Dr. Robert C. Gallo presents 2013 Keith B. Taylor Memorial/WINDREF Lecture at St. George’s University

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An overflowing audience in Patrick F. Adams Hall hung on the every word of world-renowned physician and scientist Dr. Robert C. Gallo at the fifth annual Keith B. Taylor Memorial Lecture/13th Annual WINDREF Lecture. Dr. Gallo, with his refreshing humor and calm demeanor, did not disappoint as he delivered a powerful lecture which received a well deserved standing ovation at the end.

Speaking on the topic “Viruses and Epidemics with a Focus on HIV/AIDS: Our Attempts to Control Them,” Dr. Gallo provided an overview of viral epidemics that have swept the globe over the last century.

“Humans have a 25- to 30-year attention span,” he said, explaining medicine’s shift in focus from researching infectious diseases to degenerative diseases within decades of conquering an epidemic. He pointed out that the number of medical graduates entering the field of virology was shrinking.

In 1980, Dr. Gallo discovered HTLV-1, which was the first of the human retroviruses to be discovered which caused a malignancy. Later in the decade, he discovered HTLV-2 and co-discovered HIV. Dr. Gallo provided the first clear evidence that HIV caused AIDS, and he and his team developed the first HIV diagnostic test. In the ’90s, Dr. Gallo and his co-workers also discovered the first natural inhibitors of HIV, which was instrumental in developing treatments for the infection. In addition, in 1986 he and his team also discovered the first human herpes virus in more than 25 years, HHV-6, which proved to cause the infantile disease, roseola.

Dr. Gallo’s groundbreaking work, widely accepted and revered today, was certainly not widely accepted in the 1980s and he was met with much criticism – and even ridicule – by members of his profession. “What is called translational research today was thought to be not academic enough, not intellectual enough,” he said. Dr. Gallo shared his experience swimming against the tide in the 1980s and relayed how he stuck to his guns, shattering many medical misconceptions of the time.

Dr. Gallo’s lecture also focused on HTLV-1 and HIV and what it will take to control these viral pandemics. “There are approaches to finding a cure, but as yet, no one has a cure for HIV or HTLV-1 … but we have good diagnostic tests today and treatment at least for HIV is having a positive impact on many people’s lives.” His mantra is to “test a lot, treat early and we can control the HIV pandemic – do it for the world, do it forever, until we find a preventive vaccine. This approach will take a tremendous commitment by governments and policy makers.”

In his lecture, Dr. Gallo also touched on the Global Virus Network (GVN) which he cofounded in 2011. The GVN’s mission is to ensure a rapid response to new or re-emerging viruses that threaten mankind, to bring together and achieve collaboration amongst the world’s leading virologists, and to support training of the next generation of medical virologists. He pointed out that several epidemics and global health disasters could have been averted if this network had been established earlier.

At the end of the lecture, Dr. Gallo was inducted as an honorary member of St. George’s University’s Gamma Kappachapter of the Delta Omega Public Health Honor Society in recognition of the enormous contributions he has made to our understanding of retroviruses and to medicine and public health.

In her closing remarks, Baroness Howells of St. David’s, a member of the WINDREF (UK) Board of Trustees, thanked Dr. Gallo for his insightful lecture and reflected on the impact it would have had on such an assembled audience.

Dr. Gallo, founder and co-director of the Institute of Human Virology at the University of Maryland School of Medicine, has received numerous major scientific honors and awards, including the prestigious Albert Lasker Award, which he was awarded in 1982 and 1986. He was rated the most cited scientist in the world for two decades in the 1980s and 1990s, according to the Institute for Scientific Information. Dr. Gallo was also ranked third in the world for scientific impact for the period 1983-2002. He has been awarded 30 honorary doctorates from universities in the United States, Sweden, Italy, Israel, Peru, Germany, Belgium, Mexico, Argentina, Spain, Ireland, Jamaica, and Greece.

World-Renowned Physician-Scientist Dr. Robert C. Gallo to Speak at St. George’s University

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On February 12, 2013, Robert C. Gallo, MD, who for the past 30 years has been one of the most influential scientists in the world, will visit St. George’s University to deliver the 5th Keith B. Taylor Memorial/13th Annual WINDREF Lecture. The title of his lecture will beViruses and Epidemics With a Focus on HIV/AIDS: Our Attempts to Control Them. The lecture, which is open to the public, faculty, and students, will take place at 6 pm at Patrick F. Adams Hall.

Dr. Gallo, founder and co-director of the Institute of Human Virology at the University of Maryland School of Medicine, is one of the pioneers in the field of human retrovirology. Together with his colleagues, in 1980 he discovered HTLV-1, which causes leukemia and was the first of the human retroviruses to be discovered. Later in the decade, he discovered HTLV-2 and co-discovered HIV. Dr. Gallo provided the first clear evidence that HIV caused AIDS, and he and his team developed the first HIV diagnostic test. In the ’90s, Dr. Gallo and his coworkers also discovered the first natural inhibitors of HIV, which was instrumental in developing treatments for the infection.

In addition, in 1986 he and his team also discovered the first human herpes virus in more than 25 years, HHV-6, which proved to cause the infantile disease, roseola.

Dr. Gallo has received numerous major scientific honors and awards, including the prestigious Albert Lasker Award, which he was awarded in 1982 and 1986. He was rated the most cited scientist in the world for two decades in the 1980s and 1990s, according to the Institute for Scientific Information. Dr. Gallo was also ranked third in the world for scientific impact for the period 1983-2002. He has been awarded 30 honorary doctorates from universities in the United States, Sweden, Italy, Israel, Peru, Germany, Belgium, Mexico, Argentina, Spain, Ireland, Jamaica, and Greece.

Sir George Alleyne’s speech “The Price of Privilege” St. George’s, Grenada*

First let me thank Chancellor Modica for his gracious invitation to deliver this address and the warmth with which he and his colleagues have received me. Next, let me congratulate the new graduates on having reached this milestone. It is a great relief to have achieved this, but I say milestone advisedly as I hope that many of you will continue to follow in one way or another the intellectual pursuits that you began here.

It is always a pleasure to come to Grenada and there must be few more beautiful sites in the island than the True Blue campus of your University. This is not my first visit to the University, I came here 32 years ago when it was only a medical school, and I recall the temporary facilities on Grand Anse and wondering if the students would find the almost idyllic surroundings conducive to study. I also commented then on the relevance of the school to the health care needs of the Caribbean and if it would ever become grounded in the Caribbean. It is refreshing to note how you have grown, the number of disciplines you now embrace beside medicine and the number of Caribbean students who are enrolled in your programs. But perhaps the students in arts and sciences have better powers of concentration and are less distracted than the medical students-at least those of thirty years ago. Or indeed, all students here have heeded Alfred Toynbee’s dictum that “The supreme accomplishment is to blur the line between work and play.” I really do hope you have benefitted from the beauty of the physical surroundings as a complement to the excellent courses of instruction that have been offered.

As is the case with all good universities, you have been protected and almost cosseted during your stay here and are now ready to face a world which to every fresh set of graduates is brave and new. All of you will have heard and read of the difficulties faced by Caribbean countries-some of them intrinsic to their own situation and some as a result of external conditions, particularly the financial ones.

If it is any comfort to you, let me recall an address given by a former Vice-Chancellor of the University of the West Indies some thirty years ago which could have been written today. He described the University of the West Indies as being located in a region of the world that is “passing through an economic crisis, revealed by multiple symptoms-unemployment, inflation, falling growth rates, energy shortages etc.” But he went on to say: “these symptoms are not new to us in the West Indies, excepting perhaps in their intensity and we are in the habit of looking beyond them to their causes to see the whole as a challenge of development.” You all remember the old saw, “The more things change, the more they remain the same.” He would analyze the role of the University in responding to those challenges. It is in the same vein that I wish to explore with you the role you can play in responding to some of these development challenges, as students before you from other universities in our region and certainly those from my own university have done and continue to do.

I begin by affirming that you are and will continue to be in a privileged position. You represent only a fraction of the cohort of persons who can benefit from higher education and this applies to Caribbean students as well as those from other parts of the world. I believe that there is a responsibility that comes with this privilege –there is a price for this privilege, although in this transaction I expect you to pay this price not only for the benefits you have received until now, but particularly for the continuing benefits that will accrue to you as a result of having studied and been trained here.

I discovered after I had chosen this theme that the “Price of Privilege” is the title of a book by an American psychologist who explores why wealth in the family can produce anxious, depressed teenagers. They are so taken up with objects that they never concentrate on deeper issues and never build the character necessary to take them through life. But I intend to think of the issue as it relates to universities, rather than families.

The currency in which you will pay this price of privilege has compassion, engagement and commitment among its highest denominations. As you pay in the coin of compassion, remember never to take lightly the fact that for most of you, as it was for most of my generation, the great majority are from families in which a university graduate represents the exception rather than the rule. That clearly is changing, but the change could be much more rapid.

Paying the price means you must never take lightly the responsibility of transmitting relevant information to those who do not have it. The idea or practice of information transmission has seen many phases. Mankind has always been concerned with the dual problem of his physical transportation and the transmission of his ideas. We have seen progressive growth in the capacity to do both although to date we have not been successful, as in Star Trek, of beaming one person from one place to another. When we moved primarily on foot, we depended on the heralds and minstrels to carry the words and images of our deeds. But in addition we used signals of one sort or another to try to shackle distance. We read of the smoke signals of ancient tribes and some of us have heard the talking drums of our African ancestors-the gangan of the Yorubas and the kalangu of the Hausas.

The enhanced transportation of man and his goods is now almost without limits as the physical world is stitched together by ships of ever increasing size, some of which compete with the birds for their space. Of equal significance is the increasing sophistication in the transmission of ideas. The technology of communication changes with mind-numbing speed. Our computers talk to one another. The world is becoming ever more interconnected and that is the driving force behind the much discussed and analyzed phenomenon of globalization which is really not new. It is the speed at which we are being connected and the technology that makes this possible that bring up serious reflection on the roles you can play. A major issue for you in thus interconnected and plugged-in world is the role you play and the responsibility you exercise as you take part in transmitting information as undoubtedly many of you will occupy positions of influence and authority in your countries. One of your concerns is how do you protect the values and mores of our societies as you transmit information through the tried and true methods or though new means such as social networking?

The urge to transmit information to the young seems to be hard wired into most species. See the duck instructing her young as they follow in line behind her. The responsibility of transmitting the appropriate information to the young has been taken seriously by man throughout the ages. Socrates was put to death because he was deemed to be corrupting the young by the information he was transmitting to them. So as a privileged graduate I expect you to contribute to the body of information in your society-to use the skills you have acquired here and the talents you have honed here to participate in sharing information for the creation of a better society. You will not be diminished by sharing information, as in the words of Thomas Jefferson;

“He who receives an idea from me receives instruction himself without lessening mine; as he who lights his taper at mine, receives light without darkening me.”

Perhaps this is a responsibility of all good men and women, but I place a special charge on those of you who have had the benefit of higher education.

But the information you share is not value –free. It will have an impact on how you and your fellow human beings relate to one another. This country is fortunate that it is not subject to much of the racial disharmony that besets some others. There are however other forms of intolerance and discrimination that demean a society. I wear another hat as the UN Secretary-General’s Special Envoy for HIV/AIDS in the Caribbean and have for years observed the state of the epidemic and tried to add my mite to the efforts to control it. There has been progress. The Caribbean governments have been good about providing for those persons who are HIV positive and need treatment as their disease progresses. But we have not done equally well in terms of prevention although as in all programs of prevention it is impossible to prove the counterfactual.

It is a belief shared by many of us that the stigma and discrimination attendant on homosexuality and the false notion that homosexual transmission is the dominant form are impeding the efforts to control the epidemic. We know that men who have sex with men represent a group with higher incidence of HIV positivity and the fear that such persons have about the stigma and discrimination that they suffer makes it difficult for them to come forward to be tested . It is an unfortunate fact that all but one of the Caribbean countries have laws on their books that make sex between consenting males a crime severely punishable by law. I would hope that within a university there would be a spirit and practice of tolerance that would be embraced and shared by its graduates so that surely, even if slowly we would see a change in the attitudes that lead to the discrimination against a group of persons with whose life style some do not agree. I hope some of you will accept the challenge of trying to engender the societal change needed to remove this phenomenon from our countries.

One of the questions that all graduates have to answer for themselves relates to the benefit of their higher education. There is the view that most of higher education represents a purely private as opposed to being a public good to the extent that its benefits accrue specifically to the individual. In that sense it makes the graduate more marketable and there is no need for him or her to consider anything else besides maximizing the returns from this good. As I am sure you know, a public good can be thought of as a good or service in which the benefit received by any one party does not diminish the availability of the benefits to others, and where access to the good cannot be restricted. Traffic lights are always cited as the classic example of a public good.

A university education provides benefits that go beyond the individual graduate. I have always posited that that is one reason for alumni to support their university and I would propose that it is another part of the price you should pay for the privilege of having attended this university. Your university, to the extent that it is engaged in teaching as well as research produces information that is of societal value, is producing public goods. To the extent that it fosters the kind of inquiry and curiosity that is essential for societal health then it is providing a service that is within the category of public good. This is not to deny your commitment to the institution because you have an interest in ensuring that the currency of your own credential remains valid. The validity of that currency will be a determinant of the extent to which you reap rewards form your education here. You are all aware of the differential in earnings generally between those who have received tertiary education from those who have not.

The notion of university education being uniquely a private good has been in part responsible for the tremendous growth of institutions of higher education with out walls, whose sole function is credentialing. However, I still see immense value in having at least part of the training of the young involve interaction with each other and with teachers with whom they can interact to use a popular phrase ‘live and direct”. So I trust you will pay the price of the privilege of being educated here by being good alumni. You must support your university; you must be committed to seeing it continue and prosper.

There is one last charge I wish to leave with you and another rationale for supporting higher education in general and your university in particular. Mankind throughout the ages has had periods which in retrospect were a denial of our basic humanity. We can think of places in which there has been brutality that we here in the Caribbean find it hard to conceive and sometimes we are arrogant enough to believe that it cannot happen here. But as we see the escalation in violence in some of our societies we begin to wonder. We see increasing violence in our speech, our music and our dress. I saw recently a young man wearing a T-shirt with the words “Top Shotta” on the chest. Shotta is the jargon for a gunman-a killer.

A recent report on crime violence and development in the Caribbean, examined the trends, costs and policy options. There is no doubt that crime and violence represent a major drag on our development. The causes are many and varied and the report stressed the multiple entry points for engaging in the prevention of crime and violence. It stated:

“There is no one “ideal” approach. The common denominator is that successful interventions are evidence-based, starting with a clear diagnostic about types of violence and risk factors, and ending with a careful evaluation of the intervention’s impact which will inform future actions.”

Here obviously is a role for academic institutions and my own University is dedicating considerable effort in this direction.

There is the belief that we are inherently competitive and violent and there is a thin veneer of civility that keeps the world from descending into barbarism. I believe that it is education and the presence of institutions such as ours that have a critical role in maintaining and thickening that veneer. I do not mean to suggest that we diminish moral autonomy or shift moral responsibility away from the individual, but I do believe that it is in the multiple diversities in a university that we can find part of the solution.

Finally, let me say thanks to the parents and friends of the new graduates. I know that this must be a joyous day for you and some of you are breathing a sigh of relief that the fight appears to be over and the battle won. However, I ask that you continue to support your new graduates as they go out into the world. They will continue to need it. Perhaps not financial support, but the counsel that comes from a concerned friend or elder in moments of doubt can be of inestimable value.

I hope you will assure me that the privilege you have had through attending St.George’s University will not lead to the depression, anxiety and narcissistic behavior seen in the children of the affluent who pay the price of privilege as described in the book to which I referred.

Let me thank you again for the opportunity to be with you and I wish you much luck

Mr. Speaker;

*Presented at the School of Arts and Sciences and Graduate Studies Program Graduation Ceremony, St. George’s, Grenada, 15 May 2010

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Dr. Yvette I. Sheline Delivers 10th WINDREF Lecture at St. George’s University

news she line bigDr. Yvette Sheline, Professor of Psychiatry, Radiology and Neurology and Director of the Center for Depression, Stress and Neuroimaging, Washington University School of Medicine,
delivered the 10th Annual WINDREF Lecture on the evening of

March 16th at Bell Lecture Hall on St. George’s University’s True Blue campus.  She drew upon an accomplished career in Psychiatry, with a specific research focus on neuroimaging and treatment studies of depression.  She spoke on the topic: “Brain Imaging: New Insights into Neuropsychiatric Disorders.”
Since the inception of the WINDREF Lecture Seriesin 2000, Dr. Sheline joins an impressive list of guest speakers who are experts in their fields, including Professor Sir Andrew Haines, Director of the London School of Hygiene and Tropical Medicine, Professor David Molyneux, President of the Royal Society of Tropical Medicine and Hygiene and Dr. John Rouben David, a prolific author and award winning specialist on leishmaniasis.

Dr. Sheline addressed the audience of SGU faculty, research scientists and students, emphasizing the use of neuroimaging in the diagnosis and treatment of Alzheimer’s disease.  Alzheimer’s disease is the most common form of dementia, a term that is used to describe a group of brain disorders which cause memory loss and make it harder to carry out daily tasks.  Dr. Sheline explained that the development and advancement of molecular imaging techniques of amyloid plaques in Alzheimer’s patients are critical to early diagnosis and evaluation.  The abnormal accumulation of amyloid in organs is thought to play a significant role in various neurodegenerative diseases.

After graduating from Harvard University, Dr. Sheline received an MS in neurophysiology at Yale University and an MD at Boston University Medical School.  She completed psychiatry residency training at Harvard’s Beth Israel Hospital.

A recipient of many awards including the National Alliance for Research on Schizophrenia and Depressions (NARSAD) Young Investigator and Independent Investigator Awards and a NARSAD Klerman Award Honorable Mention, Dr. Sheline’s research studies have identified structural brain changes in MRI studies of depression, serotonin neurotransmitter changes on PET scans, and functional alterations in the emotional circuitry seen during MRI studies of depression.

Dr. Sheline has also served on the Board of the American Association of Geriatric Psychiatry, and has published her work in several top-tier academic journals, including PNAS, The Journal of Neuroscience, The American Journal of Psychiatry, Biological Psychiatry, Neuropsychopharmacology, and the American Journal of Geriatric Psychiatry.

The Windward Island Research and Education Foundation (WINDREF) was established in 1994 to advance health and environmental development through multidisciplinary research and education programs.  WINDREF provides a scientific resource center which promotes collaborative relationships between internationally recognized scholars and regional scientists, adhering to the highest ethical and academic standards in all research endeavors.

417 Take Oath at School Of Medicine White Coat Ceremony

Dr. Joshua Hauser’s Inspiring Keynote on Medicine’s Delicate Balance of Compassion and Science.

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A central part of the White Coat Ceremony showcases students swearing a professional oath

St. George’s University School of Medicine (SGUSOM) officially welcomed a new class of 417 medical students to its Grenada campus on January 25, 2009.  This was a highly qualified class of students from 27 countries. Keynote speaker Dr. Joshua Hauser drew upon an extensive career in Palliative Care and Medical Ethics, providing invaluable insight into medicine’s delicate balance of compassion and science. Dr. Reginald Abraham, a board certified cardiothoracic and vascular surgeon in Southern California and a graduate from St. George’s University’s School of Medicine Class of 1990, served as Master of Ceremonies.

Dr. Joshua Hauser, a graduate of Harvard Medical School in 1995, is an Assistant Professor of Medicine and Palliative Care at Feinberg School of Medicine, Northwestern University; Director of Education at the Buehler Center on Aging, Health and Society; and Director of the Education on Palliative and End of Life (EPEC) Project.

Since a central part of the White Coat Ceremony showcases students swearing a professional oath, promising to act with integrity and in an ethical manner during their training and career in medicine, the selection of Dr. Hauser to deliver the keynote address was most appropriate.  Though he himself had admittedly never participated as a student in a White Coat Ceremony, his interpretation of its symbolism and how that has applied throughout his career offered these future physicians an interesting and important perspective; one that relies on caring, compassion, and science as the foundation of medicine.

The Keynote Address

As a palliative care physician and an internist, Dr. Hauser’s clinical work focuses on quality of life, symptom control and support for seriously ill patients and their families.  Dr. Hauser explained that since many of his patients are dying, they and their families are faced with many difficult and emotional decisions.  “One of the things that I love about palliative care is that there are often very specific medical things to do and think about…and there are also opportunities to help patients and families deal with something that I sometimes call ‘the big picture’.”  Here-in lays the delicate and crucial balance of caring and compassion and medical science.  In palliative care, Dr. Hauser explained, symptom management is the science, and helping patients and families cope with illness and dying is the caring and compassion part.

To this, Dr. Hauser added five more recently recognized values and behaviors he has embraced: curiosity; a tolerance for uncertainty; humor; passion; and service.  Beginning with curiosity, he explained that practicing medicine is “fundamentally about entering into other people’s lives,” whether figuratively as does a psychiatrist or literally as by an internist.  Dr. Hauser continued, “All physicians…require motivation in the form of curiosity: a curiosity that motivates you to want to know about someone’s life, to dig deeper into their situation or to perfect an operation.” Drawing upon personal experiences, Dr. Hauser explained that being curious will not only help diagnose a patient’s illness but has a direct benefit for the physician.  Very often, he explained, asking a patient a few simple questions about themselves, their life and family, will inspire us to reflect on our own lives, seeing the humor and the sadness, and most importantly keep us engaged in the work.

Uncertainty, said Dr. Hauser is an inevitability of medicine and accepting the uncertainty will help bring you closer to your patient and your colleagues.  In emphasizing the need for humor in the profession, Dr. Hauser made reference to his specialty of palliative care, which is by definition not supposed to be funny. This is precisely why humor is so necessary, as it is frequently through humor that a physician can connect with a patient and perhaps improve not only their day, but his own.

In closing, Dr. Hauser acknowledged that the role these characteristics play in their lives will change and evolve over time, but he encouraged them to keep them at the forefront as they begin their education and reflect upon them continuously throughout their careers.

Master of Ceremonies Dr. Reginald Abraham

Master of Ceremonies Dr. Reginald Abraham

SGU’s 1990 graduate, Dr. Abraham, was an entertaining and humorous master of ceremonies.   He connected with the entering class with heartfelt words of his own and he exhorted them to work hard and develop confidence in what they do and compassion for their patients.   Dr. Abraham’s particular interest in minimally invasive cardiothoracic surgery and off pump bypass surgery (OPCAB) is the subject of his many lectures.  He is a fellow of the American College of Surgeons, the American College of Cardiology, and the American College of Chest Physicians, as well as a board member of the American Heart and Stroke Association.  Dr. Abraham has conducted extensive research and published in the fields of ulcer, cardiovascular medicine, cardiac physiology and robotics in cardiac surgery.  His current interests are in global investment and development in innovative technologies, building and growing state-of-the-art heart institutes.

Dr. Hauser has held numerous leadership roles in national efforts in Palliative Care and Medical Ethics, and has been recognized with the International Society for the Advancement of Humanistic Studies in Medicine’s Young Physicians Award for Humanism and the Department of Medicine’s Teaching Award by Feinberg School of Medicine, Northwestern University.

He has served as past chairman of a National Institutes of Health study section on research ethics; past co-chairman of the program committee for the American Society of Bioethics and Humanities; and a current member of the ethics committee for the American Academy of Hospice and Palliative Medicine.  His research, which focuses on the development of strategies to support family caregivers in palliative care, has been published in highly regarded peer-reviewed journals including JAMA; the Journal of Pain and Symptom Management; Journal of Palliative Care; andAcademic Medicine.  Dr. Hauser has also dedicated his services to many different volunteer positions, including as a physician at the New England Shelter for Homeless Veterans and the Maria Shelter, a physician advisor for the Southside Sarcoidosis Support Group, and a volunteer physician for Connections for the Homeless in Evanston, Illinois.

Welcoming Family and Friends

The University was equally excited to have over 100 of these students’ family members participate in the “Beyond Spice” Parents’ Weekend, an opportunity to showcase the True Blue campus facilities and the Island.  Family members from as far off as Ireland, the United States, and Canada were invited to informative and culturally entertaining events, such as: campus and Island tours, an orientation cruise, student and faculty presentations, question and answer sessions.  All were designed to enhance their comfort level and familiarity with the University.  The success of the previous two Parents’ Weekends reinforces the innate value of such an event.  The faculty and staff at St. George’s University plan to incorporate this endeavor into future White Coat Ceremony events.

Gold Humanism Honor Society (GHHS) Induction

The White Coat Ceremony also welcomed the 2008 inductees into SGUSOM’s Chapter of the Gold Humanism Honor Society (GHHS).  Each year, a group of peer-nominated students who demonstrate humanistic characteristics during their time in medical school, including mentoring skills, community service, and observance of professional ethics, receive this award. Congratulations to the 2008 Inductees:

Kanchi Chadha
Christina Goette
Richard Gordon
Catherine Gribbin
Leslie Griffin
Colette Haywood
Robert Herring
Panagiota Korenis
Peter J. Lee
Louis Mazzella
Matthew Myatt
Purvi Parikh
Ruchi Parikh
Sara Safarzadeh Amiri
Carsten Stracke
Eric Thomas
Shunling Tsang
Michael Westerman

The Gold Humanism Honor Society (GHHS) was established in 2002 by the Arnold P. Gold Foundation to foster and acknowledge humanism among medical students. The GHHS has been established at 47 US medical schools and three international medical schools since its inception. St. George’s University became one of the three in 2005.

Read Dr. Hauser’s complete Keynote Address

School of Veterinary Medicine White Coat Ceremony 2009 Keynote Address

Keynote Speaker Dr. Gregory S. Hammer Helped Ring in the School of Veterinary Medicine’s 10th Anniversary Year.

Good afternoon.  It is my privilege to be here celebrating with you today.  I am Greg Hammer, and this past year I had the honor of being President of the American Veterinary Medical Association.  The AVMA represents more than 78,000 veterinarians working in private and corporate practice, government, industry, academic and the uniformed services.  The AVMA acts as the collective voice for its membership and for the profession to the public and government.  With every new member, our voice becomes stronger and more effective.

I’m glad to be here, this may be as close to paradise as I ever get.  I left 20-degree weather a couple of days ago to get here.  Delaware does not usually get that cold, so I’m glad to he here.  I practice in Delaware.  Our practice is about 70% small animal and 30% equine.  It is my hope that when you finish here, that whatever type of practice you enter, you have as much fun as I do.  Never lose the enthusiasm that you have right now.  Never lose that compassion for and desire to help those animals that we serve.

I want to first of all, congratulate you and your parents.  You are among the select few that have joined the greatest profession on earth.  I look forward to the day that you will be my colleagues.  That day will be here sooner than you think.

I think these types of speeches are supposed to be filled and with advice…so the next paragraph or two are my words of wisdom:

All of you are type “A” personalities and extremely competitive.  That is how you got here.  Each and every one of you had to compete against many others for the seat you now occupy in your class.  Well, you made it into veterinary school and it’s time to stop competing against each other.  It’s now time to start challenging yourself to become the best doctor you can be.  Take advantage and soak up every bit of information that you can.  When the information becomes tedious and overwhelming…remember you can do it.  Your clients, your patients will need you.  Remember your ultimate goal…DOCTOR!!!  Be the best, don’t settle for less.

In addition to challenging yourself, help your classmates.  This is your family for the next four years.  You will spend more time with them than anyone else.  Mentor each other.  I had the good fortune of being selected for the class of ‘73’ at Kansas State University.  We helped each other.  We learned from each other.  We pushed each other.  Get to know your classmates, help them through the next four years and they will help you.  Tell them how much you appreciate their help.  You will grow closer to some of your classmates.  They will be life long friends.  Be sure you let them know before you graduate, because unfortunately some you will never see again.   Again this is your academic family-help each other and you will all benefit.

I want to turn the page a little now, and ask you to do something for your chosen profession in the future.  You will be Doctors of Veterinary Medicine in less than four years.  With that title and respect, comes a great deal of responsibility.  No matter what type of practice you enter, or where you go, you will be a respected member of your community.  You must advocate on behalf of your profession and the animals we serve.  The public and government rely on us to educate them on animal well being and public health.  If you don’t do it, others will and you may not like the results.  You can start now by joining and participating in your student AVMA.  You should have 100% membership.  The student AVMA is your voice to the profession.  We have many positions on AVMA councils and committees that are only open to students.  They don’t require that much time and are a good way to get involved in national veterinary medicine.  There are externships that are only open to first and second year students at AVMA headquarters and the Washington DC office.  Remember if you don’t get involved in shaping the future of veterinary medicine, someone will shape it for you.

The future of veterinary medicine is bright.  There has never been a better time to be a veterinarian.  The demand in all fields of veterinary medicine is high and the supply has never been lower.  We are at a crisis in our work force.  You will be asked to do more, but you will have the freedom to get involved in any facet of veterinary medicine.  Be sure and look beyond the traditional careers of veterinarians.  Your future is unlimited in public health, food safety and bio-security.  You are our future and I think we are in great hands.  Welcome to the greatest profession…Veterinary Medicine.

Brenda Stutsky Addresses Incoming Nursing Students

Keynote Speaker Brenda Stutsky’s Poignant Leadership Driven Address to Nursing Students

Distinguished guests, faculty, family, friends, and students:

I am so proud and honoured to be invited to speak at your Nursing Induction Ceremony. This is the day that you start writing the first page of your nursing story. Nursing has a rich history, and many stories have been told including those by Florence Nightingale, the founder of modern nursing, to Hiroko Minami, the current president of the International Council of Nurses, representing millions of nurses practicing in direct care, education, research, and leadership in our hospitals, clinics, nursing stations, schools, and homes, in urban, rural, and remote areas of more than 128 countries including Grenada. Many prominent leaders have guided our way, and today YOU begin to lead nursing into the future. You may be asking yourself right now, “How can I be a nursing leader when I am just starting?” James Kouzes and Barry Posner, researchers and authors of the “Leadership Challenge,” have identified five main practices of exemplary leadership based on asking thousands of individuals their best personal leadership stories. They found that when individuals are at their personal best they Model the Way, Inspire a Shared Vision, Challenge the Process, Enable Others to Act, and Encourage the Heart. I challenge you to start incorporating these leadership strategies into your nursing practice today, and if you do, I know you will be a nursing leader throughout your educational program and your nursing career.

Model the Way
Going first and setting an example, educating yourself, and doing what you say you will do, are examples of how you Model the Way. Just being here today, you are modeling the way for young women and men to follow in your footsteps and enter nursing. As you are ONLY the second class to begin your nursing education at St. George’s University, you will always be regarded as the ones who modeled the way. So make sure that during your time as a student at St. George’s, you share your stories of being a nursing student to your sisters, brothers, nieces, and nephews. Set an example for them, and let them know that with hard work and determination that anything is possible.

Inspire a Shared Vision
To inspire a shared vision, you begin by imagining what could be, by dreaming, and creating something no one else has created. As students in a new nursing program, you are in an ideal position to establish a vision for your student body and this nursing program. Maybe your collective vision for this program is to be internationally recognized for producing extraordinary nursing graduates who are able to provide exemplary patient care not only here in Grenada, but around the world. I want my colleagues in Canada to know about you! Many know about your Medical program, but they don’t know you have started a Nursing program. How are YOU as a student body going to become internationally recognized? Start with small steps. I think one of the first things you have to do is to let the international nursing student community know that you exist. MAYBE you do that by starting your own student body Web site or wiki where you share your own knowledge and stories with each other. MAYBE you will then ask nursing students in neighbouring Carribean countries to join in. MAYBE your student body president then attends a nursing conference in the Unites States, England, Africa, or Canada, and shares your concept of an online community of learning for nursing students in the Carribean. Nurses in other countries love the idea and join your online community sharing their own expertise, knowledge, and stories. However you decide to inspire a shared vision, start small, but dream big, and follow that dream.

Challenge the Process
Kouzes and Posner say you must always ask, “Why are we doing it this way?” Since you will be one of the first students to complete the newly established courses, your faculty will rely on you to provide constructive feedback that will continually shape the nursing curriculum. Your clinical practice as students here in Grenada and other countries will challenge not only YOUR own nursing skills and knowledge, but it will be expected that YOU WILL CHALLENGE and question policies, procedures, and practices based on current evidence based knowledge, and not just accept “sacred cows” which are nursing practices that have gone on for years – just because – these sacred cows are not based on current evidence, and they may not necessarily be the best and safest practice for quality patient care. Leaders take risks, and although risks can sometimes result in failure, we learn from our mistakes and continue to challenge the process.

Enable Others to Act
Kouzes and Posner equate leadership with team effort. They also said that it is very easy to identify a true leader, and that is by how many times a leader says “We” as opposed to “I.” It is impossible to provide quality patient care without working as a team, for each healthcare professional and discipline adds their piece to the complex puzzle. Learn about your role as a nurse and how you can support your healthcare team, and in return, you will get the support that you need.

Encourage the Heart
Encouraging the Hearts of your fellow nursing students is extremely important. This is going to be a very demanding time in your lives, and you will need to make sacrifices to be successful. It is without question that you will need the support of your family whether near or far, I know, as I have had the support of my mom for many years, and she is here today, but you also need the support of your fellow students. Providing positive feedback and ongoing encouragement to your fellow nursing students is crucial, as there will be many fun and wonderful stories that you will be able to tell for years to come, but there will also be tough and challenging times, and you will need that “pat on the back” or that shoulder to cry on from someone who can really understand what you are going through. I must tell you that today in my role as a doctoral student, I have a support group that consists of fellow students from Alaska, Minnesota, Missouri, Texas, and yes, Grenada. I must tell you, that your faculty ALSO needs an encouraging word along the way, so don’t forget to tell them when they did a great job when they helped you understand a difficult concept, or helped you get through a challenging clinical day.

I asked nurse educators who are participating in my dissertation research if they had any advice for you, and one educator from British Columbia, Canada, said, “Never stop asking questions.” One educator from Manitoba, Canada, said, “When I graduated from nursing school, two former graduates from the year ahead of us came back to tell us “what it was really like out there.” One of them, a male, said something that I still remember today “Accept the compliments and gratitude from your patients… it is what will keep you coming back”

In closing, I wish to show you the front page of the Winnipeg Free Press newspaper from Wednesday morning that shows Barak Obama as he became the 44th president of the Unites States, and the first African-American president in history. The headline reads, “A Dream fulfilled!” You have much in common with the new president, you both have a dream that is coming true, you are both leaders.

Medicine’s Delicate Balance of Compassion and Science

Dr. Joshua Hauser’s Inspiring White Coat Ceremony Keynote on Medicine’s Delicate Balance of Compassion and Science.

Thank you for having me. To Cheryl McPherspon who invited me and to many others here who helped with arranging things, thank you for welcoming my family and me so warmly. It is a treat for me to have my wife, Juliet and two children, Jonathan and Emily, here listening to me today. Whether it is a treat for them….we’ll see.

To the medical students assembled today, congratulations on being here. You have chosen a profession that is endlessly fascinating, occasionally frustrating and always fulfilling.

To the families of the medical students, you have much to be proud of and you have much to offer your children in the coming months and years and decades: the experience and wisdom of parenthood and the stability of having known each other for decades.

To those of you who are the spouses and boyfriends and girlfriends and friends of any sort to the medical students, some here, many I imagine not, you also have important things to offer: you will be companions during the latest of nights and earliest of mornings and during the many joyous and sad times. Your support will mean more than you can know.

This is not an abstraction: I say these things as a son and a husband more grateful than I can ever say to my own wife and parents and now my own children.

I would be remiss in not noticing that this is a little bit of a challenging time to give a speech of any sort: on Monday, at a Martin Luther King Day celebration in Chicago, I heard excerpts of some of Dr. King’s speeches; the next day, I and I’m sure many others in this room heard the inspiring inaugural address of President Barack Obama. President Obama’s address was followed by a benediction from Reverend Joseph Lowery who marched with Martin Luther King and whose quiet passion moved many of us to tears. Whether you are a Democrat or Republican, from the United States or Grenada or another country, this is a time of great challenge, change and hope in our world.

I mention this not to make this talk into a political address, but to reveal a little of my own anxiety at giving it at this time and to plant in all of our minds the importance of the social and political context in which we find ourselves. More on that later.

Finally, as someone who never went through a white coat ceremony myself, I must confess to feeling a little like a pretender here today.

I am, however, someone who has worn a lot of white coats and still does. Each of these has certain associations for me – the one I wore as a medical student whose pockets sagged under the weight of the books and instruments and was always too clean and a little too white; the one I wore as an intern and resident whose pockets bulged with endless to do lists (not always completed) and which never did seem to get very clean or white enough; the longer one I wear now as a palliative care physician with more than a few stains from the Chicago slush kicked up on the four block walk between my office and the hospital.

I still have some of those early white coats in my closet. During my time in medical school, we got one official one at the start of first year (not in a ceremony, but in a bag) and then it was a little bit of a friendly competition between us to see how many we could get from the different hospitals we rotated through. We were supposed to return these at the end of each rotation and we rarely did: given our tuition costs, I calculated that we were actually paying 10s of thousands of dollars for each of them and that lessened my guilt over taking them.

One of these coats from my days as a medical student recently had a second life on the shoulders of my son, Jonathan, who wore it for a play. He wore it not as a doctor but as a mad scientist – a use that might have surprised the original owners of the coat at Mass. General Hospital but made the current owner, me, very proud.

As I was preparing this address, I did a few things.

First, I tried to think back to my medical school admissions essay: that must have had something about my hopes as a future physician; that could help put me in the shoes of those of you here today. Unfortunately, when your filing system consists mostly horizontal piles and cardboard boxes, as mine does (my wife is smiling broadly right now), finding such a thing is a bit of a challenge. No worries, I thought, there must be an electronic copy….there no doubt is, locked on something called a three and half inch floppy disk that we used to insert into the original Macintosh computers that came out just as some of you were entering not your pre-med years, but your pre-school years. And some of you had not entered any years at all. For those of you who are curious about these computers or like me, nostalgic about them, they can often be found on eBay, reconfigured as fish tanks or planters.

But here’s what I imagine I wrote about and here’s what I imagine many of you wrote about: wanting to be caring and compassionate and wanting to combine a love of science and a love of people. Those are noble values for all of us and I mention them not to diminish them, but to celebrate them.

I want to use my time here today to project ahead with you past your years in medical school and in residency and think together about the values and the habits that I hope will sustain you as they have me in this profession. This is important because while it might seem like a long seven or eight of nine years of medical school and residency, it is actually a relatively small percentage of the 30 or 40 or 50 or more that you will spend as a physician.

The second thing I did as I started preparing this address was look at how others have thought about the white coat ceremony. This is a habit that I have developed over the years (and one that you will soon develop if you have not already): whenever I have a new project or a new talk or a new paper to write: Look in the literature: Go to Medline, go to Google, go to your own piles of papers and see what others have had to say: it will help frame your own thoughts, it will give you perspective and, of course, it can be a great procrastination technique.

This second activity had a curious parallel to my first activity of trying to find my med school essay. In the same way that I could not find that essay, I could not find much that resonated with me in some of the published literature about the white coat ceremony.

Here’s what one commentator said. You will see in a moment why I do not identify him.

“The short white coat can be a highly useful tool allowing patients to identify practitioners in a liminal state. However, by officially sanctioning the white coat as a sign of the psychological contract of professionalism and empathy, the medical establishment may be responding to abrogations of its own authority and is teaching students that they are respected for their sartorial behavior separate from their behavior as individuals.

Conclusion: The White Coat Ceremony fosters a sense of entitlement whereby authority based on title and uniform, and authority based on trust, are poorly distinguished.”

“Authority?” “Liminal state” “Entitlement” “Abrogation” “Sartorial behavior”

It all sounded a little abstract to me: more like an undergraduate philosophy class than something relevant to medical students and physicians. And that part about “sartorial behavior” sounded like it had something to do with a tuxedo or a ball-gown. Perhaps something from an inaugural ball.

So I turned to another source, Robert Veatch, whom I know comes to St. George’s to teach ethics. Dr. Veatch is as impressive a thinker and writer as there is in bioethics and he is not someone who shies away from controversy. He wrote one of the first textbooks of medical ethics I ever read.

Here’s what Dr. Veatch wrote:

“The white coat ceremony may be an impressive ritual for the beginning of medical school. It may add an ominous drama to the first days of a student’s new career. In the process, however, the ceremony raises serious ethical questions. It is doubtful that any code recitation has any legitimate meaning when that code is imposed on a group of students too new to their profession to understand its meaning or even whether its content is controversial. It is doubtful that any code recitation is legitimate if the vast majority of students, when they are better informed and have had more time to think, would really prefer some other commitments. It is doubtful that a “bonding process” is tolerable if its real function is symbolically to remove students from the culture from which they have come.”

Well, no more “liminal states” or “abrogation,” but Dr. Veatch’s words gave me certain pause and I want to tell you why.

First, I hope that this day isn’t too ominous for most of you. I imagine it might be daunting, but I hope it’s not ominous.

Second, I commend Cheryl and others here for having a ceremony that “raises serious ethical questions,” especially when these come from an esteemed visiting professor such as Dr. Veatch: raising questions is one of the ways we all learn and one of the ways we all do better, whether as ethicists or physicians or both. And besides, I bet Dr. Veatch was being a little hyperbolic in his prose.

Third, and most importantly from my perspective, I also hope that this white coat is not representative of an attempt by St. George’s or medicine as a profession to “symbolically” “remove” you from your own culture. The best experiences of medicine for each of you will be when you are able to combine aspects of the “culture of medicine”, however defined, with aspects of your own cultural backgrounds. As a physician with two feet in the culture of medicine, I also have those same two feet planted in a cultural background that pre-dates my becoming a physician. You may want to ask my wife or friends, but I don’t think medicine has removed me from the culture from which I have come.

The third and last thing I did after turning (unsuccessfully) to my medical school essay and some of the literature on the white coat ceremony was ask some people closer to this experience than I am right now. I asked a group of third year students about what the speaker at their white coat ceremony spoke about two years earlier. And what they would recommend for me. There was some hesitation since they couldn’t quite remember at first (not a good sign I thought) and then one of them said: “Progeria.” And the others nodded and smiled. A few even rolled their eyes. Ah…premature aging, I thought, that actually did have a devious kind of relevance…

“So I should talk about a disease?” I asked.

This time there was no hesitation: “No.”

For those of you who came hoping to hear about a disease, whether progeria or any other illness, you have your Northwestern colleagues to thank (or blame).

So, no diseases, relatively few bioethical concepts, and a respectful disagreement with Dr. Veatch about the white coat ceremony removing you from the cultures from which you have come.

What I do want to talk about is my experience of the symbolism of this white coat. As I do this, my larger goal is to help all of you project 10 and 20 and even more years into the future to see what will sustain you in this profession.

I will take as a foundational element of medicine and becoming a physician that caring and compassion and science are all a part of why we are here today.

You will find that the subjects of your caring and compassion will change: sometimes patients, sometimes patient’s families, sometimes colleagues and friends and your own families.

You will also find that the underside of caring and compassion will sometimes be just below the surface: you will have moments of anger and frustration and fatigue at all of those groups of people. That’s OK, as long as you have a technique to deal with these moments. I will not suggest any today, but I ask you to recognize that these moments will happen; and when they do, seek the wisdom and the shoulders of friends and mentors. Remember what I said in the beginning about families and spouses and friends? These times and feelings are expected and will only fester if you do not find ways to share them.

The subjects of your science will change too: whether by organ system or by year of schooling. Make science a refuge when caring and compassion seem too hard and too taxing. But don’t let it replace caring and compassion. Make compassion and caring a haven when the science gets to be too overwhelming and the nerves in the brachial plexus start to blur and you eyelids start to fall. But don’t let compassion and caring replace the science.

When I was in medical school and got sick of pathophysiology or anatomy, I tried to read something in ethics or politics or something that seemed more about the “caring” side of things. Or I just hung out with friends – that’s a form of caring (and being cared for). When I was tired of hanging out or when the ethics reminded me too much of a strange high-school philosophy teacher I once had, I opened that pathophys book again.

Let me use another example to define what I mean:

I am a palliative care physician and an internist and my clinical work focuses on quality of life, symptom control and support for patients with serious illnesses and their families. Many of the patients whom I care for are dying and they and their families are facing hard choices and harder days. One of the things that I love about palliative care is that there are often very specific medical things to do and think about – what is causing this patient’s shortness of breath? What opioids am I going to use to treat this type of pain? And there are also opportunities to help patients and families deal with something that I sometimes call “the big picture.” The big picture is a little bit of a colloquialism but here are examples of it:

What does this illness mean?
What am I going to do now that my husband is dying?
How am I going to decide whether to continue the ventilator?

These types of questions require a lot of caring and compassion from each of us as physicians, nurses and every type of health care professional. Sometimes, though, it is equally important to focus on the biomedical and more concrete question of the physical pain that a patient is experiencing. Indeed, as others have observed and I have witnessed, all the talk of meaning and faith and togetherness in the world doesn’t mean much if you are in intense physical pain.

In palliative care, symptom management is the science; helping patients and families cope with illness and dying is the caring and compassion part. For every patient and family and for every physician in palliative care and in any field, the best kind of care and caring will combine both of these instincts: the compassionate one and the scientific one. An exclusive focus on either will help neither patient not family nor physician.

Now, what do I want to add to this foundation of caring and compassion and science? What have been more recent values and habits that I have embraced? Here are five:

Curiosity
A Tolerance of uncertainty Humor
Passion
And Service

I’ll begin with curiosity

Practicing medicine is fundamentally about entering into other people’s lives. Sometimes it is through talking such as in a relationship with a psychiatrist or an internist; sometimes it is literally entering into someone’s body in the case of a surgeon. Each of these requires skills that can take many years to master: what to ask and where to cut. Said in that way, it couldn’t sound more simple, but it’s not: how we ask, how we listen, how we react is everything and means the difference between connecting with a patient and perhaps a diagnostic clue and missing a diagnosis or a moment of connecting, just as for the surgeon, how and where and at what angle he or she cuts is the difference between a successful operation and a complication. All physicians, whether internist or surgeon, gynecologist or pediatrician, psychiatrist or emergency medicine physician, require motivation in the form of curiosity: a curiosity that motivates you to want to know about someone’s life to dig deeper into their situation or to perfect an operation.

The stories you will hear will amaze you, will surprise you, will sadden you and will inspire you. You will get to hear things about people that they have told no one else: things they are proud of, things they are ashamed of, things they wish they could change.

And you will be entrusted with a lot of secrets. Please treat these with the respect and dignity they deserve.

Why be curious? There are at least two reasons:

One, it can help you diagnose illness. This is most obviously true in the case of psychiatric illnesses, but it is also true for many medical illnesses. It still amazes me how often I find out things about patients’ relationships or spirituality that are mediating the pain that they are feeling. That helps me to help them with their pain. So, it can help patients to be curious.

Two, it can help you. The stories patients tell us teach us things about them, make us reflect about ourselves, make us laugh and make us wonder and keep us engaged in this work. And that helps sustain us. The 84 year old patient with COPD and pneumonia becomes much more engaging to you (and you to him) when you find out that he spent his early 20s on a Navy ship in the Pacific before coming back to the States to open up a barber shop. And what’s amazing is that this information does not require lots of digging through medical records, does not require many tests. It just requires the instinct of curiosity and the patience to listen.

Let me give you a more recent example from my own life as a physician: I recently saw a man in his 30s with Crohn’s disease and terrible abdominal pain who also struggled with depression and addiction. He was a patient who was suffering and one who angered a number of his physicians, including the one speaking you to you today. He angered us because he was demanding, because we couldn’t seem to help him, and because he was never satisfied with our attempts to be compassionate. We were not proud of our anger, but we recognized it.

Each morning we would dread going in the room and we’d be pissed off when we came out. One morning on rounds, I decided to take another tack and asked him about the tattoo on his neck – it looked familiar to me but I wasn’t sure why. He reminded me that it was the symbol of a 1980s punk band, Black Flag, that I used to listen to. He was a fan of them; in fact, he was a musician himself. And so we spent a few minutes talking about punk music. And all of a sudden we had something to talk about other than his pain. Did it cure his pain? No, but it did make it easier to talk to him; it helped us connect and it even brought back memories for me.

So, be curious: ask patients what they do for work, what they do for fun, what that tattoo means, what symbol dangling from their neck is all about. It actually doesn’t take a huge amount of time and it will make you a happier physician.

Let me move on to my second value: A tolerance for uncertainty

Being sick means dealing with many kinds of uncertainty: over diagnosis, over prognosis and over the fundamental question “Why has this happened?” If you think it will be hard not knowing the diagnosis or what to do as a student or a physician caring for a patient, try to take the next step and imagine how a patient will feel in this same situation.

You will need to join your patients in this uncertainty. You will spend years here and decades beyond here trying to be certain about as much as possible – and that is a good thing. But as carefully and thoroughly as you try to figure out what can be known, what is certain, there will always be things you will be uncertain of. Be there with and for your patients in this feeling. The uncertainty of many illnesses will not change even as diagnostic procedures and treatments improve; it is only the topics of our uncertainty that will change.

Patients don’t necessarily want all uncertainty to be erased, but they do want someone to be present with them in that uncertainty. If you cannot tolerate uncertainty, if not knowing exactly what is going on unnerves you, you will not be able to truly be with your patients and your colleagues.

My third value or habit: Embrace humor

Palliative care is not supposed to be funny. Neither are many other medical specialties. They are supposed to be serious and somber. So why can I turn on a TV and find shows like Scrubs, Grey’s Anatomy, House and find myself laughing? Think for a moment: How does a network decide a show will continue? It is a very basic calculation: if there is a market, it will happen. And so, people want to laugh about illness (or at least laugh at doctors). And who watches those shows? Medical students, of course, but you are vastly outnumbered by patients and families. And if they thought that being humorous about medicine was taboo, they would stop watching and the shows would stop airing.

It is precisely because of the awe and awesome-ness of illness and of the situations that we bear witness to that humor is so necessary. If you are open to humor, if you use it wisely with patients and colleagues and peers, it will help you. It may help you connect with a patient, it may help you connect with a colleague, it may help you have a better day – and that is worth a lot.

What do I mean?

Several months ago, I was caring for a man who was dying from heart failure. I met him in the last days of his life on our palliative care unit after his family had decided to withdraw the ventilator that was sustaining him. On morning rounds with our palliative car team, we visited him and his family at the bedside. He was an African American man in his 80s and although he was unresponsive, he looked peaceful and dignified in that bed. He was breathing slowly and his face was relaxed. He was large and muscular with gray hair around his temples and he had the look of someone whose heart failure had come on relatively suddenly: he was not as thin and wasted as many patients with chronic heart failure are.

I asked his family what he had done for work. They told me that he was a preacher at a Church on the South Side of Chicago. He had done that for decades and had many devoted congregants who had seen him in the hospital. We talked about this and his son who was there talked about how he would be taking over for him and the large shoes he would have to fill.

And then I happened to glance at his TV. He was in one of the new rooms on our unit with a huge 42” plasma TV on the wall. Does anyone here have any ideas what is on mid-morning TV in the city of Chicago? There, with the sound off, above the bed of this very dignified preacher, was that day’s episode of the Jerry Springer Show with the title in bold red letters across the bottom of the screen: “Midget madness” and two dwarves in shorts prancing around a makeshift wrestling ring. The combination of this incredibly dignified preacher and this incredibly exploitative TV show still makes me smile as it did that day. As we left the room, we all laughed as a team. Not in a disrespectful way, but a happy way – it was a moment of levity and strangeness in the face of the tremendous sadness of his dying. And I know that it was partly that glance at that show on TV that makes me remember that preacher.

So, don’t be afraid to find humor in the care you give.

Being curious, tolerating uncertainty and embracing humor will all help you respect one of the fundamental currencies of medicine: the stories of the patients and families you care for. These stories are what patients give to you. Your listening is what you give back to them. But don’t just listen: listen with curiosity, with a tolerance for the uncertainty of the situation and with an eye and an ear to humor. As you progress, add these habits to the caring and compassion that brought you here.

Let me end with two other qualities which have helped sustain me and I hope will sustain you: passion and service.

Simply put, have a passion

It can be for discovery, for taking care of patients, for teaching, for something else; just make sure it is yours and make sure you feel strongly about it.

What do I mean make sure it yours?

When I was medical student and spent some time as a pre-medical advisor, I met a student who wanted my help with his medical school application. He wasn’t sure what to write his essay about. So I said to him, “write about something you feel passionate about.” I remember this moment to this day even though it 20 years ago. I was sitting across from him in the dining hall and he paused and looked at me and he said: “What would that be?” I smiled and told him that if I were to tell him what it was, it would no longer be his.

Let me share something on this from my own life: I feel passionate about teaching. Being a better teacher to students and colleagues, to patients and families, drives me each day. I am not the only one with this passion and all of us will have a setting to realize this passion if we choose to. One of the gifts of being a physician is that you get to teach others all the time. Oh that’s just something for physicians who stay in academic medicine you might say. That is not the case: This is true for every physician almost every day of their lives. You will teach patients and families and peers and you will teach your professors. It is the rare professor who does not learn many things from the students whom he or she teaches. If teaching is your passion, indulge it fully and find ways to do it well.

Others of you may develop a passion for a type of research or for a type of procedure or for a population of patients. Some of you may already have. Nurture and sustain these passions and find opportunities to express them.

Finally, A commitment to service

I will end with service since it is very much on my mind during the US presidential transition. It verges on a cliché, but it is something that many of us feel deeply: Medicine is fundamentally the opportunity to serve patients.

But I want to use this opportunity of this white coat ceremony ask you to try to do something beyond the act of taking care of patients, teaching each other and even doing research that is an act of service. This needn’t be big, this needn’t be time-consuming, but I urge you to make it something.

Let me give you two examples from my own life to illustrate what I mean.

When I was a primary care physician, every election season I would ask my patients if they were planning to vote and urge them to do so if they were not. I would say “I don’t care who you vote for, but I care that you vote.” We would both smile knowing that was not completely true: I did care who they voted for, but it was also none of my business. If I got one person to vote who wasn’t planning to, I liked to think I did my job in this domain. Involvement in the political process is a form of service. It can take many forms. Asking your patients to vote is easy, free and doesn’t take much time.

Tere are of course, myriad other ways that you can devote time or money to the political process in every town and state and country in the world. Consider finding one of these that fits with your values.

There is also very direct service you can provide as a physician. This can be in underserved communities, this can involve seeing patients, helping raise money, serving food or being a companion. For more than a decade, I have worked one or two evenings a month at homeless clinics in Boston and Chicago. I see patients there whose strength inspires me; whose suffering moves me and sometimes, whose behavior angers me. Luckily, this last category is a small one. Mostly, this activity allows me to help patients with very basic things: a cough, high blood pressure, a pain in their back or an ache in their neck. Or the need to be heard: To have someone listen to their story, ask a question or two and, once in a while, give advice or validation.

Each of us has been given an incredible and rare gift to be a physician. And for me this is one form of giving back to others.

This is just one example of service: there are many others in many settings with many different types of people and patients. I told my patients that I didn’t care who they voted for when I asked them to vote and I confessed to you that I wasn’t being completely honest with them. But I will be completely straight with you when I urge you to involve yourself in some kind of community service, large or small, medical or non-medical, directly with patients or not.

You may not feel you have time at every stage of your career and you may not, but you always have time to develop the habit in yourselves to ask: “What ways, beyond my immediate school tasks, beyond my immediate job, am I helping to serve others?” It will sustain those around you and it will also sustain you.

I have tried to outline a set of values and habits that can build on the compassion and caring that brought you to this point: an abiding curiosity, a tolerance for uncertainty, an embrace of humor, a commitment to be passionate and a reflex to serve.

All of these will ebb and flow in your lives as students and physicians. Do not try to do everything at once, but do try to remember these characteristics in the work that you do over the next decades.

This coat that you are now wearing will give you opportunities to enter people’s lives, hear their stories, and help them in small and deep ways. As I said, I hope it represents more (and less) than the “ominous drama” that Dr. Veatch hypothesized. I hope instead that it is a reminder of the diverse ways that you will make a difference.

As you do this work of medicine, you will discover some number of patients and families, role models and mentors who will both inspire you and help keep you grounded. Savor and celebrate those people because they will remind you why you chose this profession and why you will go to work the next day. And turn, always, to your friends and peers and colleagues, because they will help balance you as they already have.

Good luck in your years here at St. George’s and good luck in the years and decades beyond, wherever they take you. And thank you again for inviting me here today and giving me the very special opportunity to share some of my reflections on what makes this profession such a special calling.

Keith B. Taylor Global Scholars Program White Coat Ceremony Keynote

Dr. John Powell-Jackson’s Heartfelt Keynote Address to the Fifth Class of the Keith B. Taylor Global Scholars Program

Deputy Vice Chancellor Mahoney, Vice Provost Randall House, Lord Walton, Senior Faculty Members, Distinguished Guests, White Coat Students, Ladies and Gentlemen.

First I would like to thank Dr Martin Stransky for his kind words of introduction.

It is an honour and a privilege to address you today on what is an important and memorable occasion especially for the White Coat Students.  You are the 5th Class to enter the Keith B Taylor Global Scholars Basic Science Programme; this class numbers 104 students and you come from 21 countries.

The programme is a unique international collaboration between St George’s University School of Medicine and Northumbria University.  It is named after the late Keith Taylor who was Vice Chancellor of St George’s University from 1991 – 1998. Before that he was a Professor of Medicine at Stanford spending 30 years studying the way the body absorbs vitamin B12.  At St George’s he helped create a dynamic research centre, WINDREF and he was instrumental in transforming a fine Medical School into an International University.  He would have enjoyed this occasion and you would have enjoyed meeting this wise and kind physician whose name will always be associated with International Medical Education, a subject close to his heart.  On his behalf I would like to congratulate all the White Coat Students for reaching this important milestone in your careers.

Now, I want to tell you the stories of two of my medical heroes.  One is an Australian, the other a Canadian.  The first illustrates the role that science and a little luck plays in medical discoveries and the second the way in which the practice of medicine is an art.  I hope they inspire you as much as they have inspired me.

Let me set the scene.  Peptic ulcers, gastric and duodenal ulcers were rare until the start of the 20th century when they became ever more frequent, affecting up to 1 in 10 of adults.  The popular belief was that they were related to an excess of acid production in the stomach brought on by stress, faulty diet, and genetic factors but the cause was unknown.  Treatment, in my day as a medical student, was bed rest, antacids and sometimes referral to surgeons for partial gastrectomy.  Ulcers tended to occur in middle life when people were at their most productive so there was an economic impact nationally as well as individual suffering.  In the 1970s drugs were introduced that reduced acid secretion in the stomach and allowed ulcers to heal.  But when the drugs were stopped the ulcers came back.

Along comes Barry Marshall.

Barry Marshall was born in Western Australia in 1951 and after graduating from medical school in Perth became a junior doctor in gastroenterology in the early 1980s.  He wanted an interesting research project and came into contact with a colleague Robin Warren who as a pathologist had observed small curved bacteria in stomach biopsies taken from patients with acute gastritis.  Neither knew the significance of these findings.

Then, quite by accident, one of the patients whose stomach biopsy had contained the unidentified bacteria reported that following a course of antibiotics for a chest infection, his indigestion had improved.  Barry Marshall promptly performed an endoscopy to inspect the stomach wall and found the bacteria had disappeared.

Since the patients’ symptoms and the bacteria in the stomach had vanished after antibiotics, he drew the obvious conclusion that the organisms might have been the cause of those symptoms.

This revelation sparked a flurry of excitement and activity.  Over the next 12 weeks Dr Marshall performed gastroscopies on many more patients and found a high prevalence of bacterial infections in those with gastritis and in every single patient with peptic ulcer.

The next step was to grow the organism on a culture dish but this proved surprisingly difficult.  Usually cultures are incubated for 48 hours after inoculation but nothing grew.  The 35th attempt was interrupted by an Easter break and unintentionally the dishes were incubated for an extra three days.  When the microbiologists returned from their vacation the culture plates were studded with small colonies of helicobacter.

It is at this point, in the summer of 1984, that Barry Marshall became a real hero.  He had to prove or disprove the idea that bacteria found in association with an illness were actually the cause of that illness.  In the great tradition of self experimentation he swallowed a cocktail containing large numbers of organisms which had been obtained from the stomach of a man suffering from indigestion.  Within a week he developed abdominal discomfort, vomiting, dyspepsia and to his wife’s and his friends dismay severe halitosis.  His breath smelt putrid.   A colleague found his stomach lining red and inflamed and a biopsy showed inflammatory cells with bacteria adhering to the surface.  After taking a course of antibiotics his symptoms quickly resolved.

Case proven you may think.

The initial reaction of doctors worldwide was utter disbelief.  Why had this connection never been made before?  Pathologists must have seen bacteria in stomach biopsies but ignored them because the prevailing wisdom suggested organisms could not survive in an acid environment.  Marshall had proved them wrong.  He stuck to his guns, absorbed all the criticism convinced that he was right.

It was another 10 years before this research was adopted into mainstream medical practice.  Nowadays gastroenterologists routinely look for helicobacter and cure peptic ulcers with antibiotics so that they don’t recur.  Gastric Surgeons rarely need to operate for ulcer disease and the outcome for patients has been transformed.

In 2005 Barry Marshall and Robin Warren were awarded the Nobel Prize for medicine for their work.

Here is an example of healthy scepticism and an inquiring mind plus an element of luck producing an important medical discovery.  Dr Marshall was able to think the unthinkable that peptic ulcers might be an infectious disease.  It raises the question that other diseases such as multiple sclerosis and ulcerative colitis may have a biological cause making them amenable to curative treatment.  Here are some opportunities for your generation.

I want to move on to my other hero, a Canadian by birth who became a Professor of medicine at the early age of 25 and spent most of his working life in the USA and England.  He wrote a textbook of medicine single handed and was the outstanding physician in his day and generation.  His influence was irresistible partly due to his intellectual gifts but also the magnetic charm of his personality.

His name was William Osler.

As a boy he thought of going into the church following his father but his love of natural history and science led him to medicine.  For this he was well fitted having a sympathetic nature, a genius for friendship and capacity for teaching and organisation.  He went to a private medical school in Toronto thence to McGill University in Montreal where he qualified.  After postgraduate studies in Europe he returned to McGill where he became Professor of medicine.  From McGill he went to Philadelphia and six years later founded, with others, a new medical school in Baltimore, The Johns Hopkins which he soon made famous.  In 1905 he was invited to become the Regius professor of medicine at Oxford, a post which he held until his death during the Spanish influenza pandemic in 1919.

What were his contributions and why was he so revered?

He made some interesting observations on some rare diseases that you will all learn about in the next few years.  These facts do not explain his unique influence.  Of greater importance were his insistence that medical students learn at the bedside and young doctors live in the hospital as interns and residents.  He started up formal journal clubs, loved books and libraries and advocated that learning should be life long.

However his outstanding characteristic was his humanity.  There is a well known story of him giving his cloak to a beggar one night who in return bequeathed his liver, rendered cirrhotic by alcohol, to his good friend William Osler.  His home was known as “The Open Arms” and his hospitality was boundless.
Incidentally Lord Walton was recently the Warden of that home at 13 Norham Gardens in Oxford and visitors are welcome to view the library and memorabilia.

Nothing pleased him more that teaching students such was his enthusiasm, knowledge of his subject and sense of obligation.  He said farewell to his students and colleagues in Philadelphia with these pearls of wisdom, which are equally relevant today.

“In the physician or surgeon no quality takes rank with imperturbability.  Imperturbability means coolness and presence of mind under all circumstances, calmness amid the storm, clearness of judgment in moments of grave peril, immobility, impassiveness.  It is the quality which is most appreciated by the public though often misunderstood by them; and the physician who has the misfortune to be without it, who betrays indecision and worry and who is flustered in ordinary emergencies loses rapidly the confidence of his patients.”

Osler goes on to say “as imperturbability is largely a bodily endowment I regret to say that there are those among you, owing to congenital defects who may never be able to acquire it.  Education however will do much and with practice and experience the majority of you will attain a fair measure”.

“Secondly there is a mental equivalent, equanimity or evenness of mind which is as important as the bodily endowment.  You cannot hope to escape entirely from the cares and anxieties of professional life.  Stand up bravely even against the worst.”  In other words keep a steady temperament, avoid getting over excited or too despondent when things go wrong.

William Osler certainly possessed the gift of equanimity such that he bore success with humility, the affection of his friends without pride and when the day of sorrow and grief came with the loss of his only son in World War One he met it with courage.

I wish you all well on the journey which is just beginning.  It will be exciting and fulfilling and I would relish the opportunity to join you.  Remember that universities are not places just for acquiring knowledge; they are for learning how to think and reason.  The friends you make at medical school over the next 4 years will endure for life.

I will leave you with a final quote from Osler.  “My belief (is) that the real work of life is done before the 40th year and that after the 60th year it would be best for the world and best for themselves if men rested from their labours”.

I will take his advice and do just that.

Thank you for your attention and good luck to you all.

Dr. Judith Balcerski Congratulates Inaugural Nursing Class

Keynote speaker Dr. Judith Balcerski, a registered nurse who served as Dean of the Barry University School of Nursing for 33 years, congratulated the “brave and privileged individuals” of SGU’s first nursing class.  

My greetings to the dignitaries, administrators, and faculty members.  Special greetings to the parents, family, friends, and especially nursing students.

Congratulations on being the first nursing class at St. George’s University.  You are both brave and privileged to be here beginning your nursing education! You are entering nursing in the company of many outstanding women and men:
The Knights Templar ministering on the battlefields;
Catherine of Sienna, one of the first nurses of the 12th century, the patroness of nursing;
Clara Barton, the creator of the Red Cross;
Florence Nightingale who led her colleagues in a sit-down strike to improve the care of soldiers;
Mother Teresa, Nobel peace winning nurse;
women and men who rode horseback into battlefields and who served in field hospitals;
women and men who conduct nursing research to dispel myths and extend lives;
women and men who deliver and care for infants;
and women and men who sit with the person who is dying.
These heroic nurses brought nursing to where it is today.

One definition of nursing is that it’s a Science and an Art.  I am going to add that it is also Sense and Heart.  Science, Art, Sense, Heart.

The science part is clear because you will be caring for persons with bodies and minds.  Nursing care is based on evidence rather than myth.  You will learn the evidence of science in your anatomy, physiology, chemistry, microbiology, sociology, and psychology courses.  You will also study nursing science and read nursing research.  When you practice nursing according to evidence based science and research, rather than myth, you will be successful.  Nursing is a science.

Nursing is an art because you will be caring for people.  No two individual’s responses to illness are alike. While you must learn procedures in your nursing courses, frequently you will have to be creative in how you design nursing care for each individual.  Your patient may not eat.  Be creative.  Your patient may not sleep.  Be creative.  Your patient may refuse a treatment because of fear.  Be creative.  How will you learn to be creative?  Painting, sculpture, jazz, and poetry are creative accomplishments.  Studying art, music, and literature in your required courses helps you to learn to be creative.  You will then be more able to propose creative solutions to confounding nursing problems.  Nursing is an art, a creative art.

To Science and Art I add Sense.  Good sense will benefit your patient and yourself.  When you make a mistake, (because we all have and you will), good sense will give you courage to tell your instructor or the Sister immediately, so that a remedy can be taken and harm prevented.  When your patient suggests there is a better way to do a procedure, good sense will support you as you consider the suggestion seriously.  Good sense will sustain you when you are tired or frustrated and need to step away for a few minutes to take a deep breath to refresh yourself.  When you are corrected by a supervisor, instructor, or physician (and you will be) good sense will permit you to listen to their concern with an open attitude.  Nursing is sense, good sense.
To Science, Art, and Sense, I add one more attribute: Heart.  Heart is why you came to nursing.  You already have heart for persons who are ill.  You want to help them get well, or have less pain, or sleep more restfully, or have a peaceful passing when a cure is impossible.  Heart is the feeling at the end of every day, that you have contributed something very important to someone’s life.  Heart is what presses you to care for someone different from yourself: of another culture, skin color, intellectual capacity, or social level; to care for a criminal and the queen equally.  Heart supports you to care for persons who are impatient, rude, unclean, or manipulative because they are ill and need your care.  Heart compels you to care for an elder woman with Alzheimer’s as if she is your grandmother, a drug addict as your brother, an infant with Down’s syndrome as your child.  Nursing is Heart.

Finally, remember these four:  nursing is Science, Art, Sense, and Heart. SASH.  Remember nursing as a sash, a mantle across your shoulders of science, art, sense, and heart.

If I could make an assignment it would be to require you to read the biographies of outstanding nurses.  Ask nurses you meet to tell you their heart experiences.  As strange as it may sound, read the obituaries of nurses recently passed in your own country. Search these stories for nursing heart.

Starting with this induction ceremony today, write your own stories.   Keep a diary of the heartfelt experiences you have during your journey in nursing education and nursing practice.  Your heart stories will fill your soul and spirit with a return immensely greater than a grade A on a paper, a promotion to a higher position, or even the gratitude bestowed on you by a patient.  It will make you profoundly proud to be a professional nurse.

Congratulations on this beginning, and may God speed you on your journey.