Filling the Cracks with Gold

There are moments in leadership when the question is not what the policy says. The question is who you are going to be. For us, that moment came when one of our ICU nurses (we’ll call him Scott) developed an opioid use disorder.

Scott was the kind of nurse every unit wishes it had more of. He ran the hospital-wide rapid response team — the team that showed up when everything else was failing. When something new came up, a process that needed fixing, a problem no one had a clear answer for, Scott was the first person who came to mind. He was highly personable, detail-oriented, and completely reliable. He made the work look manageable, which is its own kind of gift in an ICU.

So when things started to shift, I did not see it clearly at first. What I noticed was that he looked tired. I would catch him sitting and staring at a computer screen, not moving, not charting, just staring. I told myself he was exhausted. In an ICU, exhaustion is not unusual. It is practically part of the job description. I filed it away and kept moving.

That was the sign I missed.

The inconsistencies accumulated quietly until the truth could no longer be ignored. When it became clear, it did not just affect Scott. It shook the entire team. It challenged how we saw him, how we saw each other, and how we understood accountability. We were suddenly holding two truths at the same time. What happened was serious. Patients could have been harmed. Standards mattered. And also, this was Scott. Someone we knew. Someone we worked beside every day. Someone we had trusted completely. That is where trust either fractures for good or begins to take on a different form.

For Scott, the experience was even more complicated. He had not set out to break trust. He had been struggling quietly, without a clear place to go for help. There was no obvious path that said, “If you are not okay, come here first.” He did not see a safe off-ramp before things deteriorated. By the time he realized how far things had gone, he was already in it.

When the system engaged, it did not feel like support. It felt like exposure, interrogation, and consequence, with no certainty that anyone actually had his best interest in mind. He had a choice at that point. He could minimize, deflect, or fight. Or he could tell the truth.

He chose to tell the truth. It was not the safe choice. It did not guarantee a better outcome. But he trusted us, and he realized that if anything was going to be rebuilt, it had to start there.

“I need help.”

That was the beginning.

His case went to a military court. The judge was considering jail time, removal from the military, or a recommendation to permanently revoke his nursing license. From a distance, the decision seemed straightforward. From inside the team, it was anything but. How do you hold someone accountable for behavior that endangered others while also recognizing their humanity, their illness, and their capacity for recovery?

We all testified on his behalf. Not to excuse what had happened or minimize the harm. We believed that the full story and the full person mattered.

I had never been in a courtroom before. I had never testified. The room was darker and dimmer than I expected, quieter and more formal, and I was seated when I spoke, which somehow made it feel more serious, not less. I told the court about impaired provider programs. I explained that healthcare had built these programs specifically to support clinicians with substance use disorders while ensuring sobriety and patient safety. I told the judge that addiction is an illness, not a permanent verdict on a person’s worth or potential. I said that the system’s purpose was not only to punish but to rehabilitate responsibly.

And then I told the court that I believed in Scott.

Excerpted from Self-Awareness and Trust: Leading Healthcare Teams from the Inside Out , American Association for Physician Leadership, 2026.