David Moyes should be a basket case by now.
Recovering casualties Mikel Arteta and Yakubu Ayegbeni have missed the start of the season, while Phil Jagielka isn't scheduled back from cruciate knee ligament damage until November. Adding to the woes is the recent knee injury suffered by captain Phil Neville, which will likely keep him out until the end of the year.
Manchester City's protracted pursuit of want-away defender Joleon Lescott succeeded, while last season's record transfer signing Marouane Fellaini has lost significant weight after contracting a virus in the summer and has yet to regain form.
With Manchester City having taken its spending to over $150 million in the summer, Moyes knows his attempt to maintain Everton as England's fifth-best club behind the Big Four of Manchester United, Chelsea, Liverpool and Arsenal will be most endangered by Mark Hughes' new array of stars.
And there are also the Everton fans who, while they may understand how difficult his job is, remain arch optimists.
By Christmas, if Moyes is not maintaining the team's status, there is unlikely to be much sympathy emanating from the stands.
So it would be understandable were he to consider himself the inhabitant of a Goodison madhouse.
Yet this is the current holder of the League Managers Association's annual award, something Moyes has now earned three times; once more, even, than Sir Alex Ferguson.
As the record holder of the award, he receives such regular recognition from his peers because he continues to work minor miracles.
One of those happens to be that he always finds ways to stay sane. Right now that way is the American way.
Two top-class U.S. specialist fitness coaches -- Steve Tashjian and Scott Piri, both out of L.A. -- have been hired to help Moyes induce maximum performance from one of the Premier League's minorities.
What was good for Jurgen Klinsmann during the 2006 World Cup campaign that took Germany to the semifinals is also good for Moyes in his bid to ensure that lack of numbers need not equate to a lack of results.
"When Klinsmann had success with the Germans he employed Athletes' Performance, and their fitness work was perceived to be different to the norm," Moyes said. "I've always been someone who wants to check out new approaches to fitness, so after the World Cup we went out to Los Angeles and checked it out.
"We began by employing one person and now we have two, because we realize how crucial their work can be to a club like ours that is always forced to operate with such a small squad."
Moyes believes that being the first English team to adopt such methods will prove beneficial.
"At first I thought the work they did was more inclined towards American-style sports," he said. "But they are very deeply involved with the German FA, and they are now much more into soccer.
"We are the first club in the Premier League to introduce this approach, and the approach is that little bit different, but the players enjoy the workouts and regimes because I think they like to see change and progression.
"Scott and Steve provide and compile information and knowledge on strength and power in a whole range of ways -- basically we are talking biomechanics."
It's an approach the Everton squad has embraced, and the results are already apparent.
"The players like the different methodology, and I certainly enjoy it," Moyes said. "Everything is done in movement as opposed to lying on your back on a bench pressing weights, for example.
"It is more about strengthening the muscles as opposed to trying to build more bulk, and the concentration, as it is becoming in fitness training in golf, for example, is on the core of the body.
"My philosophy on training is that you are not trying to build weightlifters but ballet dancers.
"They are beautifully toned, and the best players are that same way."
Across Liverpool's Stanley Park, Rafa Benitez is England's ultimate exponent of rotation.
Some say he takes it too far, yet every top manager advocates that players be used as sparingly as possible, especially internationals, so they can produce their best when it matters most.
Moyes does not enjoy that luxury. He just has to make do.
But Tashjian and Piri are paid to apply the expertise that should mean players forced into constant overtime do not necessarily also have to mend.
"The science of preparing a player for a game, for helping him to full recovery, has become so much greater now, especially with regard to us, " Moyes said.
"Part of it is guarding against injury, taking steps that will prevent problems.
"That might sound a bit odd given how many injuries we have had to contend with in the past year, but those injures have been snapped Achilles tendons, cruciate knee ligaments, not loads of hamstring or groin strains.
"They talk about rehab. But we also work hard on 'prehab,' which helps the players' muscles to be properly prepared.
"Because we have to work with such a small squad, we had to get the right advice and help on preparation and recovery."
The hope is that a pair of Americans can help provide the solution.
Ken Lawrence is a British sports journalist based in Los Angeles. He can be reached at email@example.com.