Like most adults, I have mastered getting on and off the elevator: First you walk up to the elevator doors and push the button with the symbol that points up. When the door opens you step inside. It’s important to go all the way in or the door will keep re-opening and then trying to close. Once you are inside, you push the button for the floor you want. (It is not polite to push additional buttons—even if you are only four years old and desperately want to do so.) It is customary to stand facing the front, but some people look around or face the back as a joke. Watch the numbers above the door for your floor. When the door opens, you can acknowledge the other passengers by nodding pleasantly or saying thanks. Skip this step if you are by yourself. Walk out of the elevator, and off you go!

It’s not just the elevator that I’ve mastered—there are dozens of things that I can do routinely, without even thinking about them. I don’t have to create the skills from scratch each time I need them.

But what happens when life breaks the routine? When the elevator is out of order or stops between floors? (Or a four-year-old gets on and does push ALL the buttons?) How do I respond to that? That’s when it gets tricky.

It turns out that life is not just collecting a lot of routines; it is actually more about how to respond when the routines don’t really cover the situation. The elevator is a rather silly example, but every single day we are faced with decisions that call on us to use our brains, to figure out what to do, to be more than a collection of the tried and true.

In healthcare we can never simplify things down to just a collection of protocols or policies or processes. Sure, we need all of that—couldn’t do our jobs without it. We follow the directions on the label. We abide by the rules. But we keep our eyes open (and our hearts, I might add) for the moment when the script isn’t already written and the path is not well defined. How we respond to those moments—and we have many of them every day—is what really determines the effectiveness of our care.

Just as I learned how to use the elevator, I have learned that when I respond to the daily challenges of life with hope and optimism, I get better results than when I respond with anxiety and pessimism. Hope transforms challenging situations—the ones that go beyond our immediate understanding. Faith and confidence that the things we do can make a real difference will lead to a different result than just going through the motions and not believing or caring about the impact of our actions. And love—even the smallest smidgen of love—recasts challenges as opportunities. As Martin Luther King, Jr., famously said, “I have decided to stick with love. Hate is too great a burden to bear.”

So the next time you push the button on the elevator, think about it. And rejoice in the opportunity we are given to make a difference in people’s lives every single day.