What listed leaders can learn from stress in crisis medicine with Ryan Shuster.

Last week, we started a series of conversations built around interviews with people who know pressure. These are leaders in medicine, elite sport, and listed companies. I wanted to learn how they manage stress, where they struggle, and what habits actually help.

This week, I was lucky enough to speak with Ryan Shuster. 

Ryan’s a former trauma and ICU doctor who worked at the largest trauma centre in the Southern Hemisphere. His eye-opening story is a window into an industry where the outcomes are life or death, and it’s relevant for anyone who carries pressure at work, or takes it home.

What I learnt: That stress is relative to us, and objectively low stress situations could be relatively high stress for the individual. Stress accumulates, with the potential to turn into depression, and there are some great preventative processes and controls you can put in place to help.

I’ve linked the full transcript here, but read on for the gems of insight from our conversation.

An identity built on pressure.

Some people are drawn to high-stress environments.

Ryan was one for them and for years, he believed his ability to manage pressure set him apart. It was a characteristic that enabled him to handle situations, and progress in his medical career.

“I’ve always had a bit of a strange relationship with it because I’ve always felt like the times that I’ve gotten the most out of situations have often been the highest stress environments. I always felt that I’ve managed stress in a way that is sort of better than others.”

But as time went on, his perspective changed.

“With some maturity and over time, I’ve learned that there is a cumulative risk as you get involved with more and more stressful environments.”

The night the system failed.

Ryan was only two years into full-time work when the cumulative load of stress hit with a young patient, in a complex case compounded by multiple layers of responsibility, and a system that failed.   

“I found myself a victim of what is referred to as the Swiss cheese model. All the holes just lined up in the perfect way.”

He tried to escalate care, and call medical support multiple times. But he was told to monitor the patient and wait, and then things went south in the worst way - the patient passed away. 

In the immediate aftermath, the parent of the patient was understandably broken. 

They were “verbally aggressive - completely understandably, probably just as I would be,” said Ryan. “But [for me], it was off to go and chart paracetamol for the old lady on the other ward.

Then you just arrive the next night and continue with the status quo.”

The cost of compartmentalisation.

“The ability to compartmentalise is an absolute necessity in critical care medicine.”

You go from cardiac arrest to a stubbed toe. But what’s designed to protect you in the moment has consequences over the longer-term, especially if you don’t build the skills to manage. 

“What began as switching off emotionally for one patient creeps into the whole time you’re at work, and then it starts to creep into your everyday life. You think you’re progressing in your ability to deal with stress… but switching it on and off becomes untenable.”

Stress feels the same, no matter the stakes.

Ryan makes a critical distinction that stress isn’t about objective danger or stakes.

It’s about how your body processes it. Whether it’s a boardroom presentation or battlefield trauma, the nervous system can react the same for different people.

“The same set of processes occur in what’s referred to as the reptilian brain - the nervous system. I can be dealing with a car accident with three really sick kids, and then I could be giving a speech at a medical conference and it can feel very similar in the moment.”

“Your brain and your body can’t differentiate between those two situations.”

Burnout doesn’t announce itself.

“It is always in retrospect that you go, ‘Oh, I was pretty f***ed those last few months.’

The collapse isn’t sudden. It’s slow, insidious, and easy to justify. That’s what makes it dangerous. Ryan started noticing it from the way he interacted with his family.

“I remember getting home. My two girls ran up and sat on my lap and I just was sitting, staring at a TV that was off, completely apathetic.”

He didn’t get there overnight, but his ability to turn his emotions back on, after a stressful day, had faltered. You don’t have to be a trauma doctor to recognise this. How hard it can be to be the “family” version of yourself after coming home from a hard day.

This can spiral.

“It really was like I just woke up in this position where I was very close to losing my life… and I didn’t see it coming. I thought I was just a bit tired.”

How modelling vulnerability helped Ryan.

The biggest shift for Ryan came not from internal grit, but from the external awareness of friends, family, and colleagues who learned to read the signs better than he could. 

Those support systems helped him navigate moments of crisis - but they didn’t appear by accident. He stressed the importance of being vulnerable with others, and normalising those conversations early.

By opening up, he gave others permission to do the same and set a standard that said, “this is how we talk here.” It created an awareness in the people around him that they could check in with him, too.

“If you’ve gone to someone and said, ‘You’ve seemed really distant this week, is everything okay?’. That allows them to feel comfortable to talk. Modelling vulnerability as a leader, I think it’s an absolute requirement, it’s something that we owe to the people who work for and around us.”

Drawing a line in the sand.

Once Ryan took the time to reflect and grow, he developed one metric to track whether he was giving too much at work. What’s left for his family? At the end of the day, at the end of the week - what’s left?

If there’s nothing left, then something's wrong.

“Any time that I am giving absolutely everything to my job and I haven’t got anything left for my kids - that means that I’ve given way too much of myself to my job.”

I have spoken about goals and anti-goals before, and this is a great example of an anti-goal. Making sure you don’t lose the war by trying too hard to win the battle.

Read the full conversation. 

Thank you again, Ryan, for taking the time to have this conversation with me. 

The story you’ve read above was sourced from an extended call. To hear Ryan’s story in his own words, you can access the full transcript or watch the video here.

There’s a cost to leading and growing in public. But you don’t have to carry that cost alone.

Ryan’s story isn’t an outlier. It’s just rarely spoken aloud. The more we surface these experiences, the more we talk about stress, pressure, and performance without the armour, the stronger this community becomes. 

If you’re reading this and something resonates, share it. Talk about it. Ask someone how they’re really going. Or tell them how you’re really going. We’ll be back next week with another conversation. 

Until then, remember - We all signed up for this game. But it doesn’t mean we need to play it alone.

Cheers,
Ben