"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, one wrong move could be catastrophic. So how does he stay calm when someone's life literally depends on his steady hands and clear thinking? His answer reveals a powerful technique that applies far beyond the operating room.

"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."

This simple phrase contains a profound truth about leadership, stress management, and peak performance that every professional should master.

Why "Check Your Own Pulse First" Works

The concept is deceptively simple: before you can effectively handle any crisis or high-pressure situation, you must first regulate your own emotional and physiological state. Here's the science behind why this approach is so effective:

The Neuroscience of Calm Leadership

When we're stressed or panicked, our sympathetic nervous system activates the fight-or-flight response. This floods our system with cortisol and adrenaline, which:

• Narrows our focus and reduces creative problem-solving

• Impairs our ability to make complex decisions

• Creates tunnel vision that prevents us from seeing solutions

• Triggers similar stress responses in those around us

By literally or figuratively "checking your pulse," you activate your parasympathetic nervous system, which:

• Lowers heart rate and blood pressure

• Improves cognitive function

• Enhances decision-making abilities

• Projects calm confidence to your team

The Contagion Effect of Emotions

Dr. D'Amico understands a crucial leadership principle: emotions are contagious. "In that room, that's my room," he explains. "Everyone there 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."

Research in emotional contagion shows that when a leader displays calm composure, it spreads throughout the team. Conversely, when leaders panic, it creates a cascade of stress that can paralyze an entire group.

The 4-Step "Check Your Pulse" Method

Based on Dr. D'Amico's approach to surgical complications, here's how to apply this technique in any high-pressure situation:

Step 1: Pause and Assess Your Internal State

• Take a literal moment to check your breathing and heart rate

• Notice physical tension in your shoulders, jaw, or hands

• Acknowledge any emotional reactions without judgment

• Give yourself permission to take 3-5 seconds to center

Step 2: Think Back to Your Training

"You have to think back to your training, because you've done this," Dr. D'Amico notes. "And if it's something new, you better find something analogous quickly."

• Recall similar situations you've successfully navigated

• Identify transferable skills and strategies

• Draw confidence from your past experiences

• If it's truly new, find the closest analogous situation

Step 3: Get Control Through Clear Communication

"Once you regain a little bit of composure, you get control. And then it's very methodical: you do this, I need you to do this, I will do this."

• Communicate with clarity and specificity

• Assign roles and responsibilities

• Set immediate next steps

• Establish a timeline for regrouping

Step 4: Regroup and Reorganize

• Assess what's working and what isn't

• Adjust the plan based on new information

• Maintain open communication channels

• Prepare for the next phase of action

Real-World Applications Beyond Surgery

In Business Presentations

When a presentation goes wrong—technology fails, you lose your place, or you face hostile questions:

• Check your pulse: Take a breath and ground yourself

• Think back: Remember successful presentations you've given

• Get control: Acknowledge the issue calmly and set expectations

• Regroup: Adapt your approach and continue with confidence

During Team Crises

When projects derail, deadlines are missed, or conflicts arise:

• Check your pulse: Model the calm energy you want from your team

• Think back: Draw on previous crisis management experiences

• Get control: Clearly delegate tasks and set priorities

• Regroup: Schedule regular check-ins to reassess and adjust

In Personal Relationships

When arguments escalate or difficult conversations arise:

• Check your pulse: Recognize your emotional state before responding

• Think back: Consider what approaches have worked in the past

• Get control: Communicate your needs clearly and listen actively

• Regroup: Take breaks if needed and return with fresh perspective

The Operating Room Mindset

What makes Dr. D'Amico's approach particularly powerful is his ability to shift into what he calls being "middle of ground" during crises. "I am just there. I'm zoned in. In complications, the same exact way. I do not panic. It is: what are we gonna do? How are we gonna fix this?"

This isn't about suppressing emotions or pretending everything is fine. It's about consciously choosing your response rather than reacting automatically.

Key Characteristics of the "Middle Ground" State:

• Present-focused: Concentrating on what can be controlled now

• Solution-oriented: Asking "how do we fix this" rather than "why did this happen"

• Collaborative: Engaging others as partners in problem-solving

• Methodical: Breaking complex problems into manageable steps

Building Your Pressure Response System

Like any skill, staying calm under pressure requires practice. Here's how to develop this capability:

Daily Practice Opportunities

• Small stresses: Practice the technique during minor inconveniences

• Planned challenges: Deliberately put yourself in low-stakes pressure situations

• Breathing exercises: Develop consistent breath control practices

• Visualization: Mentally rehearse using the technique in challenging scenarios

Physical Preparation

Dr. D'Amico maintains his calm partly through physical fitness and proper preparation:

• Regular exercise to build stress resilience

• Adequate sleep to maintain emotional regulation

• Proper nutrition to support cognitive function

• Mental rehearsal of challenging scenarios

Mental Framework Development

• Study your past successes and failures under pressure

• Identify your personal stress triggers and early warning signs

• Develop a toolkit of calming techniques that work for you

• Build confidence through gradual exposure to challenging situations

The Leadership Advantage

When you master the "check your own pulse first" principle, you gain several leadership advantages:

Enhanced Team Performance

Teams perform better when led by calm, confident leaders. Your ability to stay composed during crises will:

• Reduce team anxiety and improve decision-making

• Encourage creative problem-solving

• Build trust and confidence in your leadership

• Create a culture of resilience and adaptability

Improved Decision Quality

Stress impairs judgment, while calm clarity enhances it. By managing your internal state first, you:

• See more options and possibilities

• Make more rational, less reactive choices

• Consider long-term consequences more effectively

• Communicate decisions more persuasively

Personal Resilience

Regular practice of this technique builds your overall stress tolerance and emotional intelligence, leading to:

• Better work-life balance

• Reduced burnout and anxiety

• Improved relationships

• Greater career satisfaction and success

Common Mistakes to Avoid

Rushing to Action

The natural tendency during crises is to "do something, anything." But as Dr. D'Amico demonstrates, taking a moment to center yourself first leads to better outcomes.

Ignoring Your Physical State

Your body provides crucial information about your stress levels. Learn to recognize:

• Increased heart rate and breathing

• Muscle tension

• Changes in voice pitch or speed

• Fidgeting or restless behavior

Skipping the Pause

In high-pressure situations, every second feels crucial. However, the few seconds you invest in checking your pulse will save minutes or hours of ineffective crisis response.

The Bottom Line

Dr. Randy D'Amico's "check your own pulse first" principle isn't just medical wisdom—it's a fundamental leadership and life skill. Whether you're facing a work crisis, relationship challenge, or personal setback, your ability to manage your internal state first determines the quality of everything that follows.

The next time you feel pressure mounting, remember: you can't effectively lead others, solve problems, or make good decisions until you've checked your own pulse first. Take that moment to breathe, center yourself, and approach the situation from a place of calm competence rather than reactive panic.

Your team, your family, and your future self will thank you for it.

Want more insights on peak performance under pressure? Dr. Randy D'Amico shares his complete approach to high-stakes performance on the Guyset podcast. Listen to the full episode and discover more techniques from one of the world's leading neurosurgeons.

About the Author: This article is based on insights from Dr. Randy D'Amico, a neurosurgeon at Lenox Hill Hospital in New York City, as featured on the Guyset podcast.

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