I remember the exact moment I realized I was part of the sepsis.
I was standing at the foot of the bed in the trauma bay. The room was loud — the rhythmic percussion of chest compressions, the sharp snap of gloves, the staccato calls for blood. To an outsider, it was chaos. To me, it was home. I was the surgeon; I was in control. We saved the patient that night, but as I walked to the sink to scrub off the literal and metaphorical layers of the trauma, I felt a familiar, hollow ache.
It wasn’t the patient’s vitals that were failing. It was ours. For months, the "vitals" of my surgical team had been shunting. I’d seen the narrowing pulse pressure of our communication. I’d noticed the way the nurses and techs had stopped making eye contact. I saw the yellow flags of a culture in decline, and I did exactly what I would never do to a patient: I normalized the deterioration.
In surgery, we are taught that resilience is a high-volume intake. We absorb the stress, the long hours, and the systemic friction like a sponge. I told myself that the whispers in the hallway were just the price of doing business. I was surviving. But "survivable" is a dangerous baseline. In clinical terms, a patient can survive a state of shock for a while, but eventually, the organs begin to fail. That night at the scrub sink, I realized my team was in multi-organ failure. And as the leader, I was the one withholding the oxygen.
We often wait for a catastrophe to justify fixing a broken culture. But my sentinel event was quieter. It was the realization that I had become one of the necrotic nodes I complained about. By staying silent about the friction, I was endorsing it. By prioritizing the task list over the psychological safety of my team, I was creating the very ischemia I feared. I had to learn that silence is not a strategy; it is a clinical sign of impending failure.
Repair did not come from a motivational poster. It came from a grueling, deliberate period of study and practice. I began to look at mine and my team’s communication through the same lens I used for a complex surgical procedure. I realized that if I could protocolize an emergency thoracotomy, I could protocolize the human interface. And I had to start with myself.
I began testing maneuvers in real time, treating my own interactions in the halls, the office, the unit, the boardroom, and the OR as a laboratory. I started with a commanding calm, learning to lower my volume and slow my speech so the team wouldn't mirror my “emotional hemorrhages.” When met with aggression, I practiced a deliberate and tactical pause, a three- to five-second suture that forced the “infected” party to hear their own tone.
I moved into the architecture of the space, enforcing a sort of sterile field mandate: if a grievance wasn't mission-critical, it stayed outside. To stop the systemic leakage of assumptions, I implemented true closed-loop confirmation in all locations, not just those traditionally deemed high-stakes, refusing to move forward until a directive was verified as a shared system of record for all participants.
I began practicing “linguistic debridement,” actively cutting out gossip, oversharing, and boss-beating — behaviors we all, intentionally or not, contribute to — that served no clinical purpose, and utilized a strict no-blame pivot to shift focus from any errors to the path of travel needed for the fix. I opened the valves of communication with bold bidirectional transparency, sharing information and data across roles to increase situational awareness. When a specific person blocked the flow, I used strategic rerouting to prioritize the mission over the ego of the blockage, while reserving deliberate corrective interventions for a private, protected space.
I committed to the essential debrief, transforming communication friction into clinical data for future improvement. And when the environment became too septic for immediate repair, I learned the power of “aseptic silence” — the courage to walk away and say, “We aren’t in a state to solve this now; we scrub back in tomorrow.”
The results were immediate and measurable. The numbness I felt at the scrub sink was replaced by a renewed precision. But the true validation came later, in my work with other struggling colleagues, departments, and teams. I saw the same ubiquitous patterns of communication “sepsis” in boardrooms and throughout the healthcare system that I had felt in the trauma bay.
We are trained to act before any crisis peaks in our patients. We simulate. We study. We prepare. And we strive to prevent. It is time we brought that same clinical rigor to the culture and communication of our teams. Healthcare communication and conflict deserve the same attention, the same levels of training, the same infrastructure development, and the same precision tools as clinical care protocols. I stopped being a surgeon who just endured toxic behavior and culture and became one who is driven to facilitate its repair.
Stop asking your clinicians for more resilience to a failing system, and start giving them the technical protocols to repair it. Let’s be brave enough to operate.
How have you "operated" on your team's dynamics? Share in the comments.
Shannon Marie Foster, MD, FACS, is a trauma surgeon, facilitator, coach and mediator and the founder of SMF Facilitation Services. After two decades at the head of the bed, she developed the SMF Method™ and the 10 Vital Resets™, proprietary frameworks that apply surgical precision to interpersonal or organizational conflict and team stabilization. She now facilitates strategic repair for professionals and health care systems, focusing on the tangible tools needed to restore professional autonomy and institutional flow.
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