This story is part of the Behind the Desk series where CNBC Make It gets personal with successful business executives to find out everything from how they got to where they are to what makes them get out of bed in the morning to their daily routines.
In his four decades in health care, Northwell Health CEO Michael Dowling has seen his share of crises, including the AIDS and crack epidemics of the 1980s and '90s.
But the Covid-19 pandemic is by far the worst health crisis he has been through.
"We were attacked by an enemy that we couldn't see ... and didn't know a lot about it," Dowling tells CNBC Make It.
"All hell broke loose," he says.
Today, Dowling oversees 23 hospitals, 800 outpatient facilities and more than 74,000 employees in New York. Since March, his facilities have seen and treated more than 100,000 Covid-19 patients.
Now, as numbers are rising once again in New York and across the country, Northwell made history on Dec. 14 by vaccinating Long Island intensive care nurse Sandra Lindsay, the first person in the U.S. to get a Covid vaccine, and has since inoculated more than 22,000 employees.
"It was euphoric in many ways, the staff was extraordinarily happy," he says. "All of a sudden, you could see a light at the end of the tunnel."
Here, Dowling talks to CNBC Make It about a broad range of topics, including how he went from extreme poverty to the C-suite, what the coronavirus pandemic taught him, and what was one of his biggest regrets.
Dowling says his childhood helped him prepare for a career in public health care, including the confusion and hardship of the pandemic.
"What motivates me? Poverty," says Dowling. "I grew up in serious poverty."
Dowling grew up in the 1950s in a cottage with no indoor plumbing or electricity in Knockaderry, a rural village in West Limerick, Ireland. His father, a stone crusher in a quarry, was disabled by severe arthritis, and his mother, a seamstress, often struggled to find work because she was deaf.
As the oldest of four siblings, Dowling financially supported his family as a young teen by spending summers working in a steel mill in England.
Still, Dowling's mother was a "strong, strong proponent" of the idea that "irrespective of your circumstances, it should never limit your potential," Dowling says.
For years, Dowling would mentally repeat to himself, "I'm going to college. I'm going to college."
He worked sometimes 120-hour work weeks at odd jobs to save money to go to University College Cork and was the first in his family to attend college. Dowling says he then got his master's degree in social work in 1974 at Fordham in New York, where he also worked odd jobs to pay the approximately $2,500 tuition.
His childhood helped teach him to stay optimistic and tackle big problems "bit-by-bit," which certainly came in handy with Covid.
"Where I grew up, there was difficulty all the time. You had to battle through. It gives you grit. It helps build up resilience."
At one point in April, when New York City was considered the epicenter of the pandemic, Northwell hospitals had more than 3,400 hospitalized Covid patients at one time. (Now, Northwell has less than half that many hospitalized.)
"We had basically shut down a lot of other services except for serious things, like open heart surgery," Dowling says.
Supplies were running low and patients were dying at a rapid rate, but Dowling says his team came together in a profound way.
"Despite the fact that many staff lost family members, they still came to work. So you learn an awful lot about humanity here, about true character and what shines through when things are very, very difficult," Dowling says.
Dowling and his team got "extraordinarily creative" to handle the wave. For instance, they created 200 beds every night for a week by reconfiguring hospital conference rooms.
As a leader, Dowling has made it a point to show up on the front lines. "I don't like to sit in my office and issue dictates," he says.
Though his family and staff were worried for him (he's 71, which makes him high risk), Dowling says he would go to a Northwell hospital pretty much every day, walking the intensive care units.
"If you ask your people to go into the trenches, you've got to have the courage to go in there with them," he says.
The experience "makes you think about life and what you normally take for granted that all of a sudden is turned completely upside down."
But even on the darkest days, Dowling says he never got stressed.
"When things get very, very crazy, I get very, very calm, because I really focus on what's important," he says.
"When you surround yourself with people smarter than you, then you prove how smart you are," Dowling says. So throughout his nearly 27 years at Northwell, including 18 at the helm, Dowling has made it a point to meet all new hires.
"Every single Monday, I meet with every new employee that was hired," Dowling says of his weekly group session (though it has been disrupted by the pandemic). "I learn what makes them tick. That to me is a motivator," he says.
Dowling also thrives on competition. "I tell my staff all the time, the biggest competitor is the status quo."
"The bigger the competition, the better you will become," he says.
Dowling says he's not one to meditate or do yoga to relax, and he doesn't have any special trick to help with productivity. He simply loves his work and continues to learn.
"I love to read. I read all the time. I read multiple books a month. I'm a student at heart," he says.
Every quarter, Dowling sends out a list of 20 or 30 books that he thinks his staff should read, and he writes a little synopsis of each. The books aren't necessarily about health care either but merely meant to get you to think differently" and "questions your own assumptions," he says.
Dowling's end of 2020 reading list included books about civil rights by the late Rep. John Lewis, as well as "The Violence Inside Us: A Brief History of an Ongoing American Tragedy" by Sen. Chris Murphy, D-Ct., calling the book on gun violence "essential reading."
There have certainly been things that didn't work out well during Dowling's career, but he doesn't consider them mistakes.
"I don't go backwards, you have to keep moving forward. Nostalgia is not a strategy," he says.
There is one thing that still eats at him personally, though.
"I was doing my doctorate at Columbia and I finished all my coursework and I passed all my exams and I had submitted my dissertation and then I got a call from Gov. Mario Cuomo's office asking if I wanted to join the administration," Dowling says. (He spent 12 years as deputy secretary and later as state director of Health, Education and Human Services for the then-governor of New York, the late father of Gov. Andrew Cuomo.)
"So I joined the Cuomo administration and I took the report that I had to submit for my doctorate into the trunk of my car and I got so busy working in Albany that I never finished my doctorate," he says.
"'Did it make a huge difference in what has happened since? I don't believe so," he says. "But I did spend the money, time and effort doing it and I just walked away from it and I shouldn't have done that. But it was a lesson."