“Were you on the hurricane emails this weekend?”

This was not the question I expected to start the week.

I came to Raleigh, North Carolina to spend part of my fourth year of medical school as special assistant to Dr. Mandy Cohen, the secretary of the Department of Health and Human Services in North Carolina. I wanted to work in government — to understand what public service meant, gain operational experience and test whether I wanted to be an academic researcher like my mentors at Yale.

Little did I know the education I was about to receive.

Hurricane Florence struck the east coast of North Carolina on the morning of September 14, 2018. But our work started much earlier. Upon hearing of the incoming storm, I accompanied Secretary Cohen and our team to the state’s Emergency Operations Center (EOC), sitting in on briefings to the Governor and understanding our Department’s important role in maintaining the health and safety of the state before, during, and after the storm.

It was a crisis. And I had a choice: to sit at home and wait for the storm to pass, or to do something. So I raised my hand and offered to help. I’m glad I did.

It was a whirlwind week. I had my small part helping craft media messaging — “Turn around, don’t drown!” — manning our Department’s EOC, and supporting the secretary in her work. It was an adrenaline rush, both exhausting and imminently fulfilling. Millions of North Carolinians were dependent on us, for health care, food, housing in shelters, and more. And we worked day and night to deliver.

While we still have a lot of work to do as we recover and rebuild, I have had the opportunity to reflect on this intense experience in leadership, state government and delivering health and not just health care.

I’ve often wondered what it takes to be a leader. As one of my mentors tells me, leadership is not a noun but a verb. It’s not about the position or the title, but the act of leading — about doing the work, day in and day out. Our response to Hurricane Florence was a constant example of leadership. From the senior leadership team in Raleigh down to the folks on the ground operating our shelters, people took ownership for their piece of the work and did their best to move it forward. Titles were not important, which allowed us to respond quickly and efficiently to problems that arose.

Constant, transparent communication was essential. Let me take you into our department’s EOC. Every morning, we drove through the rain and wind and sat around a conference room table, surrounded by non-perishable snacks and water bottles. We started and ended each day with call with the heads of our divisions, from state facilities to public health, to provide updates and feedback. We then had calls with key stakeholders and policymakers. We also drafted social media messages and press releases to keep the public informed about how to stay safe and healthy. Same process, different content, every day.

Of course, this was all in the context of state government. Coming down to Raleigh, I didn’t know what to expect. It is a purple state, with a Democratic governor and Republican general assembly. In this divisive time, I wondered how things might work. My experience during the storm changed my perspective.

It starts and ends with the fantastic people who work in government. The stories of service and sacrifice during the storm were countless. There were the people in our eastern counties whose homes were damaged by the storm, but still staffed shelters and cared for patients in our state hospitals. There were the people that slept overnight in the state EOC making sure staff and supplies were coordinated to help those in need. The crisis transcended differences. It was inspiring.

The bureaucracy does exist. There are policies and procedures to navigate, and we didn’t always have the money and supplies we needed. We did our best to maximize the people and resources we did have, to get all the flexibilities and funding possible and invest them thoughtfully.

Yet, I also saw the positives of bureaucracy. In a time of crisis, it served its purpose: there were clear command structures, roles, communication lines, and processes in place. It was not perfect, but it provided us a framework to mobilize quickly across the state. While it may stifle flexibility and innovation, at its best, bureaucracy facilities structured teamwork to get things done.

State government, however, could not have done this work alone. It took partnerships, within North Carolina and across state lines. Take, for example, disaster food assistance. We know food, among other social determinants, is essential for health. To ensure people did not go hungry, as a state we applied for federal flexibilities to expand access to food assistance. We also had to work with our counties to ensure they were prepared to sign people up for the program and then mobilize stakeholders to communicate the information. So far, over 720,000 people received assistance. It was truly a team effort, with state government as the quarterback.

Hurricane Florence also taught me how to run real change. It isn’t glamorous. It is a series of small decisions, informed by data and grounded in a core set of values. If we fail, we learn quickly and course correct. After building the mental muscles, you get better, and it becomes easier to make larger and lasting improvements.

I am grateful to have been in North Carolina and done my small part during Hurricane Florence. I learned the crucial role of state government, not just in disaster but also in the day-to-day lives of millions of people. To serve in government is a privilege, something I believe everyone in medicine should experience. You will learn a lot, be humbled and gratified, and may end up like me: someone who is now considering a career in public service moving forward.

Sudhakar Nuti is a medical student.

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