Melissa Valdellon


Strangely, I’ve had more instances in the last month where I’ve had to deal with more urgent or semi-urgent conditions that require extra handling and management. Usually, I get these cases every few months but in just the last few weeks, we’ve dealt with a macula-on RD, a hypertensive crisis (the patient was totally asymptomatic, yet his blood pressure was 210/162 when we read it), a kid with super angry looking marginal keratitis that had been cooking for at least a month before being seen, and a couple more things that definitely put me on a good adrenaline rush as I tried to coordinate the best care possible for these patients.

How do you stay calm in the middle of the crazy storm? Thankfully, the instances where you’ll have to deal with patient emergencies is likely not going to happen frequently, but there will be other times where things are just piling up and the stress keeps building around you and you find yourself needing to face it or be swept into the crazy yourself.

I don’t know about you, but engaging in a highly charged environment with energy that matches it means I’m going to be jumping in with irrational emotions and thoughts that will mean someone or something is going to get hurt, something’s going to be misunderstood or lost in translation, and plenty can and often does go wrong because we’ve made rash judgements and decisions.

So rather than jumping in right away unprepared, I take just a couple moments to pause and focus on my breath. Now, I’ve done a lot of meditation and yoga practice so I find that it’s not that hard for me to focus on my breathing, but this may be new to you. I would invite you to check on your breathing now as you read this. When you breathe in, do you feel any sensations? What part of your body is moving when you breathe? Do you breathe into your chest or deeper so that your stomach moves too?

One of the first things that happen physiologically when we’re under acute stress is our breathing goes shallow. As a result, our brains don’t get as much oxygen in the short term to adequately process what’s going on. We’re instead going off on instinct on how to best preserve ourselves in this highly charged situation. That’s helpful when something’s about to attack you. It’s not as helpful when you have to take care of someone else’s immediate health needs.

Even now, when my students come to me for consultations and they’re a bit flustered because their data doesn’t make sense or patients seem upset or something has shaken them out of their routine, I will stop the student and tell them to breathe. And I will breathe with the student a couple times just to get them more centered before letting them continue.

Those couple moments can be enough to reset the mind and make it aware that things are ok, there is no imminent danger, and now you can think a little bit more objectively about the situation at hand. If I’m in the middle of a high tension environment and I can’t step outside to collect myself, I do try to keep part of my focus engaged on my breathing even then, just to help  me stay more calm and grounded. I wrote more about breathing and its relation to stress in my book, Remembering to Breathe – there’s helpful information in there on how to build and maintain and healthy work/study-life balance.

Taking a few breaths for yourself is just as important as what you do next afterward. Get in the habit of periodically checking in on your breath throughout the day. Set your alarm to go off every hour for the next couple days as a reminder to check in on your breathing. Even if you don’t regularly practice meditation (and I don’t anymore, just to let you know), this practice of paying attention to your breath can be the way to begin practicing mindfulness, which is a skill that can translate into other areas of life.

Happy (deep) breathing.

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