It is about making conscious choices for ourselves.

The moment we become true and honest about ourselves to ourselves, we become better doctors as well.

So what does this look like in practice? How would this look like? Take one step back and take a bird’s-eye view on your current life.

And then examine your life’s situation as you would with your own patients.

What are the most pressing issues?

What would you recommend to a patient under those kinds of circumstances?

I believe there are many things we can do in the realm of mindset, organization, lifestyle and communication to help us feel better again.

And most likely, every single one of us already knows exactly what that would be in our case.

When we embrace this New School approach, the benefits extend far beyond our personal wellbeing. If we know our truth and can stand up for it, we become independent from other people’s conflicts of interest. We then can start treating our patients to our best knowledge.

And we can be truthful and honest with our patients as well, without having to be afraid to disappoint them or make them feel bad.

And most importantly without risking harming them by harming ourselves.

This would also reduce pressure and stress, and foster wellbeing far more significantly than any external health reform ever could.

It doesn’t and shouldn’t take away the responsibility to improve structural and institutional conditions - but it is an important pillar to tackle this multifaceted challenge.

This is the future of medicine I envision - one where healthy physicians provide the best possible care because they’ve learned to care for themselves first. This is what a New School Physician would look like.

The choice is ours. We can continue perpetuating a culture that glorifies suffering and ultimately harms both physicians and patients, or we can choose to become New School Physicians - one conscious decision at a time. The transformation of medicine begins with transforming ourselves.

I wrote this piece in 2016. Back then I was too afraid to publish it.

I have slightly adjusted the text and updated some references - which haven’t fundamentally changed, what is telling in itself.

Since then I have moved through the ranks to be now in a position where I see this problem perpetuating itself also on the administrative side. And realizing that I have become part of the problem myself - and to a certain extent - hopefully part of more structural solutions as well.

The challenge requires both individual and systemic approaches. While evidence shows that interventions targeting medical residents yield only modest benefits when implemented in isolation, combined approaches show greater promise (https://doi.org/10.1186/s12909-024-06195-3). This reinforces the need for what I call the CARE framework - a practical approach for New School Physicians:

The CARE Principles

Consciousness: Developing awareness of your own needs, limits, and warning signs. This means regularly checking in with yourself: Am I hungry? Tired? Overwhelmed? Start with simple daily check-ins.

Advocacy: Building the courage to express your needs and set boundaries. This includes saying no to excessive overtime, requesting adequate break times, and speaking up about unsafe working conditions. Practice starts with small assertions.

Responsibility: Taking ownership of your wellbeing through concrete actions - overhauling diet, exercise and sleeping habits one at a time, getting up earlier to experience the feeling of “having time” again, and seeking professional help when needed.

Expression: Opening up about your challenges to colleagues and superiors, and fostering honest collegial check-ins. Taking microbreaks in the OR and using scrubbing-in times for genuine connection. Creating psychological safety in our teams.

While I don’t think that magic AI tools will make all our problems - or jobs for that matter - suddenly disappear, I see the potential to ease some of our burdens.

A lot of creative thinking, openness and persistence is required to move the needle on many other areas.

Let’s reflect and create change in the way we interact with ourselves, our colleagues as well as our system - one day at a time.

To more in life,

Nicco

If you need oxygen, this track might be what you need today:

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WOMP. That was the muffled sound of my brother’s front teeth hitting the rim of the bathtub. Then came a remarkably long silence, followed by an infernal scream. Blood dripped from his mouth. My mother rushed in, worry sharp in her eyes, and asked what happened. I explained that he slipped and hit the rim.

Except that was a lie.

The fact that my brother’s two front teeth were rammed back into his gums, had to be pulled out with pliers, and later turned black wasn’t his fault.

It was my fault—I had pulled his legs out from under him. On purpose. I never meant for that to happen. But I was too scared to admit it.

This story haunted me for almost 18 years. Whenever it was told at family gatherings, it gave me a burning sting. The past, it turns out, is loud even when it’s silent.

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After my “honesty awakening” and learning to be honest with people close to me about my feelings and sensations, I came clean. I told both my brother and my mother the full story. To my complete disbelief and surprise, both of them said, “Ah, okay. Never mind.”

Years of shame and regret—for nothing.

What That Response Taught Me

That moment showed me how useless and debilitating regret becomes when it turns chronic. As Shakespeare gives the blunt version:

“What’s done cannot be undone.”

The question is what we do next.

As I see it now, regret tends to split into two kinds:

• Regret for having done something that shouldn’t have been done.

• Regret for not having done something that should have been done.

In both cases, the result is the same: this is what happened. The feeling of regret holds your present hostage. If regret is a signal, its job is to inform and then be dismissed—otherwise it calcifies into rumination.

The Way Through

You can let go of regret and move forward. Both kinds can be overcome only by action and forgiveness. To stop regretting what you didn’t do, either do it now or make a plan. If you can’t do it anymore, or you did something you shouldn’t have done, you have to forgive yourself.

Forgiveness is a lost superpower—and the core of Jesus’s teachings. Learn how to forgive yourself, and then others. Forgiveness doesn’t excuse the harm; it releases you from carrying it. If meditation cultivates equanimity toward whatever arises, forgiveness acknowledges what happened for what it was and allows you to move on from it. As the Stoics might put it, we can’t control the past, only our present posture toward it.

What Forgiveness Is—and Isn't

I used to fear that forgiving would make me approve of bad behavior, the way I once feared that meditation would make me indifferent.

I was wrong on both counts.

Forgiveness is not approval, and it is not reconciliation.

It changes your relationship to the past; it doesn’t obligate you to excuse harm or re-enter unsafe dynamics. If you like frameworks, psychologist Everett Worthington’s REACH model (Recall, Empathize, Altruistic gift, Commit, Hold) offers a practical way to do this work.

A Story I Return To

There’s a story about an older and a younger monk hiking. They come to a river where a young woman is waiting because she is afraid to cross it on her own. The old monk lifts her up, carries her over, sets her down on the other side, and continues walking. After two hours, the younger monk can’t hold it in anymore. “Why did you pick up that woman? You know that, according to our rules, we’re not allowed to touch women?” “I set the woman down two hours ago. Why are you still carrying her?” replies the old monk.

I think of this whenever I catch myself carrying a grudge or regret about something or someone for months, even years. As mundane as it may sound—and as often as it’s already happened—remembering to set the burden down has been extremely valuable to me.

The Music of Time

The fleeting nature of time—nothing ever comes back, whatever happened happened—is most tangible for me in music. You hear a note, and then it’s gone. You can’t cling to it. Only because it’s gone is there space, silence, and room for the next note. Only then can a melody develop. As Faulkner wrote:

“The past is never dead. It’s not even past.”

But in practice, the note has already sounded. The question is whether we keep replaying it in our heads, or make room for the next phrase.

I can’t change what happened, but I can change how I relate to it—right now. And the best next step for that is forgiveness.

One sticky note I once saw summarizes its power for me in a beautiful way:

Forgiving is for giving, not for getting or forgetting.

If you really start forgiving yourself—if you start owning the mess that is your life—you become free.

Free from regrets.

Free from the shackles of your past.

Free to openly explore and shape the future of what lies ahead.

That is a life of no regrets.

To more from life

Nicco

The song for letting go:

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Most people are experts at doing the wrong kind of stupid.

This thought hit me like a truck around 2am in the morning, drunk in a rundown club in Berlin in 2010.

Everyone has a 2am moment when they realize they're living someone else's life.

I was seeing myself from the outside, talking to a girl, trying to be attractive,

seeing myself miserably failing with that,

realizing I was drunk and absolutely not enjoying it,

realizing how much money I had already spent on that undesirable state,

realizing that tomorrow I will not only have no memory of that evening but the mother of all hangovers.

And I asked myself "What on earth am I doing here?"

"Why am I doing stupid things that I don't even enjoy?"

Fast forward a couple of months - after I learned how to sit still - and I had stopped doing that particular stupid thing. It actually was the last time I had alcohol altogether.

This isn't about abstinence or moral superiority. This is about recognizing the programming that keeps us trapped in voluntary stupidity.

Stanford researchers found that 73% of people systematically avoid beneficial risks while embracing harmful ones - exactly what I discovered that night in Berlin.

If you've ever caught yourself living on autopilot, doing things you don't enjoy while avoiding what excites you, this distinction will change everything.

Here's how to flip this script and start making the 'stupid' decisions that actually transform your life—the ones that lead to the adventures, relationships, and opportunities you've been avoiding.

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Two Types of Stupidity

In my mind there are two kinds of stupid things.

Really stupid things and supposedly stupid things.

Really stupid things include examples like the above or gazing at the three lights of a freight train approaching too fast while crossing train tracks. Going on a hike half an hour before sundown with no equipment on a remote island in Australia. Things that really put you and your health in danger in the short or long run. Things that you don't really enjoy while doing them.

And then there are supposedly stupid things.

These are things you were implicitly or explicitly taught to think of as stupid because of the unknown associated with them.

Moving in with someone after three months.

Moving to another country with family and kids without speaking a single word of that language.

Starting a company.

Writing a book.

Accepting to pick up a Japanese dragon shirt at 2am in the morning.

Things that stir that tingle, that are scarily exciting with a feeling of enjoyment.

[Most people have this backwards. They avoid the supposedly stupid things that could transform them while repeatedly choosing the actually stupid things that slowly erode their vitality.]

The Habit Problem

We are creatures of habit. That makes stopping the really stupid stuff hard.

We are afraid of the unknown. That makes starting the "stupid" stuff hard.

We are still used to asking and waiting for permission. That makes both harder.

The third barrier is perhaps the most insidious. We've been conditioned to seek approval for our own impulses.

The Unknown

With regards to the unknown - there is no hack around that:

You have to learn to embrace the unknown. To be in that space of not knowing. It will always be a little frightening. You will have to learn to feel the fear and do it anyway. Because it is in that fear where you find what you have been looking for. This is something you will never entirely get used to. But you can train yourself to stay in that sensation without running away or reverting back to stupid things.

My friends think I am crazy. But I am not. I am just like they would be if they weren't so scared.

—Johnny Depp (allegedly)

The Permission Problem

Here's what I've observed: 99% of what we think requires permission actually doesn't.

We have been raised and trained to ask for permission. All the time. Now I am not advocating that you don't give a damn about anything and just go ride your ego trip. There is high value for interpersonal and societal functioning in asking for permission. Your personal freedom ends when you begin to invade someone else's.

But that is not the case in 99% of the situations we are referring to here. I am referring to the things that seem stupid by conventional norms. Things that threaten to disrupt the comfort and homeostasis of your social circles and surroundings. Things that might bring others to face their own fears or question their own behavior. In short we are afraid of how our behavior may make other people feel.

Scientists have shown that 60% of people give too much weight to what other people might think.

You don't need anyone's permission to do these "stupid" things.

After all, you are not responsible for other people's feelings.

Training Your Permission Muscle

So how do you learn to give yourself permission?

By training. By training your permission muscle. By noticing the little nudges from your gut or subconscious or however you want to call it. You can get much better at that by learning to sit still and to notice your sensations. And then acting on those nudges without rationalizing them away first.

Drive to the airport and book the next available flight to an island instead of your next all-inclusive battery cage vacation - if that is what your nudge is telling you. You might end up on a millionaire's finca private party and serendipitously meet people that can have lasting impact on the future of your life.

This is what common wisdom calls following your heart. Open up to these tiny impulses.

And prepare to find that the "most stupid" things turn out to be your smartest decisions.

Here's the beautiful irony:

In the end you might find out that the very people who were warning you about the stupid decisions you were about to take and whom you didn't want to disappoint, might end up envying you for those very actions.

But by then it won't matter. Because you'll be living while they're still preparing to live.

At the end, the only one who can give yourself permission, is you.

To more in life,

Nicco

‘Stupid’ song

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High achievers have more brutal days than failures. Here's why that's actually the point.

It's 7:15am, one of my lead consultants calls in sick, I delegate the adaptation of the daily schedule with that info. 7:20am another one calls in sick because of child sickness. Now the OR program starts to fail, I need to step in but can't. I am trying to help my youngest one put on his socks. My wife is traveling for concerts. I am dropping off child 1, 2, 3 while simultaneously coordinating meetings to be moved around.

I am sweating against the drizzly cold gusty headwind to just make it in time and jump through the closing doors of the train. Some frantic 25 minutes mail correspondence later I rush into the OR, assist the surgery. A couple of back-to-back meeting marathons afterwards and no lunch and I ask myself not for the first time that day if it really has to be so brutal.

Another call, some issue during surgery, if I can come and help. Of course I do. Texting my wife on the way to the OR that I won't make it home in time as planned. She kindly arranges things with our nanny, as she is still out of town. I fly to the train to read my private mails, harsh reminder to send my finalized speech proposal. And the reminder from the tax accountant. I compose some music to calm down and arrive at the main train station. It pours.

It's one of those days, one of those dog days. But I'll make it home. We all sit down, share our frustrations from the day and with each other because of that day. Then we dance. And after the kids went to bed I am finalizing my speech proposal.

Most people would pity this. You could shake your head and think why would anyone do that. You could question my life choices and ask if this is all worth it. I do that too.

The Reality of Dog Days

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But here's the truth: There will always be dog days. Days where nothing works out. Or at least not as expected.

But these days will be there irrespective of what I choose to do. I could have not worked as head of a surgery department. I could have decided against a big family, I could not do any of these things. But the dog days would still come.

Often times we go about life pretending that every day is a dog day, when it actually isn't. And at the same time there is a clear sign to change something in your life if the amount of dog days increase significantly.

The Success Paradox

In the bigger scheme of things, dog days are a built-in part of a glorious life. The more glorious your regular life, the doggier the dog days. Higher ups, deeper downs.

This isn't a bug—it's a feature.

Ambitious people don't have fewer problems—they have more expensive ones. Your capacity for joy is directly proportional to your tolerance for chaos. The art lies in keeping your equanimity through both.

A Lesson from the Burn Ward

It was in 2014 in my early resident days when I got my first rotation on the burn ward. A time of lots of personnel rotation, many experienced nurses leaving, bad vibes, gossiping and badmouthing. The burn ward was a psychological infection zone. Negativity spread like sepsis. I caught it within a week—started taking other people's misery home, dumping it on my wife. She called me out: "This stops now." Best intervention of my career.

The next day I went and talked to an old navy anesthesiologist - very Christian in his everything. I told him my frustration, my worries about everything going down.

He looked at me and said with biblical pathos:

"Care for your next, not for their neighbor"

I took that as advice to change the things within my circle of influence and stop focusing on the ones outside of that circle.

I went up to the ward room, tore down all yellowed, bleached out documents from the wall, put up a whiteboard and had an impromptu discussion with the entire staff on the principles of our collaboration. It felt liberating. And it was the last day of me spreading the negativity virus.

Why Comfortable People Never Win

The world is not only roses and sunshine, it's not all crap and rain weather either.

Einstein boiled it down to one choice: Is the universe friendly or hostile? I chose friendly. This doesn't mean it's easy. It means the chaos serves a purpose.

That being said, life will throw - what you at first glance believe to be - rocks at you. According to “Free”, a freestyle vipassana monk I recently had a discussion with: Suffering is a built-in part of living. Why else would your body start hurting when you are sitting still for a longer while. Asking why that is, is a futile question. Similar to the Buddha's reply to the question of what the meaning of life is: It is the wrong question. No answer will ever be satisfying. It just is.

Why am I writing about this today?

For one, to show and share that every life has suffering. Mine does too. The degrees differ. But suffering is always subjective and not fun. It is a normal part of life.

Yes, I'm privileged. Yes, I have help. That's exactly the point—even with every advantage, life still throws curveballs. If you're waiting for easier circumstances to start pursuing what matters, you're waiting forever.

Living and striving for a multipassionate life will not eliminate your suffering. But it will increase your joy and happiness overall.

Living out all the yearning parts is not easy. It is actually brutal. But it is also incredibly satisfying. And it will make the necessary dog days much more tolerable - because you know and deep down feel what you are experiencing them for.

So have a good look at your current life. Have a good look at your attitude towards Einstein's question - whether you believe the universe to be a friendly place.

Then look at the doggy areas of your life, focus on your own circle of influence and glorify them.

The next time chaos hits, remember: this isn't happening to you, it's happening for you. Your capacity to handle it is exactly what separates you from everyone still making excuses.

To more in life

Nicco

Dog Days The Song

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The first hit in my face hurt, but I didn't really feel the pain. I was in utter disbelief. He hit me. He really hit me, in the face.

I don't know why it actually surprised me. I was standing in the middle of my empty living room, professional mouthguards protecting my teeth, strapped into semi-professional boxing gloves—same as my roommate. From the outside, it looked like we were really boxing, and that was what we had agreed on. I just didn't believe it until he hit me.

And while I was thinking all these thoughts, the second hit landed. Again, my face. This time it really hurt.

That was when I felt a long-absent emotion boiling up from deep down.

Anger. With a hint of rage.

"You don't get to hit me like that" was the thought that drove my uppercut.

Two minutes later, we agreed to stop because it became painfully clear that we would really hurt each other.

Hunting My Shadows

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At that time, I was on a quest to find my shadows—my hidden and suppressed emotions, the parts that I had locked away for whatever reasons. During that process, I realized that I never got mad. This didn't seem like a healthy way of dealing with frustration, and this was long before my meditation journey began. So I went out and tried a crazy amount of things to get back in touch with my anger.

Boxing did the trick.

But here's the thing about shadows—they're sneaky. Just when you think you've found one, another emerges from a different corner. Anger was just the beginning of my archaeological dig into the dark parts of myself.

A bit later, I came to realize that I used envy as a substitute emotion—an emotion I wouldn't necessarily show in public but would at least be aware of. What if the parts of ourselves we try to hide are actually the keys to our growth?

I envied a lot of people for a lot of things. But I'd rather judge them than admit that I wanted to have all of that too. It became a decade-long process to work through that, and it became, in part, the fuel to follow my desires and grow into a multipassionate person who is owning and accepting his interests and curiosities.

The irony wasn't lost on me—I was judging people for having exactly what I secretly craved. It's like being angry at someone for eating ice cream while you're on a diet you imposed on yourself. The real question became: what was I dieting myself from, and why?

It's fascinating how many different limiting emotions we carry with us: the envy of people farther along the path than us, the fear of "not being good enough" or "being found out," the shame of not fitting in, the doubts of morality. What Brad Blanton calls the prison of the mind—and what Carl Gustav Jung calls the "shadow"—the parts of ourselves we repress, deny, or feel ashamed of.

The Invitation to Wholeness

Jung was a proponent of owning that shadow. According to him, it is not only the striving for the good and noble, but the awareness and acceptance of the dark and wicked.

Through years of reading, trying, and discussions with mentors and people much smarter than me, I realized that the reasons why these shadows develop(ed) is of less relevance. That almost trendy focus on finding triggering and traumatic events in one's past doesn't seem very fruitful and helpful to me—quite the contrary.

I like Alfred Adler's approach: taking what currently is—your shadowy emotions—and turning them into drivers that work toward your growth. It is forward-focused action, not backward-focused contemplation. A lot like the martial art Aikido that I used to practice for a while, which takes the attacker's energy and turns it into motion against the attacker. Aikido masters never attack. It is the most elegant and calm way of self-defense I have seen so far.

That is what I strive for on an experiential level—being the Aikido master to my emotions. When they come for my sanity, I take their energy and direct it toward something purposeful.

The Drive to Belong

According to Adler, our human core drive is to belong and to contribute. When we feel that we don't belong, that we don't fit in, or feel inferior or unappreciated, then shadowy feelings like envy and anger are natural responses. Whether they turn into anxiety or achievement depends on how you use their energy.

And that is the hopeful bit here: This is your decision. This is something you can learn.

So rather than trying—desperately, hopelessly—to eliminate the shadow, accept it, learn from it, and turn its energy into creative striving and contribution.

We are not monolithic personalities. We are ever-changing and adapting mosaics. We are made up of many, sometimes contradicting parts—let's embrace that complexity, as this is what allows us to live a multipassionate renaissance life.

What if your scattered interests aren't a bug in your system, but a feature? What if having "too many" passions is actually your secret weapon in a world that rewards unique combinations over single-note expertise? What if wanting to have it all is actually ok?

When we live out loud all of our facets, our contribution becomes the result of our unique combination of strengths. And that ultimately brings the feeling of true belonging we were afraid of losing by suppressing that uniqueness.

The absurdity of our ridiculous tendency of losing by trying everything not to lose—the definition of a self-fulfilling prophecy—sometimes breaks my mind. And then I have to laugh about myself and us as a species.

Practical Shadow Work

As a practical reflection, ask yourself:

What is my shadow trying to teach me? How can I use envy or comparison as a guide to my next step?

Use your own frustrations as an unfair advantage and secret energy pack.

Here are some prompts that I found helpful for reflecting on that:

• Recent Envy Check: What is a recent moment of envy or comparison? What's the hidden desire or value underneath?

• Identity Mapping: List your different identities/roles. How do they interact? Where do they conflict and why? Where do they support each other?

• Shadow Sharing: Share your shadow with your partner or a trusted friend—healing happens in relationship.

The most powerful shadow work isn't done in isolation. It happens when we risk being seen—really seen—by someone who can hold space for all of our contradictions and still choose to stay.

I am curious to hear about your shadow stories.

To more in life,

Nicco

Shadow dancing…

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Someone asked me how to develop the courage to follow your own path.

I thought it would be easy to answer. I was wrong.

The question sent me spiraling—not forward into advice, but backward into something more unsettling. Watching my four-year-old, I realized we've been asking the wrong question entirely.

The Space to Feel What's Yours

He was doing his thing the other day. Building something elaborate with blocks, completely absorbed. I called him over to help with something trivial. He ignored me. I called again. Still building. It took three attempts to pull him away from his project.

That's when it hit me: he wasn't lacking courage to follow his path. He was already on it.

But more than that—he had something most adults have lost entirely: space to feel what actually interested him.

No notifications pulling his attention. No voice in his head questioning whether block-building was "productive" or "practical." No anxiety about whether this activity would lead somewhere meaningful.

Just pure, undiluted connection to his own impulse.

The Great Theft

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We didn't lose our courage. We lost the space to feel it.

Modern life systematically removes both simultaneously. You can't follow your own path if you can't feel what it is. And you can't feel what it is if you never have space to sit with yourself without distraction, without judgment, without the constant input of what you "should" want instead.

Think about it: when did you stop having space to feel what you actually wanted? When did other people's voices become louder than your own instincts? When did being busy become more important than being aware?

School taught us to ignore our internal rhythms and follow external schedules. Culture taught us to optimize for metrics that had nothing to do with what made us feel alive. Technology taught us that empty space was a problem to be filled rather than a gift to be protected.

We weren't born without courage. We were trained out of the space needed to access it.

The Connection Crisis

This is why your relationships feel hollow. This is why your career feels like someone else's life. This is why you can't connect authentically with others.

You can't give what you don't have access to.

If you don't have space to feel what you actually want, how can you know what you bring to a relationship? If you don't know what energizes you, how can you share that energy with others? If you can't feel your own path, how can you walk alongside someone else on theirs?

The relationship advice that never works—"communicate better," "be more vulnerable," "listen actively"—fails because it assumes you know what you're trying to communicate. But if you never have space to sit with yourself, to feel what's actually happening inside you, you're trying to share from an empty well.

Watching the Theft in Real Time

Here's what terrifies me as a parent: I catch myself stealing this space from my children. The same phrases I heard, the same "reasonable" advice that slowly eroded my own connection to myself.

"Stop wasting time." "Be productive." "What are you going to do when you grow up?"

These aren't protective statements. They're space killers.

My four-year-old has both space to feel what he wants and courage to follow it because I haven't fully trained him out of it yet. But I can see the machinery already at work. The slow, systematic replacement of internal navigation with external approval.

My job isn't to give my children courage—they already have it. My job is to protect their space to feel it.

Connecting the Dots Backwards

Steve Jobs said you can't connect the dots looking forward, only backwards. Everyone quotes this. Few understand what it actually means for daily decision-making.

When I decided to become a plastic surgeon, nothing in my background pointed that direction. No research, no observerships, no obvious pathway. But when I needed to make my case, I went back and created the narrative.

Dermatology experience became "wanting to learn more about skin." Random encounters became "meaningful exposure." Unrelated skills became "foundational preparation."

I wasn't lying. I was authoring. Taking the scattered dots of experience and connecting them in a way that made sense of where I was going.

But here's what I understand now that I didn't then: the dots were only meaningful because I had space to feel which direction actually called to me.

Without that space—without time to sit with myself and notice what energized me versus what drained me—I would have been connecting dots toward someone else's vision of my life.

The Liberation

Here's the psychological breakthrough that changes everything: if you create space to feel what's actually yours, and you can connect the dots backwards any way you choose, then it doesn't matter which dot comes next.

The path isn't predetermined. You're not missing some cosmic roadmap. There is no "right" choice that you might mess up.

You take the next step that feels most alive. Then the next one. Then you look back and create the story that makes it all make sense.

This isn't delusion. This is how humans actually navigate.

But it only works if you have space to feel which direction feels most alive.

The Return to Feeling

Your four-year-old self knew exactly what to do because they had both ingredients: space to feel and courage to follow.

They didn't need permission, validation, or a ten-year plan. They had something more powerful: uninterrupted connection to their own impulse.

The courage to follow your own path isn't about becoming someone new. It's about creating enough space to remember who you were before the world convinced you to be someone else.

This is why the relationship with yourself is the foundation of everything else. Not because you need to "love yourself first"—that's therapeutic cliché. But because you can't share what you can't access.

Create space to feel what's actually yours. The courage will follow naturally. The path will become clear. And the relationships—with yourself, with others, with your work, with your life—will finally have something real to build on.

Your courage isn't lost. Your path isn't missing.

They're both waiting in the space you're afraid to create.

Time to stop filling every moment and start feeling what emerges in the silence.

To more in life,

Nicco

The vocal help to find your path

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I’ve just returned from a transformational business retreat in Mallorca. In the beginning, I was a bit reluctant, since I didn’t know the coach and the setting; it was my wife who took me with her. In preparation, I had worked through a workbook, answering questions on different areas and aspects of my life.

In terms of business goals, I had a tough time describing what I was aiming for—and what I expected as a result from the retreat. I outlined a concept I’d developed from observing people over the last couple of years who had built a personal brand and developed a lean, minimal-effort group coaching business as their main source of income. I liked the overall idea—hence, I began creating a similar community myself, the Renaissance Society. But it always felt a bit off and effort-intense, with baseline reluctance.

The first three days, we did more creative exercises paired with—to my great joy—vipassana meditation facilitated by a former monk.

All of this took place in a serene setting: an impeccable Mediterranean villa with ample space for everyone. Everything was taken care of—food, schedule, all the details you’d usually fuss over. To sum it up, I technically didn’t HAVE to think about anything. Combine that with plenty of sun, music, dance, movement, and fresh air, and I got a sensation I hadn’t felt in a long time:

Space. And time.

There used to be a legendary club at the waterfront in Berlin called Bar25, with parties lasting 72 hours and more. One of their famous music collections is called “Days Outside of Time” (highly recommended, by the way), because that’s exactly what they created—days outside of time.

This was the feeling I had again.

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As I sat there one morning journaling over one of the prompts, it suddenly happened. I reconnected fully to myself and one thing became crystal clear to me:

All I want is to get on stage.

This insight felt incredibly relieving. I realized I had been barking up the wrong tree for quite some time. In that particular area of my life.

I’d had that urge and wish before, but I didn’t have enough courage, knowledge, or experience to act on it properly. And then I forgot.

When I returned home to my kid-sitting parents and told them, my mother simply said:

“That’s interesting. Now you are back to where you were 35 years ago, when you announced that you wanted to speak at Olympia stadium in front of a big audience.”

Life is funny and the universe a joker.

This episode reminded me of Lao Tzu’s famous saying: “Can you wait, quietly, until the mud settles and the water is clear?”

The thing is, for a long time I hadn’t made space or time to simply wait, quietly, and let the mud settle so I could have a good look at the water—that is, myself.

To really go into relationship with myself, to feel and listen to what’s underneath. The voice that got buried by reasoning, moral, and forgetfulness.

Scientific research consistently shows that the quality of our relationships is the single most important predictor of happiness and longevity. The 75-year Harvard Study of Adult Development found that “close relationships, more than money or fame, are what keep people happy throughout their lives. Those ties protect people from life’s discontents, help to delay mental and physical decline, and are better predictors of long and happy lives than social class, IQ, or even genes.

Meanwhile, a 2018 Gallup poll found that approximately 50% of employees left a job to “get away from their manager,” highlighting that people leave organizations not because of pay, but because of relationships.

During the retreat, I gave a short talk about the importance of personal relationships for your entire life. If they are not good, nothing else is really good.

It’s not productivity hacks or perfect morning routines—it’s relationships (with ourselves and others) that run the whole show.

Relationships aren’t just ‘important’—they’re everything.

Think about your own life. If your personal relationship with your partner, spouse, child, sibling, parent, or any other important person is unbalanced, it directly impacts your overall quality of life. It usually consumes much of your feelings and thoughts.

Take a moment—think about which relationship is “off” right now. How much does that occupy your mind?

But as so often, it’s obvious with outward relationships—they fuel much of what we call culture: art, music, architecture, maybe even technology.

But underneath all that sits the relationship you have with yourself. For most people, it’s—let’s just say “complicated,” if they’re aware of it at all.

(In my book on effective planning—Super Effective Planning—I elaborate on the idea that any task you want to get done needs a place and a time. Otherwise, it won’t get done.)

Similarly, on a much larger scale, the task of getting into relationship with yourself—or in deep relationship with others—requires space and time.

The Problem: Starving in a Sea of Contacts

Which are exactly the two things most under attack in our lives today. We live in times of hyper-mobility and hyper-connectedness. The promise of every technological advancement was “saved time.” And yet, where is that time? Since we allegedly have more of it, we feel compelled to fill it. To do more. To make “good use of it”—because, as we all know from countless fortune cookies and calendar quotes, time is our most valuable asset.

This is our modern dilemma. We can be almost anywhere, anytime. But we end up being nowhere for real, ever.

We live dispersed, away from family members; friends are cross-country. We have 800 followers on Instagram, 1,500 connections on LinkedIn, but no one who just knocks on the door for a chat.

We are afraid of the silence. We are afraid of the space in relationship with time. Silence could make us realize we don’t know anymore who we are, what we want, and that we are more alone than we like to admit.

Obviously, these are simplifications. It would be naive to think everything was better “in the good old days” when villagers watched your every step and you were stuck at home with a hostile stepmother.

Modern life can be wonderful—if you have your relationships in place and they’re healthy.

That requires awareness. And for that, you need to be able to sit still (see Why You Can’t Sit Still: The Missing Link in Modern Meditation). Once you can do that and have reconnected to your inner workings, your feelings and sensations, you can begin communicating them, as we explored before using sensual honesty (see Sensual Honesty). This is how you fix your relationships.

I had to learn these tools and techniques before I was able to find and keep the one core relationship outside myself that forms the bedrock of my life: my wife.

I had to learn to meditate and to communicate with sensual, radical honesty. Everything before had failed.

The Relationship Feedback Loop: Self, Others, World

They say nobody can help you but yourself. If you don’t fix your relationship with yourself first—if you seek the fix outside, in a partner, a child, a profession, a religion, whatever—you will fail.

When I was in pre-med school, one of my professors told me before failing me, “Physics is the root of medicine. If the root is sick, the tree dies.” He was wrong, but the parable holds true.

The relationship with yourself is the root of life. If it is sick, your life slowly dies. Fix it, and your tree blossoms and grows, radiating into all your other relationships. Ultimately, it will define your relationship with the world.

Wouldn’t that be great, if those were all great relationships?

Relationship Neglect: The Downstream Dominoes

As mentioned above—if your core relationship has issues, you will feel it in every area of your life. Maybe not all at once. Maybe only subtly. But like a wave slowly building, if left unchecked, it will come crashing down eventually.

It can have many names—it can be physical or mental. It can come as burnout, depression, anxiety, stress. It can manifest as pain, allergies, or chronic disease. You might have “it all” by conventional standards, yet enjoy none of it.

At the end of the day, something is not being taken care of.

This is so sad. The explosion in mental health issues, divorce rates, and work dissatisfaction are a testament to that. (According to the American Psychological Association, workplace stress is at an all-time high in recent years, strongly correlating with relationship strain both at work and at home.

It is neither the things themselves, but our relationship to them.

Now, typical advice includes “follow your real passion”—usually identified after expensive coaching or therapy sessions, often resulting in quitting the job or the partner or both. Often, this process breaks through when you can’t contain it anymore, manifesting as a midlife crisis.

It typically doesn’t solve anything—just recreates a new setup for the same issues to play out again after a time. I call that the problem-donkey. When I had my first quarter-life crisis—for the above reasons—I fled to Italy. Life was great; I was living the dolce vita, no more problems. Until one day, a few months later, I heard a subtle knock at the door. I opened it, and there stood a donkey with a faithful, sheepish look. When I had left Berlin, he had collected all my problems, put them on his back, and taken the long, cumbersome land route to bring them to my new place. And there I was—same problems, different country.

Since I refused to believe it, I tried again, fleeing to France, and then again to Berlin. But every time, with some delay, the problem-donkey showed up.

Only then did I realize I had to face my relationship with myself. It was then that I began to learn to sit still, to get out of my head and into my senses, and to communicate my sensations honestly.

What Actually Works: Simple Shifts That Change Everything

After my most recent reminder, I can’t stress enough the importance of actually making space and time to retreat regularly—whether through a retreat or other means.

A digital-detox weekend most likely won’t suffice.

How to Begin:

• Start a meditation practice. (If you don’t know where to start, see (Why You Can’t Sit Still)

• Practice communicating with radical honesty. (See Sensual Honesty for more.)

• Create space and time intentionally. The quieter you become, the more space you reserve, and the longer you allocate to it, the clearer the answers will be.

Key Tip: Do the little steps. Find a daily check-in with yourself: “What am I feeling right now?” Schedule moments—literally put them in your calendar—for self-reflection or meaningful conversation with someone close.

Grounded in evidence-based relationship science, use these three questions to reflect on and improve your most important connections:

• Do I feel genuinely seen and heard by those closest to me—and do I actively listen in return?

• How am I showing up emotionally today—in my relationship with myself and others?

• Have I taken a moment today to express appreciation or affection to someone I care about?

Try asking yourself these questions each day to cultivate awareness, gratitude, and authentic connection—a foundation for happiness and resilience.

I have talked a lot about “The Renaissance Life.” A life where you can have it all. It is a life deeply rooted in relationships.

If you know what’s important to you, and you are in touch with your emotions, you can communicate accordingly. You’ll do more of what you want and less of what you don’t—within obvious limits. This creates the space and time to build a life in which you “have all the things you want”—whatever that means for you.

Work, family, creativity—they’re not separate silos, but a single, interwoven tapestry powered by connection. It is meditation—or call it contemplation—and honesty practices that make these connections possible. These build the relationships where the magic lives.

Build a life where success and connection never compete—they amplify each other.

To more in life,

Nicco

Sing your relationship song here:

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It was a random afternoon in 2008—a warm breeze, Berlin university campus grass under my feet, nothing special at first glance. Little did I know that this was going to be one of the most important afternoons of my life.

I was the first to start—agreeing to this exercise, which my then-new best friend and I had decided to try together. It was the first time in my life that I came, well, fully clean.

The first time since early childhood that I told someone the truth. The unabridged, complete, painful, shameful, hurtful, beautiful truth. The truth about myself.

At that moment, and for hours after, I felt a bouquet of emotions I hadn’t experienced in a very long time—not all pleasant. But through the discomfort, something else started to accumulate as well: a deep, almost disorienting relief.

When it finally hit, pure joy came tumbling after, as if the doors to a long-locked cellar in my heart had swung wide open. I felt as if the weight of a lifetime had been lifted—the weight, as I would realize, of lying and withholding. Not only to others but mostly to myself.

That open space—and a non-judgmental counterpart receiving it all—felt like a gift I didn’t even know I’d been searching for.

Have you ever noticed the subtle but constant pressure of what goes unsaid?’

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The Catalyst Honesty

A few weeks earlier, my friend shared a book: “You have to read this.” It was Brad Blanton’s Radical Honesty.

That afternoon was the direct aftermath of absorbing his message: that most of us are, consciously or not, almost always lying—to others, yes, but most of all to ourselves.

Blanton claims that lying is what makes us sick; that the path to healing and genuine connection is paved by sharing the truth, even the awkward or embarrassing bits. Especially the awkward or embarrassing bits.

Why Do We Learn to Lie?

Years later, I repeated the exercise. I even recorded it and made my future wife watch it in the first weeks of our relationship—this was my way of starting on a blank, honest slate.

Lying, it turns out, is a developmental milestone. According to current research, it starts around age three. There’s a well-known experimental setup: The parent covers an object, asks the child not to peek, then leaves. The moment is simple but profound: Most kids peek. When asked if they looked, the child is confronted with a choice—tell the truth, risk punishment, or try out a little white lie. This is when humans discover something powerful: The other cannot know for sure. You can try lying. It gives you a sudden glimpse of power. But it also brings the slippery slope—the need to remember your story, to cover new lies with more lies, to carry the guilt or shame of being found out.

As children, we quickly learn to tell half-truths, to omit, to fudge a little—especially when the emotional incentive is high enough (survival, belonging, love, or just getting a cookie). But the habit grows, layer by layer, until we hardly notice the constant work of managing these little (and sometimes big) fabrications.

Consider breaking up here for reader clarity and flow.

We’re taught lying is bad… except, sometimes, it’s encouraged. Stories of ‘noble lies,’ white lies, and ‘protecting’ others muddy the water. Family, school, and society layer in more complexity: morality, ethics, shame, respectability. All this combines into a web inside, shaping what we call “my truth”—when I choose to speak up, how much discomfort I’ll tolerate, and the pains I’ll swallow in silence.

The House of Cards and the Cost of Withholding

No surprise, this can create an enormous house of cards. But there’s something more subtle and, in a way, more damaging: withholding. Often, withholding is praised as tact, politeness, or maturity. But in reality, it can be pure speculation—imagining what others will feel if we speak, when really, we’re mostly afraid of the discomfort inside ourselves.

What makes withholding so draining is that it’s invisible, even to ourselves. The world rewards ‘nice,’ but beneath the surface, the cost is ongoing and compounding.

To me withholding feels like shoveling snow in a blizzard. Every shovelful you don’t toss away, every feeling unshared, piles up, making the burden heavier and heavier. If you don’t clear it out regularly, eventually the shovel is too heavy to lift—paralysis, or a sudden collapse.

When we here the term radical honesty for the first time, we usually think about sharing our thoughts, our interpretation of situations. That is though actually not advisible, because your interpretations are debatable. And this is exactly what is happening usually, you get arguments because your creating situations where you argue over who's interpretation of any given situation is right. Here’s what changed everything for me: I realized that the key to radical honesty lies in confessing your feelings—the emotions your were feeling in or because of any situation. Your feelings are yours. If you say "What you said, made me feel sad", then I can't say "No, it didn't". But it opens up a space for me to tell you how this now makes me feel. And then begins the process of working through these motions, thus letting them go and resolving the whole thing.

That is not easy, but it works.

You can go one level deeper, and that would be to sharing the actual, unfiltered sensations that arise in your body. This is why I prefer to call it ‘sensual honesty’ —a concept where you share your sensations honestly, taking vulnerability to another, more embodied level.

It’s only fair to say there’s a vast difference between telling somebody what you think and sharing what you’re sensing. What sets sensual honesty apart is its focus: telling the truth about what is happening in your body right now—the sensation, not the thought.

When you say, “I’m angry,” that’s a thought about a feeling. When you say, “My chest feels tight, my stomach is buzzing, my hands are clammy,” that’s a direct sensation—a physical signal your body is sending in real time.

Why is this so powerful? Sensations cannot be debated, criticized, or even misunderstood the way stories can. They’re real, grounded, and—if you pay attention—are the foundation of all emotions and thoughts.

The Sensual Honesty Framework in Action

How do you practice sensual honesty?

Notice what is happening in your body as you interact with someone—heat, tension, butterflies, numbness. Name that sensation then even if it feels awkward “Right now, I feel a tightness in my throat and a flutter in my stomach as I share this with you”. Allow both you and the other person to process; don’t rush to fill the space. You’ll be amazed at how quickly an honest moment of shared sensation can break tension, invite intimacy, or clear away decades of habitual patterns.

I made plenty of rookie mistakes in the beginning.

One was to guess what of the truth I was about to share will be a truth bomb, and which won't. The reason for guessing was that I was still terrified of potentially dropping a truth bomb. A truth-bomb is a piece of honest sharing that has the potential to trigger intense emotional reactions on both sides. In thus developed the truth-bomb matrix. It shows that your chances of what is going to be a truth-bomb or not is only right in 50% of cases - which is essentially guessing. That insight was helpful to me to stop overthinking and start sharing these more often.

Another classic? The so-called “drive-by shooting honesty.” That’s when you drop a truth bomb and then vanish, leaving the other person reeling without the chance to respond or process.

It quickly became clear: Honesty is not a monologue. Sensual honesty—real honesty—requires presence and patience. It asks you to stay, to witness, and to hold a shared space as whatever arises comes up.

In the beginning I had to setup regular Honesty sessions with my wife, every Wednesday evening, where we sat down, look each other in the eyes and shared all the feelings and sensations of situations of the past week, that didn't find space to be expressed.

It was during these episodes where I came to realise that these moments of sensual honesty are like cups of creme brulée. Especially in times when you share a truth bombs, I experienced that something broke. In the beginning I got very scared because I though I had completely broken something. At one point I thought I had actually broken my relationship. But if you manage to sit through it and keep sharing your sensual truth, you work through and can see that actually something just broke open. Like when you crack the crust of a creme brulée with your spoon. And what you find underneath is just delicious pudding.

Sensual Honesty for a Renaissance Life

Why is sensual honesty the heart of what I call a Renaissance life? Because the foundation of true change is the willingness to experience—and communicate—the reality of your desires, needs, and boundaries as they actually manifest. When you show up with sensual honesty, resentment and pretense have nowhere to hide. And in that courageous vulnerability, you’ll find a new strength and ease in every type of human connection.

I teach a full Sensual Honesty protocol inside my group, The Renaissance Society. This includes practical exercises, peer support, and guided practices to help you live this principle every day.

If you want to learn more or experience the practice yourself, send me a message with the word “honesty.” I love helping people rediscover their own aliveness, authenticity, and connection.

To more honesty (and more pudding!) in your life,

Nicco

Your sensual honesty song waits here:

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I traveled halfway around the world to discover what my body already knew.

"Excuse me, do you have a book on how to stretch the muscles for cross-legged position?" Puzzled face, defensive hands. Long pause. "Dude, aaaaah dunno." Apparently even the surfer-employee at the Byron-Bay book store had no idea what I was talking about. Unfortunately for both, neither had I. But I was desperate to find something—anything—that would prepare me for what lay ahead.

It was before smartphones and chatbots, and despite my medical background I had no idea what to do when my friend had said "Train, so that you can sit longer in cross-legged position." That was his preparatory advice for my upcoming 10-day meditation retreat. So that is what I was trying to figure out while traveling Australia's East Coast.

Once back home, I hitchhiked to the retreat up in the woods in former east Germany's no-man's land. First I had to deliver my phone, that was expected. Then all my books, ok, so no reading for me. Then I had to deliver all paper, pencil and other writing material, now I became mildly suspicious. After the introductory welcome, I mildly freaked out as I thought that I had landed at a cult-like sect and was about to be brain-washed. Since up in the woods in no-man's land and hitchhiking - no way for me to flee. I scolded myself for - yet again - not having prepared myself properly of what it was I was getting myself into. "Life changing meditation retreat" as summary from my trusted friend was enough for me to sign up without ever reading the fine-print.

THE MONKEY MIND PROBLEM

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Why the need for a "life changing meditation retreat" in the first place?

Like many I was both blessed and cursed with that monkey called my mind. I had tried a gazillion ways to reign him in. But that guy tuned in every morning like a mexican radio-station and when not giving a very specific task or when not giving a damn about that very specific task, it just did its monkey thing of running wild and living the misconception that it is the monkey is in charge.

During that retreat—after overcoming my initial panic—I discovered something fundamental about meditation that no book had ever properly explained to me.

I had heard before that meditation is a thing. Supposedly something that tames that monkey and re-established order between the ears. It was just so freaking hard to do, because none of the explanations or advice I got, heard or read about actually worked. I had read "The Power of Now" by Eckhart Tolle. Good book, no question. But I couldn't implement the advice of "Just be in the Now". How tf do you actually do that?

THE MEDITATION MISCONCEPTION

Many believe meditation is about emptying the mind completely or achieving some blissful trance state. This misconception leads to frustration when thoughts inevitably arise. The real practice isn't about having no thoughts—it's about changing your relationship with them.

One of the key revelations for me was the intertwined connection between body and mind. The mind is most of the time either in the past - musing and worrying about things that happened, things that have been said and done, or should have been said and done. Or it is in the future - musing and worrying about things that are expected to happen, things that will be said and done, or should be said and done. Nothing against a conscious evaluation about how things went for learning purposes. Nothing against future plannings and preparation. It's just, that this is not what we do 95% of the time. We spend our mental time in a dream world that is either already gone - so nothing to do about that - or hasn't yet happened - so nothing to do about that either. So the only thing that actually is - is now.

THE LIGHTNING INSIGHT

It hit me like a bolt of lightning: while my mind could time-travel endlessly between past and future, my body existed nowhere but NOW. This wasn't just philosophical—it was the practical key I'd been missing. I could anchor my awareness in bodily sensation, I could finally access the present moment.

"The mind can travel through time, but the body exists only in the now. This isn't philosophy—it's the practical key to presence."

Sounds logical, sounds profound and smart. Problem is, it is extremely hard to choose to be in that state just with your mind - as we discussed above. That is because that ability is like a muscle that for most of us has never been trained and thus is very weak. The monkey mind is a very useful and powerful tool, but he should not be in charge. So it requires you to take the leash from him steering the mighty elephant that is your body, put him in the back and take charge yourself.

And the easiest entry point to do just that is to realize that your body is the only thing that is tied to the ever-continuing present moment of now. Think about it - your body is not in the past (think your body of youth) nor in the future (think of your body of age). It is always in the now. That is why if you root your awareness in a bodily sensation, you anchor yourself in the now.

I am not the first to realize that our current way of living and lifestyle makes it even harder to actually come to our senses, lose our minds and be in the present moment.

THE BUDDHA'S DECEPTIVELY SIMPLE ADVICE

Technically, the solution is simple and is publicly available for centuries. Legend has it that when the Buddha was getting ready to leave his earthly body, hundreds of people gathered to say their farewell. One man came running, panting that he wanted to learn the path to enlightenment. The Buddha waved him close and with his last breath told him the secret:

Sit down.

Close your eyes.

Watch your breath.

Most people can manage step one. But once we close our eyes the problems start for most.

THE MODERN ATTENTION CRISIS

For once, our visual senses have the biggest bandwidth in terms of amount of informational intake per time unit. That's why we say an image says more than a thousand words. Now, we live in a world with nearly ubiquitous giant screens and displays with moving images in our surroundings and the addictive honeytraps of endlessly-scrolling of moving images on the little displays we always carry around with us. Pair that with constant auditory stimulation via headphones and canned-music on every public bathroom and you have a perfect mix of constant information overload. This is like a constant delivery of crystal meth for your monkey mind.

So once you closed your eyes, you crave visual stimulus and you revert to your image-generating powers - your imagination.

And our app-swiping gold-fish-like attention spans do the rest in rendering watching your own breath longer than three seconds a seemingly impossible task.

If you've tried meditation and felt like a failure because your mind wouldn't 'shut up,' know this: everyone—literally everyone—faces the same challenge. The difference isn't having no thoughts; it's developing the capacity to notice them without being swept away.

There is a clear need for peace of mind, quietness and mental stillness - meditation app downloads in the millions attest to that.

And although these guided meditations with rainforest background sounds have their merit, they achieve only a superficial type of calmness. One where you just divert the attention away, again away from the present moment. Like if you would lure the mental monkey away with a banana. The effect is just temporary in nature.

Research has consistently shown that regular meditation practice reduces stress hormones like cortisol while increasing gray matter density in areas of the brain associated with self-awareness and compassion—tangible evidence of what I had experienced subjectively.

We were sitting in a little park in Milano, Italy. A weird bunch of people from all walks of life, a greek millionaire from Crete, a singer song-writer from California, a couple of other people and Franky a part-time yoga teacher from the Netherlands. We all just have had some sort of otherworldly experience in the great Dome of Milano, listening to a rehearsal of the cathedral's choir. After 10 days of sensual deprivation at my second Vipassana retreat, my perception was so heightened that I could literally feel the sound waves produced by the choir as we sat in meditation inside the magnificent church.

In that great Dome of Milano, the choir's voices didn't just reach my ears—they vibrated through my chest, tingled along my spine, and seemed to illuminate the space behind my closed eyelids. After days of sensory deprivation, each note felt like a physical presence in the sacred space.

THE YOGA CONNECTION

In the park Franky was telling me about his belief that Yoga is major beneficial linking step for life in our society to get the mind into a state where you actually can go through Buddha's simple three step program. That is a system to reduce circulating energy in your body. I remember how he told me that he is able to stay in headstand for longer stretches of time, and how beneficial that would be to the practice. I was deeply impressed.

On my way home I was trying to figure out what that Yoga thing exactly was - it was before the big every-fitness-studio-offers-yoga-classes wave. I ended up with an old very technical, very philosophical text about Yoga that I couldn't use for anything. So I dropped the subject. But somehow Franky's words lingered on. And as I was having a hard time keeping my meditation habit in my regular work and life environment, I set out to seek that Yoga thing again.

I started with some online classes, geeked out, tried every type of Yoga - understood as the physical exercise focused part, not the entire philosophy - from Hatha, to Vinyasa, to Bikram, Ashtanga and Kundalini, just to name the most common ones. I built my very own best-practice version for myself, I can comfortably stand in headstand for longer periods of time. But that is not the point.

The point is, that a breath-focused physical practice does a tremendous job in activating your parasympathetic nervous circuitry, helping you to get out of your head, into your body, into the now. And it lays the ground work for doing what we call meditation.

There is this theory, that if you were only to do one Yoga pose it would be Shavasana, the corpse pose. As people can't lay still, similar to that they can't sit still, we require the prior exercises to bring the body to a state where it can lay still. Twists and stretches as well as holding positions of the big muscle groups help tremendously with that.

So in short: You can't sit still because you can't lay still. You can't lay still because of all that circulating energy in your body and mind. So you exhaust and calm your body and mind so can lay still and then sit still.

THE RENAISSANCE APPROACH

This meditation insight was a pivotal moment in my journey—one that eventually led me to develop a comprehensive framework for high-achievers balancing career success, family life, and personal fulfillment. What began as a quest to quiet my mind evolved into something much more profound: a complete Renaissance Operating System for living a Renaissance life where professional achievement doesn't come at the cost of sacrificing yourself.

Although proven as a legend, the common quote still holds some truth:

How long should I meditate daily?

- 20 minutes.

I don't have so much time.

- Then it should be one hour.

Based on my own experience, it is especially in times when I "don't feel like" doing Yoga or meditation, that if I do it anyways it has a seemingly even greater beneficial impact on my wellbeing.

Like with any thing we know we would like to do more - I don't like the word "should" - and we don't do, it becomes a matter of prioritization. We say it's important to us - maybe because it feels good and creates a delightful image of ourselves, classical ego flattering. But we don't act as if it's important to us. So it factually isn't.

It is like some of my patients showing up with giant tumors on their heads, barely concealed by a baseball cap. When you ask them why they didn't see any doctor sooner, they say "I was afraid it might be something malignant."

The same way we shy away from practices where we might be confronted with feelings and emotions that are unpleasant or come to face existential questions that frighten us. It's just easier to sit in some white noise ocean sound carpet on your headphones, having some chic affirmations read to you while you keep engaging in mental arguments over things that have or might happen. It's our feel-good basecap.

I am not here to tell anyone what is right or what is wrong, nor what works or what doesn't. Simply because I don't know either.

I can only point to the things that have proven to work for me. One reason why that first meditation retreat had such a lasting impact on me, was a specific feeling I got there. The feeling of someone actually being able to help not just in theory. Someone saying, look, here is the path, here is a backpack with essentials, I put your foot on the first step. Now you know how to work and where to go, good luck with your journey.

This journey from meditation insight to fully integrated living wasn't straightforward. As someone balancing a demanding surgical career, research pursuits, family responsibilities, and creative expression, I've had to develop systems that allow for the full spectrum of achievement without the burnout that typically follows. The body-mind connection I discovered through meditation became just one component of what I now call the Renaissance Operating System—a comprehensive framework for those who refuse to sacrifice themselves while succeeding everywhere else.

Either way, the best thing to do after reading this would be some sort of physical exercise for 10 minutes where you at least mildly sweat, then sit down, close your eyes and watch your breath. This isn't just philosophical advice—it's the practical pathway that has worked for countless practitioners, including myself, for thousands of years.

To more in life,

Nicco

Today’s white noise:

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I am having an elderberry-flavored soda; he is having a regular beer. He is a gifted surgeon, my mentor and colleague. I am a green youngster just beginning to grasp the grueling work conditions I have gotten myself into, starting residency at the major surgical department of a university hospital.

He tells me the story of how one day he told his wife he thought he was burned out. Apparently, she laughed and said it was impossible. He asked why. She replied, "You are not burning for anything."

That story stuck with me. It took me years to understand why.

The Misconception of Burnout

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It’s not just the silent epidemic of burnout among surgeons and the rising number of suicides, especially among young physicians (Shanafelt et al., 2015). Nor is it only the "burned out" part—the phrase has become a buzzword. It's the "you are not burning for anything" that lingers. It hints at a common misconception: that the extinction of the flame—or burnout—is an immediate, visible event. In reality, it’s more like a slow suffocation; the flame dims as oxygen deprivation increases, until, silently, it fades into nothing.

This creates the impression that the flame never existed in the first place, and hence there was no burnout. However, for high achievers, the deprivation starts early on. You could argue that this “strategic deprivation” slightly enhances performance, similar to how increasing L-theanine in Japanese gyokuro and matcha tea is accomplished by shading the tea plants to restrict sunlight. But restrict the sunlight—or, metaphorically, the oxygen—too much, and the system suffocates.

Before that final extinction, there is often an overactivation of the sympathetic fight-or-flight system. Understandably so—you're fighting for survival.

I remember waking up in the middle of the night, kneeling in the middle of my bedroom, my fist hammered into the ground onto my curtains that I had apparently ripped from the ceiling. I had an ultra-realistic dream of a patient with an acute femoral bleeding that I desperately had tried to stop, my jaw hurt from my clenched teeth. That's when I realized something is off, and something has to change.

I lost track of how many shouting matches between (more senior) colleagues I have witnessed, how many overreactions and insults I suffered myself. I've seen surgical instruments flying through the OR, a consultant circling the table to semi-sterilely kick a co-surgeon, and pictures of holes in walls from frustrated boxing kicks or mangled trashcans absorbing agony.

Even during my parallel studies of medicine and economics—and throughout my intentional leaves from the medical career track—I consciously examined nearly every area of life to figure out what works best for me and why. Many of these learnings turned out to be generalizable.

Based on my experiences and countless conversations with young colleagues, I found myself putting up flyers at Brigham and Women’s Hospital in Boston during my post-doc at Harvard University, advertising “The New School Physician – Secrets to Stay Focused and Prevent Burnout in Today’s Draining Work Environment.”

I was laughed at by superiors, but transformative sessions occurred with those who showed up.

A greek colleague of mine was in tears after our first workshop - he said he couldn't believe that it would be allowed to openly voice these thoughts and how relieving it felt to see that he was not the only one having these experiences. We successfully worked through his insomnia.

Ironically, I later forgot these lessons when I became fully absorbed in my own ever-increasing skill levels and responsibilities. Luckily, I remembered in time—a prime example of how we often know what to do, but need consistent reminders.

From Empty Cup to Roman Fountain

The key concepts underlying all these strategies are the analogies of the empty cup and of the Roman fountain; they complement each other.

“You can't pour from an empty cup.”—unknown

This statement encapsulates the root problem—and the solution—beautifully. If your cup is empty, there is nothing for you to pour.

Roman fountains operate on a similar principle. Traditionally, they have three levels: a top “cup” that, once filled, overflows into the next “cup,” which then overflows into the largest lower basin. The top cup is “Me,” the second “You,” and the third “Them.” If my cup runs dry, there’s nothing to give to others, let alone to my community.

For a while, I collected pictures of Roman fountains—both online and offline. It was a powerful reminder for my own sanity. I had my wife stay stand guard on a street in Rome while I was half-trespassing into a property to get a perfect shot of a impeccable marble fountain at 1.30 AM in the morning.

The obvious question then becomes—what fills your cup? How do you fill your cup?

Take a moment and reflect on that before you continue.

The Four Dimensions of Personal Energy

You have a selection of cups: physical, mental, emotional, and spiritual. Each requires different types of filling. Depending on your current stage and self-awareness, you might already know what each cup should be filled with and how. If not, it’s time to find out. I have some best practices to share that can serve as starting points, additions, or just inspiration.

Importantly, filling your own cup isn’t a single “thing” you check off. It’s a philosophy—a way of living. This shouldn’t be confused with selfishness or arrogance. It’s about responsibly tending to your own energetic system and wellbeing, recognizing that your fullest self is of greatest service to others.

“If you would list all the things and people you love, how long would it take you to name yourself?” —[Board at Encinitas café, paraphrased]

How long did it take you?

This is direct feedback on where you currently place yourself and your own needs. Work from there.

The Science of Burnout and Renewal

Recent research shows that chronic work-related stress can elevate cortisol levels, impair cognitive function, and even depress immune function (Smith et al., 2018). Burnout isn’t just about psychological exhaustion but about actual physical changes in brain and body.

Recognition and intentional action are key. Here are seven strategies I have found helpful for preventing depletion and encouraging overflow.

Seven Strategies for Energy Renewal

1. You Need More Than Just Function to Flourish

There’s a sneaky myth that being “fine”—just ticking off a checklist of eat, work, scroll, and sleep—is enough. But we aren’t machines. True energy comes from engaging our whole selves: moving, breathing, feeling, sensing. Look beyond maintenance and ask: What actually recharges my system, not just keeps the lights on?

2. Renewal Requires Deliberate Spaces and Rituals

In the hospital, I learned that without intentional moments of reset, chaos fills every gap. The same is true in life. Find your “charging stations”—the sauna by the lake, a walk in the woods, a favorite chair and book, the simple act of mindful breathing. Ritualize them. Make energy renewal as non-negotiable as brushing your teeth.

Science tidbit: Rituals trigger the parasympathetic nervous system, counteracting chronic stress (Porges, 2011).

3. Pay Radical Attention to What You’ve Lost (and Need)

Burnout often creeps in, masked as endless irritability or numbness. Notice those moments—snapping at loved ones or sensing your body’s silent protest. These are signals. Pause and ask: What’s missing? Remember, recognizing the need for rest or play is a strength, not a weakness.

4. It’s OK if Your Cup-Fillers Look Different

Some recharge with yoga; others with rock music and a PlayStation. Recreation isn’t about performing wellness for others; it's about honest experimentation and permission to follow what actually works for you. Try things. Some will stick, some won’t. That’s the point.

5. Micro-Rituals Matter—Start Small, Especially in Busy Phases

You don’t need three hours or a clear calendar. Even brief moments—a few steady breaths, stepping outside, a five-minute foot massage, a quick stretch—can shift your nervous system from fight-or-flight to rest-and-renew. The simpler the tool, the more likely you’ll actually use it.

I had a custom-made cigarette-shaped tube 3D-printed because I realized how smokers always get their 5 minute "fresh-air" breaks. Like this I regularly could do some 5 minutes of conscious breathing while adding the benefits of restricted yogic uyaii breathing to it.

6. Community and Conversation Are Central to Energy

Sometimes, renewal is social. A deep talk with a friend, laughing about stress, or having regular connection rituals can be as revitalizing as time alone. Don’t dismiss the power of being witnessed (or even gently pushed) by others on the same journey.

Denmark has a wonderful tradition of monthly fridays-bar get-togethers at the office after work for example.

7. Reflection Is Your Compass

Regularly checking in with yourself is crucial. Borrow from the “energy audit” idea: ask, “How do I feel? Where's my energy leaking?” Gather this data like a scientist of your own vitality, and let it shape your routines. Each day, ask: What activity energized me most? Where did I feel drained? What’s one small action I can take tomorrow?

Overflow as a Practice

As in the fountain metaphor, let your energy renewal practices be the steady trickle that keeps each cup—body, mind, spirit—overflowing. It’s not about grand gestures, but daily—even hourly—recommitment to refilling so you can give from a place of true abundance, not depletion.

“You can’t pour from an empty cup, but you also can’t fill it with what everyone else tells you to. Find your sources. Protect them, fiercely. Ritualize recreation—not as luxury, but as the foundation for everything and everyone that matters.”

The knowledge is out there. The principles are simple, but implementation is not easy—otherwise you and everyone else would have mastered this already.

If you’re like most, you’ll bookmark this newsletter, add it to your someday-to-do list, and move on. But if you reply with “energy,” I’ll send you the info for The Renaissance Society, where we tackle this together, and I’ll help you start right now.

To more in life,

Nicco

Maybe this episode’s song can spark some energy:

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3 am, Berlin. I am freezing. We have been in line for almost two hours now. You can hear the dampened pounding of the deep bass through the walls of the temple. Next to us, a guy is barely able to stay on his feet. He's swaying like a reed in the wind, most of his upper body covered in vomit, likely his own. He's definitely on more than one drug that night.

The queue advances and we're finally in front of probably the world's most famous bouncer, with his signature metal piercings and tattoo over his face. A quick one-second glance, and with a friendly "No company outings tonight," our journey ends then and there. With a pat on the shoulder, he winks vomit-guy in.

I had warned my friends from out of town that this could be a likely outcome, but they wanted to keep their button-down shirts on—the same ones that got us into that posh high-rise penthouse club earlier that night.

This was one of those moments when I viscerally realized just how much we, as humans, love to create exclusive clubs—granting access based on arbitrary parameters. It became clear that being on the outside isn't just a misfortune; it's a chance to define your own terms.

You like techno? Throw up on your shirt. You like hip-hop? Better wear those baggy pants. You dig current pop and EDM? Button up.

Mine – yours. Us – them. In – out. It's a primal need to draw a line in the sand and define the boundary as what separates two sides.

It always made me sad and sometimes angry.

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The Biology of Belonging: From Cells to Society

But it's probably one of the defining features of what we call life: an organizing principle to increase the likelihood of survival.

It was only when basic molecules in the primordial soup of existence became charged and developed polarity that they could arrange themselves to create layers. Once connected, these layers created a fenced-off area—separated and protected from the surroundings. The primordial line in the sand. Here, different chemical reactions could take place that wouldn't be possible or stable on the other side—and thus, a cell was born.

Over time, more cells flocked together, creating larger entities shielding themselves off from the environment. DNA became a blueprint for creating shielded-off entities. This continues all the way up to complex, multi-trillion cell human beings. We then start the process over again—forming groups to create larger entities shielding ourselves from the surroundings: tribes, towns, cities, states.

Social psychologists—including Henri Tajfel with his 'minimal group paradigm' experiments—have shown just how quickly and arbitrarily humans form in-groups and out-groups.

This has served evolution and humanity well in terms of survival and spreading. It doesn't necessarily do so on an individual level today. Not that evolution would care, but I do.

The Fear That Shapes Us

Not that long ago, being excluded from your fenced-off community—your tribe—meant you would be alone, fighting for survival. Nature was never the romanticized, hippy-place we like to imagine. It's rough, and surviving as a naked ape is tough. So, for most, exclusion meant certain death, which is why we understandably fear it more than anything.

So we do everything we can to stay within the circle. Please our parents, give in to peer pressure, conform.

Our culture hasn't helped our reptilian brains catch up with these new social structures. Fragmentation—driven by capitalistic incentives—created an infinite number of groups. Each group has to define itself against all the others: taste, talk, access, dress, or any number of exclusive features.

Everybody wants to be like the others. But everybody is unique. By pressing yourself into conformity, you make yourself miserable.

According to research published in the Journal of Personality and Social Psychology, individuals who consistently act contrary to their authentic selves experience significant psychological strain. In one study, people who reported high levels of 'false-self behavior' showed a 37% higher rate of depression and anxiety symptoms. Another study from Harvard Business Review found that 61% of employees admit to 'covering' aspects of their identity to fit workplace norms, with 73% reporting decreased commitment to their organization as a result.

Almost everyone also has had that feeling of "I am different"—and also secretly wants to feel special.

For many, it's fine to have their defined set of groups; it helps structure the chaos of reality and gives an illusion of control.

But then, there are those of us who never really felt they belonged.

Most of us never learn how to navigate these feelings or know what to do about them.

My Journey Through the Borderlands

For most of my school career, I was the geek with the glasses. But even then, I tried living out all the renaissance elements—with only minor success. The peer groups were merciless. I was always only partially part of any group, since I refused to denounce all the others. I did half-pipe inline skating but hated the skater-music and the hang-around-weed lifestyle. I liked being a party animal but didn't want to dress like a dork. I was chief editor of the school newspaper, but converted it into a black-satire magazine. I had a foot in many circles, but nowhere really. I felt lonely often.

Fast forward some 15 years. During surgery residency, I read a book that transformed my life—Radical Honesty by Brad Blanton. I wanted everybody to read it; many refused because of the language barrier. So I reached out to Brad, got the German rights for the book, actually translated it, and published it. I then met him in Stockholm, where we did a fantastic idiot meditation in a café (link). He asked me if I wanted to become a Radical Honesty teacher and help create an online course.

There, I realized I'm not a fanboy or a disciple. I can get excited for people and ideas and thereby for groups, but not to the point that I subscribe to them exclusively. I can't. I am my own guru.

The Superpower of Non-Belonging

That was a freeing moment: realizing that not belonging is not a bug, but a feature. It's my superpower. If I can be in that feeling of not belonging without reacting to it, it creates more freedom to explore and live all the things that excite and interest me—without limitation from any group or moral model.

Think of innovators like Steve Jobs, who credited his outsider perspective for much of his success, or artists like Frida Kahlo, who defied mainstream conventions to become icons in their own right.

The Parable of the Sweet Rice

At the end of my first Vipassana meditation retreat—highly recommended—they shared the parable of the rice and the black pebble. A mother prepared a bowl of sweet rice for her child. The child, eating, discovers a little black pebble in the bowl, gets angry, and throws the bowl across the room. The mother kindly explains—the child could simply take the black pebble out and enjoy the rest of the sweet rice.

I took that as a framework: remove the pebbles from the sweet-rice-groups I want to enjoy. I can go to an electronic dance music festival and have the best of times dressed as an accountant, without any stimulants or drugs, if that's what I feel like. I can sit with a hoodie in a conference room. I can have a giant scorpion temptoo on my neck and still do surgery (true story).

There are, of course, limitations. I'm not consulting patients in a Speedo. But the principle remains.

Funnily enough, much of coaching is about helping people get out of the mental jails they built themselves when subscribing too deeply to certain groups. Most of us forget: it's only a subscription, and you can always cancel. Once you figure that out, you can guide others to do the same (this publication is no different).

Practical Steps for Embracing Your Outsider Status

As an easy start, sit down and write up all the groups you are part of—voluntarily or involuntarily—and then decide which you want to stay in, and which you don't.

You can train your outside-of-group muscle by exposing yourself to groups outside your regular ones. Go live in a different country, start a new hobby in a club, and notice what it feels like to be an outsider. Watch how the transition from outsider to insider takes place and notice the pressure to adapt your worldview. Then consciously throw out the black pebbles you don't like and enjoy the rest of the sweet rice.

Reflection Exercises

Reflection is key to turning difference into strength—try these prompts to dig deeper:

1. What groups do you feel you're "supposed" to belong to, but never quite fit in with?

2. Think of a time when your outside perspective allowed you to see something others missed. How did that benefit you?

3. What "black pebbles" can you remove from groups you otherwise enjoy?

As a reminder of what's possible, consider the path of outsiders who changed the world by honoring their perspective rather than conforming. Their impact wasn't in blending in, but in embracing what set them apart.

Finding Freedom in the Fringe

Throughout my journey, embracing outsider status has been both a challenge and a gift. The sense of freedom and possibility I've gained grows every time I accept that belonging isn't always the goal—living authentically on my terms is. This isn't something I've mastered once and for all; it's an ongoing, active process. But each step outside the "expected" strengthens my sense of purpose and joy.

Your challenge for this week: Identify one group or community where you censor part of yourself to belong. What would happen if you brought your whole self to that space? Or, find a setting where you feel like an outsider and practice being comfortable with that discomfort for 30 minutes. Notice what insights emerge when you're able to observe without needing to belong.

Remember: your difference isn't a limitation, it's a unique vantage point that gives you perspective and freedom others might never experience. Embrace it as your superpower.

To more in life,

Nicco

P.S: This wouldn't be a proper piece on anti-group-think if I didn't offer my own group. I'm working on a small community called "The Renaissance Society," where I'll share my favorite rice (and life) recipes. It will be specifically designed for high-achieving professionals who feel trapped between their success and fulfillment. Using the Renaissance Protocol Framework, we aim to reclaim 5+ hours weekly for creative pursuits and personal passions while maintaining their professional excellence. Each week, we explore one element of the protocol through guided implementation workshops and practical tools that work within your existing schedule. Reply "society" if you want to know more.

P.P.S: This episodes track to dance with

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