The Peg-Hole Fit: Finding Authentic Alignment Before Crisis Strikes

Introduction

Success can look immaculate from the outside while quietly unravelling on the inside. I have been there. Gallery openings, board certifications, a private practice booming beyond capacity — by every external measure, a life firing on all cylinders. And yet, somewhere beneath the momentum, a persistent feeling: like  wearing a badly fitting suit.

This is not a story about failure. It is a story about the particularly unique  danger of succeeding at the wrong thing for too long. In You Might Live Twice I describe the seductive pull of high-performance environments – the vortex of LA glamour, surgical prestige, relentless ambition — and the slow, almost invisible erosion of spiritual balance that follows. What most people call burnout, I reframe and rename: moral injury. The distinction matters enormously.

This post unpacks one of my book’s most quietly powerful concepts – the “peg-hole fit” -and offers a framework for assessing your own alignment before circumstances force the question. You do not need a catastrophic brain injury to benefit from this perspective. But you need to be honest about whether the hole you are currently occupying is actually shaped like the peg that symbolizes you.

The Danger of the High Wire

There is a particular kind of vertigo that comes with altitude. Not fear of falling – but a distortion of perception so gradual you barely notice it happening. In the book, I describe this phenomenon: “Stay too long on the high wire and the view distorts, leading to a loss of spiritual balance and character drift.”

This is the distinction the book draws between burnout and moral injury. Burnout is exhaustion – the tank running dry.

 Moral injury is something more insidious: you know you are harming yourself; you can see the drift happening, and yet you stay on the wire anyway. Part adrenaline addiction. Part no readily available off-ramps. The machinery of ambition keeps running.

I use the imagery of Icarus revisited — not as cliché, but as lived experience.

The ascent feels like green lights all the way. Board exam scores in the top percentile. A surgi centre opening its doors. Invitations to the right rooms in the right cities. The very momentum that signals success can become the mechanism of its undoing, because momentum does not pause to ask whether the direction still makes sense. Momentum often takes on a fly-wheel  characteristic and often goes faster.

For me the first twinge of unease occurred on a drive back to Los Angeles from Las Vegas in 1999. The warning sign was not dramatic. A vague unease. A spiritual conflict felt in my bones. The soul registering what the conscious mind is too busy to process. The conscious mind may not process it, but the feeling cannot be entirely ignored.

Defining the Peg-Hole Fit

The concept of the peg-hole fit is deceptively simple: what shape are you, and what shape is the environment you are trying to occupy? I introduce this framework not as a career assessment tool, but as a question of authentic selfhood. “Wellness and happiness start with you” I write. “Seeing clearly begins with seeing yourself clearly – what shape of peg you are, what type of hole you fit.” Ideally, it should be a friction free fit.

Critically, my book argues that completion, balance, and perspective matter more than raw precision or excellence. This is a significant reframe for high achievers.

The assumption embedded in most ambitious lives is that performance is the primary variable – work harder, achieve more, optimize relentlessly. But the peg-hole fit framework suggests the more fundamental question is fit, not output. The idea certainly begets longevity.

A square peg driven into a round hole with extraordinary force may “fit” but it is not friction free and, in the end, is still a mismatch.

My book illustrates this contrast vividly through geography. The mahogany and marble of Bedford Drive in Beverly Hills, one block from Rodeo Drive, versus sitting alone on granite rocks beside a Newfoundland river, watching salmon leap the waterfalls. Both are real. Both have genuine appeal. But they are not equally right for the same person. This sorting takes honest reckoning. It is self diagnostic. Which environment actually produces a sense of completion? Which struggles can you tolerate, and which can you embrace?

The book is careful to note that this answer is different for each person, and may even shift across different seasons of a life. What the framework demands is not a permanent answer, but an honest current one. The danger is not choosing the wrong environment once. The danger is never pausing long enough to ask the question at all.

Course-Correcting Before the Landslide

One of my book’s most practical and underappreciated concepts is the “spiritual pit stop.” I describe a spontaneous afternoon at the Hotel del Coronado bar with two close friends – three surgeons, early-career, quietly slipping away from a conference to drink Chardonnay and talk. From the outside, irresponsible. From the inside, survival. “The soul knows what you need even if the conscious mind refuses to admit it.”

The spiritual pit stop is not a sabbatical or a dramatic life overhaul. It is an intentional pause – the kind of maintenance the soul requires just as much as the body does. Without it, the book argues, the consequences compound: medical errors, strained relationships, failing health, a creeping sense of inauthenticity that eventually becomes impossible to ignore. The vortex spins faster. The red line is eclipsed, your “engine” starts leaking oil.

Here is a quick-win exercise drawn directly from the book’s framework that you can use within the next five minutes. Ask yourself three reflective  questions: First, which environment in your current life makes you feel most like yourself – not most impressive, but most genuinely at ease? Second, where do you feel like you are performing a version of yourself rather than being one? Third, what is one small act of course-correction — a walk, a conversation, a boundary drawn — that your gut has been suggesting and your schedule has been overriding?

The book is emphatic on one point: you do not need a catastrophic event to initiate a life upgrade. The vortex is not inevitable. Course-correction is available at any point — but it requires the willingness to look clearly at what your current fit actually is, rather than what it is supposed to be.