Dealing With Leadership Anxiety

What I learned my first day as a hospital chaplain with no training.

What do you do when you don’t know what to do?

This leadership journey began when I was twenty-four years old and had been married six days. It was my first day as a hospital chaplain at the University of Tennessee Medical Center in Knoxville. It housed six hundred beds, home hospice, and the only level-one trauma ER in the region, complete with a LifeStar medical helicopter. This was when people used pagers, and I was given three pagers to begin my twenty-eight-hour shift. One pager was for my units, one was for the emergency room, and one for the code team. That beeper buzzed violently and flashed bright blue anytime someone’s heart stopped anywhere in the hospital. As one medical resident later put it, “The code team . . . when the patient’s heart stops, yours starts racing.”

So, first day on the job: slacks, dress shirt, comfy dress shoes, and a racing heart. The comfy shoes turned out to be the most important item because hospitals are a giant maze of stairs and wards covering several surface miles, and a chaplain can clock three or four miles on any given day. My wife dropped me and my overnight bag off at the front entrance with a kiss, a prayer, and “I’ll see you at lunch tomorrow; you’re going to do great.” The doors opened, and I walked into a foreign world. I had never seen a dead body before. I had very little experience with grief. I had just finished a bachelor of arts in Bible and preaching, and this was my first full-time ministry assignment.

I was participating somewhat by accident in clinical pastoral education, or CPE. It was by accident because my wife had one more year of college left, and I needed a job to provide for us. After looking into a few options, the local employment agency suggested I try chaplaincy. UT Medical Center just happened to be hiring its annual slate of chaplain residents, and in spite of my age, lack of experience, and lack of a graduate degree, they offered me the job. I didn’t know what I was getting into, but the pay was enough to provide for us, and the experience sounded promising. I had no idea what an understatement that would become.

A chaplain resident is like a medical resident—you spend one year serving the spiritual needs of the hospital in a clinical learning environment. On that first morning the six new chaplain residents negotiated who got which departments of the hospital, and these departments became our “parish” for six months. For the second half of the year, we’d switch to another parish. We were the frontline response for any situation needing a chaplain. The permanent chaplain staff each had other duties and would back us up as needed.

I was assigned the following: pediatrics; labor and delivery; neonatal intensive care; pediatric intensive care; and the heart floor, kidney floor, and their respective intensive care wards. In the second six months, I served in home hospice and home health, chemotherapy, radiation, pre- and post-surgery, surgical intensive care, and on the medical ethics board. Most days the residents worked 8 a.m. to 5 p.m., but four to six times each month we worked a marathon shift from eight in the morning until noon the next day. The overnight chaplain covered the ER and code team for those twenty-eight hours and the entire hospital through the evening and overnight.

After assigning our wards, Randy, one of the supervisors, toured us around the hospital. We started at the top floor and slowly wound our way down, visiting every ward and meeting staff and patients. The tour was utterly overwhelming—odd smells lingered; medical tubes were everywhere holding weird-colored fluids; people walked around in all kinds of medical shape, mostly bad shape. The intensive care units were worse and I couldn’t keep eye contact with some of the patients. Then there was the pediatric intensive care unit with bald-headed kids fighting cancer and the neonatal intensive care unit with the smallest babies I’d ever seen. Within the first hour I was completely overwhelmed and wondered what sort of terrible mistake I had made when I agreed to this job.

Only the day before, Lisa and I had lazily left our honeymoon cabin in the Smoky Mountains and stopped by the grocery store to buy the first of everything a married couple needs: spices, toilet paper, and Tupperware. We needed three carts for all our stuff, and the receipt was two feet long. We proudly drove to our new home—married student housing—a 1970s single-wide trailer right on the French Broad River on the outskirts of Knoxville. Setting up our new home felt like we were real adults, but touring the hospital sobered me up to just how young and inexperienced I was.

As Randy finished our tour my blue pager started buzzing. “Which one is the blue one again?” I asked. “That’s the code team. You need to go.” Right. The pager that says someone’s heart has stopped. My heart had been racing for some time already. And here, verbatim, is the full extent of the preparation I was given as a chaplain. I asked Randy, “What do I do now?” “It will be interesting to find out, won’t it?” he replied. I looked at Randy, thinking he was teasing me, but he was serious. Kind, but serious. I waited a few more seconds in case he’d give me more instruction, but he was silent. “But what if I make a mistake?” “You are going to make hundreds of mistakes this year.”

And with that little pep talk, I was on my own. I walked toward the intensive care waiting lounge but didn’t need to check in to see where I was needed; I could hear the commotion as I approached. Someone had died, people were screaming, and I was supposed to do something about it.

What do you do when you don’t know what to do?

Leaders are faced with countless situations where they only have a notion of what to do or partial information yet are required to act anyway. Most of the time leaders have to do something regardless of how equipped or ready they feel. I’ve read dozens of leadership books, and many of them define leadership. John Maxwell says that “Leadership is influence.” Marcus Buckingham says that “Leadership is rallying others to a better future.” Darcy Eikenberg defines leadership as “The courage to do the right things even when they are hard.”

These are all accurate and helpful definitions. I’ll add mine: leadership is knowing what to do.

One of the simplest ways to know you are the leader in a group is that people look at you when they don’t know what to do. When I toured the hospital and my beeper went off, I didn’t know what to do, so I looked to Randy because he was the leader.

A few minutes later, I was in the intensive care waiting lounge, and everybody was looking at me because they did not know what to do. I was the presumed leader because I was the chaplain. Never mind that I didn’t know what to do either; I needed to do something.

Leadership is almost always intuitive because leadership situations are fluid and dynamic. Most of the time we don’t exactly know what to do. We end up with a gap between not knowing what to do and needing to do something.

The gap is one of the most uncomfortable places to live because a leader feels immense internal and external pressure to do something. In that gap all kinds of interesting things emerge: a bubbling cauldron of anxiety, fear, childhood trauma, the stories we tell ourselves, idols, and more. All of these show up in leadership environments. So as a leader lives in the gap, she is faced with three options: (1) run from it and give up leading because it is too uncomfortable; (2) fake it and pretend she knows what she is doing and thus build a chasm of hypocrisy; or (3) develop a capacity to “mind the gap.”

Minding the gap, as you might imagine, takes some sweat and tears, but the result can be a deeper level of freedom. When you find yourself in this gap, take a pause rather than blazing forward. If you pause and tune in to your inner dialogue, anxiety, triggers, what makes you mad, who makes you mad, assumptions you bring into every leadership situation, how you manage mistakes and how they inform your leadership, you can be free of the recurring patterns that keep you stuck.

But not only that.

Equally interesting is the emotional context of every leadership situation. Because leadership involves at least one other person, it involves at least one other boiling collective. So, leadership becomes about the emotional context: yours and theirs. Managing anxiety under the surface: yours and theirs.

We begin by becoming more self-aware about how this unconscious material informs leadership. If a leader can, in the words of Henry Cloud, “think about the way you think,” he can become a very powerful presence, able to understand himself and, most powerfully, able to become fully present to the people he is called to lead and serve.

Every leader will find herself in an unfamiliar situation, no matter how much formal training or experience she has. She will make mistakes, deal with conflict, and change her leadership style to adapt to the organization. Every leader can benefit from a set of tools that help develop a hyper awareness to what is going on under the surface, in the mind and in the body. This hyper awareness offers the leader a rare gift of being able to manage, rather than be managed by, all this subtext.

Have you ever gone into a meeting dreading the conversation you need to have, so you play it out in your mind obsessively as if manic worry will help the meeting? Have you ever led a meeting and stepped on a landmine you didn’t even know existed, and suddenly your well-intentioned leadership has turned into hurt feelings and misunderstanding? Have you struggled to focus on the person in front of you because your mind is elsewhere? Have you brought a previous situation into the present? Have you felt shame over a mistake and wish you could have a do-over?

Any honest leader will answer yes to all these situations. They are the frequent experience for every leader, and I believe they are the cause for leader burnout. Burnout has less to do with workload and more to do with internal and external leadership anxiety. As surely as the sun rises every morning, so will a leader face a situation where she is anxious or annoyed at the person she is leading, or she wonders why she feels ashamed. Or he gets tired of being stuck in the same pattern with his team. Or he doesn’t know what to do, yet he must do something.

That was the situation I faced after the code team pager went off. I walked into a war zone of grief and death called the intensive care waiting lounge.

The intensive care waiting lounge is a large room full of recliners. Families set up camp in that room while patients fight for life on the other side of the wall. Because of the open nature of the room, the hospital built a very small corner room to offer privacy for doctors to meet with families when they needed a medical update. Except it isn’t like that at all. The small room isn’t even a whole room—just four self-standing walls with no closed ceiling, lots of windows, and no privacy. I’m sure in the early days of the room’s existence doctors pulled every family in for medical updates, but over time busy doctors decided to skip the effort if they had good news. Instead they’d just walk right over to the recliners and give the update in front of other families. If it was bad news, however, they’d walk over to the recliners and ask the family to come into the private room. This practice of selective updates in the small room caused families to name it the Death Room.

I didn’t know any of this at the time. I didn’t know that the small room is the most hated and resisted room in the entire hospital. All I knew was that as I walked out of the elevator, there was screaming and wailing coming out of the small room. I felt everyone in the recliners looking at me as I walked in. The anxiety in me and around me was palpable. I could barely breath.

I walked inside the room. There were more than a dozen family members, most of them screaming, and four or five doctors and nurses trying to calm them. I was struggling to track my many thoughts, but one of them was, Oh good, doctors and nurses are here, they will know what to do.

One woman was banging her head against the wall in a rhythm while wailing loudly. Another was leaning over a trash can heaving and vomiting. One person was wildly swinging her arms in the air as if trying to punch the grief away. Some people were groaning, some were screaming at the top of their lungs and hyperventilating—it was a sheer onslaught of volume and guttural sounds that are indescribable. The experienced chaplains later told me this is known as “wailing and flailing.” The family’s matriarch had suddenly died on the surgery table from complications, and the nurses brought the family into the Death Room to give them the news. I turned up about three minutes later. Within moments all the white coats were gone, and I was alone with this wailing and flailing family. It turned out that the white coats had thought to themselves, At least the chaplain is here; he’ll know what to do. No one chooses to be in a situation like this, but this was my job. I was supposed to do something.

I stood there for a couple of minutes trying to tell myself that this was real life, it was time to act. Should I call a coroner? Should I usher the family into the ICU to see their mother? This would be my first-ever time being in the same room as a dead body. What if I passed out or threw up? Should I make funeral arrangements or does someone else? I had no idea, but I was getting very anxious just standing there in the middle of all this volume and commotion.

A leader can only handle the internal and external pressure to do something for so long. I could see the other families in the waiting lounge staring at me. All the noise from the Death Room was escalating their own anxiety, because they all had loved ones in the ICU fighting for their lives. I could feel the nurse who managed the waiting lounge desk looking at me—she didn’t want a noisy room. Everyone was anxious, including the young chaplain. I attempted to talk to this grieving family. “Could someone tell me what happened?”

No response, no acknowledgment that I was even in the room. I walked closer to the hysterical woman and caught one of her swing-ing fists in my hand. I held it tightly and looked right into her eyes, trying to silently communicate that I cared. She settled down and I asked one of the family members to hold her hand as I worked my way to the lady hitting the wall with her head. I didn’t speak, I just took her shoulders and guided her to a seat. This seemed to be working pretty well. Okay, this must be what you do. Take charge. Be kind, but directive. These people were so upset they were barely able to function, let alone communicate. But as I walked over and made eye contact and reached out to touch them, they seemed to calm one at a time. I can do this, I thought.

A nurse walked in and beckoned me outside to talk. “Chaplain, we need the bed for another patient. Can you get this family to come visit their mum so we can turn the room?”

So that must be what I was supposed to do—hustle a grieving family in and out to free up needed bed space. It didn’t seem very compassionate, but at least I had a clear directive. I walked back in and asserted myself, “It’s time to go visit your mother.” But this announcement caused a huge regression and reactivated the wailing and flailing. We were back to square one.

At this point you may be thinking, gentle reader, that the chaplain staff had ill-equipped me for this particular moment, and you may be harboring some level of anger toward Randy, the supervisor, with his lack of advice when the pager first went off. I can relate. Why didn’t Randy tell me what to do? How irresponsible is a hospital to entrust the care of a family in shock to an inexperienced ministry student?

But Randy knew something I didn’t know: no one can prepare you for this. There is no manual, there is no procedure. Leadership in the face of unhinged grief is pure intuition. All you can do is face it, manage yourself, and respond as situations arise.

Taken from Steve Cuss’s book Managing Leadership Anxiety.

Steve Cuss
Steve Cuss
Steve Cuss is the Lead Pastor of Discovery Christian Church in Broomfield, Colorado, and he is the author of the book Managing Leadership Anxiety: Yours and Theirs.