Stay calm under pressure with lessons learned in the world’s most stressful careers

You may not be a trauma surgeon, but you can use some of the same coping mechanisms.
A helicopter with a person on the hoist below it.

Even if you don't fly a Coast Guard rescue helicopter, you can still benefit from the advice that pilots—and others—have for managing stress. Zach Lezniewicz / Unsplash

Living through a pandemic is stressful. Decisions that used to feel mundane—to get that haircut or not—become much more loaded when your health might hang in the balance. Finances are tight; jobs have disappeared; childcare and education have been in flux since last March.

While being a human is rarely a stress-free endeavor, this level of anxiety is new for many of us. But for people with the world’s most intense and dangerous jobs—occupations that can involve life-and-death decisions—such tension is a fact of life.

We reached out to a few of them to learn about how they cope without freaking out, and to hear what advice they have for the rest of us. From the land to the air to the sea, the terrain—both literal and psychological—these folks navigate can be tough. Here’s what it’s like.

The air traffic controller

If the thought of managing air traffic into and out of a very busy airport like Hartsfield-Jackson Atlanta sounds tough to you, you’d be right. Just ask Nichole Surunis. “It’s absolutely stressful,” she says. “It’s one of the world’s busiest airports, so almost every bit of airspace that we have, there’s going to be planes there.”

Surunis, who has 18 years of experience as a controller, doesn’t work in the tower near the tarmac. Instead, she operates at an FAA facility called Atlanta TRACON in Peachtree City, Georgia, which is more than a 30-minute drive from the international airport. Like the other controllers who work there, Surunis’ job is to remotely coordinate planes as they come in for a landing or after they’ve departed. If the weather is nice, as many as 132 craft can land at the airport in an hour—that’s more than two per minute. It takes two to three controllers at a time to handle that load.

The situation can get more hectic due to a complexifier like the weather. “Something that could be as simple as working a plane into an airport on one of these approaches, turns into something not-so-simple when you’re trying to vector them around thunderstorms, and keep them away from lightning, or keep them away from hail,” she says.

She emphasizes the importance of taking care of herself when she’s not at work so that she comes prepared to do her job; reading and baking are two of her favorite hobbies. “We all have a duty to the flying public that when we come to work, we’re ready to work,” she says.

In addition to taking care of your health outside of the job, Surunis advises people to “rely on the team around you.” In her case, that’s a union-organized support group called CISM, or Critical Incident Stress Management. “You can talk to them about anything,” she says. “They get it because they’re controllers as well.”

Even if your job doesn’t involve shepherding speeding jets into and out of an airport, reaching out for help is still an excellent idea. That could be a phone call to a trained caregiver like a therapist, to a peer in a work-sponsored support group, or just to a friend or colleague who’s in a similar situation. Just as an air-traffic controller will naturally get what a colleague is dealing with, so might someone who shares your occupation or is experiencing the same stressors you do.

An air traffic controller inside Atlanta TRACON FAA and a radar screen.
A glimpse inside Atlanta TRACON. F.A.A.

The Coast Guard rescue pilot

“It was a beautiful night here in Kodiak,” recalls Jared Carbajal, who pilots MH-60 Jayhawk helicopters for the Coast Guard out of an air station in Alaska. The mission: Grab an injured person off a fishing boat. But on the crew’s way out, high clouds obscured any ambient light the night had offered. “As we were closing in on the boat, the starlight, the moonlight, everything was blocked out,” he says.

The boat was small, the scene was dark, and “there were some good seas that day,” Carbajal remembers. His task was to carefully lower a Coast Guard swimmer down onto the boat, and then, after the swimmer had prepared the injured person for evacuation, bring them both back up to the Jayhawk helicopter, which is similar to the Black Hawks the U.S. Army flies.

That search-and-rescue mission involved “one of the more challenging hoists I’ve ever done,” he says. “It was taking all my concentration just to try to hold a stable hover, basically, and safely put the swimmer down.”

Flying Coast Guard rescue missions—especially in Alaska—offers its own challenges. For one, Air Station Kodiak must be ready to launch either a helicopter or C-130 aircraft within 30 minutes if needed, meaning that when it’s Carbajal’s 24-hour shift, he may have to go from sleeping to operating a helicopter in half an hour. Besides that fast turnaround and the sense of unknown that a search and rescue case brings, he cites the long distances he may need to cover, “the extreme weather,” and the “very dark conditions” as stressors. He does use night vision goggles to fly, but “those are not the magic, see-in-the-dark goggles that some people think they are.”

Managing stressful scenarios like that complex night hoist requires a careful balance of focusing on executing the task at hand while not freaking out about every future possibility. “I’m an instructor pilot as well, and I’ll watch people look too far ahead, and get overwhelmed—and for a minute, I started to do that,” he remembers.

“It can be crippling sometimes to look too far ahead,” he says. An important caveat, though: In aviation, looking ahead is required. You don’t drop a colleague down onto a boat in the first place if you don’t think you can get them back up, and you need to make sure you save enough fuel for the return trip.

For Carbajal, it comes down to mentally separating what he has power over and what he doesn’t. “I can’t control how dark it is out there,” he says. “I can’t control how small the boat is.” For the variables he can control, he suggests separating tasks into steps. “And then execute those.”

Those of us who don’t fly rescue helicopters can benefit from keeping that control question in mind. We can’t change that a pandemic is happening; we can’t predict whether there will be major repercussions if we get the virus. But we can take clear steps to prevent our lives from spinning out of a stable hover. Wear a mask. Wash your hands. Think through your plan for how you’ll endure the waiting period before you get a vaccine. Don’t look ahead to 2022—focus on the first months of this year.

Carbajal also suggests tamping down other anxieties. “Don’t worry about something that you can’t make a contingency plan for,” he says. For example, this might be a great time to stop worrying about an extinction-level meteor impact on our planet.

Finally, like Surunis, Carbajal emphasizes working with the team that’s on hand, and ideally, choosing to be with people who are constructive. “Your feedback has to be actionable,” he notes. “You can’t just say, ‘you sucked.’”

As for that dimly-lit mission, Carbajal successfully got the Coast Guard swimmer and the injured person off the fishing boat.

A Coast Guard MH-60 Jayhawk helicopter hovering.
An MH-60 Jayhawk, based out of Kodiak, in 2008. Petty Officer Richard Brahm / U.S. Coast Guard

The fishing boat captain

Richard Ogg is a commercial fisherman based in Bodega Bay, California. “It’s extremely hazardous,” he says. “The weather conditions [are often] just absolutely miserable.” But those hazards, he adds, are just part of the job.

Ogg ventures out in his boat, the Karen Jeanne, to fish for salmon, albacore, black cod, and dungeness crab in the Pacific. And despite the dangers, he says, “it’s extremely enjoyable to be 100 miles offshore. The freedom is unexplainable.”

But that freedom isn’t carefree. Bad weather, sleep deprivation, regulatory issues, and dealing with the gear are all serious concerns, but Ogg says that the biggest challenge comes from the complexities of working with fellow humans. He usually supervises a crew of one or two others. “How do you deal with individuals who may disrespect the potential hazards that are occuring, or disrespect the other crew members that are on the vessel, or disrespect the equipment?” he says. At stake is safety—and money.

Say, for instance, the crew is stacking heavy crab pots. If someone doesn’t do that task the right way, the pots could topple off the boat. “We’ve lost thousands of dollars [in that situation], in addition to the fact that we don’t have that equipment again to make the money,” Ogg says.

A conflict with another person can get even more heated when you’re both working on a boat that measures just about 56 feet long by 16 feet wide, a geographic plight that many of us can relate to with the pandemic keeping us stuck at home. Ogg says he manages stressors like that by taking a mediatory approach, in which he listens to other perspectives. “It’s typically understood that the captain’s word is the final word,” he says. “My personal way of dealing with it is that I don’t do that—I bring it to the group, and we discuss it.”

There are limits to the democratic approach, of course. “If I see that it’s going to continue to be an issue, then I have to step in and become the captain,” he adds, “but aside from that, I try to be very open and understanding of the fact that maybe they have a different way of looking at it.”

Ogg, who spent his earliest days in an orphanage in Nagasaki, Japan, before being adopted by an American family, credits a history in martial arts with informing his attitude. He argues that it’s more effective to guide a punch past you than to outright block it. He suggests “trying to join forces and work for a common goal, rather than fight each other.”

For people feeling stressed, he advises first trying to understand what’s causing the issue. “Once you know where it’s coming from—that creates an acceptance,” he says. And perhaps with acceptance, a resolution may emerge.

You probably don’t have a job that takes you out to sea, fishing for albacore and dealing with storms. But if you can identify the source of stress—there’s a deadly pandemic happening, and that’s causing tension—then perhaps you can accept it. It doesn’t mean that you have to like it. But by acknowledging it, you may feel more at peace, because you know why you’re having the feelings you’re feeling.

A Coast Guard pilot, air traffic controller, fishing boat captain, and a trauma surgeon.
From top left, clockwise: Jared Carbajal, Nichole Surunis, Richard Ogg, and Daniel Hagler. Courtesy of sources

The trauma surgeon

Removing a patient’s gallbladder or appendix is routine stuff for Daniel Hagler, an acute care surgeon at New York-Presbyterian Queens Hospital in New York. But when it comes to emergency general surgery, not all moments are going to be typical. And while Hagler identifies himself as having a “relatively low-stress” personality, some tasks are bound to be more intense than others.

For example, when he hears that a level-one trauma case is coming into the emergency room: “They’re on their way in, and the whole team’s assembling—you don’t know what to expect,” he says. In some of those cases, he adds, “what you do within seconds or minutes of them arriving can be the difference between life and death.”

A patient who has suffered a blunt trauma like a car accident and has multiple injuries can be a challenge. “What you address first can be a big decision point,” he says. The patient may be bleeding in two separate areas. “Do you fix their pelvis, or do you go into the belly first, and fix the bleeding there?” Hagler says. Making the wrong decision can cost that person their life. And though he’ll make the best decision he can based on what he knows, part of being a trauma surgeon means being ready to live with the knowledge that you might be wrong.

So how does he manage all that? Of course, surgeons like Hagler have specific training and experience that guide them, as all these people with extreme jobs do. But there’s also a key thought process and sequence that guides him: He focuses on the injury that could kill the patient most rapidly. “You act in a very algorithmic and deliberate fashion,” he says. That gory-looking bone fracture? Don’t let it distract you. Instead, work to fix critical issues like breathing and circulation.

“The way to deal with the unknowns, and the uncertainties, is by making them more certain,” he reflects. That means figuring out in advance how to respond to certain scenarios.

Outside of an operating room and other catastrophic scenarios, thinking algorithmically is still a good idea. That means pondering what you’d do if certain events happen with an if-this, then-that mentality. Hagler refers to this kind of thinking as having “at least the beginning of a plan.” What if your car doesn’t start one morning? You’d jump it, meaning that now is a great time to ensure you own jumper cables. Or, you could join AAA.

No matter what you’re up against, know that there are some key ideas that can help you navigate the dark skies, violent seas, and busy air traffic that might come your way: control, acceptance, planning, support, teamwork. If you can accept that some events are beyond your own power, and make a plan for how to cope with the aspects you can manage, all while reaching out for support when you need it—well, then, you may just make it through in one piece. Maybe you’ll even come out tougher and wiser on the other end.