You’ve met the players. You’ve been initiated into the rites of the OR, which can be one of the most rewarding places to work because of the skills required, and can be the most stressful because of the skills required. Before we deal with this tension between reward and stress, I want to share several perks to working in the OR that are seldom discussed. First, you are pretty safe from being held accountable to anything embarrassing that you might do out in public; working in the OR is sometimes like being in the Witness Protection Program because no one will recognize you with your own clothes on and without the mask and hat. Many people who work in the OR have an inside joke: “I didn’t recognize you with your clothes on.” Also, if you don’t want to talk about work in social settings, a single episode describing body fluids, open cavities, or anything else surgical will generally discourage questions about your job in the future.

There are so many great things about being in the OR that are completely unique, and these are what help to keep the stress down to a dull roar. You hear all the time about the need for great communication skills in order to work as a team. After all, “teamwork makes the dream work,” and it keeps patients safe. In the OR, almost everyone is gowned and gloved with only their eyes showing, making it hard to relate to someone you are talking to as a “normal” human. With the surgeons up to their elbows in body parts, nurses and techs running around counting, slapping instruments around, answering phones and taking messages for the docs who may be belting out the lyrics to their favorite songs, you can see why it can be hard to stay focused. Some days it’s like a three-ring circus. With everyone concentrating on their particular job, yet needing to stay aware of what everyone else is doing because of the potential impact on the patient, it is important to stay alert and accountable to what is happening. Because of the tension that can come from strong personalities and the difficulty of the surgery, stress reactions are common.

The stress reaction is a primitive survival instinct. It is hardwired in the nervous system, which has not changed in 200,000 years. The stress reaction is instinctive and when triggered takes over the rational part of the brain—the cortex—driving one into a response often referred to as “lizard brain” (the primitive survival instinct). When stressed, you respond not to your thoughts but to your feelings. Stress can make you act stupid. The good news is that something as simple as conscious breathing can help you to stop the stress response in its tracks. Breathe in for a count of four, hold it for a count of four, and then exhale a count of four. Repeat. This will help you focus and re-engages your cortex so your inner lizard doesn’t start running around the room shouting silly things.