How to Stay Calm Under Pressure: Lessons from a Neurosurgeon

Check Your Own Pulse First: How a Brain Surgeon Handles Pressure When Everything’s on the Line

Dr. Randy D’Amico spends his days inside operating rooms where panic is not an option. When things go wrong during brain surgery, emotions don’t get a vote. Calm does.

His advice for moments like that is simple:

“Check your own pulse first.”

Dr. Randy D’Amico, a neurosurgeon at Lenox Hill Hospital, lives by that rule when complications hit mid-operation. Someone’s life is on the table. Panic would only make things worse.

What’s surprising is how well this mindset translates outside the operating room. The same principles that keep surgeons steady during 15-hour brain surgeries work just as well for tough conversations, high-stakes meetings, and moments when life suddenly feels out of control.

This perspective echoes what I talk about in How to Build Confidence When You Feel Behind in Life, where pressure is often more internal than situational.

Preparation Is What Creates Calm

“When problems happen, it’s because you didn’t take that time and go over it. As long as you do a little prep work, things go fine.”

Dr. D’Amico doesn’t rely on instinct alone. Calm starts long before pressure shows up.

Mental Rehearsal

“I’ll spend time at the end of the day going in my head over what the incision will look like, how the bone will come off, what I expect to see… what it’ll look like when I’m done.”

Before anything important, he’s already walked through it mentally.

You can do the same:

• What will the situation look like?

• What questions might come up?

• What’s your ideal outcome?

• What could go wrong, and how would you respond?

Running the scenario ahead of time removes fear of the unknown. This is the same reason preparation shows up repeatedly in How Do I Stop Overthinking Everything.

Research from Harvard Medical School backs this up. Mental rehearsal reduces anxiety by giving the brain familiarity before stress hits.

Physical Preparation

“I’ve probably been doing it for two days already because I know these cases are coming up.”

Preparation isn’t rushed. It starts early. The earlier you prepare, the steadier you feel when pressure arrives.

When Things Go Wrong: The Four-Step Reset

Even with preparation, problems still happen. When they do, Dr. D’Amico follows a simple internal protocol.

1. Check Your Own Pulse

“If you panic, everyone panics.”

Your nervous system sets the tone. Lose control internally and the situation spirals externally.

2. Pause and Think

“If something’s going wrong, you have to stop and pause. And you have to think back to your training.”

Reacting fast isn’t the same as reacting well. A brief pause creates clarity.

3. Take Control

“Once you regain a little composure… it becomes very clear: you do this, I need you to do that.”

Calm direction beats emotional reaction every time.

4. Regroup

“Then we regroup in a couple of minutes and reorganize.”

Pressure doesn’t end with action. You reassess and adjust.

This same pause-and-respond approach shows up in How to Stay Calm Under Pressure: Lessons from a Neurosurgeon, because stress compounds when reaction replaces intention.

You Don’t Need to Be Naturally Calm

“I’m a high-octane guy, but in the operating room… I’m middle of ground. I’m zoned in.”

Calm isn’t a personality trait. It’s a practiced response.

Dr. D’Amico learned composure by watching mentors, practicing in lower-stakes situations, and building systems that made steady behavior automatic.

This aligns closely with principles from Stoic philosophy, especially the idea that you can’t control events, only your response to them. Modern psychology echoes this, including findings from The American Psychological Association on emotional regulation under stress.

Perspective Is the Ultimate Pressure Release

“There’s no race, there’s no rush, there’s no timeline. The only thing you’re racing towards is death.”

That sounds harsh until you sit with it.

Most stress comes from imagined urgency. Remembering what actually matters keeps small problems from becoming big ones.

He leans on a stoic mindset:

“What’s in the way becomes the way.”

Obstacles aren’t interruptions. They’re part of the story.

This perspective mirrors what we unpack in Why Comparing Yourself to Others Makes Everyone Feel Worse, where false timelines quietly create pressure that doesn’t need to exist.

Truth Is What Keeps You Grounded

“The way to process delivering bad news is to tell the truth because the truth is the truth.”

When pressure rises, facts stabilize you. Sugarcoating creates instability. Honesty gives you solid ground.

How He Lets It Go Afterward

Even surgeons have to decompress.

“They’re separate. This is career. This is life.”

Boundaries matter. So do support systems. For him, it’s time with family and being fully present once the day ends.

Your Pressure-Handling Framework

Before

• Prepare early

• Mentally rehearse

• Sleep well

During

• Check your pulse

• Pause before reacting

• Communicate clearly

• Stick to facts

After

• Debrief

• Learn

• Reset

• Move forward

Pressure doesn’t need to control you. It just needs structure.

Frequently Asked Questions

Who is Dr. Randy D’Amico?
He is a neurosurgeon at Lenox Hill Hospital who performs brain surgery and treats patients facing life-threatening neurological conditions.

What does “check your own pulse first” mean?
It means regulating your own emotions before reacting. Calm thinking leads to better decisions.

How can this apply outside medicine?
The same principles help with work stress, tough conversations, public speaking, and crisis moments.

Why does preparation reduce stress so much?
Preparation removes uncertainty. When you know what to expect, fear has less room to grow.

What’s the biggest takeaway from Dr. D’Amico’s mindset?
There’s no race. Most pressure is imagined. How you respond matters more than what happens.

And Here's The Thing

You don’t need to be a brain surgeon to handle pressure well.

Prepare early.
Regulate yourself first.
Act clearly.
Tell the truth.
Keep perspective.

When things get intense, the most important thing to stabilize isn’t the situation.

It’s you.

If you want more grounded perspective like this, start with Why Do I Feel Behind Even When I’m Doing Fine or How Do I Handle Stress Without Shutting Down next.