Nov. 4, 2020
Dear Members of the Baylor College of Medicine Community,
I had the honor this week of participating in the White Coat Ceremony for Baylor’s new medical school class. This is a relatively new tradition, as traditions go, of close to 30 years. Students don their white coats for the first time, a symbolic entrance into the medical profession. Our pandemic version of the ceremony was largely virtual, engineered to be “COVID safe.” Although I prefer the pre-COVID face-to-face tactile version, it was still full of meaning. During the event, it struck me how important it is to maintain our traditions and milestones during these challenging times. It also caused me to slow down for a few moments of introspection and reflection.
If you have been reading these messages over the past three weeks, you will note a certain monotony. Europe and much of the U.S. are again experiencing major surges, in many cases surpassing the experience of earlier in the year. In a distinct shift, the growth seems to be disproportionately impacting smaller, rural communities in the U.S. In urban Houston and surrounding communities, our numbers continue to inch up. New daily case rates continue to rise slowly (last week averaging 643 per day, compared with 394 one month prior). Hospitalizations are rising as well, but more slowly. It feels like our community is a patient with a difficult to treat cancer – our scan this week shows the tumor is about the same size. We are grateful it is not growing quickly, but anxious and disappointed it is still there.
Returning to the White Coat Ceremony, although my message was directed to the new students, for me it has broader applicability to our College community.
My message:
"It is difficult for me to believe that it has been 35 years since my graduation from medical school. As I look out (at least virtually) at all of you, and reflect on the commitment you are making to our chosen profession – to use Dr. Klotman’s words – as you fully accept the weight of the white coat – I would like to reflect on two very specific years in my career that taught me much about what it means to be a physician.
My internship was in internal medicine and pediatrics – it was intensive. Two months caring for neutropenic oncology patients; a month in the neonatal intensive care unit, which included “sleeping” every third night on a cot in the middle of 3 dozen intubated preemies. ICU. CCU. I cared for a ton of sick people. I could draw fluid out of just about any body cavity, and could get a line into just about any major blood vessel. By the end of the year, I had learned a lot. My procedural skills vastly improved. I was confident. I finally felt like a doctor.
But that is not one of the two years I want to tell you about.
The following year, I left with my wife to volunteer as a general practitioner in rural Guatemala, based in a small, unsophisticated, poorly equipped hospital serving a few thousand people in the region. I was their healthcare, and did what needed to be done. Obstetrics, treatment of parasites, malaria and TB, suturing of machete wounds. I quickly learned my internship-induced confidence was badly misplaced. I was humbled by how little I was able to do. As an individual, I brought little value. This was my most important lesson. My real power came from those around me – from their broad diversity of knowledge, skills, informed opinion and frame of reference. My value came from, and was dependent upon, a team.
That year I learned my most important lesson, which I never forgot. Although I did have an opportunity for a later life refresher course. Which brings me to the second important year I want to tell you about: 2020.
You are entering the profession of medicine during a unique time. The pandemic will help to define your generation – it will leave an indelible mark on your professional psyche.
As our weeks of disruption transition to months, I have struggled to come up with a good analogy for what physicians on the front lines are feeling. We have a lot of experience with hurricanes, but that does not quite describe this experience. Hurricanes strike, inflict their damage, move on and we rebuild. During that time, we run on adrenaline. We can rest later, when the danger is past. COVID-19 remains with us, disrupting our personal and professional lives. We know it will end, and hope it will end soon, but know it could go on for months and months.
How to describe the experience of our front-line providers? The best analogy I have heard comes from Dr. Shad Deering, Baylor’s Associate Dean of our faculty based at Children’s Hospital of San Antonio. Dr. Deering, who has a military background, says this feels like a military deployment. When you are deployed, you are suddenly in a new environment. You are at a heightened state of arousal and vigilance as you struggle to understand where you are and how to stay safe. You run on adrenaline. You are never completely at ease. You experience things others never will. Over time, it begins to grind you down.
Excited about your new profession yet?
Take heart. Even on difficult deployments, people build resiliency. According to Dr. Deering, this grit come from the knowledge you are serving a higher purpose, and you derive strength from the loyalty and commitment of your team.
In donning your white coat today, you are committing to serving a higher purpose.
Loyalty and commitment of team? Here is what front-line Baylor faculty said following the height of our hospital crisis:
“Everyone was committed.”
“We had a shared spirit.”
“I was proud of our new faculty. They were fearless.”
“We really rose to support each other.”
There is an old story of an introductory lecture to first year law students. Supposedly, an intimidating dean looked at the new students and said: "Look to your left, look to your right. One of you won't be here next year."
I have something different to say. Look to your left, look to your right. Look behind you, and look in front of you. These are your colleagues. You will rely on them, and they will rely on you.
That is the lesson I learned almost 35 years ago, and was blessed to relearn this year.
I am very pleased to welcome you to our profession."
Clearly, our strength and resilience come from the talented and committed people around us. There are many. Front line clinicians whose contribution is obvious. Clinicians across the organization who keep our affiliates operating – institutions always critical, but now indispensable to the community. The Baylor Medicine practice, which in the midst of a global pandemic, managed to increase clinical volumes and improve patient satisfaction. Baylor’s already highly productive researchers who became even more productive in the past several months, and many of whom have added significantly to our fundamental understanding of the pandemic. Our learners, who are engaged in a novel and evolving educational experience, which they did not expect, but have embraced. Our educators, who made this experience a great one. Administrative staff, supply chain, IT, HR, legal, security, support staff all of whom embraced the challenges posed by doing their jobs – and doing them well – in this new environment.
So we await our next scan. Will our shared societal tumor continue to be relatively stable or begin to spread more rapidly? Honestly, I do not believe we will escape a significant winter surge. However, I suspect enough people in our community have embraced good viral control practices that we will not return to our July peak levels. I wish I had a reliable crystal ball, but no one does.
Regardless of what the future brings – stability or return to crisis – I am confident the Baylor College of Medicine will do whatever is necessary to take care of our community, and each other.
Thank you all, and stay well.
James T. McDeavitt, M.D.
Senior Vice President and Dean of Clinical Affairs
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