Learning to Lead in a Storm

It’s one thing to work in the emergency room—it’s another thing to lead it. Years ago, I served as the ER Director at a busy regional hospital in Alabama. I’d been practicing medicine for several years by then, but stepping into a leadership role in that environment was like going from the eye of the storm to steering the whole ship through it.

The ER is unpredictable. One moment you’re treating a sprained ankle, the next you’re leading a full trauma resuscitation. When you’re the director, the responsibility goes beyond treating patients—you’re responsible for the team, the systems, and the morale that holds everything together. There’s no manual for that. You learn as you go, usually in the middle of the chaos.

But that experience shaped me, and many of the lessons I learned in those years have stayed with me. Whether I’m mentoring younger doctors or just trying to keep calm in the middle of a hectic shift, I still lean on the things I picked up during that time.

It Starts With Listening

One of the first things I realized as a leader is that the people around you want to be heard. Nurses, techs, clerks, residents—they all have ideas, frustrations, and insight. I wasn’t there to bark orders. I was there to make sure our team could function at its best. That meant listening—really listening—when someone said, “This process isn’t working,” or “We’re short-staffed, and it’s affecting care.”

At first, I thought leadership meant having the answers. But I quickly learned that good leadership means creating a space where others feel safe to speak up, and then having the humility to listen and act. That’s something I still carry with me. Whether I’m dealing with a medical student on their first shift or a seasoned nurse who sees something I don’t, I try to keep my ears open. You can’t lead well if you’re not listening well.

Staying Steady Under Pressure

Every ER doctor learns to stay calm during a crisis, but as a director, that calm had to extend beyond my own actions. I needed to set the tone for the whole department. If I panicked, or got short with people, or let frustration show, it would ripple through the team. And in a high-stakes environment, that kind of ripple can lead to mistakes.

So I learned how to be a steady presence, even when everything around me felt like it was coming apart. Sometimes that meant stepping into a situation just to say, “We’ve got this. Let’s slow down and take it one step at a time.” Other times it meant staying late to help cover shifts or just being visible when things got tough. People don’t just need answers—they need to know someone is standing with them when the pressure’s on.

To this day, I still try to be that steady voice in the room. Not because I have everything figured out, but because I know what it feels like to need someone who isn’t shaken by the storm.

People First, Always

Another thing I learned during my time as ER Director is that if you don’t take care of your people, the whole system breaks down. It’s easy in medicine to get focused on efficiency, on metrics, on getting people in and out faster. But behind every role is a person. And if that person feels burned out, unseen, or unsupported, it affects everything they do.

I made it a point to check in on the team, not just during shifts, but outside of them. I got to know people. I learned who was struggling, who had something going on at home, who just needed someone to say, “Thanks for what you’re doing.” It didn’t fix everything, but it mattered. People work harder and smarter when they know they’re valued.

Now, even though I’m not in a formal leadership role anymore, I still carry that mindset. Every shift is a chance to encourage someone, to back them up, to be the kind of teammate that makes the job feel a little lighter.

Adapt and Keep Moving

Nothing in the ER stays the same for long. Policies change. Staffing shifts. New technology gets introduced. When I was director, I had to learn to adapt—quickly and often. Some days it felt like we were flying the plane while we were building it. But you figure out how to move forward anyway.

That ability to adapt is one of the most useful things I ever learned. I use it constantly now, especially in emergency medicine, where even the best plans fall apart and you’re left improvising on the fly. The key is to stay flexible without losing your sense of purpose. Keep your eye on what matters—quality care, patient safety, team cohesion—and let the rest shift as it needs to.

A Role That Never Really Leaves You

I may not be an ER Director anymore, but that role never really left me. I still find myself looking out for the team, trying to see the big picture, thinking about how things can run more smoothly. Leadership isn’t just a title—it’s a way of showing up. And once you’ve led in the chaos of an emergency department, it becomes part of who you are.

So when people ask me what leadership in the ER taught me, I tell them this: listen more than you speak, be steady when others are shaking, care deeply about your people, and always stay flexible. Those lessons didn’t just make me a better leader. They made me a better doctor, a better teammate, and, I hope, a better person.

And for that, I’m grateful.