I’ll never forget the day I learned the meaning of stress in the emergency room (ER). A massive multi-car accident brought in many patients, pulling away the other ER doctors and leaving the rest of the ER in my care. I was focusing on a procedure to save a man with a life-threateningly low blood pressure, trying to block out the surrounding mayhem, when a nurse came up to me with the EKG for a new patient. Even at a distance, I could see he was having a massive heart attack, what some call “The Widowmaker.” As the operator called overhead for yet another new trauma patient, I felt my blood pressure rise — and for a millisecond, my throat suddenly felt full. I thought, “I can’t do this.” I learned that day that I’d just never had to do it.
What makes ER doctors and other crisis professionals able to not only stay cool, but function at the top of their game in an emergency? Sure, some people may naturally be better at this. But what I’ve learned in the ER is that all of us can rise to the challenge, and sometimes even surprise ourselves. But to be effective, you have to keep your head. The lessons below apply with any challenge, whether it’s a true physical emergency or the stuff of daily living: Your toddler pulled down the pasta display in a supermarket, or your boss gave you a major project due the next day, or the babysitter calls in sick, or you spill coffee on your smartphone. Stay in control with my five tips that I use in the ER and… well… life in general.
1. Check your pulse. I was told in residency, “When you get to a crashing patient, the first pulse to check is your own.” That’s because when we’re in panic mode, we inherently flip into fight-or-flight mode — not the critical executive thinking we need. Pause. Don’t jump into a situation if you’re feeling as chaotic as the world around you (see #2 to help).
2. Breathe — the right way. When the body is in fight or flight mode, it starts to hyperventilate. If you’re not actually about to run from real danger, hyperventilating drops your carbon dioxide levels and makes you feel worse. How you breathe can short-circuit that response — if you do it correctly. Don’t just take slow, deep breaths as we often hear — focus on a long, slow exhale. Try inhaling for three to four seconds, then exhaling for six to seven seconds to make this work for you.
3. Focus on what needs to be done first, and do it. The complexity of a crisis can overwhelm our thinking, almost paralyzing decisions. In medicine, we overcome this by prioritizing “The A-B-Cs.” That means that you find the most important thing (A), and do that. Then do (B), then (C). Don’t get bogged down trying to figure out everything, including things that are less urgent. Focus on the top three things that must be done right now.
4. Don’t let them see you sweat. When you’re the leader — whether that’s running a code in the ER, a teacher, a CEO or a parent — everyone looks to you. If you freak out, they freak out. And, especially in a crisis, you really need them to stay calm. Yes, you can be terrified on the inside (that’s only human — and happens to the best leaders), but if you can stay calm externally, your entire team will feel — and be — more capable. Plus, that helps bypass some of your own panic, keeping you calmer on the inside too.
5. Communicate. Don’t forget that your team can be a great source of insight. When I’m taking care of a particularly challenging case, I’ll often stop — take inventory out loud of what we’ve done, and then ask my team if they have suggestions. Sometimes, just a little different point of view — and remembering that you’re not alone — makes all the difference.
People who can function in a crisis are no less emotional, no less invested, no less worried, than those who cannot function. It’s a mindset, and it takes practice. Try these tips and see for yourself — and remember, you’ve got this.
What tips help you keep your head in a crisis? Know anyone who’s especially good at this? Tweet me @DrDarria — I’d love to hear from you.