How to Stay Calm Under Pressure: Lessons from a Neurosurgeon

Dr. Randy D’Amico’s advice for chaos is simple: check your own pulse first. His method for handling stress in the operating room applies to any high-pressure situation.

The Lesson From the Operating Room

“Check your own pulse first.”

That’s the advice Dr. Randy D’Amico, a neurosurgeon at Lenox Hill Hospital, lives by when things go wrong in the operating room.
When someone’s life is literally in your hands and complications arise, panic isn’t an option.

But here’s the thing: the same techniques that keep surgeons calm during 15-hour brain operations can help you handle pressure in your own life — whether that’s a big presentation, a tough conversation, or any high-stakes moment you face.

The Foundation: Preparation Is Everything

“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’s routine before surgery is methodical. Preparation removes panic.

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 based on past cases, what it’ll look like when I’m done.”

Before any big moment, run through it mentally.
Ask yourself:

• What will the room look like?

• What questions might come up?

• What’s my ideal outcome?

• What could go wrong, and how would I handle it?

Physical Preparation

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

He starts early, reviews scans, and uses augmented reality to visualize the operation in 3D.

The lesson? The earlier you start preparing, the more confident you’ll feel when pressure hits.

When Things Go Wrong: The STOP Protocol

Even with perfect preparation, complications happen. Dr. D’Amico uses a simple framework that applies to any crisis.

Step 1: Stay Calm (Check Your Own Pulse)

“If you panic, everyone panics. You have to be calm. Everyone there has to choreograph and work together.”

Your emotional state sets the tone for everyone around you.
If you lose control, the situation spirals.

Step 2: Pause and Think

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

Don’t react instantly. Take a second to assess, recall what you know, and find something similar you’ve handled before.

Step 3: Take Control

“Once you regain a little bit of composure, you get control. And that’s it. Then it’s very, very clear: you do this, I need you to do that, I will do this.”

Crisis management is about calm direction, not chaos. Clarity beats panic.

Step 4: Regroup

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

After initial action, step back and reassess. What’s working? What isn’t?

The Mindset: Middle of Ground

“I’m a high-octane guy, but in the operating room, especially in those situations, I am middle of ground. I’m there. I’m zoned in.”

He doesn’t try to suppress energy. He channels it into focus.

You don’t need to be naturally calm to handle stress. You just need to know how to find calm when it matters.

The Long Game: Building Pressure Tolerance

Learn From Mentors

“You learn through watching. You have good mentors who teach you this stuff.”

Find people who stay composed under pressure and observe how they do it.

Practice in Lower Stakes Situations

He didn’t start with brain surgery. He practiced in training until his reactions became automatic.
You can do the same — rehearse staying calm in smaller moments.

Build Your Support System

“When those things happen, I go next door and I’m like, look, this is what I did. And I get a, you did your best or we could have done this differently.”

Have people you can debrief with. They help you process, learn, and keep perspective.

The Daily Preparation

Dr. D’Amico’s composure starts long before he steps into surgery.

Morning Routine

He’s up at 4:30 AM.
He starts his day with quiet focus, exercise, and proper nutrition.
Those habits create a foundation for handling stress later.

Evening Routine

“I go to sleep at like nine thirty or ten o’clock. I’m usually reading until I pass out.”

Rest and recovery matter. A calm mind starts with consistent sleep.

Perspective: What Actually Matters

Here’s where his outlook becomes powerful.

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

It sounds harsh, but it’s freeing. Most of what you stress about isn’t urgent or permanent. Remembering that helps you stay grounded when small things feel big.

The Stoic Approach

Dr. D’Amico reads Marcus Aurelius’ Meditations.

“What is in the way becomes the way. It just becomes part of the story. You have to deal with these things and that completes your story.”

Problems aren’t interruptions. They’re the story itself.

When you start seeing obstacles as part of your path, they lose power over you.

Truth as Your Foundation

“The way to process delivering bad news is to tell the truth because the truth is the truth. It’s fact. And you’re not at fault for fact.”

In pressure situations, honesty keeps you steady.

“When you start to sugarcoat things or bullshit people, all of a sudden you’re on thin ice.”

Facts give you solid ground when everything else feels uncertain.

Processing Afterward

Even neurosurgeons have to recover from high-pressure moments.

Separate Work From Life

“They’re separate. This is career, this is job. I can draw a line and I’ve learned that.”

Boundaries keep you from carrying stress home.

Find Comfort Sources

“You find your sources of comfort in your support systems, you build that and you get used to it.”

For him, that means dinner with his kids, being present, and pushing the day’s stress to the background until they’re asleep.

Your Pressure-Handling Action Plan

Before High-Pressure Situations:

• Mentally rehearse what’s coming

• Prepare early

• Sleep well

• Have a backup plan

During High-Pressure Moments:

• Check your own pulse

• Pause and think

• Communicate clearly

• Stick to facts

After High-Pressure Situations:

• Debrief with trusted people

• Set boundaries

• Find what helps you reset

• Learn from it

The Bottom Line

You don’t need to perform brain surgery to use these tools.
Whether it’s a tough meeting, a conflict, or a personal crisis, the principles are the same: prepare well, stay calm, act clearly, and focus on what actually matters.

“You have to be able to leave it. You don’t leave it at the door, you take the lessons home with you.”

The goal isn’t to avoid pressure. It’s to master it. And that’s something anyone can learn, one situation at a time.

Want more practical lessons for handling pressure, stress, and real life in your twenties?
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