"Three Trees and a Computer Bug: Lessons in Crisis Leadership" by Ryan Hoover

The one may be overpowered by another, two can withstand him, and a threefold cord is not quickly broken.

All right, it's 6 o'clock. We can get started here. Welcome, everyone, to Strength to Strength this morning. Appreciate you getting up early to participate in this meeting. My name is Sam Baer, and I come to you from Boston, Massachusetts. I'm actually from Cochrane, Alberta, but I'm down here for the winter, studying at Sattler College. And this morning, we have Brother Ryan Hoover coming to us from Virginia.

Before we get started with that, let's pause for a word of prayer.

Heavenly Father, most gracious one, we come to you this morning. We thank you, Lord, that you are here with us this morning and that we are your children and that you love us. Thank you for the provision of Jesus Christ in his life and work here on earth and death on the cross and resurrection. Thank you that through the work of Christ, we can be made new and have our old hearts transformed into hearts of flesh that can be sensitive to those around us, sensitive to the needs of the world. Just pray, Lord, that this meeting this morning would be a blessing to your kingdom here on the earth and that each one of us would be challenged in our walk with Christ and how we think about the world.

I just pray that you would be with Brother Ryan as he delivers his message this morning. I pray that you would anoint his lips so that your name could be praised in all that is said. Be with us today, and may your Spirit protect us from the evil one. We pray in Jesus' name. Amen.

All right, go ahead, Brother Ryan, and give us a bit of an introduction to who you are and where you're from and any pertinent details.

All right, well, good morning.

I'm Ryan Hoover. I was born and raised in northwest Ohio as an affiliated Mennonite and eventually got married. And my wife was a nurse at that point, and I got bit by the nursing bug and pulled into nursing.

We lived in Rochester, Minnesota, for nine years. I went through nursing school there, became a nurse, worked in long-term care, nursing homes, eventually did hospice nursing, which is still my favorite kind of nursing. It's still my passion. End-of-life care is, I think, the best nursing someone could do.

And eventually worked in the hospital at Mayo Clinic there in Rochester. In 2018, we were asked to come to Mountain View and become the administrator here. So in October of '18, we moved here to Mountain View Nursing Home in northern Virginia. We're just north of Charlottesville, Virginia, about an hour and a half outside DC.

And we've been here since. I'm the administrator of the nursing home here. Mountain View is a small 40-bed long-term care nursing home. We specialize in end-stage dementia and end-of-life care. Of my residents this morning, only a handful can walk or talk.

And by virtue of us being long-term care only, we do not do any short-term care. Grandma falls and breaks a hip and needs rehab. That's not us. We are not certified to take Medicare, the programs that pay for that care. We are Medicaid only. So it's rare we discharge anyone to somewhere other than a funeral home.

The vast majority of our residents will die here with us. We're owned and operated by Oak Grove Mennonite Church, a local beachy church a mile and a half down the road. And the most interesting thing about Mountain View is that we're run by volunteers.

About 80% of my workforce are volunteer youth. And so we sit on an 80-acre campus. I have 40 volunteers in the dorms. I have 40 residents in the nursing home. And then I have five administrative families with their associated children. So we have a campus of about 120 people. It is a real community or commune or compound or colony or whatever other word you'd like to use for it. I support here as the administrator. Like I say, I've been here for just under four years.

I know today's discussion is going to be unpalatable to some. We've had to make choices the past two years, two and a half years dealing with COVID that some people have deeply disagreed with. And I have no desire to stir up controversy this morning. I'm simply here to share my story and my perspective.

Talking about leadership this morning, lessons in leadership, crisis leadership specifically, these are the lessons I've learned. Now, some of you on here, I see John and Tony and a few of you that have been in leadership a whole lot longer than I. These might not be lessons to you, and you may say, "Well, what a rube. You should have known that." But this is where I am.

So three trees and a computer bug. What does that have to do with anything? Well, October, August 14th, 2003, 19 years ago, was a very hot, still day. Northwest Ohio, the power grid was loaded. Air conditioners were running hot, running heavy.

And the power grid is much more complex than I realized and interconnected and webs of power companies and supply and demand. And there was a computer program whose job it was to monitor conditions and forecast.

If this were to happen, could we handle it? If that were to happen, what would happen next? That computer system was offline that August day, but people didn't know it.

As things warm up, if you're well familiar with science, most things expand, power lines included. And because it was a hot, still day and there was no wind to keep the power lines cooler, one line expanded and sagged enough that it touched a tree, shorted out. Well, there are systems to protect this, and a relay tripped.

Well, that overloaded other lines carrying the load.

But because that computer system was offline, the operators did not realize this. A while later, a second line sagged into a tree, tripped, and overloaded other systems. And again, I'm broadly overgeneralizing this. Eventually, a third line sagged and tripped a relay.

And this was in the Akron, Ohio area. But within about three minutes, 55 million people, eight states in the province of Ontario, were in the dark. It was the biggest power outage in U.S. history. New York City residents for the first time saw the Milky Way.

Well, this caused all manner of cascading failures. For example, loss of water pressure in systems triggers a boil-water advisory. Communications were shut down. Entire airports were shut down. Loss of pumps and pumping stations meant raw sewage was discharged into rivers. At one chemical plant, a considerable release of toxic chemicals in Michigan was released into a river.

It's been blamed for at least directly 100 deaths and cost $10 billion.

Well, in March of 2020, our disaster hit. COVID-19 locked down nursing homes by the order of CMS at Centers for Medicare and Medicaid, where we get 85% of our funding. So in short, we're Medicaid-certified. The easiest way to say it is, "We'll take your money in exchange for caring for your poor people by following your rules."

So we were mandated many things. We shut down visitation. And again, a whole cascade of clinical changes here at the nursing home. This also brought changes in the way we live here on campus as well.

For the most part, we followed CDC recommendations. We had a choir tour with our volunteers two weeks later. We canceled that. Our staff and families quit traveling. Our campus became basically a family bubble. We worked with the local sheriff during lockdown. I explained our situation to him. He said, "Basically, consider your campus one family. You're fine."

It was sort of our cozy little enclave here. We had our own church services. We've got a volleyball court. We've got plenty of food. We've got things to do. We sort of huddled down here on campus.

And if you had to live through lockdown in March and April and May of 2020, Mountain View wasn't a terrible place to be. We had support, infrastructure, people. There were plenty of disappointments, yes. But that was universal. You all had those as well.

So initial lockdown was not terrible. But as things wore on, the pain increased. We had our first case of COVID here in September of '20. Ten days later, on September 11th, we had our first major outbreak, which put all of our leadership in quarantine. All three of us executive leaders and my entire clinical leadership team were all in quarantine on that day.

Three days later, we had our first catastrophic outbreak. 25 people out of my staff of 70, only a third were in quarantine.

A day after that, I was hospitalized with a septic leg infection.

September of '20 to January of '21 is five months of darkness around here. It was brutal. We had 31 positive staff in that time. We've had many more since, but during that time, 31 of our staff were positive. We had nine positive residents. We had one resident death. Now, why we didn't have more positive residents and more residents die, I don't know.

It's but the goodness of God.

When I talk to other nursing homes, there's a Waverly and Drawn Assisted Living facility in Pennsylvania that 100% of their residents got COVID and 50% of them died, fully half. I talked to an administrator in Richmond last week that 100% of her building of 180 or something like this got COVID and many died.

Why it didn't happen here, I don't know. It's the grace of God. It's the goodness of God. In looking at things, the most critical factor of how a resident, a nursing home did in COVID was community spread. It wasn't their five-star rating. It wasn't their quality metrics. It wasn't their funding. It wasn't whether or not they were profit or nonprofit. It was the community rates around them.

But through those dark days, it was ugly. All staff and residents were tested twice a week. All contacts were quarantined for a full 14 days. Repeatedly, staff would travel and come back exposed and sick and expose other people. During those five months, we had 800 shifts that we had to cover with somebody else.

The person supposed to work that was in quarantine, and we had to cover it other ways. It was a daily grind. It was difficult in the extreme to try to cover shifts. Our scheduler begged any former staff who was able to come back and work for us.

Mandatory testing, reporting, screening, symptom management, managing housing for the quarantined, other housing for the isolated, for the infected. The people in quarantine were bored. We took them sewing machines. We took them laptops so they could catch up on all their required routine education. We delivered supplies and meals around campus.

As soon as this person was out of quarantine, we needed that housing for that person. It was an incredible amount of work to care for 40 residents, like always. But now, all these other people in quarantine and isolation.

I know of no other word to use than brutal. We've had several other smaller outbreaks since, but with further knowledge and, as importantly, further rules change from CMS, CDC, and Virginia Department of Health, more recent outbreaks have been much more manageable.

But in short, it was the most difficult two and a half years of my life by far. So lessons from disaster leadership. And these are in no particular order. But number one, disaster preparedness is not glamorous. Many people don't see the value of disaster preparedness. Mennonites in general aren't big on this. At times, we even scorn it and take on this air of superiority. We don't need that. We'll just do what's right in the moment.

And there's some truth in that, but there's some fallacy in that. Disaster preparedness is critically important because without it, people die. Right now, where you live, your state, your county has disaster plans that you benefit from, and you'd be really miserable without, even if you aren't aware of them.

In a nursing home, a significant portion of time and money go to disaster preparedness. It's one of the significant portions of my job. Every week, our generator tests. Every month, we have fire drills. We have quarterly sprinkler inspections. We have to do two disaster drills a year. Every year, we have to inspect the fire doors.

Every three years, we have to do a load bank test to have a generator company come out and put our generator under load. That was about two weeks ago. It's a ginormous electric toaster, effectively. And he was pulling 624 amps on our generator and simply turning it into heat in this big heater box.

Every five years, we replace certain parts of the sprinkler system. And we do all this all for things I really hope I never need.

Daily preparation and diligence are critical. Had the men responsible for trimming those trees in Akron, Ohio, I don't know if it was failure or I don't know. I'm not here to assign any blame. But had those trees been trimmed differently, that power outage would have looked different.

January 3rd and 4th of this year, we lost power for two days because of a snowstorm. It was 20 degrees outside. Well, the moment the power went off, three seconds later, my generator automatically is online producing power. Well, suddenly, I was really glad for that generator. Suddenly, I cared about that generator. Suddenly, I cared about how much fuel was in the tank and that there was quality fuel in the tank because I had residents whose health and well-being was dependent on that generator.

Over the next two days, I spent hours making plans and phone calls of, "What do I do if that generator stops? Do we evacuate? How difficult is it going to be to get a replacement generator?" The entire region was without power.

This county was 75% dark. Louisa County across the way at one point was 100% without power. What am I going to do? Well, because of that day, those two days, I now have plans and options, and I know of resources I didn't know then.

Disaster preparedness is important, and we have to prepare before the storm. Number two, communication is critical. I've learned the hard way that in disaster, you have to over-communicate because people, particularly when they're scared, tend not to think very clearly. They tend to get less than you think they should. They tend not to hear what is said to them.

And when things are going badly, less information is not necessarily a better thing.

I've bungled this many times.

Saying too much gives rise to fear. In the early days of COVID, we didn't know what we were dealing with. I was reading reports of other nursing homes and morbidity and mortality cases and statistics and advice from authorities.

And statistically, my residents are among the most vulnerable. They are in their last days of life on a good day. Very little disease would take to take them on to eternity. And so I was quite frank with our staff about what could happen. But when I said what could happen, some people heard, "This is what will happen." And someone told me later, "Well, Ryan said residents would die. That never happened. So clearly, he doesn't know what he's talking about."

So saying too much about what could happen, well, came back to bite us. However, saying too little gives rise to all sorts of unhealthy speculation. One of my staff said, "If you give us generalities, we will make up our own specifics."

We can tend to assume the worst. One of my staff, about a year ago during the hostage crisis in Haiti, after CAM released one of their statements, they made the comment, "Well, they didn't say they're sure they're all alive.

So that must mean they're dead." I said, "No, that just means they're not positive. They're all alive." But this person instantly went to, "They must be dead."

Second, we have to aim for transparency. People don't need to know everything, but they need to know the how and why. With every staff positive case, our leadership team would meet at this conference table, do contact tracing, figure out who was exposed, who needed to be quarantined.

After that meeting, there were multiple reports I had to file, many people I had to notify, documentation. Linford had to rewrite schedules. My wife and our deans would have to manage housing, who's going to live where for the next two weeks.

But one night, we met to start this process. And on the other side of the wall of this conference room is our dining room, our staff dining room. And there's this foldable wall between here and there. And that particular evening, staff were in the dining room playing games.

And somehow, I don't remember how or why, but the wall got opened up. And so a handful of these staff had a front-row seat to our meeting. And they saw the negotiations and the back and forth and the scribblings on the whiteboard and the lists of people and their levels of exposure and who did what with whom and who sleeps in which dorm and who is exposed to who by what.

And okay, who had the most resident contact? What level of risk is this going to carry? It's a significant meeting. And afterward, the one staff said she had no idea the detail we considered in that. She said it had always looked somewhat random and capricious as to who got put in quarantine and who didn't. And after seeing the consideration and the nuance and everything that factored into our decisions, she had a new respect for those decisions.

We wished we had shown that process to our staff earlier. Be transparent enough that people know the how and why of your decisions. Know your audience. It's been said that every joke has three components: content, audience, and timing.

And if you mess up any of them, the joke's going to fall flat.

Crisis communication is much the same. Content, audience, and timing. Know your audience. We're a healthcare facility. We use 24-hour time. Now, for most of you this morning, you probably don't use 24-hour time. And so in dealing with you, I try to remember that. And I try to say 5 o'clock instead of 1700.

But as a nurse, I've been trained in this, required to use it. It's the standard of healthcare. And as much as I want my staff to use it, I know that outside of this campus, very few Anabaptists use it, and some even mock it. Know your audience.

Our health department epidemiologist, his name's Daniel Ferrell. He and I became very good friends through this time. When I talk to Daniel, I know that he has different concerns and different thought processes than when I'm talking to a minister from my church, Mike Yoder.

Know your audience. Communication in crisis is critical. Number three, leaders aren't going to be popular. And this is hard for me because by personality or carnality or something, I have this drive to be liked. I want you this morning to like me and agree with me and support me.

But leaders aren't going to be popular. People aren't going to understand. No matter what you decide, some people won't agree. There are people in my own church, the church that owns this facility, by the way, who said, "Just skip the COVID regulations. Be done with it. Say it's over. Stop everything today."

Well, they didn't understand. They don't understand because they can't. They can't understand because they aren't sitting in your chair. I have a degree in nursing, nine years in healthcare. I look at infectious diseases differently than a block mason.

And there's no way in one conversation I can convince a block mason of my perspective, nor will I understand his. I'm responsible for the regulatory compliance of a $4 million nursing home. I see government regulation different than a rural furniture builder, for example.

I have multiple years of experience with government interaction at various levels from Red Cross and disaster response in Minnesota to compliance here. I don't view government with nearly the suspicion that most Anabaptists do. And perhaps I need more, and perhaps some of the rest of them need less. But it's unfair to expect people to always agree with leadership, no matter how badly I want them to. It's been really, really, genuinely difficult for me to let go of this. Because again, by personality, I'm just deeply convinced automatically that with enough data, if I give you enough information, eventually you will come around to see the truth like I do.

It's been hard for me to realize that that's not going to happen. It's hard for me to realize that no matter what, some people will never agree with me. Even if I happen to be completely right and they happen to be completely wrong, some people aren't going to agree with me. I mean, for example, the Flat Earth Society still exists. There's not a shred of evidence, but the Flat Earth Society still exists.

Quinn Bissonnet was a manager I worked with at Mayo Clinic. And he said, "If you want to be popular, give away ice cream cones. If you want to be a leader and make a difference, that's something else entirely."

And that truth has been difficult for me to internalize. If you want to be popular, give away ice cream cones. If you want to make a difference and be a leader, that's going to be something different. We had to make unpopular decisions. For example, routine testing of all staff and residents.

Nobody enjoyed our twice-weekly testing. It took about 20 man-hours each time. Each testing event twice a week cost me about $10,000. In the year 2020 alone, I spent almost $300,000 through UVA Labs.

That's a chunk of change for testing I didn't want to do, most of it. Nobody enjoys wearing a mask. We didn't enjoy it back then. We don't enjoy it today. But guess what? We're still in healthcare. Right now, back on the floor, my staff are still wearing masks. Out here later in the offices, we'll still be masked because it's the regulation and we're required to do it.

See, if democracy was good enough, we wouldn't need leadership. And unless I'm sitting in the room and facing the pressure and the consequences and carrying the responsibility, I can't possibly fully understand the pressure my leaders are under.

And I want this to generate in me a bit more support for my leaders. Our church leaders through COVID, they had different responsibilities than I did. They're going to look at COVID differently than I do. Our civil leaders, government leaders, they had different responsibilities than me. They had different pressures than me. They had different tools than I did. They're going to look at things differently than me.

It's been said that if engineers and designers do a great job, nobody knows they're involved. Stuff just works. Doors work and traffic flows and lights work. You never think about the person who worked on the design of that, which is kind of sad when you get no credit for your best work.

Public health is even worse, though. Public health people will tell you that if public health does a great job, not only do they not get credit, they get scorned. Well, that wasn't such a big deal. I don't know why they made such a big deal about that.

It wasn't a big deal because we made such a big deal about it. The better job public health does, the more they get scorned. The other part of the joke is if public health does their job bad enough, you still don't know about it because you're dead.

But that's the joke. So the next time you want to criticize the CDC, remember that you don't understand what they're trying to accomplish. You don't see the picture that they see.

I want this to generate in me more humility toward my leadership. When the church makes decisions I don't understand, I have to remember I wasn't in the room. I'm not facing the pressure that they're facing. I'm not facing the consequences they're facing.

If you want to be popular, give away ice cream cones. If you want to be a leader and make a difference, that's going to be something else entirely.

Number four, leadership comes in surprising packages. During that power outage of August 2003, Toronto was one of the cities that was totally dark, including traffic lights. A man whose name I can't find simply drove his car up on the curb, stepped out into the intersection, and started directing traffic.

Eventually, police came along, gave him a vest and a bottle of water, and said, "Good job. Keep it up." And he stood there and directed traffic for hours. It wasn't on his calendar that day. He just did it.

He wasn't trained. He wasn't asked. He wasn't paid. He just did it.

Not all leadership is official.

Early on, when our entire clinical leadership team went into quarantine, my director of nursing, Leroy, grabbed our night nurse, Sheldon, and just deputized him as DON for the next two weeks. Leroy was leaving the building, going to quarantine. He said, "Sheldon, it's yours. You have the skills. You know what you're doing. The place is yours. Make it work."

Sheldon became a lifesaver. Some new regulation, some new practice change. Okay, we're going to have to do it this way now. He and his night shift would figure it out. The night of our first positive resident, we deployed PAPRs for the first time. That's a powered air purifying respirator. Basically, it's a belt and a fan and a filter on the belt, an air tube up the back, and then this hood that supplies you with a constant supply of fresh filtered air.

These are expensive gadgets that we had invested thanks to the CARES Act funding. Thanks to you taxpayers, we appreciate it. Because of us that have facial hair, can't pass a fit test on an N95. And because we are a beachy organization, we had made the commitment we were not going to require people to shave. They could voluntarily. And most of our guys said, "Come that day, sure, I'll shave." But we had decided to pursue these PAPRs since we had 10 of them ready to go. Again, disaster preparedness because the night you need them, you won't be able to buy them.

I came in at midnight, trained Sheldon and the night crew, checked off their competency papers, and said, "I'm going home for a couple of hours of sleep. I'll be back at 5:00 to train in the day crew." When I came back at 5 o'clock, a few hours later, Sheldon had things set up. He had brought up tables from the basement. He had sanitizing stations set up. He had a place for hoods. He had shelves. He had everything set up. He was ready to go. He and his night crew had done a whole bunch of work.

Leadership isn't always official. And just because you don't have the corner office or carry the official title doesn't preclude you from leadership. Just step out into the chaos and direct traffic. Bring order in chaos. Leadership comes in surprising packages.

Just step out and start directing traffic.

Number five, and this is one of the harder ones for me to talk about. Harlan's razor says, "Never attribute to malice what can be explained by ignorance or misunderstanding."

Basically, don't take things personally, even though it will most certainly feel that way.

For example, multiple of our staff tried to get infected. Because in those days, once you had recovered from COVID, you had basically had a 90-day pass where you weren't tested and wouldn't be quarantined if you were exposed.

And so some of these staff had been quarantined multiple times for exposures. And so it looked really tempting to them, "Let me just get infected and then I'll have a 90-day pass." And we pled with them not to. You don't know the consequences.

Don't do it. Multiple staff tried. It felt like a kick in the face. When the one messaged me and told me what they and three of their friends had done, I stood on my front porch and bawled like a baby.

It felt like everything we were trying to do in protecting our staff and, more importantly, protecting our residents was in vain. It was worthless. I walked in the house. I told my wife, and she burst into tears. And she said, "All that we're working for isn't worth the paper it's printed on."

These were in the days, in addition to being a full-time mom, she was also acting as our staff infection preventionist. Some of those weeks, she put in 30 hours on her time card.

It felt incredibly personal. It felt like a personal assault. And it took me a long time to realize those staff weren't trying to hurt me. It wasn't personal. It felt like it. But they assured me it wasn't.

In conversation since, they said they didn't realize the burden it put other people under. They didn't realize the actual consequences. They didn't realize the potential consequences. I didn't realize how inviting it looked to them. It was ignorance and misunderstanding, not malice.

There was a video interview of a conservative man that stated how he and his people had done many things completely the opposite of recommendation or of mandates and laws. He went on to brag how they made more money during COVID than ever before.

He was rather derisive about things that I was required to do. And he finished up the interview saying he thinks they were smarter than everybody else.

When I saw that, I wept. I cried. It felt like a punch in the face. I'm part of the same group of people as this man bragging how he's made lots of money by defying the law, bragging how he's smarter than everybody else.

I became convicted I had to forgive him. And I had to realize that he wasn't being malicious toward me. He doesn't even know my name. He doesn't know me. He was speaking from his perspective, a perspective I don't understand. But he was speaking from his perspective.

And he doesn't understand my perspective or my responsibilities. He had no malicious intent toward Ryan Hoover. It was ignorance and misunderstanding.

And I had to realize I can't take that personally. Don't assume malice where it may well be ignorance and misunderstanding. Number six, submit to your authorities. In times of crisis, this becomes even more important. I was always supported by our board.

I'm deeply grateful. Many times, I had to submit to things I didn't like.

But as much as it's hard to admit it, I found a certain measure of peace knowing I was under authority. My board chair assured me many times, "You won't hang alone. If this goes badly, you're not going to hang alone. We will stand with you every step of the way."

It was hard to hear. It was hard to trust because it's my license that hangs on the wall out there, which is part of the journey I've been on to learn to trust. But Romans 13 is clear. Earthly authority is from God.

It's for our good. And they that resist will receive damnation, even if that authority is unperfect. Because imperfect authority is the only kind we have. Outside of God, imperfect authority is the only kind we get. Christ commanded us to go the second mile.

And if you think about that, that means carrying what we think was a 70-pound pack two miles the wrong direction. The only way you could meet a Roman soldier was if you were going one way and he was going the other.

So if he's going to carry, if he's going to make you carry his pack two miles, you're going the wrong direction. This is going to cost you four miles to serve an oppressive, heathen, foreign government. And Christ said, "Do it.

And do it with a good attitude." I'll admit, I've had to carry many packs the last two and a half years, and often without the greatest attitude. Now, to be clear, I'm not talking open and direct sin here.

But even in decisions and authorities I disagree with, I can rest if I'm in submission to my authority. Our church did things I didn't agree with. I had to submit to that authority. There are things we're doing now that I don't think are the best.

But I've been asked to submit and leave it in God's hands.

And the truth is, He can work in ways that I can't.

And so God can bless submission to imperfect authority because at the end of the day, imperfect is all we get. Number seven is do what's right regardless of apparent cost. When the right way is clear, decisions are much easier.

I found decisions are orders of magnitude more difficult when I'm not confident of what I'm doing.

I told staff many times, "If I was 100% confident this is the right way, it'd be far easier." But the fact is, I don't know if this is right. We're not certain what's going to happen here. We're doing the best we can. But we don't know how this is going to turn out.

When our values are clear, decisions are much easier. I've been on a quest here at Mount View to delineate and codify our values. We have to define them and then commit to them. And we've been here 60 years. We were founded in 1962. We've never wrestled through and codified and delineated exactly this is what we value.

I've been working with our board on this. It's a time-consuming process. This is not the work of one board meeting. And some people will push back and say, "Why do we need to do this? Why do we need to codify our mission, vision, and values? Why do we need to go through that work? It's just silly. Just do the right thing."

How do we determine what the right thing is if we haven't decided what it is most important to us or what's most valuable? I saw this in a way I'll never forget when I was working at Mayo Clinic.

CNN had published a three-part series about Mayo Clinic, accusing them of various things, including medical kidnap, published the details of a very difficult case, and slanted things. Some things were factually inaccurate. Some things lacked context. But of course, they published their story with their spin.

Mayo published a response, what they could, given HIPAA privacy laws. And it went back and forth for a while. And I was at a staff meeting one day. And after the staff meeting, I mean, at the end of the staff meeting, with Q&A time, somebody spoke up and asked the vice president, Jeff Bolton, "Why doesn't Mayo sue CNN for defamation?"

Vice president Jeff Bolton said, "I knew that question would come up. So I've asked our chief legal counsel to be with us today." Turned the podium over to him. Mayo Clinic's head lawyer stood up. He said, "There's nothing I like better than a good lawsuit. I'm a lawyer. I eat them for breakfast."

He said, "But defamation is really hard to prove. And defamation lawsuits are really hard to win." He said, "We aren't sure we've been damaged that much." And he went through some of the polling they had done. And X many percent of the people they polled hadn't even heard of the story. And those that had heard of it, those that found it to be unfavorable at Mayo and changed their opinion, well, most of those said that Mayo's response satisfied them. And so you go all through all the numbers. He's like, "We really don't think it's hurt our credibility and reputation that much.

And so a defamation lawsuit would be really hard to win." But then he said, "All of that is nothing compared to my last point." He said, "What is our primary value?" And everyone in the room responded, "The needs of the patient come first." This is deeply ingrained in Mayo Clinic culture. Every employee knows it from day one. You will hear it frequently. The needs of the patient come first.

He leaned forward. He said, "Would a lawsuit serve the needs of this patient? Is it in her best interest to be drug into court and testify and back and forth?

And would a lawsuit serve the needs of this patient? Would a lawsuit serve the needs of our other one million patients this year?"

The room was silent. He said, "And for that reason, ladies and gentlemen, there will be no lawsuit."

Everyone in the room understood and supported the decision because it came straight from an accepted value. Their values were clear. The decision was clear.

I found that the times we caved into pressure for an easier road were the times we regretted. One time, we fudged our testing time to avoid consequences because this happened 48 hours before. So let's wait till tomorrow morning to test.

It backfired. We tried to monkey with a gray area. Well, okay, if we do it this way, we'll see. It's kind of a gray area. We regretted it. The times we gave into pressure because we were just too tired and exhausted to hold the line, we regretted it.

When my values are clear, even the hardest decisions are easier.

Follow your values regardless of the seemed cost. My last point, number eight, is leaders are lonely. And again, this has been one of the harder ones for me to learn and digest. By virtue of position, you can't let your guard down. You're always on duty.

This week was camp week here, where we bring in 24 extra volunteers, many of them siblings of our current staff. And they clean the place from top to bottom, end to end. And it's a giant, busy, chaotic week with, again, about a 50% increase in volunteers on campus.

And these are young and energetic.

And Thursday night is volleyball tournaments and it's staff against campers. And it's intense. And the pressure's on. And somewhere from the activities department, they drug out a bag of pom-poms. And there's cheering on the sidelines, and there's some smack talk. And I mean, it's a rich and intense game. Well, even the administrator gets into this sometimes.

And Thursday night, I'm standing there on the sidelines. And the guy beside me is shaking his pom-pom. He's cheering for the campers. Of course, I'm cheering for staff. And I watched and waited for my opportunity. I reached over, stole his pom-pom, and went running.

This guy's considerably smaller than I am. Anyway, got around to the other side of the court, tossed a pom-pom to one of my staff. He grabbed one of theirs. We tussled on the ground. Had a great time.

Guess what video has been circulated and put on the camper chat and sent to parents, etc.? The administrator cutting up on the side of a volleyball court. Not all the staff. No, they were doing it all night too.

But we got lots of mileage out of the administrator doing it. Well, then we added sound effects of like a dirt bike. By virtue of leadership, everything I do is scrutinized more closely. You're always on duty. As a leader, you're always on display. You're never off the clock. And again, to those of you in leadership, that's old news.

It's been hard for me to adjust to. No matter what you do, the organization is judged by you. And that increases pressure as well. But leaders are lonely. During my training here in 2019, after our annual inspection, I gave a gift basket to my boss, Trent Clugston.

He sat there at his desk in tears. He said, "No one has ever done that for him. No one's ever said thank you for a good inspection." And he said, "That's one of the hard parts you'll learn of leadership is the loneliness."

I've learned you can't do it alone. You have to be humble enough to be cared for. And that's difficult. For a proud guy like me, that's difficult. At my lowest point in April of '21, I had an emotional breakdown. I couldn't quit crying.

After the fact that I found out that my wife was ready to call my director of nursing and say, "Come pick him up. I need help. He's not okay." I had to be willing to get help. It was incredibly hard because I'm the leader. I'm not allowed to collapse.

Leaders don't call in sick.

I had to be willing to get help. Find somebody to talk to. Everybody needs someone that they can talk to without fear. You need somebody that you can be honest with and show them the real you.

You need to care for other people. They need it. You might see your leaders faltering, struggling, and sobbing, but you might not. They may cover it up. They may compensate really, really well. But leadership needs your help. I was barely holding it together. And Jeff Kennegie, our campus pastor at the time, the day I couldn't quit crying, said, "You're not okay.

Are we going to talk about it tonight or tomorrow morning?" And it was his directness that got my attention. It wasn't, "Is everything okay?" It wasn't, "Do you want to talk about it?" It was statements. "You're not okay."

And the choice was, "Do you want to talk tonight or tomorrow?"

He was pretty direct. Be willing to step up and say, "You're not okay." Be willing to support your leadership. Part of what makes pediatric medicine much more difficult is that babies compensate well. They can be very ill and not look sick. Their compensatory mechanisms work really, really well until they don't.

And when babies crash, they crash hard and they crash fast. And that's why medicine is always more conservative and cautious with children. Things can be much worse than they look. You have to factor that in. Remember that with your leadership.

They might be compensating really well, but that doesn't mean all is well. November 6th of '20, right in the middle of those five difficult months, it was one of our darkest days. I was feeling pretty low.

But God was with us. He showed us that in two ways that night. The first one, Wes and Karen Sensenick, friends of ours, and their family stopped by with a gift basket. Sat in our living room. We stayed distanced.

But their visit was a monumental encouragement to us. It was worth far more than the chocolate and crackers in that basket. The fact they simply came over and cared.

But around 8:30 that night,

three Stoltz Foos sisters live about a half hour from here. They showed up on our doorstep and sang us a lullaby on our porch. "Soft be thy slumbers, sweet be thy dreams."

Two years later, I can't talk about it without crying. Words fail me to describe how much their care meant.

Big, strong leaders are more vulnerable than you think they are. And a simple lullaby sung in three-quart harmony on a front porch at 8:30 at night just might change their darkest moment and give them hope to carry on.

Perhaps these lessons in leadership are old hat for you. And that's okay.

I'm going to stop there. I could go on and talk about the fact leaders are sleep deprived, talk about trust capital, talk about how God works to frustrate our idols, the thing we hold most dear, be that freedom or wealth or success or popularity. God's going to ask us to die to that. I've had to learn that character assassination and gossip are sin. And I cut down the people that disagree with me and are doing things differently than I think they should. But that gossip and character assassination is sin.

And even if I'm right, perhaps, I still don't have to kill them to prove it.

Because in our own way, just war theory comes much closer to our Anabaptist circles than we'd like to admit sometimes. I could talk about how forgiveness has to be a daily habit for leaders. But we're out of time for this morning. So we'll stop there. I'll turn it back over to you, Sam. Thank you, Brother Ryan, for having the courage and the humility to share some of those difficult things that you did. I really appreciated that. We're going to open it up for some questions and comments.

So yeah, before we get into that, that first point you gave about disaster preparedness, that isn't something that is front and center in a lot of people's minds in daily life or even in organizations, from my experience anyway.

I just finished listening to a book by Chris Hadfield, who is a Canadian astronaut. And he made the statement that all through the book, "Sweat the small stuff." How could you be an astronaut, strap a rocket to your back, go to space, and not be scared that that's going to happen, that things are going to blow up or something terrible? And he said, "Sweat the small stuff." And that was a strange concept to me. We always hear, "Don't sweat the small stuff."