Ladies and gentlemen, please welcome the President of the American Society for Surgery of the Hand, Dr. Kevin Chung. Thank you, everyone. We or better part, just as good, I am gushing with excitement to welcome Dr. Julie Fleischlock as our President's Guest Lecturer. I've admired Dr. Fleischlock from afar. She serves as a CEO and Dean at Wake Forest University. She's a vascular surgeon whose illustrious surgical career includes being the Halstead Chairwoman for the Department of Surgery at Johns Hopkins University, followed by Vice Chancellor and Dean at UC Davis. Her honors are innumerable, but most notably, she was past Chair of the Board of Regents of the American College of Surgeons and incoming President of the American College of Surgeons. She was elected to the National Academy of Medicine in 2015, the greatest, the highest honor for a physician in our nation. Dr. Fleischlock has published over 300 papers, but her proudest moment, I think, is to talk about her students and overcoming adversity in our professional lives. Please warmly welcome Dr. Fleischlock, our President's Guest Lecturer. Well, it's my distinct pleasure to be with you today, and I've really been impressed what Dr. Chung has done to accomplish what he's done in his life coming from a small island, being deposited in the middle of Georgia, and going forth to do great things. I also am going to dovetail a little bit on things that he spoke about about this last 18 months for all of us that have tried to be a surgeon, tried to be a parent, tried to be a traveler, certainly trying to be a leader. The biggest problem is we don't know when it's going to end, and we don't know if we're a villain, a helper, or the hero. And some days I feel like I'm all three at the same time. So today I wanted to talk to you about how to get through that, how you can break through too brave. I'm going to use some of my own stories to talk about, but I really want you to think about your stories. You know, how did you get here? I've seen quite a few of my students and residents that have gone into hand surgery here, which was a great surprise. I know many of your mentors and leaders that I've gotten the chance to be involved with in the American College of Surgeons, and I think there's a real role for surgeons to help lead through this and to be brave as we go. Oh, there it worked. Was that me or you? So brave means to be ready to face and endure danger, pain, and showing courage. Bravery is the quality of state of being brave, resolute and facing odds, able to meet danger or endure pain or hardship without giving in to fear. And then braving is to endure our face conditions without showing fear. So when you think about being a surgeon, you do this all the time. As you face those patients who have had trauma, injury, that you go fix their hands, or when you go do a complicated procedure that takes you all day to put together, or those procedures you have to do multiple times to help people get better. And then what you do for a living, too, takes a long time to see, was it good enough? Did I do a good job as they rehab and do what they need to do? Many of you know I do thoracic outlet surgery primarily now. And I have that, too, where you have to wait a long time to see what's going to happen. So as we go forward in your career, as we go forward on the other side of this pandemic, being brave is going to be very important as you go forward. And surgeons are uniquely able to do that. Your attention to detail, your honesty, your integrity, your commitment, your compassion for what you do, above all else, the thought that you couldn't wait to come back to see each other, to talk about what went well. And I see also you talk about what didn't go so well. And that's really important as a surgeon as well. The most important thing we do is on this slide. This is a patient, perhaps a COVID patient, perhaps a cancer patient, perhaps a post-op patient, being cared for by someone that really cares. There's a book called Capassionomics that talks about what we need to do to make sure our patients care. And they say it only takes about 40 seconds of us sitting just like she is to listen and to show how big you're brave is as a patient. It takes about 40 seconds for that patient to know how you care. And as surgeons, you do that all the time as you assess them in your clinic, in the operating room, in the emergency department. And you explain to them what they need to do. And most times we sit, right? And I hold the hand of my patient as they go to sleep. It's that 40 seconds that really makes the difference. And that can make the difference not only in your patients, but in your trainees. I've heard a lot about that the last day. In your partners, in your colleagues, and in those that are important to you, such as your family during this crazy time of COVID-19. Now for me, for me, as I came through my training in the 80s, I was the most diverse candidate they'd ever seen at UCLA. That's where I did my general surgery. I was one of three women that were taken into that class that year. It was Debbie, Barbara, and myself. They constantly got our names mixed up, even though Debbie was a Jewish girl from New York and 5'10". And Barb was a beach gal from Los Angeles with blonde hair. And me, who had gotten a perm for reasons I don't remember with curly hair. And I remember if they called me Barb or Debbie and I was doing something really good, I'd tell them my name was Julie. But if it was something really bad, I just let them think it was Deb or Barb. It was a different time. And as I went through training at that time, I was only the sixth woman to finish the training program at UCLA. I was the second Vasker fellow there. But I did learn it's not the size of the dog in the fight. So as you go through this, no matter who you are, whether you came from international means like Dr. Chung, whether you're female, whether you're a person of color, whether you came from which university, which training program, it is the fight in you. It is that resilience that makes you amazing. We had a talk just about a week and a half ago in a big conference about how to choose the best resident for your program. Because as you know, I'm a dean and we're taking away that step one score in the next year or so. Because that step one score was our screening tool. It was everything we did. We got them into the programs. Your programs are so competitive that you use that to do your screening. And it's going to go away. And how are we going to find out who is that best surgeon? Because as you know, you've chosen some really good numbers and some really good surgeon candidates, but they show up and not so much, right? And sometimes I wonder if we should have taken those files when they were paper and just thrown them down the stairs and see which ones hit the bottom and take them because they're all really good. But what differentiates the fight and the dog? Where do you get that resilience? Where does it come from? Who tells you that you're going to be able to do that? And can you do these adverse circumstances, including COVID-19? Can you make this work as you go forward? One of my mentors at UCLA, Ed Pizarro, who looked a lot like George C. Patton, used to say that the ones that he liked to take are those that worked hard. Whether it was like the beautiful musicians we saw play today who obviously worked hard throughout their career to be so crafted and so able. Or was it the underprivileged kid or young person who had to work in their parent's shop? Or for me, I was a lifeguard and a waitress. Was it someone like that that could work hard and manage not only getting their schoolwork done but other things, managing their time? It is that resilience factor that we're going to need to figure out what is there for us as we choose these people to go forward. And part of it might be, it just might be asking people, what kind of things did they do during this pandemic to survive and thrive? What kind of things did they do to take care of themselves and their family and others? And what kind of things did they do with those patients? Like I just had to delay a few of my cases this last month because we're quite a bit of COVID at Wake Forest and we're not doing those cases who are not time sensitive right now. And so those patients that I couldn't do their case for another month or two, even they had planned their whole life to have that done. And I'll tell you, you'll find that in people if you ask them to tell their stories. Because stories are the things that define us. Numbers are good and where you went to school and who did train you. We all like to say that. You know, where were you a faculty member? Where are you? Those are all important. But asking people to tell their stories reveals that true fight in their dog. I was only the second woman faculty member at UCSD, or the first faculty member at UCSD and UCLA, the second woman faculty member at the Medical College of Wisconsin. I was only the sixth woman to get her VASCR certificate in the country. And I must admit, I didn't notice that. When I went to take my boards, I just went and took them. You know, I figured this is what I'm going to do. I want to be a VASCR surgeon so bad to make that happen. And when I was in practice with my second job back at UCLA, you have to sit for that American College of Surgeons interview to make sure that you're a credible surgeon, right? And two of my partners were on the team and the man who was asking the questions was very, very kind. But at the end, he said, so I just have one more question for you. I said, okay. And he said, how do you get your housework done? Serious, 1989. And I just smiled and my two colleagues were like, oh boy, she's going to lose this one. And I said, I just, I'm very efficient. I get it all done. So as I walked out the door, the next woman coming in was pregnant. And I said, whoa, you're going to have to explain that when you go in there. So I did write a letter to the American College of Surgeons. And I said, I'm not sure they asked every candidate how they got their housework done. I said, they could have, you know, I wasn't at all the interviews, but I think you ought to watch. You ought to watch what you ask. And I got a very nice letter back. And as you know, I'm a leader in the American College of Surgeons now. So sometimes you just need to have that fight in the dog. So when you are brave, when you are brave, you do empower others around you to be brave too. They say during the pandemic, five million women in the United States have left the workforce. Five million women. And this is because many women are involved in entertainment, in restaurant businesses, and they've not been able to work, or the children haven't been in school, and they're single moms, they're married moms, they're just having a tough time. And five million women are out of work trying to raise their families to do that. They also say, as I listened to Nancy Spector talk to us, who runs the ELAM program in Philadelphia, that we're very, very worried about women in medicine. That women at mid-level are a crisis. I love the choir of the children singing today. That was wonderful. We've learned to do all these things, right? We can now work from home, work from the car, work from the store, work anywhere. It's very efficient, it's very flexible, but I spent my whole career trying not to work at home, so when I walk in the door, I don't want to work from home. I work at work, and I don't work at home. So it's been really confusing. It's been my paradox, Kevin, of trying to figure that out. And we're also really worried about leaders in general, because it's been hard, especially women leaders. If you think about people you know, there's a lot of movement out there. They say it's going to be an incredible resignation year, where I have a lot of my friends retiring in that age group. Many deans have quit, many chairs have quit. I think there's almost eight or nine open chairs of surgery in the country right now. I think people are rethinking what's important and what's not important. I wanted to come give this talk, because Dr. Chung and Dr. Levin asked me, but one of the main reasons I'm here is I have two grandkids in Berkeley. So I spent three days over in Berkeley seeing my seven- and four-and-a-half-year-old before I came here, and I'm headed down to Los Angeles to give a talk after I go through Phoenix to see my other two grandkids. And you've got to do that. You've got to figure out how you're going to do that in these times. And I think we have to be very worried about women in the workforce, very worried of the underrepresented in the workforce, and very worried about how we're going to come out at the other end. There are so many amazing things that have happened because of COVID-19. We can have people viewing this meeting from all over the world, which makes it easier for them to come. I do think COVID-19 is going to give flexibility to all of us, so that you don't have to go to every meeting, but you'll want to, because you want to see your colleagues. You can pop into a meeting. You can have a quick intersection with someone. It's really great. But then you also, when you spend eight hours on that computer, they say you don't blink and your eyes are shot, and you just can't do it anymore. So we have to watch to monitor that. And certainly our patients have really enjoyed telehealth, especially post-operative cases that are doing well. I don't think there's any reason those patients should have to travel to see us. I used to call how I practiced in my first 10 years really Julie-centered practice. I was Julie-centered care, because wherever Julie was, that's what happened. If I was in the OR, if I was traveling, if I did research, it was a great life, right, to do it. But now it's patient-centered care. It's outpatient. It's at different hospitals. It's virtual. It's where you want to meet them, and especially what our patients have had to undergo with delayed surgery. I bet all of you read the piece that Dr. Zinner, Michael Zinner, wrote in the U.S. News and U.S. Today about how many patients have put off getting screened for cancer, and how many people are coming in late with vascular disease, and how many patients are not getting cared for. I just had an email today about a patient who couldn't get in our hospital. We had no bed that needed dialysis because of COVID, and trying to find beds from the rural areas to move them in. But with that, though, we've learned to work as a network, and learned how to do things in a different way. So I think you heard in the presidential presentation also is that we need to have hope. Hope is what's going to make us get to wherever we want to go next. Hope is what we tell our patients, that we can make you better, that we can make that happen. Hope is what you have as you look at your career blossoming, as you look at your children growing, as I watch my granddaughter swimming on Monday. Hope is what the future is, and it should reflect your hopes, not your fears. About five years ago, one of my faculty members at UC Davis asked me where I put my fear. This is pre-COVID, and I looked at him, and of course, as a surgeon, he's a PhD. My first response was to go, what fear? I don't have no fear, right? That's what we are, right? And I said, let me think about that. Where do you put your fear? So for me, when you have a ruptured aneurysm, and you go into that OR, I mean, you put your fear over here. You're a little scared, it's bleeding, you got to get in there fast, put up the balloon, put the clamp on. But I think I put my fear here, whether it's a case, whether it's COVID, where there is a tough situation, a confrontation, and as a leader to having conversations and trying to keep my people hopeful about what their careers and where they're going to be. I think my fear is right here, so I sort of see it, but it's not here. It doesn't blind me. So as we go forward, on the other side of the pandemic, I think we need to have our fear here, and we have to have hope forward. And I think that will get us through. So your belief really does open the path, and you need to have courage, to call courage everywhere. So many people ask me, how did I get through all of this? You know, as I trained in vascular surgery, as I became a division chief, as I became a chair of surgery at Hopkins for 11 years, and then off to be a dean, and it really wasn't a slide. You know, it was a ladder, it was bumpy, it was like a really windy road. All these careers are confusing. It sounds so simple when we stand here and we can tell you all we've accomplished, but it was hard. And I think one of the things I learned to do early, which is something we're teaching now at Wake and really across the country, is really learning to be a really great bystander, upstander, mentor, sponsor, and ally. And I think I was always those things, but I didn't know that's what I was doing. So as you go forward, many of you mentor. You take care of your students, there's a whole bunch of them sitting here. And a mentor really is always positive. They want you to do well. Frankly, we want you to sort of be like us, you know, to do it. So we want to promote you with your career. And mentorship is a really kind, lovely, wonderful relationship. And then sponsorship is really putting people up for positions and asking them to run the committees and asking them to be involved. And sponsorship's so fun, because as you get older, you really don't want to do all of those things, so you can volunteer another name. But when you become a bystander, it's someone that needs to stand up when you see something that's not right. And I think all of us as surgeons are uniquely poised to do that, because we work in an operating room. Operating rooms, many people think, are sanctuaries, that you can do anything you want. But you and I both know they're really megaphones. Whatever goes on in that operating room, I hear about. When I ran the operating rooms at Hopkins, if something weird happened in those ORs, I heard within minutes of what happened in those ORs. And some of the most unusual things are said and done in those ORs, because of stress and strain and really trying to take care of the patient. I was in operating rooms where instruments were thrown in the 80s. I was in operating rooms where people yelled and screamed at each other. I was in operating rooms where things were so awry that there was no way that patient was going to get care. And I, many times, was operating on my own, because that was the 80s, and that's what you did. And many times, it was hard, especially when I would show up to a hospital as a young faculty and go running in to do a ruptured aneurysm. It was at Olive View Medical Center, and I parked my car real close, because I don't want to walk across the parking lot in the middle of the night. Granted, I had jeans on. There's no question. He said, who are you? You need to move your car. And I said, well, you know what? After I fix that aneurysm, I'll be right back to move my car. Learning how to take those situations where they don't think you're the one in charge to turn it around. And many of you have been in an operating room where someone said something really awful to a student or to a resident, or maybe it was you that said something awful to the nurse or someone else. So we teach bystander training, where you actually pay attention to that and do something right there to make it civil. We call it wake training. You don't have to call it wake training, but we'd love it if you did. But wake training is where you need to figure out who you are and how you can address a situation right away so someone's not offended, so the patient's well taken care of, so that people can see you understand that everyone should be treated in an appropriate way. For me, I always say, did you really mean to say something so rude to her? Or did you really mean to denounce that nurse in the corner? Or I'm sure you didn't mean to yell at the anesthesiologist like that. You know, when I first started practicing, we called the anesthesiologist anesthesia and they answered. We didn't even know their name, you know, so timeouts to me have really made that operating room more of a family situation. And then you need to ask questions like that about what did people say or do, because sometimes they just say or do some things that are just not appropriate. And then you do need to know how to ask others to help you. We've had some great discussions with women's surgery groups across the country looking at microaggressions, looking at how people are treated as residents and fellows, looking at how you talk to your medical students. I cannot tell you the number of women medical students have told me still that people tell them they can't be surgeons if they're women and they want to have a family. I mean, I have a very messy family. I have stepkids and a kid and grandkids. You can have anything you want and be a surgeon. The men do. But they still say things to women that perhaps they shouldn't do that. And then you sometimes need to employ distraction, where you can't take care of it right then. You've got to get that case done. You've got to make it happen. But then you do. You need to follow back, because those young people that are watching you are going to see that you didn't do it or you didn't want to do it. And I would really empower you to do that, because it feels really good, because then people know you've got your back. You'll stand up for them. And that once you start doing that, people around you will behave better and act better, because we do need to have a civil world. I don't know about you, but people are much more crabby after this COVID-19. I see much more behavior issues. I see hate emails. People get in that chat and say the most stupid things I've ever seen. I've had a stop chat at a couple of meetings where people just get going, right, to do it. It's almost like social media. And I know it's so frustrating. It's so hard. And I'm so sick of the virus, too. It's sort of like the sign that says, please wear a mask. We do. And we don't like it either. But I think we have to call it out and be the best people we can be as we go forward. And it's going to be hard. But I would tell you, if you haven't had bystander training, we actually are doing that with a group of orthopedic residents that I've gotten involved with. I have a college student that has helped me do it, and she said it has really empowered her to speak up and also to do a better job. She just got into medical school. the conflict with COVID, to be a better person on the other side and make sure everybody around you feels respected and honored. Now, when you are bold enough to use your voice, okay, so you're gonna speak up, most of us feel we're really outspoken and strident, and you're brave enough to listen to your heart because you know what you need to do, then you're gonna have the strength to have that amazing life you've always wanted. Everybody asks me, too, do you have any regrets? I have none. Now, did everything go well? Heck no, it didn't. I was married to an oncologist for a bit and got divorced. I'm not quite sure why we were married, but that was the first marriage, right, to do it. And I remember being with the social workers, we were talking, trying to figure out our next steps, and he basically said, this will work out if you quit being a surgeon. And so as he left, she looked at me, she goes, I think you need to get rid of him. Yeah, and I did. And so instead, I married to Phil, who you met last night. I met him at a dating service, and Phil's just been the best ever. He loves coming to surgery conferences, he loves the fact that now there's a lot of women at the VASCR meeting. It was funny, this year, a lot of our senior people didn't travel, so we were at a cocktail party out on a deck in San Diego, and my husband said, is this a VASCR meeting? There's a lot of women and people of color and young people here. Are you sure you're at the right place? I said, yes, we are, it's changing. It was so exciting. And actually, just today, I was on the phone call with a young heart surgeon who just started a new job, and he just split from his wife and was looking at another opportunity. And I told him that story today, because she didn't want him to be that busy. He's a heart surgeon, that's what he's gonna do. And she's a dental surgeon, but wanted more predictable life. And that conversation today was real important, that I was able to tell my story about it happened to me too, but look now. better because of your failures and what you did, so you can show your vulnerability. Because vulnerability as a leader is the most important thing to show, whether it's telling your story, saying you're wrong, moving things along. And if you do that, then you will have a life that you will enjoy much more than you would in the past. So fear, to a great extent, is born of these stories we tell ourselves. When I was younger, my grandparents, my grandfather on one side, Freischlag, he was a boiler maker, and my great-grandfather, Freischlag means free hit, he carved stone buildings. My other grandfather was a coal miner, and my coal miner grandfather was talking to me I skipped first grade in a small town in Illinois, Carbondale, Illinois, mainly because my brother was a year ahead, I read all his books, I talk a lot for those that know me, I talk a lot and I was a discipline problem, so they skipped me really to get me out of that class. There wasn't much to do. And I didn't remember that for many, many years because a year later, he died suddenly when he was fishing. And then my uncle died suddenly when he was about 58, his oldest son. And then when my mom was 72, she was in a CT scanner for osteoporosis, as we were just talking about, back pain, and my mom had a 6.7 centimeter aneurysm on the scanner in Decatur, Illinois, where, I don't know, they do an aneurysm repair once a year. So my grandfather probably ruptured an aneurysm, as did his son. And so we rushed my mom sort of up to Chicago, to Hopkins, and she had an open repair because of her short, angulated, calcified neck. But all of a sudden, it made me realize that, you know, I have a family of rupturing aneurysms. And in case you're concerned about me, my aorta is 1.7 centimeters, so I'm good to go. My partner was reading it. But he told me that, you know, and so I think what you tell your children about where they want to go, and my mother always said, get educated. If you talk to many women leaders, the education piece was really a focus. We saw that with Dr. Chung's life, getting educated so you have a ticket to go wherever you want. And that's where we really need to work, on our pipeline. At UC Davis, we had about a fourth of our class first-generation college students, mainly Hispanic. Many of their parents hadn't been to college and worked up in the fields in Northern California. When they would go home, they'd say, this is too hard, you need to quit, you can't do medical school. Well, everybody's stressed in medical school, so I told them, go home, eat, come back and talk to me. Because you can do this. And you can put your fear on the side, and you can tell them that they can do this. So I would tell all of you who do teach students, could you please take a little bit of time and just ask them a few questions, and just tell them they can do it. Tell them they can be a hand surgeon. Tell them they can do whatever they want. And listen to their stories about where they've come from. Because I think those stories are the ones you're going to decide, are they going to be one of my residents, right? Is that who's going to make that happen for me? And how is that going to happen as we go forward to make a difference? So courage is being scared to death, but you saddle up anyway and you go forward. Just like John Wayne ever did. And if I were to tell you my story, I never stopped saying I could do that, as you went ahead and made it happen. I remember when I did take the job as chair of surgery at Hopkins, I had looked at a bunch. And when you look at these jobs, it takes a few to get those jobs. And my mentor, Ron Busatil, who wasn't chair yet at UCLA, said, how did you get that job? And I said, well, everything you taught me. Of course, everything you taught me, that's how I got this job. And that was the hardest three years of my life when I came to Hopkins. It was really tough. I was the only woman chair there for 11 years. There were a lot of steep traditions in ways we did things. I showed up on the year where we started timeouts. We started 80-hour work week, and they all thought it was my idea, that those were those two things. And it was like, whoa, you know how compliant we were back in 2003. And really, luck had it that a medicine resident complained about work hours, so we sort of got cited. So we had to obey the work hours, and we had to obey that. And actually did a very fine job organizing how we worked in teams to get that done. And I do think timeouts have made our patients real, right? You probably do that anyway, because many of your patients, I'm sure, are awake as you operate on them as well, too. And making that torn tendon or that fractured finger or the amputation a person. When I operate on thoracic outlet patients, I actually tell the story of why they have it. What kind of did they do? Are they athletes as a venous clot? Do they have an extra rib? What kind of jobs do they have? And certainly during the pandemic, I saw many people who were laborers who did a lot of work, like on assembly lines and putting things together, getting injured, and telling those stories. Again, the stories that are so powerful as you go forward to understand why people need care and understand why people need help. Now, it was alluded to in the few slides that began this meeting was about racial equity and how the murder of George Floyd has really put that in many of our spaces that perhaps we knew we weren't paying enough attention. The American College of Surgeons has done a lot going with an anti-racist campaign and committee, and we actually stood up a racial equity task force where I worked, too, really looking at what we can do better in the community with our students, with our education, with everything so that we're fair. And we have to do action. We can't sit and just watch. Again, that has to do with being a bystander, an upstander, and saying something. And I know I have learned a lot about intersection this last year and a half. I really speak a lot about women's issues. I talk a lot about that because that's where I come from, what I know, but I really didn't feel I had the competence or really the bravery to talk about race and underprivilege. And I've learned that. I learned that I can be an ally and be on panels with other people of color and have a comment about how I see making sure that everything I put together, I call it a mosaic, too, Kevin, where I put teams together of not only men and women, or those of different color, but age. Age is so important. And they're the future. They're the ones why we have to have hope to get on the side of COVID. They're the reasons that we have to make this better. They're the reasons that you have to continue doing incredible surgery and actually making that happen. So you need to stand up and speak out. We actually have an occlusion chair in every department, every center where people are constantly talking about it and thinking about it. And certainly surgery is not a very diverse group of trainees. We're getting better. We have more women, but they're primarily white women. We don't have as many people of color in our training programs. I need to deliver more through the medical school, so you get that. But with the virtual interviews, we actually ended up with the most diverse class I ever had, 15% African-American and 14% Hispanic, and two students who identify themselves as American Indians. And that is in Winston-Salem, North Carolina. Now, why is that? This last year, because of COVID, they all did their own interview, because they're so skilled with their phone or whatever, do their own interview, same questions. And then we could look at those and then virtually interview them, so many, many, many people could interview. We have over 11,000 that interview at our medical school. And it really lowered the bar. Similar, if you've given virtual board exams, did you see how relaxed the candidates are? Because they're not breathing your air. You remember when we took them, you're in that hotel room with the bed there, and they're glaring at you, and you're having to walk up and down the hallways. And the year I took it, they said, come at 8. I said, oh, no, your test isn't until 10. And so then we walked around San Diego for two hours. I mean, they were so comfortable taking that exam. And I remember when I applied to medical school, it was mainly a one-on-one interview. I had one at SIU Medical School, downstate Illinois, with an elderly white family medicine doctor who said, you'll never be a doctor. There's not a chance you'll make it, and rejected me the next day. So the next week, I went up to Rush, and I met with a woman histologist, PhD. And we had both read the same book, Watership Down, all about rabbit hierarchy. She loved me, and I got in the next day early decision. Both of those are really unfair, but I liked two. OK, two worked for me, because I got in. But you shouldn't have to have someone like you. Malachi Shen, who's the chair of vascular surgery in LSU, just wrote an article saying we shouldn't interview anybody, because we really are almost like dating them. We're trying to say, are you like me? Do I like you? Can you talk about the same things I like to do? Can I brush my teeth next to you? Can I live with you? Is that how we find a resilient resident? And he said we shouldn't interview anybody, because we're crummy about it. Because if they're like us, like the woman histologist, we go, let her in. And if I'm not like him, we say no. I know we started asking standardized questions as I've interviewed people, and certainly asking, again, stories. Have people tell you stories about themselves. I think that actually will better, similar to their personal statement, but maybe a little bit more poignant. I think that can make a big difference. So I think as we go forward, thinking about how to choose residents and students, telling stories, being resilient, having them talk about things they accomplish, talk about the passion and the compassion in their eyes and how they want to go and be an incredible surgeon someday, just like you. I think that's important. So as I wrap this up to talk to you about, I would be lying to you if I told you that every single day I'm brave and there's no problem. But bravery is being that only person who knows you're afraid. Because there are days where I go, I can't do this, especially if you have to fire someone or do something uncomfortable or do a tough case or whatever. My first year at Wake, I had to fire five chairs. It was a really tough time there as well, too. And leaders do that. You go do action items, and people will respect you. This young girl sits up in Wall Street and looks a lot like my granddaughter Zoe that stands there with her hands on hips saying, I'm not afraid. But for those people who can't confront, who can't make decisions, those are the ones that are probably real afraid. As a surgeon, I really implore you, wherever you work or whatever you do, go lead something as you go back to get us through the other side of COVID. Go lead and be brave to make it better. Make sure you give hope to your patients and your trainees. And constantly think about how to encourage them to be the best they can be, which means asking them what they can do, telling them the sky's the limit, being like my grandfather who was a coal miner that said, you can do anything you want. How did he know that? Just looking at your spirit. So, bravery, blunt fear, believe, brave stance. Think about how you're going to be that brave person that's going to help your institution, your clinic, your place, your patients, your people get through the other side. And we do hope, we do hope this turns into an endemic. They say it should real soon where it'll be more like the flu and that we won't have to be scared about dying and that we won't have, I call it bumper cars about the vaccine I got yelled at last year because I didn't have enough vaccines and now I'm getting yelled at because I don't want to get vaccinated and then people want boosters. People either want lots of shots or no shots. You can't find anybody right in the middle, right? So can we actually go be brave to do this better? Reflect on your role models, the people that you had train you or people that you admire so much and go be that person every day. One of the things my assistant tells me is you see the same Julie every day that whether or not you're a student or a resident or the new CEO or the new president of the college, it's Julie. Julie talks to you in her way of being honest and having high integrity. And so you go do that. You know, make sure you are that person that everybody seeks out for hope, health and healing. Make sure that you're the person that solves those problems. Make sure you say too, you know, this COVID thing is driving me crazy too and I'm having a really bad day and I'm sick of it. You know, I'm sick of it and I get why you are too, but it doesn't mean you can't be kind to those on your team or those in the hospital. And you need to act to avoid regret. I've never regretted anything I've done and I've, my son just asked me, he's looking at a new job that's going to be very busy and he's going to meet some incredible people and I tell him there's three things about a new job or a new opportunity. Who's your boss? I just got two new ones, so I'll let you know next year how that went. New CEO, new president. What am I learning and what impact am I having? And when he did the first round of interviews, he goes, boy, this team is really smart and it's real exciting. He goes, I get it, whether it's intense or hard work, because I said, you're probably talking to the wrong mother. I was a general surgery resident in the 80s, you know, every other night in the house. I think you should probably go do that, because that's what I did. But I think he's going to do it. So you don't want to avoid regret that you didn't take that opportunity. You want to visualize outcomes. I talked to another person today, somebody who I mentor who's a general surgeon. She was offered a big job at a wonderful university and trying to balance whether or not her two children, one who's starting high school, would do okay with moving and how we're going to do it. And if she doesn't take this job, is she going to be too senior to take one later? And I have people visualize this. So live two or three days taking the job, see how you eat, drink, and feel, and then take two or three days and visualize not. And then compare how you feel with both of those. And if you really feel you can give up this opportunity, don't take it. Because to me, it sounds like you're going to have a better boss, you're going to have a bigger impact, and you're going to learn a whole lot more, because where you are now is comfortable. I'm not sure comfortable is where you should be, not as a surgeon, not as a leader, and not after COVID-19. We should always be uncomfortable, that we know that we have to take advantage of every moment we have, because so many people lost their lives, lost their time, lost their jobs, lost their ability to really have a good life, and it's going to take years for many people to get back. And energize, encourage, and empower others. I tell you, when I do that, because I am a big extrovert, I'm a big energizer person, I get so much energy back after I've taught somebody. I loved what they said about Dr. Chung saying, what three things did you learn from this operation? Where's that paper? Energize, do this, do that, where you know, let's do that, because the sense of accomplishments is so wonderful. And empower others. Every single day, tell others that they can do this too, that you can make that happen, that this will be great for all involved, and that those people will be around you to have your back and help you accomplish everything. Yesterday I had a virtual meeting with my CEO group, there's about 20 of us, and one guy was just really irritated about an issue. He's one of my calmest people, he's an ID guy, and he said he had to go take a walk, he was so frustrated, which for him is like huge to do it. So we let everybody vent on the screen about what was driving them crazy with our new integration and with COVID and the OR and the ICUs and stuff, and I actually got pretty emotional because it was great that we trusted each other so much that we could complain even virtual about that, and at the end I gave him a gift of 30 minutes of the meeting, ended it early so they could take a deep breath, sent him a quote saying lead with your heart but don't forget your brain, you know, to make that happen. And it's great to have a team like that, so as you do that, if you empower your team so you can be you and be wherever you want to be, that's really important. One year at Hopkins I wore black for a year because people always commented on what I wore and I decided I didn't want to hear it, and I wear a lot of color, wear a lot of shoes, and after a year I said I can't do that anymore, I have to be me. So make sure you're always you in everything you do because that's what makes life so interesting. So these are our patients, it's the triumph over the fear, it's not the absence of fear, it's going forward. You have to be, you only have this one life. You don't want to apologize, regret, or question, COVID-19 has really revealed that for all of us. You do have to believe in yourself, you need to take risks, you have this one life. Make yourself proud. And be brave. Again, thank you so much for giving me this opportunity, it was delightful being here to see what an incredible association you have, and I wish you great fun in London when you go there, and may everybody be able to travel and see each other next year. Thanks so much.

Dr. Julie Freischlag

bravery

resilience

COVID-19 pandemic

compassion

mentorship

racial equity

inclusive healthcare