How to Stay Calm Under Pressure: Lessons from a Neurosurgeon

"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 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 at work, a difficult conversation, or any high-stakes situation you're facing.

The Foundation: Preparation Is Everything

"When problems happen, it's because you didn't take that time and go over it," Dr. D'Amico explains about surgical complications. "As long as you do a little prep work, things go fine."

His pre-surgery preparation routine is methodical:

Mental Rehearsal

"I will spend time at the end of the day just going in my head kind of what the incision is going to look like, how the bone is going to come off. What do I expect to see based on stuff I've done in the past? What is it going to look like when I'm done?"

This isn't just for surgery. Before any high-pressure situation, run through it mentally:

• What will the room look like?

• What questions might come up?

• What's your ideal outcome?

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

Physical Preparation

"I've probably been doing it for two days already because I know these cases are coming up."

Dr. D'Amico doesn't wait until the morning of surgery to prepare. He starts mental rehearsal days in advance, reviews brain scans, and uses augmented reality systems to visualize the procedure in 3D.

The lesson? Start preparing early. The more familiar you are with what's coming, the less likely you are to be thrown off by unexpected challenges.

When Things Go Wrong: The STOP Protocol

Even with perfect preparation, complications happen. Dr. D'Amico has a clear framework for handling crisis situations that applies far beyond the operating room.

Step 1: Stay Calm (Check Your Own Pulse)

"If you panic, everyone panics. You have to be calm so you know if you panic everyone panic and you know I may not be the leader of this ship right this enterprise but in that room that's my room everyone there has to choreograph and we have to work all together."

The first rule of crisis management: your emotional state sets the tone for everyone around you. If you lose control, the situation gets worse.

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 immediately. Take a moment to:

• Assess what's actually happening

• Remember your training or past experience

• Find something analogous if it's a new situation

Step 3: Take Control

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

Clear, direct communication about next steps. No yelling, no blame - just systematic problem-solving.

Step 4: Regroup

"And then we will regroup in a couple of minutes and then you reorganize."

After immediate actions are taken, step back and reassess. What's working? What needs to change?

The Mindset: "I Am Middle of Ground"

"I'm a high octane guy, but in the operating room, especially in those situations, I am middle of ground. That's it. I am just, I'm there. I'm zoned in."

This is crucial. Dr. D'Amico doesn't try to suppress his naturally high-energy personality - he channels it into focused calm when it matters most.

You don't need to be naturally calm to handle pressure well. You need to be able to access that calm state when you need it.

The Long Game: Building Pressure Tolerance

Learn from Mentors

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

Dr. D'Amico learned to handle complications by watching experienced surgeons deal with them first. Find people in your field who handle pressure well and observe how they do it.

Practice in Lower Stakes Situations

Before performing brain surgery solo, Dr. D'Amico practiced these techniques in training situations. You can do the same - use smaller pressure situations to practice your response patterns.

Build Your Support System

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

Having people you can debrief with after high-pressure situations is crucial. They help you process what happened and maintain perspective.

The Daily Preparation: Setting Yourself Up for Success

Dr. D'Amico's ability to stay calm under extreme pressure doesn't just happen in the operating room - it's built through daily habits.

Morning Routine for Mental Clarity

His 4:30 AM routine creates the foundation for handling whatever the day brings:

• Immediate alertness upon waking

• Focused work time with zero interruptions (6:30-8:00 AM)

• Physical exercise to manage stress

• Proper nutrition for sustained energy

Evening Preparation

"I go to sleep at like nine 30 10 o'clock... I'm usually reading until I pass out."

Quality sleep and a calm evening routine set you up for better stress response the next day.

Perspective: What Actually Matters

Here's where Dr. D'Amico's advice gets really powerful. His daily exposure to life-and-death situations gives him unique perspective on what's worth stressing about.

The Reality Check

"There's no race, there's no rush, there's no timeline. The only thing you're racing towards is death."

This isn't morbid - it's liberating. Most of your daily stresses are temporary and fixable. Keeping this perspective helps you stay calm when smaller problems feel overwhelming.

The Stoic Approach

Dr. D'Amico references Marcus Aurelius' "Meditations" as bedside reading: "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 obstacles to your life - they're part of your life. This reframe changes how you approach challenges.

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."

When you're under pressure, stick to facts. Don't sugarcoat, don't catastrophize, don't make things up. Truth gives you solid ground to stand on when everything else feels chaotic.

"When you start to sugarcoat things or bullshit people, all of a sudden, now you're treading, you you're on thin ice."

Processing Afterward: The Recovery Phase

Even neurosurgeons have to deal with the emotional aftermath of high-pressure situations.

Separate Work from Life

"They're separate. This is career, this is job... I can draw a line and I've learned that."

You need to be able to leave work stress at work. Dr. D'Amico does this by having clear boundaries and focusing on his family when he gets home.

Find Your Comfort Sources

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

For Dr. D'Amico, this means sitting with his kids at dinner, focusing on their happiness and putting work stress "in the back of your mind until they go to bed."

Your Pressure-Handling Action Plan

Based on Dr. D'Amico's approach, here's how you can build better stress response:

Before High-Pressure Situations

1. Mental rehearsal - Visualize the situation and your ideal response

2. Prepare early - Don't wait until the last minute

3. Get good sleep - Your stress response depends on being well-rested

4. Have a plan - Know what you'll do if things go wrong

During High-Pressure Moments

1. Check your own pulse - Stay calm to keep others calm

2. Pause and think - Don't react immediately

3. Take control - Clear communication and systematic action

4. Stick to facts - Truth is your foundation

After High-Pressure Situations

1. Debrief with trusted people - Process what happened

2. Set clear boundaries - Don't carry work stress home

3. Find your comfort sources - Have activities that help you reset

4. Learn from the experience - What worked? What didn't?

The Bottom Line

You don't need to perform brain surgery to benefit from these techniques. Whether you're dealing with a difficult conversation, a big presentation, or any high-stakes situation, the principles are the same:

Prepare thoroughly, stay calm in the moment, take systematic action, and maintain perspective on what actually matters.

As Dr. D'Amico puts it: "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 get better at handling it. And that's a skill you can build, one situation at a time.

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