How to Practice a Mindful Moment in the OR

As a neurosurgeon, John Boockvar, MD, knows a lot about the brain, including how to cool it down (literally) to manage stress.

It starts with a specific type of mindful breathing where you inhale for four seconds, hold your breath for seven seconds, and exhale for eight seconds.

Functional MRI studies show that repeating this 4-7-8 mindful breathing over and over again for two minutes a day, every day, for at least one month can reduce the temperature of your amygdala—the almond-sized structure in your brain that controls your “fight or flight” stress response.

A cooler amygdala means your stress response is less likely to be triggered when something stressful happens, which inevitably will happen in surgery, Boockvar explains, and he says having this cool head in the OR saves lives.

“Think of mindfulness as a defense mechanism to get yourself out of trouble, for example, when a bleeding aneurysm can’t be controlled—mindfulness has been a way for me to channel the anxiety these stresses bring into a more productive mechanism.”

Take a “Mindful” Moment to Generate Calm

In Boockvar’s OR at Lenox Hill Hospital in New York City, after the team completes the Surgical Time Out, they take 30 seconds for a collective ‘mindful moment’ of deep breathing.

“The Surgical Time Out involves different team members taking the lead to confirm procedural details and patient information, but the mindful moment brings everyone into the same mental place right before the procedure.”

Sometimes Boockvar leads this mindful moment, sometimes other team members lead it, but the process is always the same …

1. Gather the team to stand together.
2. Introduce the team to mindfulness by inviting everyone to close their eyes.
3. Guide collective 4-7-8 breathing for 30 seconds.
4. Bring the team back to attention to initiate the case.

“The basic fundamentals of mindfulness help us recognize the stresses we face, even beyond the OR, and effectively counter them with these breathing techniques, which ultimately helps the team achieve peak performance for their patient.”

Tap into your “Gritflowness”

Mindfulness is one piece of a larger approach Boockvar calls “gritflowness,” in which muscle memory gained from obsessive practice leads to mastery that allows you to be in your flow state where you can achieve peak performance, whether you are clipping an aneurysm or ensuring everything is in place when circulating a case.

“Think about when you run. It’s when you realize you just ran four miles and could keep going without effort, that is when you have achieved your flow state.”

While “gritflowness” is a little different for each member of the surgical team, the key is to recognize how these three stress-reducing principles (grit, flow, and mindfulness) help everyone avoid mistakes.

“A nurse’s flow state is essential in the OR, every member of the team needs to appreciate how the seamless way they engage is equally important to the outcome of the case.”