How to thrive under pressure, according to a neurosurgeon

Practice the “5 P’s” to remain calm and focused in the face of adversity

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Photo by Francisco Moreno on Unsplash

Do you freeze up in high-stress instances, or do you act decisively? There’s no avoiding these circumstances in life, no matter how much we’d prefer it – but we do have a choice about how we handle them. Whether or not you’re able to operate effectively in these situations depends entirely on your capacity to train your brain to deal with stress and pressure in a positive and productive manner rather than shrinking away from it in fear.

Contrary to popular belief, most brain and spine surgery is not life and death or making split-second decisions. Most of the time as a neurosurgeon I have a normal routine, often toggling between low and medium stress and occasionally hitting the “red zone.” When that alarm sounds, I have to be ready to get out of “regular care” mode and switch to “life and death” mode.

We’ve all experienced a sudden shift from low to high stress, which can sometimes elicit intense fear. That’s not necessarily a bad thing – I happen to think fear is good, provided you have the tools to harness it.

Over the years, I’ve developed a coping mechanism I utilize in the operating room that I call my “5Ps.” These five simple steps of systematic mindful behaviors have been essential to training my brain to thrive under pressure.


Before making any tough decision or entering into a stressful situation, take a moment for a period of internal reflection. This crucial “pause” creates the mental space required to gain the upper hand on stress and fear. The pause can be five minutes, 20 minutes, or an hour – whatever the situation requires – but make it a priority and practice it often. Schedule time for it, if necessary, until it becomes a habit.

Patient (objective/perspective)

Use the space your pause has created to assess the problem (in my case the patient) to really put your situation in perspective. Before I begin any surgery, I take a moment to recite a brief paragraph about my patient and why I’m about to do the operation. This step not only provides a sense of calm by taking a step back and looking at things a little more objectively, it also helps focus your intention and sense of purpose moving forward – which, in turn, significantly reduces stress.


Before I enter the operating room each time, I go through the entire surgery I’m about to perform very briefly in my own head, in a series of 5-10 steps in order to prime my body for performance.

Likewise, before you enter that courtroom, make that important phone call, have that nerve-wracking job interview, or make a life-changing decision, walk through every step of the scenario completely in your mind. This helps instill a self-confidence that’s vital for operating effectively under pressure, in any situation in life. You know the plan. Now, execute.

Positive thought

There’s a reason so much has been written on the power of positive thinking – it absolutely works, even on a physical level! In high-pressure moments in life, it can make the difference between being able to effectively tackle stress and crumbling under the weight of your own fears and anxiety. Once you’ve paused, put the situation in perspective and made your plan, intentionally think at least one positive thought. I say to myself something like: “This is your case. Nobody has trained harder than you. No one has thought about this more than you. You have trained your whole life for this moment. This person has entrusted their life to you. Honor that trust. I am blessed and privileged to be able to do what I do.”

This might be the toughest step of all at first; but with a little practice, it may actually become the most powerful key to improving your performance in tough situations. Ask yourself: What have I sacrificed to be here today? What have I studied to get here? Aren’t I lucky to have this opportunity?


Finally, I say a little prayer. Prayer or meditation does more than just provide one with a feeling of support from a higher power when facing fear. It actually floods your brain with feel-good hormones like oxytocin and helps manage the fight-or-flight “survival mode” our system reverts to during stressful situations, which keeps us from making good decisions. A simple prayer could allow your brain to better utilize the prefrontal cortex, which controls executive functioning, helping you to think more clearly and make intentional, well-thought-out decisions under extreme stress.

We all face situations in life requiring us to operate under extreme pressure, whether from limited time and resources, external stress or even the debilitating weight of major life decisions. It’s been said that your motions will move your emotions. Repetitive practice of the 5Ps will enhance your mental agility and help you navigate many high-stress situations.

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