An excerpt from The Heart of Fear: A Surgeon’s Collection of Stories on Adversity, Passion and Perseverance.

Each step is calculated.

Each step is deliberate.

Each step is taken with the goal of saving a life.

Everyone needs a hobby, but skydiving can predispose you to precarious scenarios. When you’re in a high-stress situation, your training kicks in. You do what you need to do to regain control, deploy your reserve, and fly your canopy to safety. The same goes for a high-stress situation in the operating room. Your training kicks in. You do what you need to do to save the life of your patient.

You do what you need to do to fix the problem.

It’s interesting that the mindset I learned from skydiving has translated to my career as a physician. In both skydiving and medicine, you have to be able to think on your feet and make quick decisions under pressure. You need to be confident in your abilities, but also humble enough to acknowledge that there is always room for growth.

Both require a commitment to safety and attention to detail. The consequences of a mistake in either skydiving or medicine can be severe, so it’s important to always be vigilant and proactive in identifying and addressing potential issues. It’s a great feeling when everything goes smoothly, and the end result is a successful jump or a successful operation. But what do we do when things go wrong?

I was first exposed to skydiving when I was a medical student. There was a drop zone forty-five minutes north of the medical school campus. The training came naturally to me because it was similar to medical training in many ways.

The training started with the accelerated freefall program, or AFF. This consisted of a ground school and a written test on the logistics of skydiving. Next was a series of competencies that need to be demonstrated in the air.

I began with two instructors, downgraded to one, and then was released on my own. The maneuvers were meant to demonstrate stability in the air and the ability to regain control in an unstable position during free fall.

Barrel roll.

Simple flip.

The second part of the jump consisted of parachute deployment and canopy piloting. Once the parachute is safely overhead, the focus shifts to flying the landing pattern—landing into the wind, and safely.

The most critical portion of the training is learning the emergency procedures. A skydiving rig consists of a main canopy, a reserve canopy, in some cases, an automatic activation device, and a reserve static line which is designed to automatically deploy the reserve parachute after the main canopy is cut away.

I learned the emergency procedures. I learned my gear inside and out. I learned about the plethora of malfunctions, the most common of which is line twists. One of the less common malfunctions is two parachutes out. I studied these malfunctions and learned how to deal with them quickly. In theory.

When the day my first malfunction came, it was my fourth skydive of the day. It was jump number one hundred twenty-eight. I had a successful three-way free fall with two friends. We waved to each other before we split, and flew our separate ways.

At thirty-five hundred feet, I pulled out my pilot chute. Under normal circumstances, this dislodges the closing pin and opens the container, deploying the main parachute. Except mine didn’t come out.

I turned behind me to see the pilot chute flapping in the air. I reached back and tried to manually pull on it and open the main container.

Now I was down to three-thousand feet. It wasn’t coming out. I kept trying.

Twenty-five hundred feet. My audible altimeter was beeping louder and louder. There was still no canopy above my head. I couldn’t get my main chute out.

I pulled my reserve handle. It was a rough opening, but there it was: my blue-and-white reserve canopy. I flew it down.

After my feet hit the ground, the emotions set in.

Relief.

Fear.

“That was a close call.”

So what happened?

I talked to the rigger at the drop zone, then to several friends and jump partners. Most likely, it was faulty packing on my part. Mistakes are unavoidable. Predictable, even. What matters is dealing with them when they inevitably arise.

The importance of knowing emergency procedures cannot be overstated, as they can mean the difference between success and failure.

One Monday morning, I was scheduled to do bypass surgery, but I got called urgently to the cath lab for a different patient. The cardiologist asked me to come right away. Once I was there, he showed me the films.

The patient was originally brought to the cath lab as a STEMI, but after further evaluation, the cardiologist discovered the patient was actually suffering from a Type A aortic dissection.

The patient was awake on the cath lab table. His name was John. I walked in and told him this was a surgical emergency I would have to replace the ascending aorta. I explained to him that to do this, I would have to open his chest, put him on cardiopulmonary bypass, and arrest the heart. This operation would also require deep hypothermic circulatory arrest, where we would cool the body to take off the cross-clamp.

As you can imagine, the patient was shocked. I asked him what family he had. He told me it was him, his wife, and their baby girl. She was the same age as my little girl, Harper, who was almost two at the time.

The operation itself went well. I was able to sew in the graft. After multiple blood products, we were finally ready to close the patient’s chest.

We took him back to the ICU. I went to the call room to get some rest. It had been an eight-hour operation. About thirty minutes after arrival at the ICU, at around three a.m., I heard a Code Blue overhead in his room. His heart was fibrillating. The ICU team tried to defibrillate with external pads unsuccessfully.

Quickly, I opened the chest at the bedside. I looked up at the monitor as I was removing the sternal wires. Asystole.

Shit. Come on, John.

I started cardiac massage. The heart came back. We started pacing.

I left the chest open that night and brought him back the next day to close him.

He eventually made it out of the hospital and saw his little girl again.

Looking back, I recognized that what was going through my head at the time was very similar to a malfunction during a skydive. I had to do what needed to be done to save my patient’s life.

There was no panic.

Everything moves in slow motion when I’m in a situation like this.

I take a deep breath and act.

Alexandra Kharazi is a board-certified cardiothoracic surgeon with over 11 years of experience practicing in San Diego, CA. She has completed more than 200 skydives, is a mother, and is the author of The Heart of Fear. Now, she assists with a strategic approach to renewing dedication in a highly stressful occupation.

Dr. Kharazi serves as the CEO and founder, The Heart of Motivation consulting, where she helps individuals make informed decisions and live their best lives. She has received multiple honors and recognition for patient satisfaction and has been featured in regional and national media outlets, including Forbes, TIME, Communication Intelligence, San Diego Union-Tribune, Authority Magazine, POP Sugar, and Doximity, among others.