"Check Your Own Pulse First": A Neurosurgeon's Method for Staying Calm Under Ultimate Pressure

When Dr. Randy D’Amico performs 15-hour brain surgeries at Lenox Hill Hospital, every move matters. One slip could be catastrophic, yet he stays calm and focused the entire time. His secret? A simple rule that applies just as powerfully in boardrooms, breakups, and everyday stress: check your own pulse first.

“There’s an old saying,” Dr. D’Amico explains. “Check your own pulse first, because you have to be calm. If you panic, everyone panics.”

It sounds simple, but this mindset is the foundation of composure, leadership, and high performance under pressure.

Why “Check Your Own Pulse First” Works

Before you can lead others or handle a crisis, you have to regulate yourself. The calm comes before the control. Here’s why it works.

The Neuroscience of Calm Leadership

When stress hits, your body activates fight-or-flight mode. Cortisol and adrenaline spike, which:

• Narrow your focus and reduce problem-solving

• Impair judgment

• Create tunnel vision

• Spread anxiety to everyone around you

Taking a breath and “checking your pulse” activates your parasympathetic nervous system, which:

• Lowers heart rate and blood pressure

• Improves cognitive clarity

• Strengthens decision-making

• Projects calm confidence to others

The Contagion Effect of Emotions

“In that room, that’s my room,” Dr. D’Amico says. “Everyone has to choreograph and work together, but at the end of the day, I’m kind of captain of that ship because my hands are the ones in there.”

Science backs this up. Emotional states spread quickly through teams. When a leader stays composed, others follow. When the leader panics, the stress multiplies.

The 4-Step “Check Your Pulse” Method

Based on Dr. D’Amico’s approach in the operating room, here’s how to apply it anywhere — from work stress to real-life pressure moments.

1. Pause and Assess

Take a literal moment to breathe. Notice your heart rate, shoulders, and jaw. Feel the tension without judgment. That few-second pause separates reaction from response.

2. Think Back to Your Training

“You have to think back to your training,” Dr. D’Amico says. “And if it’s something new, you better find something analogous quickly.”

Remember times you’ve handled similar challenges. Use what worked before. If it’s something new, find the closest situation you’ve already faced.

3. Get Control Through Communication

“Once you regain composure, you get control,” he explains. “Then it’s methodical: you do this, I need you to do this, I will do this.”

Calm communication is power. Be clear, direct, and specific. Assign roles. Set immediate next steps. Make it simple for others to follow.

4. Regroup and Reorganize

After the initial response, step back. Evaluate what worked. Adjust based on new information. Keep communication open and focused.

How to Use It in Real Life

Dr. D’Amico’s method works far beyond the operating room. Here’s how to use it in everyday situations.

In a Work Presentation

When tech fails or questions throw you off:

• Check your pulse. Breathe.

• Think back to your last solid presentation.

• Get control. Address the glitch calmly.

• Regroup. Shift focus and continue with confidence.

During a Team Crisis

When deadlines are missed or things fall apart:

• Model calm energy.

• Draw from past experience.

• Give clear instructions.

• Check in regularly as the team regroups.

In a Relationship Conflict

When emotions run high:

• Notice your own reaction before responding.

• Remember what’s worked in past conflicts.

• Speak clearly. Listen fully.

• Take a break if needed, then return grounded.

The “Middle of Ground” Mindset

Dr. D’Amico calls his crisis state “middle of ground.”

“I’m a high-octane guy,” he says. “But in those situations, I am middle of ground. I’m just there. I’m zoned in. In complications, I do not panic. It’s, ‘What are we going to do? How are we going to fix this?’”

He’s not suppressing emotion. He’s controlling the frame. It’s deliberate focus — not denial.

The traits of this mindset:

• Present-focused thinking

• Solution-oriented action

• Calm communication

• Step-by-step problem solving

Building Your Pressure Response System

Like any muscle, calmness can be trained. Here’s how.

Daily Practice

• Use small stress moments (traffic, delays, deadlines) as practice reps.

• Try breathwork or visualization before big meetings.

• Prepare mentally for difficult conversations.

Physical Preparation

Dr. D’Amico’s composure starts with his habits:

• Early mornings

• Consistent exercise

• Nutritious meals

• Enough sleep to think clearly

When your body’s steady, your brain follows.

Mental Framework

Study how you’ve handled pressure in the past. Identify triggers. Build a few grounding tools that always work for you — deep breathing, short walks, or visualization. Confidence grows through repetition.

The Leadership Advantage

When you learn to check your own pulse first, everything improves.

1. Better Team Performance

Teams mirror your state. Calm leaders create clear-headed teams that trust their process and solve problems faster.

2. Smarter Decisions

Calm clarity widens your perspective and helps you make rational, long-term choices.

3. Stronger Resilience

Every time you practice this, your stress threshold grows. You build composure you can rely on anywhere.

Common Mistakes to Avoid

• Rushing to act: Pause first, act second.

• Ignoring your body: Notice tension before it controls you.

• Skipping the regroup: Always reassess after the first response.

Even a few seconds of awareness can change everything.

The Bottom Line

Dr. Randy D’Amico’s “check your own pulse first” mindset isn’t just surgical wisdom — it’s a guide to performing under pressure in any area of life.

Before you fix the problem, lead the team, or react to stress, take that moment to center yourself. Calm isn’t weakness. It’s control.

Because you can’t lead others, make good choices, or think clearly until you’ve checked your own pulse first.

Want more insights on performing under pressure?
Dr. Randy D’Amico shares his full approach on the Guyset podcast. Listen to the episode to learn how one of the world’s top neurosurgeons stays grounded in high-stakes situations.

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