A call comes through to the triage desk of a large hospital in the New York City metropolitan area: a pregnant woman with multiple abdominal gunshot wounds is due to arrive in three minutes. Activating a trauma alert, the head nurse on duty, Denise, requests intubation, scans, anesthesia, surgery, and, due to the special circumstances, sonography and labor and delivery. The emergency medical service team slides the gurney into the hospital, and the trauma center staff starts in with Denise coordinating and overseeing the entire process. How is it possible to think about so much so quickly?
When Denise (not her real name) recounted this story to me, she was enrolled in my philosophy of science course for nursing doctoral students. In this course, amid discussions of Karl Popper’s criterion for demarcating science from nonscience and Thomas Kuhn’s theory of scientific revolutions, I would hear stories from her and other students about nursing: about newborns in the critical care unit; about patients who would, against all orders, remove their EKG monitors to use the toilet; about the travails of discussing the benefits of blood transfusions with desperately ill Jehovah’s Witnesses. These stories often reminded me of how little urgency exists in philosophy—one doesn’t feel much time pressure to solve the problem of free will when it has been open for the past two thousand years—as well as how little tragedy. The nurses in my classes learned fairly quickly that they should bring tissues for me. The day I heard Denise’s story was not an exception: neither mother nor baby were able to be saved. Their stories also sometimes illustrated how much thought goes into even the quickest decisions.
Let us now step away from the bustle of the emergency department and consider the conscious mind. Did Denise need to think consciously about what she had to do? Did she consciously decide to request the labor and delivery team? Or, after the call came in, were her actions unconscious and automatic? What is the role of consciousness in emergency decision making?
Unconscious, reflex-like decisions are fast. Neural signals that result in action can travel along myelinated nerves at upwards of 120 meters per second. A runner at the starting block, after hearing the pistol, pushes off in less time than it takes to blink an eye. Compare this to the leisurely 0.5 – 2 meters per second pace at which pain signals travel along unmyelinated nerves. But how fast can one follow through a conscious train of reasoning, one that leads, for example, from the weather forecast to a decision about what clothes to wear? When we have time, we weigh the options—if I bring the light jacket, I’ll be somewhat cold outside but won’t need to carry it when I’m inside—and arrive at what, upon consideration, seems to be the best decision. Yet what happens when, as in Denise’s case, there is a starting pistol for our decisions? Do we go on autopilot, grab the galoshes and run?
To probe the speed limits of conscious thought, I conducted an experiment. I had four accomplished chess players—two masters, one national master and one (retired) international master—think aloud, saying what came into their minds, if anything, as they were playing a game of lightning chess, which is a variation of chess that allows a mere one minute per player for an entire game. After I explained the task, my participants all expressed doubts; they think all the time, they said, but thinking aloud while playing would likely slow them down too much. Indeed, the first player I was scheduled to test made such a convincing case for this, I almost skipped over the one-minute game trials and moved on to the five-minute ones. However, the five-minute trials were not necessary. As soon as they were paired with their online opponents, clocks started ticking and they started talking, very rapidly and more or less nonstop, about their reasoning processes as they were playing.
To be sure, much of what they said was elliptical. For example, at one point during a game I heard: “if I play B6, he plays F3; is that the idea? B6, F3; what about C5, D5—D5? D5? If he plays D5 I get into a Leningrad-y thing; but I don’t want a Leningrad-y thing . . .” Nonetheless, such comments indicate that my chess players were engaged in rapid, conscious deliberations.
How did this affect their games? The results were what would be expected given the pairings: when paired against slightly weaker players, they won; against slightly stronger ones, they lost. And in terms of their own personal evaluations of their games, they all felt that they performed at least as well as they usually do, with one commenting, “I think it actually helped my game.” Another said, “I never think I play well, but I played like I play.”
From an outside perspective, it might seem that a one-minute-per-player match proceeds so rapidly that it intercepts conscious deliberation. Hands fly over the board or move the cursor on what appears to be mere impulse. Could it be that when the chess players in my experiment vocalized what was going on in their minds, it was the vocalization that elevated their thoughts and plans to the level of consciousness? Or is it that the appearance of automatic and effortless expertise in lightning chess, in nursing, and elsewhere, can be deceptive?
Daniel Kahneman, in his book Thinking, Fast and Slow, distinguishes what he calls “System 1” thinking, which he describes as automatic and intuitive—what you use when you add two and two—from “System 2,” thinking, which he describes as slow and analytical—what you use when you mentally compute seventeen times twenty-four. The calculations of the chess players in my study were System 2, but accelerated. Though perhaps not as fast as the blink of an eye, it seems that our complex, conscious deliberations can, when necessary, be fast. Or as the seventeenth-century philosopher Thomas Hobbes put it, “thought is quick.”
A Marine once told me that endless drills have allowed him to reload his weapons without any thought at all. Reloading a weapon, hitting the chess clock, picking up the call from the emergency service team—yes, all that is fast and automatic. But what about shooting? I wanted to ask the Marine that question, but, perhaps because of the large M4 carbine in his arms, I was too intimidated. If someone suddenly points a gun at you in the midst of battle, one hopes that the impulse to respond gets carried along those myelinated nerves that serve as a super highway. Yet, at the same time, in war, as on the emergency room floor, one wants to be like the chess player: capable of justifying what you have done. Acting automatically precludes this.
There is an old saying, “look before you leap.” But if there really isn’t time to look beforehand, look while you leap and be ready to adjust plans mid-air.
Featured image: Relay Race by ThomasWolter. Public domain via Pixabay.