Gratitude is The Shortest-Lived Human Emotion

Do Your Part to Keep It Alive

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We should remember that none of us got to where we are today by our efforts alone.  Each of us had lots of help.  I think it’s  important for clinicians to recognize the roles of others in our success.  Recognizing how much others helped us makes us more sympathetic to our patients, many of whom are far less fortunate. It also makes us more enthusiastic about teaching and helping others with their careers.

I am going to use this blog to remember some folks who have helped me, but specifically, I am going to present the “rules” they taught me because they might be useful to you.

I had wonderful teachers in the Danvers, Massachusetts public school system. I still punctuate the way Mrs. O'Connell taught us in ninth grade English. 

The Rule - Support excellent public education.  Low socioeconomic status is a major risk factor for heart disease and poor health.  One of the best ways out of a low socioeconomic state is a good education for children in low-income families.

I spent my third year of medical school at the Maine Medical Center in Portland, Maine, which was a Tufts affiliate.  Paulding Phelps, MD, a rheumatologist there, had participated in the early studies of pseudogout when he was at the University of Pennsylvania.  I remember him on attending rounds speaking to a woman with cervical cancer and who was refusing probably curative surgery.  He asked her about her children and grandchildren.  Her delight in her family was obvious.  Dr. Phelps paused and said, “There are lots of people who will miss you if you do not have the surgery.” 

The Rule – Listening and kindness go a long way to improving medical care.

I was an internal medicine resident at Tufts.  Jerome Kassirer, MD, was our acting Chief of Medicine and would become the editor of the New England Journal of Medicine.  He was one of the smartest clinicians I have known, but he constantly asked questions that we residents thought everybody should know.  We came to appreciate that he was using us as his teacher.

The Rule – Don’t be ashamed to ask “dumb” questions.  It’s a great way to learn.  Asking “dumb” questions should be part of our medical culture.

I  finished my cardiology training at Stanford in the Stanford Heart Disease Prevention Program.  I worked with Bill Haskell, PhD, an exercise physiologist and epidemiologist.  Knowing Bill opened doors for me in exercise epidemiology.  I worked with Peter Wood, PhD, who was a lipid chemist and runner, and the first to report that HDL cholesterol levels were elevated in distance runners.  Peter’s teaching would lead to my National Institutes of Health (NIH) funded grants on lipid metabolism during exercise and the effect of statins on muscle and exercise performance.  Michael Stern, MD, was an endocrinologist in the program and had collected newspaper clippings of people who died jogging.  Kevin Duncan, a medical student from Kansas, and I  expanded that collection and published the results in JAMA in 1979.(1)  That manuscript was included on the September 16, 1979 front page of the New York Times because Jimmy Carter collapsed from heat exhaustion the day before during a road race.(2)  Overnight I went from being a cardiology fellow to an “expert” in the cardiac complications of exercise.  (You know the definition of an “expert”?  It’s a jerk from out of town with a slide presentation. joke.)

The Rules – Work with the best people because they make you better, and it’s better to be lucky than good.

I met Peter Herbert, MD, who would become the Chief of the Medical Staff at Yale, at my first job at Brown.  Peter was an NIH-trained lipid expert, and taught me almost everything I know about lipids and writing papers and grants.  When my 1979 JAMA paper was published, he noted that the first eight sentences of the introduction started with a prepositional phrase or a disclaimer.  I think his comment was, “That’s a very weak writing style.”  I cringe every time I start a sentence defensively, even now.  (Note that “even now” ended the sentence).  There were many other lessons from Peter, but these are two I remember best. 

Peter was proposed as the Chief of Medicine at Brown.  I was at that meeting where Peter replied, “You can find someone much better than I.”  Peter subsequently left because of issues with leadership.  I reminded him of that day and his statement, and he said, “There’s a corollary to that statement.  They can find someone better than you but they usually don’t.”  I subsequently never refused the chance to be in charge simply for my self-preservation. 

One more.  My first NIH competitive grant renewal was rejected.  I was upset because I thought it was an excellent application and my best work.  Peter said to me, “If you are easily discouraged you should plan to do something other than research.”   We later learned that an NIH reviewer had rejected the grant but had started a nearly identical project and had showed my grant to one of his assistants who called me for some details.  This reviewer was ultimately rebuked by the NIH for other transgressions.(3) The grant was ultimately funded.

The Rules –  Don’t start sentences with prepositional phrases; it’s weak.  They can hire someone better than you, but they usually don’t.  Don’t do research or write grants and papers if you are easily discouraged.   

I’ll finish with what is probably my best lesson.  I was recruited to Hartford Hospital by David Waters, MD, who told me I would replace him when he left.  But when he left he did not recommend me as Chief.  I pushed him for the reason.  He resisted, but finally said, “You’re not a good listener.”  I was furious, but later that night thought about his observation and decided he was right.  I then worked hard at listening and not rendering an opinion early in a conversation, even if I thought I knew the path.  I have thanked David multiple times for his constructive criticism.  I would later often start faculty meetings with the phrase, “OK, tell me what I need to know, but don’t want to hear.” 

The Rule –  Work at listening.  You learn more from listening than from speaking.  Be grateful for people who give you constructive feedback.  What you don’t want to hear is often what you need to hear.

Please think about the people who have helped you and thank them.  A kind word to someone who helped you might help them.  It reminds them and you about the enormous impact each of us has on other peoples’ lives.

1.     P D Thompson, M P Stern, P Williams, K Duncan, W L Haskell, P D Wood. Death during jogging or running. A study of 18 cases. JAMA. 1979 Sep 21;242(12):1265-7.  PMID: 480538

2.     https://www.nytimes.com/1979/09/16/archives/carter-exhausted-and-pale-drops-out-of-6mile-race-still-an.html (accessed September 19, 2024)

3.    https://www.nytimes.com/1987/07/18/us/cholesterol-researcher-is-censured-for-misrepresenting-data-in-article.html (accessed September 19, 2024)

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