ER physicians and growth-stage startup CEOs have a lot more in common than you'd think.

Last weekend, I binged all fifteen hours of The Pitt on HBO Max. If you haven't seen it, it's an incredible show that follows a single, brutal shift in an emergency room in Pittsburgh, with each episode covering a single hour in the ER. Noah Wyle from the original ER plays Dr. Robby, the attending physician in charge of the Emergency Department.

All week, I've been thinking about the surprising parallels between how Dr. Robby and I approach managing our teams, making high-stakes decisions, and trying to leave the world a little bit better than we found it.

Even though I'm not keeping anyone from bleeding out or triaging trauma patients, it's remarkable how similarly an ER attending and a growth-stage startup CEO have to think about their work. Both Dr. Robby and I are leading high-performing teams through uncharted waters. And the cost of failure is enormous.

If you're a startup CEO at the inflection point of explosive growth, that feeling—that everything is a race against the clock, the stakes are life-or-death, and that you have the potential to have tremendous impact every day—might feel familiar.

Seeing the similarities between my own job and Dr. Robby's wasn't just validating that being a startup CEO can be as isolating and intense as the highest-pressure jobs on the planet. As the best art often does, The Pitt helped me reframe how I already think about my role more clearly and purposefully.

What an Attending Physician Does

The Pitt's protagonist, Dr. Robby, is in charge of the Emergency Department at Pittsburgh Trauma Medical Hospital. His ER handles constant chaos—a steady stream of patients experiencing gunshot wounds, overdoses, and heart attacks demand the team's unrelenting attention.

Dr. Robby's job is to make sure his team does what's necessary to stabilize patients, get them to a point where they won't die, and then either discharge them or refer them to specialists for further care.

He essentially acts as the CEO of his ER. He roams the floor constantly to get an of-the-moment, high-level view of what's going on. He drops in on different cases and gauges the team's bandwidth and priorities in real time. When doctors get stuck or don't know what to do, he either steps in to solve the problem directly or teaches them how to. He's part fixer, part teacher, part leader.

His breadth of knowledge is incredible, and the buck stops with him when serious technical expertise is needed. But he's also a brilliant people manager. He gives tactical feedback when doctors make mistakes, and he keeps things calm and maintains the culture and professionalism of the ER, even as catastrophic medical emergencies test his team's emotional resilience.

And just like any CEO, he's accountable to people above him who care about patient outcomes, throughput, and costs.

My role isn't that different. I stay on top of everything happening at Blaze in product, engineering, design, marketing, customer ops, and finance to unblock people and solve problems fast when they pop up. I maintain personal relationships with everyone on my team so I can manage them proactively and effectively, and I bring in perspectives from work happening elsewhere in the company to give everyone the context they need.

Why Growth Stage CEOs Work Harder

My job wasn't always like this. Our company isn't a scrappy team of 5 or 6 people anymore—just like the ER on The Pitt, we now have dozens of high performers working on different projects at Blaze, all survival-critical. That's changed how I need to work.

Early on, my job description as a founder was a bit more straightforward. To find product-market fit, I needed to talk to customers, build something they wanted, raise money, and recruit an early team. At that stage, our team was small enough that sharing information internally happened more organically.

Later-stage company CEOs also have a pretty clear role—when you've scaled successfully and hired experienced executives to help you run the business, your job becomes about vision, resource allocation, investor relations, recruiting top talent, and maintaining company culture. Your job looks more like a hospital CEO's than an ER attending.

But Blaze—and any growth-stage startup—lives in an interesting middle ground. We have a product in market, customers, revenue, and a diverse team of about 35 people plus contractors. We've found product-market fit and we're growing quickly, but we're still learning, iterating, and launching brand-new products at a pace that you just don't see at large, established companies. We're still uncovering what works and what doesn't every day, and we don't have endless runway, so every decision is existential. And we've gotten big enough that sharing context across teams doesn't just happen in the background anymore. So my job changes every single day depending on what our team needs to do great work fast.

Sometimes, we can follow a playbook. More often, like Dr. Robby's team, we're figuring out the best approach on the fly—and it's my job to make sure we're headed in the right direction.

Setting Culture Under Pressure

The hardest part of being a CEO isn't the logistics or code-switching. It's maintaining our culture and broadcasting positivity to keep spirits up, even when I have my own emotions about the work or I'm putting out 3 separate fires at the same time.

Being able to process your emotions so you can help everyone focus on the task at hand is as critical in startupland as it is in the ER. It's easy to get swept up in the urgency of the problems we're solving, but keeping smart, driven people motivated to work hard starts with me creating a professional, results-focused environment.

We recently did an exercise identifying the characteristics of our top-performing team members, and one thing that stood out was what we call "professional maturity."

Professional maturity means being able to separate your sense of self-worth from how your work is going. Sometimes, being a manager in a workplace as demanding as a high-growth startup or emergency department means doling out harsh feedback, forcing a change of course, or switching up who's in charge of something. Our most successful team members—and the best ER docs—know that ego can get in the way of responding to those events well. I encourage our people not to judge themselves for getting stuff wrong, but rather to take in new information and pivot to better decisions.

If you can't maintain professional maturity, whether you're a product manager or emergency room doctor or nurse, you'll burn out or quit. There's so much out of our control that the only thing we do have power over is how we choose to react.

When we fall short, the only way to keep building a world-changing product or saving lives day after day is to get up and do a little bit better tomorrow.

Why We Choose the Hard Path

Constantly pushing through headwinds is taxing. By no means is it the easy path for doctors or founders alike. You have to be a little bit insane to go into emergency medicine for less pay and infinitely more stress than choosing to practice anesthesiology or dermatology.

ER doctors deal with crushing pressure and constant death, get paid less than other doctors, and often get less recognition and appreciation for their work.

Sound familiar?

Becoming a founder means forgoing a cushier, better-paid job at a more established company to bet on the infinitesimal chance that your startup defies the odds and becomes a household name. You're more likely to fail and fade into obscurity.

Why would anyone choose that? Wouldn't it be nicer if the work were easy or fast?

Sure. But having an impact isn't easy or fast. And just like emergency medicine doctors and nurses, I want to have an impact. I want to tackle the most challenging problems of our time, and I want to spend my days on something that people will remember. I think the care providers that go into emergency medicine feel similarly.

The reality of that choice is that by nature, the journey to having an impact is full of obstacles and personal discomfort, and often bears a physical and emotional cost.

At this point, I know Blaze is going to be successful, but our hard days aren't behind us yet. Someday, I'll get to tell the full, crazy, meandering, unpredictable story.

As painful and hard as the work is, there's clearly something about it that I enjoy—and that everyone on our team enjoys. Why else would you specialize in emergency medicine, or choose to work at a startup?

Because the work is urgent and important. You matter. Every single person on our team matters—there's no dead weight.

And my job is to be the backstop—to help our team not fail. It's what great startup CEOs do. It's what the best emergency medicine doctors do. If we don't, the patient dies.

That's why I can't imagine doing anything else.