It seemed like all the alarms in the world were going off at the same time. Rebecca’s Oxygen levels were plummeting despite being on a ventilator and ECMO (a machine directly oxygenating her blood). The ICU nurse was visibly rattled and I could see she was tearing up as her shaky voice yelled for a doctor. I stood just out of the way with Becca’s mother and sister watching helplessly as they worked to save her life. This was the scene in early June 2015 on a particularly challenging day leading up to transplant.

I remember watching the attending physician come in with a completely calm demeaner and serious expression. He spoke clearly and succinctly. He instructed the perfusionist controlling the ECMO machine to change some settings. He then ordered the nurse to give her a blood transfusion. As the nurse rushed around getting this together she continued to raise her concerns but he firmly told her again to give her the transfusion and then explained that the hemoglobin that she would be receiving would help to carry the oxygen in her blood. He also explained that it was not dropping as so quickly that they couldn’t respond.

His presence was calming because he was calm. His clarity and directness showed his knowledge and experience while none of us questioned whether he was doing the right thing. In retrospect, there were several things that projected his confidence which in turn inspired our confidence in him. The first was his presence. It was informed by his posture, tone, and purposeful movement which made it clear that he was not going to run around and panic like others were doing. The second was a clear expertise since he was decisive and direct. The third was that he came across as oddly optimistic. Perhaps it was his experience but it seemed as if he wasn’t panicked because he believed that she would be ok if there was a proper response. We also wanted to believe that the outcome would be positive so watching his assessment of the situation reinforced that belief and drove near immediate alignment.

Fortunately, we don’t all need to step into life or death situations every day but I took with me those three characteristics that he showed in those moments. He’d immediately calmed our already emotionally exhausted group huddled in the corner with his presence, expertise, and optimism. And in every demonstration of confidence that I’ve noticed since, those three elements were always front and center.