Her remarks preceded a speech by AAMC President and CEO David J. Skorton, MD, entitled “Let’s Walk This Path Together.”
Good morning, everybody! Good morning. Happy Sunday morning, happy time-change-day morning, good morning. I am honored to be with you today.
It is my hope that in a few minutes when I leave the podium, you will be spurred to think about two sides of a coin and the choices that we get to make, with that coin representing each of us individually and us as a collective. The likenesses and the contrast of the two sides showing how we are different and how we are not.
So, paradoxes. This is the theme of my talk today.
First, I want to tell you how much of a true privilege it has been to serve as the chair of the AAMC Board of Directors this year. The board is a thoughtful and dedicated group of professionals. Each member cares deeply about the students, the trainees, the staff, the researchers, and the clinicians who make up our vast academic medicine community. And each board member is passionate about the health and the well-being of the patients, and the families, and the communities we all serve.
If I had to give my year as board chair a theme, it would be the issue of polarization in academic medicine, just as in our country. As a board, we have had lengthy and deep discussions about how to have meaningful deliberations in the supercharged environment in which we live and work today. We strive to have all voices heard, we strive to have assemblies where speakers can present without being drowned out by “boos,” and we strive to have safe forums that provide people an opportunity to express dissent. That sounds easy, right?
As you heard from Dr. Lee Jones, I am a Mississippian. I’ve lived there all my life. While it is a unique and sometimes almost mystical place, I see my home state as a place that, in a very concentrated manner, reflects all the good and the bad, the joy and the grief, the celebration and the heartbreak that is experienced all throughout our nation.
I am a Mississippian... I see my home state as a place that, in a concentrated manner, reflects all the good and the bad, the joy and the grief, the celebration and the heartbreak that is experienced all throughout our nation.
I like the famous quote, which is often attributed to William Faulkner: “To understand the world, you must first understand a place like Mississippi.”
So, let me start with this: We know what y’all say about us.
To address a few common questions and misconceptions about Mississippi, I’ll use components of a marketing campaign that was originally released more than a decade ago.
Can you read? Yes, we can read. A few of us can even write.
Do you wear shoes? Yes, we do.
OK. You can read, and write, and you wear shoes, but do you have any culture? Yes, with an exclamation point!
So, you can read and write. You wear shoes. You can sing, dance, make people laugh — but what about science and medicine? This is Dr. James Hardy, University of Mississippi Medical Center’s first chair of surgery and a pioneer in organ transplantation. You’ll hear more about him in a bit.
This is Dr. Arthur Guyton, first chair of our department of physiology and biophysics and the author of the bestselling physiology textbook ever produced — in its 14th edition and translated into more than 23 languages — and what I would wager many of us in the room used to learn human physiology. Yes, this was done in Mississippi. Believe it.
I could go on, but you get the idea. The images you just saw are of extraordinary people and extraordinary happenings from Mississippi. A state with as many challenges as points of pride.
I want to share with you, however, a story about something very ordinary. A story that is special because, in fact, it isn’t actually special at all. It was an ordinary day, but it left on me an extraordinary memory and is a great example of the two-sided coin.
It was an average Tuesday, a Tuesday morning, some years ago in our University of Mississippi Medical Center adult emergency room. I was seeing patients, as I always did during that time, to allow other faculty and residents to attend the weekly resident education conferences. On this average and insignificant Tuesday, a snapshot of the essence of Mississippi presented itself to me.
I’m in the back area of the emergency department, where patients are roomed who are not acutely sick or injured. Looking at the patient tracking board, I see there are two patients in adjacent rooms, right next to each other, with a chief complaint of “sore throat.” Some days are like that, multiple patients presenting with similar conditions: sore throat, low back pain, nausea, vomiting, etc. I thought to myself, “This may be a sore throat day.”
Two patients presenting to the same emergency room, on the same day, at the same time, with the same chief complaint — but each representing the opposite ends of the health care spectrum.
I step into the first room and see a young male patient who appears healthy. This young man, in his early 20s, attended a nearby college and woke up that morning with a sore throat. He has health insurance through his parents. He does not want to be sick. He is worried about missing classes and getting behind in his coursework. He had already spoken that morning to his parents, who, of course, are willing and able to support him in any way needed to be sure he is healthy and successful in school. So, he decided he would come to the emergency room and get checked out. After my exam, I actually spent most of our time together providing counseling, similar to how I would counsel one of my own children with a sore throat, giving advice that was as much parenting as doctoring.
His diagnosis: Minor sore throat. Prognosis: A rapid return to an excellent state of health.
I leave his room, slip into the next one to find the next patient with complaint of a sore throat, but that is where the similarity ended. Everything was different.
Looking at his chart, I see that this gentleman is in his late 50s but looks much older. He is thin, he is gaunt, he appears unhealthy. There is a mass on the left side of his neck, about the size of a large orange. It has clearly been there a while. The surface was raw, it was bleeding, it was oozing, a blood-tinged fluid was dripping out. My approach, my speed, my tone, everything changed in the blink of an eye. Every particle in my being slowed down.
After several initial questions, it became clear that I was the first physician to see him for this. I say, “Tell me why today is the day. Does it hurt more? Is it bleeding more? Are you having a hard time breathing, a hard time swallowing?” And I wait.
He said, “I just got a ride.”
I just got a ride. His diagnosis is probably an advanced stage of cancer, with a very poor prognosis.
I stepped out of that second room and paused for a moment in the hallway to let it all soak in. I wanted to memorize every detail of those last two encounters, because in them, there was the picture of both sides of the coin, in every aspect of health care delivery. A snapshot of Mississippi, and our country, as a whole.
Two patients presenting to the same emergency room, the same day, the same time, with the same chief complaint — but each representing just opposite ends of the health care spectrum. Two sides of the coin, each representing the dichotomy of life and means.
One young and healthy and positioned in life so that concerns for his health can take center focus when needed, supported by resources such as family, professors, insurance, money, and available transportation. The other, older, in very poor health, having lived a life where health could not be a priority, lacking basic resources, so that getting a ride to the doctor was a major obstacle. His life, surroundings, support systems, socioeconomic status, all void of the sophistication needed to navigate the complexities of our health care maze.
In some ways, what makes this story so meaningful is that it isn’t special or unusual at all. I expect many of you could tell your own very similar stories.
Let me tell you another story. This is a little further back in time. In this case, I was not the physician. Actually this happened at the University of Mississippi Medical Center the year I was born. In June of 1963, Dr. James Hardy, from the earlier slide, performed the world’s first human lung transplant. Think about that: the phrase “world’s first” is being used to refer to a major medical event occurring in Jackson, Mississippi.
Even today, I would be hesitant to call Jackson a true destination compared to some the big cities in our country, but back then it was certainly just a rural, small town by most anybody’s standards. Yet, it was home to this renowned surgeon and scientist, this force of nature, this bold, young physician who would change the world of transplant medicine. It is simply fascinating to me that in our little insignificant place, in this insignificant town, honestly, magic was happening.
But that’s only one side of that night’s coin. The other side was tragic.
While Dr. Hardy and his team were in the OR performing the lung transplant, a call came in from the emergency department about a critical patient with a gunshot wound to the chest. A surgeon was needed urgently. Hardy released a resident from the OR to respond to the emergency and the surgical team went to complete the transplant and make medical history. The transplant patient lived 18 days.
But the gunshot wound to the chest proved to be fatal that night, and 37-year-old Mississippian Medgar Evers died in the ER. Medgar Evers was a prominent civil rights leader whose national profile was rising, and he was killed by a white supremacist who was hiding in the bushes outside his home.
In that moment, at that place, was evidence of the best of us and the worst of us.
Just seven months later, another worldwide news event occurred. In January of 1964, Dr. Hardy and his team performed the world’s first transplant of a heart into a human, placing a chimpanzee heart in a dying prisoner from the Mississippi State Penitentiary. The heart beat for ninety minutes, but an important scientific theory was proven possible. For all the reasons we understand, the coin analogy applies here as well.
And I want to make a point. Clearly, I was not present for these events, but the stories from the elders who were there are enthralling. Now, we are so proud of this history and Hardy is credited for proving many theories possible that others would build upon to advance transplant medicine. But then, in that moment, it was not all good. Then, he was ostracized, he was questioned, he was called out for playing God. There was much controversy and dissent surrounding organ transplantation, especially the use of a nonhuman organ. Some people wanted to run him out of the state. Thank goodness he carried on despite that.
How do we clear our thinking and find a path through all of this? In my opinion, the way — the only way — is to keep our focus on the students, the science, the patients, the communities we serve. The why.
So, over the arc of history, do things ever really change? Was the reaction to the groundbreaking work happening at that time so very different than the environment that we’re in today? And can you imagine what it would have been like if the internet or social media had been around? Thank goodness he overlooked that proverbial noise. He continued to focus on the science, the patient, the why.
In our current polarized environment, where there is a never-ending tsunami of bad news and drama coming at us, how do we clear our thinking and find a path through all of this? In my opinion, the way — the only way — is to keep our focus on the students, the science, the patients, and the communities we serve. The why.
That is how we — the big “we,” academic medicine — can lead the way. We are leaders here, all of us — whatever your role in your life and work — because you have a reason to be here, you are a leader. And students, I am including you. You may not see it yet, but you are already leaders. Everyone in this room is a leader in medical education, in science, in health care, in running a medical school, in running a hospital, and on and on.
In the current frenzy of dissension, disagreement, discord, and conflict, how do we present the other side of the coin? The positives. The good side. How do we prevent the negatives from overtaking us? And the volume is loud. Threats and change are coming at us from every side — financial, political, financial, federal and state policy, financial, health care work force, mental health issues, financial — it goes on and on.
We are the frontline in the battle for healthier communities. The patients we serve are counting on us to do what they need us to do.
We are all working in our own space to manage this reality and the challenges that it brings. There is no savior, there is no cavalry coming to solve these challenges for us. It’s just us — again, the individual “us” and the big “us.” We are the front line in the battle for healthier communities. The patients we serve are counting on us to do what they need us to do.
In a world where not a lot is certain, we can be certain that each day, the sun rises and the sun sets. I encourage us to keep our focus on the students, the science, the patients. They are our why. I very much believe that in the future when we look back on this time, it will be looked upon as a great time for science and medicine. Even in the most difficult times or circumstances, we must get the job done. That is exactly what academic medicine is and was always supposed to be. Our why.
Even in the most difficult of times or circumstances, we must get the job done. This is exactly what academic medicine is and was always supposed to be. Our why.
When the coin flips, academic medicine — the collective “us” — we have to be ready for whichever side turns up.
We’ve all seen so many advances in science. Consider the treatment options for awful diseases like cancer that we have available today. Look at how, in the face of a pandemic, we all modified our practices to be responsive to our patients and the needs of the communities we serve — and much more quickly than we could have ever imagined. Innovation occurred all throughout the academic medicine spectrum, at institutions big and small, rural and urban.
Recognize that while the discord of our nation is troubling, there is another side to that coin. It is good that we are speaking up and out. It is good that voices are being heard. It is good that intolerable acts are no longer being tolerated in silence.
While the discord of our nation is troubling, there is another other side to that coin. It is good that we are speaking up and out. It is good that voices are being heard. It is good that intolerable acts are no longer being tolerated in silence.
Have we solved all of our problems? Not by a long shot. But in many instances, we are having a conversation. This is good. This is progress. How do we calibrate that good with the constant headlines that are designed to inflame and fueled at times with partial truths, if any truth at all?
So, each day we have the space between the sunrise and the sunset allotted to us. How can we use that time to have an impact? Gandalf said it best with this sage advice to Frodo: “All we have to decide is what to do with the time that is given to us.” You probably didn’t expect to hear a Lord of the Rings reference this morning!
We are all entrusted to make impactful use of the time that we are in our positions. What will we do today to promote the foundations of academic medicine: to advance patient care, to save lives, to shape the future of health care through medical training, and to create medical research breakthroughs?
What will we do today to promote the foundations of academic medicine: to advance patient care, to save lives, to shape the future of health care through medical training, and to create medical research breakthroughs?
I believe that the turmoil we are facing today is the current verse of an old, old song. Hardy, like all of the other past heroes from all of your institutions, chose to stay true to purpose and science and our mission. I encourage us to make that same choice. A decision based on our why.
I have heard it said that attention is the currency of leadership. In our current environment where one side of the coin is disagreement and conflict, I encourage us to focus most of our attention on the other side. To be attentive, to listen, to engage in real and honest dialogue, to put an emphasis on what brings us together rather than what divides us. Do all this, all the while keeping a laser focus on the students, the science, the patients, and our communities.
In our current environment where one side of the coin is disagreement and conflict, I encourage us to focus most of our attention on other side. To be attentive, to listen, to engage in real and honest dialogue, to put an emphasis on what brings us together rather than what divides us.
If we don’t, who will?
Thank you for your time today and thank you for all that you do to further academic medicine. It matters. Thank you.