War Stories #3: Triage

Self-Brain Surgery™ helps you decide what to treat first

A Rare Moment of Surprise

After over twenty years practicing neurosurgery, I am rarely surprised anymore. I’ve seen one version or another of most everything in my specialty, and am at the point in my career when I’m more surprised by being surprised than I am when I actually encounter something new.

Recently, however, I was genuinely shocked by something someone said to me in the office.

It had been a routine office visit, a new patient who definitely needed surgery. I spent a half hour or so explaining the problem to them, showing them the MRI scan and laying out the type of operation that would help them get back to their life and avoid the impending neurological problem for which they were destined if surgery was not performed. I answered all their questions, and then, as I always do, encouraged them to seek a second opinion with another surgeon.

That’s when it happened: after we shook hands, I started to leave when the patient said, “Doctor, I want to mention something to you. I saw from your bio that you had served in the military, in combat. I read all about how you performed two hundred brain surgeries in a tent hospital.”

“Yes,” I said, “That was the greatest honor and most valuable learning experience of my life.”

They shook their head and said, “Well, I don’t think I feel comfortable having surgery with someone who’s just a triage doctor.”

Suffice it to say that I was surprised. Not just at the audacity of someone using a term like “triage doctor” to reduce my work as a neurosurgeon serving in the most dangerous corner of Iraq, surviving over 100 mortar attacks, and saving dozens of lives as being simply “triage,” but also that literally thousands of patients over the years have told me that they chose me as their doctor because of my military service.

It did remind me, though, of how important triage was to us in that environment. And as I’ve thought about that encounter over the past few days, I’ve also realized that triage is a vital skill for all of us who are called to war, no matter what type of war you’re facing.

Bringing the Fight to Us

The morning of January 2, 2005 started off like the other three days I spent since arriving in Iraq on December 29. A few rockets had hit the base, I’d performed a handful of surgeries already, and I was just beginning to emerge from the shock of being there at all.

That’s when it happened: my first car bomb, and my first mass casualty event. I’d been briefed that we were likely to see victims of vehicle-borne improvised explosive devices (VBEDS, or “car bombs”), as they were a favorite insurgent tactic at the time. And the briefings also told us that it was common to have twenty or more injured patients arrive at the hospital simultaneously, a “mass casualty event” that we rarely saw in civilian trauma hospitals.

I just didn’t expect that the first car bomb-related mass casualty I was a part of to happen because someone drove a car bomb onto my base, and that the casualties I treated were from a bomb that detonated two hundred fifty yards from where I was standing.

If you were watching the news that day, you likely heard a story something like this:

BAGHDAD, Iraq (CNN) -- A suicide bomber, driving a bus carrying 24 Iraqi National Guard soldiers, detonated the vehicle Sunday morning outside a coalition base near Balad, north of Baghdad, killing 18 soldiers and an Iraqi female civilian, a 1st Infantry Division spokesman has told CNN…

Emergency department at Balad Air Base, January 2005

In my email home the next day, I described the event like this:

Tuesday, January 4, 2005 Good morning from Iraq, everyone. Two hundred fifty yards from the hospital, outside the twelve-foot chain-link fence that surrounds our base, there are three checkpoints. These are designed to keep the bad guys out, and they consist of concrete barriers, guard towers, lots of men with powerful weapons, and three one-inch-thick steel cables, which serve as the gates. When the guards decide to let someone inside, they lower the cables. The cables are called wires, and whenever someone inside the (relatively) safe base has to venture off base, we say that they are going outside the wire. Trust me, you do not want to go outside the wire. But more importantly, we definitely do not want the wrong people getting inside the wire. They tried to yesterday.

Around seven in the morning, a taxi brought four INGs (Iraqi National Guardsmen) to the gate. The guards let the car through the first two checkpoints. When the driver let off the four INGs, he hit the gas and tried to run through the third checkpoint. The wire stopped him, and as our guys were firing on him he detonated the car. Four ING guys and the driver were killed instantly, and many were injured. Praise God, though, even in this: if he had gotten past the wire, there were a hundred and fifty ING soldiers standing in formation just past the barrier beyond the wire. They would probably have all been killed or injured if he’d made it twenty yards more. Another hundred yards and he would have driven that taxi right into the hospital, and you wouldn’t be getting this email.

Sorting Them Out

I was inside the hospital when the bomb detonated, and the concussion from the blast knocked me to the floor. Within minutes, dozens of terribly injured people began to arrive at our hospital. Some medics from the hospital, some ambulance crews rolled out to work the scene, and some of the wounded simply walked themselves to the hospital. Very soon, the room filled up with blown up, burned, and severely injured people, and the controlled chaos unfolded into my first experience with military triage. With our ears still ringing from being almost blown up, all of us had to snap into action.

The task in most civilian triage situations is, “Which of these five not-very-sick people gets to see the doctor first?” Our task that day (and on too many other days) was, “Which of these dying people has the best chance not to die if we move fast enough?”

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Who/What Goes First?

When the bomb goes off in your life, it may knock you off your feet at first. It did when it happened to me. Whatever yours is- a diagnosis, a marriage in crisis, a child in addiction- when the war comes crashing into your gate and detonates right in your front yard, the problems will quickly present themselves to you. That’s when you’ll realize, as we did that day, that you are both a witness to and participant in the fight that is unfolding.

Your other problems and the other people in your life don’t just vaporize, leaving you with a one-front war. No, the task now is one of triage: what do I deal with first, what can wait, what is absolutely critical, and what must be left to die?

The Neuroscience of Triage and Self-Brain Surgery

In trauma or crisis situations, your brain’s reticular activating system (RAS) helps filter out distractions and prioritize what’s most important. The RAS plays a key role in attention and alertness, like triage in a war zone sorts out which injuries demand the most immediate care.

Just as my first mass casualty event required us to categorize patients into urgent, delayed, minimal, and expectant groups, our minds must categorize the challenges in our lives—determining what requires immediate action, what needs strategic intervention, and what we must let go of or delegate.

Without mental triage, your brain’s default mode network (DMN) tends toward rumination, stress, and overwhelm, which can paralyze us. But taking up your role as the empowered self-brain surgeon helps you override this by focusing your cognitive energy where it can make the most impact—just like my colleagues and I had to act decisively in Iraq.

Triage and Faith: Prioritization and Battle Readiness

Jesus demonstrated a form of spiritual triage. He didn’t heal everyone in the crowd—he focused on those who sought him in faith. This mirrors the principle that not every battle is ours to fight (2 Chronicles 20:15) and that some things must be released to God’s control.

Paul instructs us to "take every thought captive" (2 Corinthians 10:5)—this is spiritual triage. Not every thought deserves immediate attention. Some must be sidelined (delayed), treated (urgent), or dismissed (minimal) before they grow into destructive patterns. Using the self-brain surgery discipline of biopsying your thoughts and feelings will give you the mental space to master this crucial tactic.

Proverbs 4:23 warns, "Above all else, guard your heart, for everything you do flows from it." This is battlefield wisdom: you must protect your mental and spiritual resources, ensuring you’re not expending energy on things that do not serve your mission.

Life Requires Tactical Thinking

Every day, we face a mix of urgent problems, delayed-action challenges, and things we should ignore—yet many of us don’t triage well. Instead, we waste time on worries that won’t matter in a year while neglecting the things that will shape our future.

In self-brain surgery, learning to triage thoughts, decisions, and emotions correctly is a survival skill. Just like in the hospital, where patients must be sorted based on their likelihood of survival, we must sort out our focus, attention, and actions based on their likelihood of leading to growth, healing, and purpose.

Learning to triage you thoughts—filtering out what is true, what is urgent, what is important, and what is merely noise—is an act of both wisdom and faith.

Merging Neuroscience and Faith for a Strategic Mindset

Whether on a battlefield or in daily life, triage is the key to survival. Neuroscience helps us understand why we must focus and prioritize to avoid cognitive overload. Faith gives us the clarity and courage to let go of battles that aren’t ours and lean on divine guidance for the fights we must engage in.

The lesson? Triage wisely, act decisively, and trust that not every fight is yours alone to win.

What’s Your Next Move?

When the bomb goes off in your life—whether it's a diagnosis, a crisis, or the weight of a thousand little battles—you don’t have to be overwhelmed. Triage wisely. Take a step back, assess what truly matters, and direct your energy where it will have the most impact.

If you’re ready to take control of your thoughts and master the art of mental triage, here are your next steps:

✅ Biopsy your thoughts. What are you focusing on that doesn’t deserve your attention? What must be addressed now, and what must be surrendered?

✅ Take control of your mind. Start practicing Self-Brain Surgery™—the neuroscience-based, faith-driven method to change your thinking and change your life.

✅ Dive deeper. If this concept resonates with you, I told the whole story of this bombing and the first time I had to make the triage decision between two badly injured men in Chapter 7 of my book, No Place to Hide.

💡 What battles are you facing today? Hit reply and let me know how you’re learning to triage your struggles. I’d love to hear from you.

Lisa and I are praying for you. Thanks for reading this letter from an old triage doctor. 😀

Dum spiro spero (While I breathe, I hope),

Lee

Psalm 71:14 ("As for me, I will always have hope.")

From the banks of the North Platte river on Moon River Ranch in Nebraska, USA

Share this message with someone who needs encouragement, and we’ll get through the war together!

We’re going all in on believing that we have the tools to change our minds and change our lives. Living from a mind-down perspective changes everything, and it will help you harness the transforming power the Bible promises in Romans 12.

And the good news is, you can start today.

Be sure to check out the archive of previous posts if you missed last week’s letter.

If you need a treatment plan to help you overcome any kind of trauma, tragedy, or massive thing in your life, check out my latest book, Hope Is the First Dose.

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