“First Responders,” with Dr. Steve Mitchell

Dr. Steven Mitchell is the medical director of the emergency department at Seattle's Harborview Medical Center and a University of Washington associate professor of emergency medicine. Harborview is a comprehensive health care facility dedicated to providing specialized care for a broad spectrum of patients from throughout the Pacific Northwest, including the most vulnerable residents of King County.

As the only designated level one adult and pediatric trauma and verified burn center in Washington state, Harborview serves as the regional trauma and burn referral center for Alaska, Montana, and Idaho, and the disaster preparedness and disaster control hospital for Seattle and King County.

Amanda Stubbert: It’s funny, I read that description of Harborview and it seems amazing, and then yet when I think of your role in it, it feels overwhelming. I wonder if you ever feel that way?

Dr. Steven Mitchell: Yes. At times, it can feel overwhelming and oftentimes it’s why I have to, I have to oftentimes break things down into hour by hour, minute by minute, and ask what can we work on now? What do we need to change now? And when we do that and when you quickly recognize that there is an unbelievable team here at this hospital, you realize I just need to stay in my lane and do my job, and I’m always confident that the great folks that we have here will come along and as a team, we will accomplish the mission that we’ve all been given.

Amanda: Yeah. I feel like that’s something we’re probably all doing now more than ever, right? Just sometimes take it day by day, hour by hour. Like you said, even minute by minute when we need to.

Dr. Mitchell: Absolutely.

Amanda: Let’s back up a little bit and talk about your educational journey. I hear it was a little bit of a non-traditional path toward becoming a medical doctor.

Dr. Mitchell: Yeah, it was very unusual but then looking back on it, it was also sort of, yeah, of course. But my first love professionally in high school was for pre-hospital emergency medicine, or being a paramedic. And my heroes were really those guys. These people who became mentors for me, who I would watch them and hear stories but then see them also resuscitate people, bring people back to life or just meet urgent needs, and I was really profoundly impacted by that. And that was my first love professionally.

“My first love professionally in high school was for pre-hospital emergency medicine, or being a paramedic.”

And secondarily, my goal was always to get my undergraduate degree, but it did not displace my first school. And so I went to two different paramedic training schools, and I got a job in the fire department. And so while I was at SPU, I was working full time in the fire department. And then subsequent to that, ended up having to do community college classes and a variety of different things to where at 10 years after high school, I finally finished my undergraduate degree. So that’s not necessarily the best way to create a resume or a CV to get into medical school. But it’s the journey that I took and that I’m very grateful for.

Amanda: What drew you to working in emergency response specifically? Obviously you had that training of first responder. Did you know when you went to medical school that that’s where you wanted to land?

Dr. Mitchell: Actually, no. That’s a great question. And I certainly, my first love and passion was really, I thought it was unbelievably cool and fun to be at those places where people’s lives were hanging in the balance and to try and impact that in some way. But that was sort of a young person’s view of everything. And as I got into this and actually started doing the work, my love really changed. And what happened was I realized that what medicine affords you and what really emergency medicine affords you is this incredible opportunity to you to walk into people’s lives at remarkably intimate times when all of their pretenses have really been dropped, especially in the emergency situation. C.S. Lewis uses the term “the faces that we all put on to go meet the other faces that we meet.”

All that stuff is stripped away and so you are invited in at this remarkable time, and it’s an incredible opportunity to love and to care for people and to meet their needs when the pretenses of life that we all walk around with are stripped away. And that sort of intimate connection with people was something that became frankly very sacred early on and became the primary motivator for me then to say, “I want more of my life to be about that.” And what eventually became the motivation part of the motivation to pursue medical school. And yet originally, when I first started taking my pre-med classes at SPU, I thought I wanted to do something that was not emergency medicine-based, something like palliative care or something like geriatrics, something like hematology and oncology, something where you would have long-term relationships with people. But then I was drawn back to my first love of emergency medicine and have been very grateful for that decision.

Amanda: The older I get, the more I think there are people who are sort of born with the different personalities of that first responder personality of exactly what you said. Like that is what fuels me. That is what makes me feel like I am using my purpose in life is to be there in those moments where everything’s stripped away and it’s that emergent time. And I don’t think it has to be anything about medical, it could be mental, it could be financial, but there are people who want to help in those emergency situations. And that’s what fuels them. And then there are people who don’t want that emergency. They want to help long term.

Dr. Mitchell: Yeah.

Amanda: And yeah, I feel like people are kind of born that way.

Dr. Mitchell: Yeah, no, absolutely. I am big on really exploring with people who they were created to be, trying to get to who they were created to be and what their true identity is, how they were created. Who God created them to be, what gifts they have, what abilities they’ve been given, and the more you move in that direction, the more I think life makes sense. And you find meaning and purpose because as you move in that direction, you discover the reason why you were created. And who God made you to be and being absolutely free in that and not second-guessing, well, and wishing you were somebody else but instead, instead working out of a sense of gratitude and willingness and the freedom that comes with that is, I think, incredible. And it’s an antidote to a lot of the struggles that people face, in particular professionally, when they’re working in their careers and maybe struggling.

Amanda: Well, I agree with that a lot. I think part of sort of maturing in your own self and in your career is realizing that you’re not actually supposed to be all things to all people. You’re not actually supposed to be able to be good at everything but that thing that you were created to be, you dig into that, and then you let other people take it from there.

But even once you’ve found that niche, and you’re working well in that lane that God has created you to work in, I’m sure there’s still just an immense personal toll, I think, of just working in an emergency room that I’m sure there are intense days that you can just go home and have dinner with your family, but there must be days where it’s just too much. And I just wonder what’s the self-care like when it’s a day that most of us couldn’t imagine.

Dr. Mitchell: Yeah. That’s a great question. And that’s a constantly evolving reality. For me I think really it begins and ends with having a worldview that can make sense of, or at least even if there are times when things just frankly don’t make sense, but a worldview that can absorb the things that we see and participate in the brokenness and the pain and the tragedy, where I won’t go into the details of things, but having that worldview that absorbs and can transform that even into something meaningful. Something that made a really significant impact on me quite a while ago was, I heard a sermon by Earl Palmer, who was a longtime pastor at University Presbyterian Church. And he talked about how the cross of Jesus is the only thing in this world that promises to absorb all the pain, all the brokenness that we see, even that we experienced, but not only absorb it but promises to transform it and in the midst of it, find meaning at the end of it.

“There is hope despite what is happening now.”

And it’s why for me, when things get particularly challenging or difficult, because of certain incidents that are going on in my professional context and in the emergency department, I have a walk that I do where I’ll just hold out my arms and see where my body takes the shape of the cross as a reminder, that even this can be absorbed, even this can be transformed, even though I have absolutely no idea or have no vision for what that could possibly look like. But there is hope despite what is happening now.

And so for me as a way to understand and create meaning and to not get completely burned out or calloused, or get dark with all the distraction that we see in people’s lives that we experience or you’re faced with every day has to start with a worldview, again, that can make sense of it, absorb it, and hopefully be part of a transformation going on not only in my life, which it starts there, but also in the lives of the people that I meet.

Amanda: Well, I just hear in your story the true definition of faith, the hope without all the answers. Because sometimes I think we feel like the answer is the faith. Like I’m going to come up with some logical reason why this makes sense and that’s going to give me peace when that’s just not possible in a world that you live and work in. And so to be able to find that hope even without the answers is just an amazing thing that I think we all need more of.

Dr. Mitchell: Yeah, no, I completely agree with you, and hope is what we all need, but the reality of our broken world is all of us in our finite ways can only see snippets, see small parts of it. But that’s frankly, one of the great things about becoming older is being able to see some of that transformation happen and things that you would have never been able to predict, be used in certain ways. And you can see that redemptive process happening, that transformation process happening. And it just is a massive encouragement in my life.

Amanda: The other side of that coin is in your role, not only are you in the trenches of patient care, but you spend a lot of your time these days in the administrative side and serving those who are in the trenches. How do you, because obviously not everyone who works for you and with you has that same worldview. How do you begin to care for those around you when you can’t offer the answer, at least in full, that you just gave to us?

Dr. Mitchell: Yeah, no, I think that’s another great question, and part of how I try and lead in helping the folks that I work with not get burned out or cold or calloused (and we have varying success with that), I don’t want to be Pollyanna-ish and think that everybody is open to receiving it. But I think one of the gifts that leaders can give to people is to remind them in our situation, everybody who is working in medicine, in the emergency department that I work in and help lead every one of those persons who decided to pursue medicine, usually out of a desire to help people, to care for people, to love people, and so always my goal in leadership is to try to remind people of that first love, try and remind them who they are, who their best selves are, and then make sure they live then from that first love forward, and when you are reminded of that, you can give yourself a lot more grace.

You can give other people a lot more grace, and I see it almost as an antidote to being burned out and calloused and to where the weight of the tragedy begins to overwhelm you. But when we operate from that place, frankly, they’re closer to who they’re created to be, that’s true identity, too, and encouraging them to move in love instead of in the broken part of who they are, then I think that people are healthier, the systems are healthier, the interpersonal relationships are healthier. And hopefully the team then is better able to function and perform, as well as doing all the necessary administrative work to try and make the systems actually work and perform as they’re supposed to. But that’s always my goal with people and meeting people is to be that reminder for them.

Amanda: Well, I hope we all have a boss just like you at some point in our career. All right. Well, let’s go a little bit sideways here just to hit head on what we’re coming out of now. I think we can say we’re coming out of our COVID-19 world, at least beginning to emerge and you were right there on the front lines from the very beginning. How did you feel prepared for such a time? It seems like out of the blue, and yet, I’m sure it’s part of your job to prepare for just such a thing as a pandemic. How did you feel prepared for that?

Dr. Mitchell: Yeah, great question. And none of us felt prepared. I can remember having planning meetings for pandemic flu and those were frankly meetings that I might even get a lot of other things done at because it’s like, “Oh, come on. This will never happen here. And then we’ve got more important things to focus on.” There is something else at least that took over. But when it hit, none of us felt completely unprepared but yet as we were moving into it, we realized, “Oh, my word.” I just would sit and reflect for a few minutes and say, “Man.” Even though we felt unprepared, I quickly realized that my entire life had been kind of pointed toward this moment or this time, this season, for such a time as this, if you will.

“Even though we felt unprepared, I quickly realized that my entire life had been kind of pointed toward this moment.”

And so all of the relationships that I’ve been building over the years in a variety of different circumstances, fusing my work in the fire department and as a paramedic, the Medic One world with a hospital world, with relationships outside of that, was just amazing. And it was definitely a season, at the very beginning, where truthfully, nobody knew. There was zero playbook. We like to say we were building the plane while we’re flying the plane, and it became just a remarkably creative time, a thankful time, a productive time, and some things that came out of here, that will be just long term, really impactful, for positive reasons. Things that will serve the people of the state of Washington for a long time. So it’s been just quite fantastic that way, but also at the same time, very exhausting.

Amanda: Oh, I’m sure. But that was actually going to be my next question: If you look through history, times of war and crisis are times where we have all this new invention because we have to, but sometimes it’s those things that push medicine and push society forward. So I wondered if you could think of a specific thing that you feel, in your world, that has come out of this that will make our lives better in the future.

Dr. Mitchell: Yeah. Yeah. There’s several, right, when the Kirkland Life Care Center thing was happening, and where over a 10-day period 37 patients who left Lifecare, all with COVID, the first patients in North America to have COVID, 33 of them went to one hospital: Evergreen Hospital. That’s been publicly reported and written about. And the role of Harborview serves, as you mentioned in your intro, is as the disaster medical coordination center, and myself and one of my close colleagues help run that coordination center, but we took the idea of that and then you realize, “Wow, we not only have to figure out what’s the deal with this emergency this crisis right now, at Life Care, at Evergreen Hospital, but this is going to be all over the place.”

And so whether it be other nursing homes or shelters or prisons or other hospitals, we have got to know and understand what’s going on in all these different circumstances and settings and build a platform. And in particular, the goal, given that one nursing home, one skilled nursing facility, could overwhelm a hospital, we have got to know and understand what’s going on in hospitals. Hospitals normally compete against each other as the marketplace. And you don’t openly share things like how many beds you have, what sort of staffing problems you have, what sort of equipment challenges are you having? Those are not widely available, but we realized if we were going to be effective as a health system at this moment in time, this had to be built and had to be built right away. There was no platform that got us to really understand what was happening in the hospitals.

And so we cold-called two major technology companies in Seattle, I’ll just say that. And what was fantastic is that each of those two major tech companies within about two or three days made a presentation for us and said, “Essentially, here’s what we can build. And we will build it completely for free, not charge you. We are committed to making this all work. How can we use our skills, our abilities, to serve?” And it was exciting. And what came from that now is a platform called WAHealth, Washington Health, that every single hospital and health system in the state of Washington feeds data into every day, and it’s data about how many beds they have, how many ICU beds and acute-care beds, what their staffing challenges are like, how many COVID-positive patients they have, how many ventilators they have or don’t have, and all the different impact points that were created in the pandemic.

“We now have a data platform to be able to understand what’s happening in every single hospital in the state of Washington.”

We now have a data platform to be able to understand what’s happening in every single hospital in the state of Washington. And what was also so beautiful about this time is those former competitors in the marketplace of health care decided collectively, to where they literally all signed a piece of paper that said, “We are all in this together. We are not going to let any one hospital or health system or area or region fail when there’s capacity that exists in other places. And we are committed to everybody being in equally and sharing the pain and sharing the load and serving the citizens of the state of Washington.”

And so my team in this, we took this thing called the disaster medical coordination center and that is now evolved into a statewide pandemic-focused resource called the Washington Medical Coordination Center to where when any hospital is gets overwhelmed and they can’t adequately take care of a patient and they can’t transfer them as they normally would, they call us. And using that data platform, we were able to move patients around the hospitals and when we call the  chief executives at every hospital, they’ve said, “Yes, we will say yes.”

And so when we call, they take these patients, and we’ve been able to successfully keep every single hospital in the state of Washington out of crisis at this point, which other states just can’t say, and haven’t been able to, and haven’t had that level of coordination and true statewide commitment to all being in this together. And so that’s been just phenomenal; I think it’ll be a lasting legacy that emerges out of that. And that data platform will be something that lives on and will continue to morph, to serve people. And so that’s just an exciting perspective to have, and to see so many leaders in our state working effectively to really meet the needs of the public.

Amanda: Well, that’s phenomenal. I can just imagine how once the pandemic is over and it’s kind of business as usual, and yet for individual patients that could mean everything, right? Because when you’re in an emergency, you just go where the ambulance takes you. You’re not shopping for the right hospital that has what you need for your issues, right? Like that just seems like something that’s going to help everyone in the long run.

Dr. Mitchell: And that’s the nature of the pandemic because what we know is it spreads in intense ways in certain communities of people, whether on a micro level or on a macro level. And so we have seen this all over the state of Washington, where like Yakima will explode, Spokane will … there’s been a massive explosion in Idaho or an outbreak that has impacted Washington hospitals. And so we work with those places that are being overwhelmed and then effectively offload them and distribute those patients. And what we find also is that usually those hubs, in those urban areas, are able to provide an incredible service to very rural communities, to communities that have only critical-access hospitals.

And it’s a scary thing, and this is going on right now in other states, to be at your very tiny hospital without any resources and have patients there that you cannot take care of, and to spend hours and days trying to transfer that patient to a hospital that can care for that patient. And so we’ve developed our system to be able to meet that specific need where that does not happen in our state, which we’re all very thankful for and proud of.

Amanda: Well, that’s amazing. Talk about for such a time as this. We started with your somewhat unusual journey, and yet I can just see how that’s serving all of us, the entire state, so well now. Praise God for that. We’ll end with the last question we ask everyone. But before that, when looking at everything from patient care to completely changing how the entire state of Washington has its hospital network, how do you have time to balance your family, your kids, your personal life, with all of this work that you do?

Dr. Mitchell: Yeah, that’s another great question. And it has absolutely been a struggle, especially the first six months of the pandemic. You would wake up early in the morning and work as long as you could at night until you were just completely exhausted and then try and get some sleep. And then just repeat the same cycle, seven days a week. And we would try and cover for each other to be able to give each other a day off, but it was pretty exhausting. But as we’ve moved along, one, what I try and do is when I’m staying in my home environment is probably to try and be as present as possible. You can be physically present, but not really there, and so I try and remember to be not only physically present, but relationally and spiritually and present with my wife, with my children, and hopefully give myself permission and others permission to take time to get away and to be able to reset and recharge and that sort of thing.

“You would wake up early in the morning and work as long as you could at night until you were just completely exhausted and then try and get some sleep. And then just repeat the same cycle, seven days a week.”

And I’m often reminded of a Kierkegaard quote that’s been meaningful for me really since my SPU days, that life can only be understood backwards but it has to be lived forward. Meaning, I try and live my life with the end in mind and in the midst of craziness. And I’ve got to remember that the most important thing in my life, first, is my faith. The second is my wife and my family, and third is my professional commitments. And hopefully that re-orders things enough to where we’re trying to keep those things in balance. But it’s an everyday struggle, and my wife and kids will say, “Some days, Dad’s pretty good about that. And some days, he’s very good about that.” And so anyway.

Amanda: Well, let’s end with our famous last question: From your unique perspective, if you could have everyone in Seattle wake up tomorrow and do one thing differently that’s going to make the world a better place, what would you have us all do?

Dr. Mitchell: Well, besides taking a vaccine, the social distancing, wearing a mask, the thing I’m just really struck by time and time again is just being, just being intentional and being purposeful and knowing that the people that you encounter, whether it be on Zoom now or whether it be in person, as Lewis says, you’ve never met a mere mortal. There are no such things as ordinary people. And to remind yourself that every person that you encounter reveals the presence of Jesus in who they are. And some people are quite broken and some people aren’t. But as Mother Teresa said, you can see Jesus in absolutely everybody.

And so I’m trying to encourage people to approach each other with the seriousness and the grace as though you were encountering somebody who the person of Christ can be revealed in. And when we do that, there’s a lot more hope … it changes our conversations with each other. It changes our respect for each other. It changes the way we love each and it’ll, by itself, bring a lot of healing and truthfulness, as well, to our dialogues and to our interactions with each other. And that’s what I would hope, and if I could change anything, that would be the thing that I would change.

Amanda: Amen. All right. I’m going to end with a little prayer of blessing over you and all you do, and all those you care for. May the Lord bless you and all you put your hand to. May the Lord be gracious to you and all who hear your story. May the Lord bring unity to our community and peace to us all. Thank you so much, Steve.

Photo by Eugene Lee for Response Magazine

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