 |
| High School Graduation Picture at 17y/o (1964) |
 |
| Neonatal Fellowship Years at UCSD 29y/o |
 |
| My first and only marathon at 42 y/o |
 |
| 69 y/o |
 |
| My latest European cruise 77 y/o (Aug 2024) |
This is to announce and document my decision to retire at day’s end on September 30th 2024, from the Research Corporation of the University of Hawaii (RCUH).
There is no need to read further, except for those curious about a faculty member who has completed more than 47 years of service at JABSOM, UHM. Eighteen of those years were spent in part time employment, mostly supported through the RCUH.
It Was the Only Job I Ever Applied For: It was June 1977 – immediately after I completed my fellowship training - when I first started my tenure at JABSOM as an assistant professor in the Department of Pediatrics. I interviewed with the Department Chair, Dr Sherrell Hammer the prior summer at the old Children’s Hospital on Kuakini Street. I remember meeting Ken Robbins at the entrance who was a UCSD medical student performing a pediatric elective at the Children’s Hospital. I sensed his stature, and intelligence would take him a long way over time, and I was proven correct in this assessment.
The old hospital was housed in an aging, dilapidated building that leaked into the makeshift pediatric and neonatal intensive care unit (NICU) (AKA the Pediatric Pulmonary Center) when it rained. The remaining hospital and full hospital staff were very interesting and worthy of a full characterization, but I’ll leave that for another time.
Dr. Hammer’s office was set in a dreary, dimly lit dust filled room set awkwardly off to the side and difficult to locate. I was taken back when I entered as my eyes were drawn to the dense floor to ceiling drapes which hung heavily over the windows, and the very large curved and beautifully crafted wooden desk which encircled Dr. Hammer who greeted me kindly and respectfully. He was a pleasant fellow, dressed formally with his signature tie, and amiable to talk to. As an Adolescent Medicine specialist, he knew nothing of Neonatology and was just happy to see some young sucker from UCSD interested in accepting a heretofore contentious position in the department - after so many candidates had failed to make the grade or meet their own expectations for the position. In all, we had a cordial albeit brief meeting that was pleasant and singularly focused.
To be sure, the historical origins of Neonatology in Honolulu is very interesting and emblematic of a broader unwelcoming ecosystem, but I’ll also leave that for another day. This treatise is only meant to recount some of the oddly imprinted experiences in my otherwise progressively aging brain, meant more for entertainment than enlightenment.
I returned home happy to have my first – and only job I have every applied for – with a starting salary of $40,000. I was delighted that the process of employment was quick and for me, noncontentious. I was happy and honored that I was truly needed somewhere for my training and newly minted expertise.
The Early Years – The Best of the Worst: It was luck and timing that provided me the opportunity to assume the directorship of the Neonatology program within three months of my arrival. Both with the Hospital Director (Kapiolani Medical Center) and the JABSOM Division Director, I was handed on a silver platter the opportunity to fulfil my dream of developing from a rudimentary shell, an academic Neonatology program in a large metropolitan center. I was ecstatic! My tenure lasted more than 20 years, probably longer than it should have. During this time, we moved from the Kuakini address to Punahou Street (Kapiolani Medical Center), survived one revision and relocation of the NICU, rescued and advanced a fellowship program in partnership with Tripler Army Medical Center (which is still ongoing), became involved to some extent in all of the hospitals in the state that delivered babies including forming a strong relationship with Queen’s Medical Center where I positioned myself as the Contracted Director of that Nursery as well. We were also involved with the TAMC’s NICU on many levels, and even contributed intermittently to the Kaiser Permanente neonatal ICU program. In all, we cared for thousand among thousands of Hawaii born babies at both low and high risk and took part in state-of-the-art clinical trials that kept us on the forefront of medical care at a critical period when Neonatology and neonatal care was in its most formative stages of development.
Ostensibly the opportunity to unearth whatever unproven leadership potential I possessed, came not from any perception of my talents, but rather from the prevailing view that I was the best of the worst choices at the time to take the helm. This was a risky proposition for any institution to take but fortunately for me it represented an unmistakable opportunity for growth and ultimately represented the crowning glory of my career. That is, to become the Director or Division Head of any academic or clinical program usually takes years to decades of apprenticeship and even then, there is no guaranty. For me, I was just thrown into the lion’s den to survive on my own instincts and New York street smarts. I also always believed in my medical skills and the sixth sense that I possessed in the care of critically ill infants, who had no way of communicating their distress and symptoms to their caregivers.
Hard Work While Trying to Grow a Family: It was fun growing the neonatal program in Hawaii. Mushrooming our neonatology faculty to 12 full-time equivalents, acquiring the latest ventilators and monitors, participating in teaching, training of students, residents, fellows, and other MD’s, and in participation in national studies supported by industry and the National Institutes of Health. This full menu of activities took up more than a full-day of work. One morning at 3AM, my usual wake up time, as I was gathering my wits preparing myself for the drive to work from Kailua to Honolulu and Kapiolani Medical Center, I bumped into my daughter who passed me in the hallway of my home, nearly knocking me over was this body of an awkwardly growing adolescent. How did she grow up so fast? Where was I the last 12 years?
I don’t think I had a sound night of sleep for the full 30 years of my training and clinical practice. I was called when I was on-call, and I was called when I wasn’t on call. I worried nonstop for my aging parents in New York, my wife’s mother and aunts in North Carolina and increasingly so, the health and welfare of my children who demanded increasing independence as they mushroomed from preadolescence to feign adulthood. “I am the best driver” – my son would claim as he wrecked two cars with his testosterone laden driving. My daughter dabbled occasionally in some clandestine behavior that only my wife was able to uncover and respond to. Sleeping was not an easy or natural task. Too much was happening under my watch to ever feel comfortable sleeping soundly. Moreover, I worried about paying the mortgage and other bills including to Punahou School for both children, followed by Duke University, University College London and Middlebury College for my daughter and to Princeton University for my son.
During my 30 years of clinical practice, we were clueless regarding the limits of viability or how far we could/should go in saving the lives of one-to-two-pound babies. The survival, the long-term disability, the cost - all of this information was evolving in real time. New treatments such as exogenous surfactant and nitric oxide represented major breakthroughs in survival outcome for extremely premature infants and those more mature babies with pulmonary hypertension. Ventilators became sophisticated and complex, and approaches to feeding orally and intravenously vacillated greatly through unproven strategies overtime. Other treatment strategies that were appropriate for adults backfired when we attempted to simply miniaturize those treatments. There was no easy solution to caring for a prematurely born infant whose normal intrauterine nature, nurture and development was cut short by both understandable and inexplicable factors. These continue the plague the field of knowledge as to etiology of preterm birth. Nevertheless, these middle years (1977-2000) of my life and career were mostly work and duty, hardly any time for any personal avocations, but one that was thoroughly fulfilling and joyous. It was probably the best and happiest years of my life – I seldom if ever even wanted to take vacations.
I was meant to be a fireman! In the NICU, I would run around barking orders, doing procedures and focused on keeping track of each critically ill baby’s labs. I was running around putting out fires and I was good at it. Serious, decisive and self-assured, a mixture of many traits blended into my persona, and I was comfortable in my skin. I was never internally shaken by the moment in the ICU. That doesn’t mean that I was an angel, far from it but inside I was contained and composed, even if on the outside I resembled a beast. Nothing that can be learned but probably the only real talent I had in this life was in the ICU as a neonatal physician doing my best to save the lives of the most fragile and vulnerable of humans.
The Tripler Army Medical Center Department of Clinical Investigation (DCI): Perhaps the phase of my career that I was the most excited about research was during the 10+ year period when I was an active participant in laboratory research at DCI. Day and night, hours on-end were dedicated to performing pulmonary related research on neonatal piglets with other pediatric faculty members, undergraduate students, colleagues at TAMC, veterinarians, and laboratory technicians. I was fully emersed in this effort, while leading a diverse team of dedicated colleagues. I developed collaborations with researchers from other mainland universities and had some exciting manuscripts accepted to high impact journals. Truth be told, I was not much of a laboratory researcher. All my novel ideas were a day late, a dollar short. Someone else invariably beat me to the finish line. In fact, instead of aiming to conduct earth shattering research, I rather strove to do good enough work to get at least a few publications accepted to both Pediatric Research and the American Journal of Respiratory and Critical Care Medicine – and when this was accomplished, I was thrilled!
Nevertheless, this animal research became more burdensome when we decided to lengthen the experimental period of observation to 24 hours. Thus, someone needed to be in the laboratory over night for monitoring and to perform the frequent laboratory testing. The specter of working late at night in DCI turned out to be menacing, unsettling and even downright spooky. DCI at the time was housed in an old and outdated military psychiatric facility. The steel security doors of the patient rooms had small windows not only at eye level but also at floor level so hospital staff could check to see if any of the incarcerated patients were blocking the door when you entered or posed a threat to the medical staff. Who knows what went on in those days, what types of patients and types of pathology that was on display at the time. When it was my turn to spend the night, I would become increasingly anxious as the evening progressed from the twilight hours into the hollow darkness of midnight and the ensuing early morning hours. I was constantly on guard for any noises or movements from the nearby rooms and surroundings. My imagination unleashed some fearful hallucinations as my fatigue progressively robbed me of my composure and rational thinking. Overdosing on coffee and caffeine only contributed further to this paranoia and fearful anxiety of being in the proximity of some demented or aggrieved, lingering spirit that has been confined there for the last 50 years.
Life Through Its Curve Balls: 1995 was the year my wife died of breast cancer. It was also the year that Fred Greenwood (Director of the Pacific Biomedical Research Institute at UHM) offered me the job of Program Director for an upcoming NIH minority institution grant that established a Clinical Research Center in Hawaii. Unwittingly, this jumpstarted another phase of my academic career as an NIH researcher, research administrator, grants writer, director of a Grant Development Office and the acquisition of a half a billion in research dollars over the next twenty years that in some way or another had my mark on its origin/success and legacy.
The Department of Pediatrics: There is always someone you butt heads with, don’t respect, feel antipathy for working in any large organization. The truth is that my interactions and status in the Department of Pediatrics over my 47-year tenure was magical. I fully respected and revered most of the faculty members, and the rest posed no direct threat or hostile targeting behavior toward me.
The Dean’s Office and the Office of the Vice Chancellor for Research and Education: Unfortunately, I can’t provide this glowing report of my interactions in the Dean’s Office or in the Office of the Vice Chancellor for Research and Graduate Education where I worked in the second half of my academic career at UHM after retiring from clinical practice. Nevertheless, I had a number of unique opportunities to work in research infrastructure, research compliance and perform many special projects during this new chapter of my career. In all, JABSOM and UHM have given me the greatest opportunities in my life for professional advancement and self-fulfillment, and I want to leave the university truly appreciative as a dedicated and loyal servant.
Paying Back: I have helped three dozen faculty members, mostly from JABSOM, with their dossier development in seeking promotion to the next level of faculty status. My record is 100% success and I’m hoping the last group of faculty members I am working with ride the wave of my success to promotion. This role has given me tremendous joy and satisfaction.
One quirky Recollection: When Dr. Hammer offered me that one and only job I ever applied for, he declared what my salary would be – I didn’t even consider negotiating for more? Looking forward the next 47 years, I never once negotiated for adjustments to my salary despite numerous modifications to my job description, having moved to the Dean’s Office and later the Office of the Vice Chancellor for Research and Graduate Education at UH Manoa, and then back to the Department of Pediatrics at JABSOM. My job description changed, my direct report changed, my home base unit changed, but my salary increases which occurred periodically were always dictated by the JABSOM Union, or the Dean of JABSOM. My input was never invited or welcomed. More importantly, I never questioned the wisdom of such an arrangement, nor was I bothered by or complained about my salary or my working conditions – not once in the last 47 years.
Parting Words: Well I’ve been advised that if I add a little about my early pre JABSOM life, I could cut and paste the document and offer it as my eulogy. What a good idea!
Seriously: There is always some value in putting into words your experiences and impressions. My parents were immigrants from Ramallah, Jordan with a second-grade education. My father taught himself how to read and write English, make a living selling dry goods door to door and provide me with a middle-class home environment through his hard work and determination. Somehow, he lived to almost 102. My mother was not as fortunate after 11 pregnancies – she passed at 84y/o. I could not have imagined accomplishing in my life what I have accomplished under those conditions. I have been truly blessed with the honor and privilege of a career focused on caring for other humans. I hope to carry this positive message forward to others who face ongoing challenges in their lives and wonder whether it is worth it to dream about their future.
No comments:
Post a Comment