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How to Mentally Prepare for a Crisis Like an ER Doctor

Reminding yourself of your true mission can help you let go of what you can’t control

Credit: Vincent Hazat/Getty Images

AtAt one o’clock in the morning, the emergency radio goes off — a team of paramedics is calling with a critical case. They’ve found a young child in cardiac arrest, blue, and not breathing. It’s going to be up to you and your team to try to get the child’s heart started again.

You have five minutes before the patient arrives. What do you do?

As an emergency doctor, I’ve responded to this type of situation hundreds of times. What I’ve learned is that while external groundwork is clearly important (we need to set up equipment and mobilize the necessary resources), it is the internal preparation — how we mentally ready ourselves in the moments before a crisis — that can make all the difference.

Everyone faces emergencies at some point in their lives. Maybe the one coming your way is a loved one needing surgery, or layoffs at work, or the familiar pull of addiction. Whatever your crisis, you can use the same tools that we use in the emergency department to respond as smoothly and effectively as possible.

Accept reality

The first thing I do when facing a critical case is to take a deep breath and accept what is about to happen. This certainly doesn’t mean I like what’s to come, or even that I’m okay with it. It simply means I recognize the reality and commit to facing it fully. Wishing things were different only takes up energy that I won’t be able to spend on solving the problem.

In these moments, it helps me to have a phrase that I repeat to myself as a mental anchor. I cycle through a few of these depending on what feels right for the moment, from simple motivations (“Time to go to work, Dworkis”) to deeper reminders of my purpose. If things are looking grim for a patient, I sometimes propel myself to keep going with, “Well, at least they’re not on fire.” If they actually are on fire, the thought becomes, “Well, at least I’m not on fire.”

Identify the areas in which you have control

Sometimes in the emergency room, people die and families will suffer. There’s no getting around this.

I am a good doctor and an expert in resuscitation, but I am not omnipotent, and I cannot control this fact. What I can control, though, is my commitment to bringing the best version of myself to any situation, to handle the worst-case scenarios with as much skill and compassion as I can. Mindfulness expert Jon Kabat-Zinn puts it like this: “You can’t stop the waves, but you can learn to surf.”

To that end, I often try to remind my team of the true mission we’re facing during a crisis. Declaring, “Our job is to save this child’s life” identifies a goal, which may or may not be accomplishable. Instead, I might say, “Okay, we have a critically ill child. Our goal here is to take the best medical knowledge we have and deliver it to this child as flawlessly as possible.” This gives us a tactical mission, one whose success isn’t dependent on forces beyond our control.

Ground yourself in your body

Before a crisis, I put my fingertips on my radial (wrist) or carotid (neck) pulse and feel a few heartbeats. This serves two purposes: First, it reminds me of all the training I have gone through to be where I am, and how much I’ve learned since the first time someone taught how me to take a pulse, which gives me the confidence to act when I’m most needed.

Second, it reminds me what I do and do not have control of. I do not have control over how long I will be alive or how many heartbeats I get. I do have this heartbeat that I’m feeling right now, and maybe a few more. It is up to me to decide what I do with them.

Prepare to solve small problems

When junior doctors begin to run critical resuscitations, a common mistake they make is attempting to solve the entire situation in a single move. Because resuscitations are complicated and full of uncertainty, they’re usually best approached as a series of smaller, easier-to-handle problems.

For instance, within the first minute, I do not have to fix the child completely, but I do have to get the cardiac monitors in place, obtain intravenous access, deliver oxygen, and analyze the initial heart rhythm. In the second minute, I might concentrate on placing a breathing tube, or delivering medicines or an electric shock, depending on what I learned during the first minute. Strung together, these small steps allow me to travel through uncertainty toward the outcome I am aiming for.

Visualize your actions

In the moments before the patient arrives, I construct a mental picture that answers to simple but crucial questions. Which side will the paramedics stand on? How will we move the patient from the ambulance stretcher to our bed? Where will I stand? What is the very first thing I will do? I’ll visualize placing a breathing tube, and then double or triple check the location of my backup equipment. I might turn on the cardiac defibrillator and visualize delivering an electric shock. This way, when the patient gets to the room, I hit the ground running.

In this, I know, I have an advantage: I know roughly what my crisis will look like. Yours may catch you by surprise. But if you practice these strategies regularly, you may find yourself more prepared when the metaphorical radio call comes through.

Emergency Doctor. Applying knowledge under pressure. The Emergency Mind Book: bit.ly/emindbook