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#99 - Dr. James Lemons MD


James Lemons Incubator POdcast

Hello Friends 👋


This week we have the pleasure of chatting with the exceptional Dr. James Lemonds from Riley Children's hospital. Dr. Lemons' work in neonatology has impacted thousand of babies and families around the globe. His kindness shined throughout the episode and it was a true honor to host such an amazing human being on our show. You will definitely enjoy this episode full of positivity. Enjoy!



 

Bio: Jim is the Emeritus Hugh McK. Landon Professor of Pediatrics and past Director of the Section of Neonatal-Perinatal Medicine at the Indiana University School of Medicine for 22 years. He attended Princeton U. as an undergraduate, then medical school at Northwestern U, residency at the U. of Michigan, and fellowship at U. of Colorado. He has served in numerous leadership positions nationally and internationally, and was Chair of the Perinatal Section for AAP, Chair of the Committee on Fetus and Newborn, and Principal Investigator for the NICHD Neonatal Research Network for 20 years. He has been funded for his research by the NIH for over 35 years, and has published over 300 scientific manuscripts and edited several books. The Newborn Intensive Care program at IUSM is one of the largest in the country, providing state-of-the-art care for ~10,000 newborn infants and their families each year. Jim is particularly proud of the Family Support Program, which is run by six former parents of critically ill newborns, and who are now employed full time at Riley Children’s Hospital and the Indiana U. Medical Center to support families in the NICU. With 40 MD neonatologists and 12 PhD faculty, the neonatology research programs in stem cell biology, fetal and neonatal metabolism, clinical and translational research, and international health care are recognized internationally. Jim and his wife, Pam, have been to Kenya over 30 times (at least annually since 1994), and raised $3 million to build the Riley Mother and Baby Hospital of Kenya in Eldoret, Kenya, where they now deliver ~20,000 babies annually and have a 140 bed newborn intensive care unit – all directed by Kenyan physicians and staff. Jim works on social justice issues locally and globally, including human trafficking, mental illness and addiction, orphans and vulnerable children, deaf and hearing-impaired children, poverty, environmental justice, and interfaith cooperation. He and Pam have three adult children – Ken, Kevin and Meghan, and two grandsons, Nick (11) and Ben (8).


 

The transcript of today's episode can be found below 👇

Unknown Speaker 1:00

Hello, everybody. Welcome back to another episode of the incubator. It is Sunday, we have a great interview scheduled for you guys today, Daphna, how are you? I'm doing well. You know, we've been so caught up planning for the Delphi conference that


Unknown Speaker 1:17

we had to remember that we had such a such an interesting interview today.


Unknown Speaker 1:23

We hadn't forgotten to be honest, we didn't forget, you know, the days are running together. So the problem that we ran into, is that we underestimated the enthusiasm that would be generated by this conference. Because


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in typical incubator fashion, we all sat around a table, and we were like, Who would we love to have come speak at this conference, and we made a list. And we thought, Alright, we're gonna get probably 20, we drafted a long list of speakers, right? And we're like, we're probably going to get 20% of these guys, right, because like, that's the way it's going to be. And then we'll, and then we'll scramble for for more speakers, and our dream list of speakers. Pretty much it's, it's coming true. It's insane. It is insane. That's so exciting. It's super exciting. However, despite the success, we're still we're still aiming to make this a successful conference. And to that end, we do not want to find ourselves overwhelmed. And so we are going to keep the number of seats kept, as we've discussed. And so we'll let you guys know, when the tickets go on sale, we'll probably have a special episode release that day, so that we can announce some of the specifics of the conference, we can talk about a little bit what we're going to cover the format, because everything is a bit novel. And it's not like a regular medical conference. Because we do we do feel that there are many medical conferences that are happening in the field of neonatology that are doing a phenomenal job, and that we're not really there to compete with, but there is


Unknown Speaker 3:10

a place for a conference on innovation in neonatology. And that's what we're putting together. So that's exciting.


Unknown Speaker 3:17

Yeah. So for more details to come, and to tide you over. We have a great, like we said, it's a really good interview today. Yeah, I mean, I think we do.


Unknown Speaker 3:32

I think we've done a shout out to the person who has recommended this interview to us. And, and I think, I think she deserves yet another shout out because it is, again, when we say that we we welcome your emails and your suggestions, we do take them very seriously. And for example, so Teresa Rexrode, is the one who reached out to us. When was it done? I have her email, her email opened up months ago.


Unknown Speaker 4:03

I think, April, she reached out to us in April. And she was like, Hey, I think this would be a great interview. And this obviously started the process of us getting in touch with Dr. Lemons and trying to set up the recording, and so on and so forth. And look, look where we are today. So we take your suggestions, extremely seriously. And I would say 99% of them do materialize into a podcast episode. And so for the ones who have recommended other people,


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takes us some time.


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It's also we're lucky we're lucky to be ahead of schedule, let's say the time of us scrambling for interviews and everything else is thankfully now behind us I think now we've reached a level of


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of professionalism and organization that allows us to to have some poise and be able to see things coming but anyway, all right. This is we're taking way too much time of this interview.


Unknown Speaker 5:00

Hey, let me tell you you have Dr. Lemons bio. Tell you about Dr. Lemons for sure. Dr. James lemons is the emeritus Hugh Mackay land and Professor of Pediatrics and the past director of this section of neonatal perinatal medicine at the Indiana University School of Medicine for 22 years. He attended Princeton University as an undergraduate medical school at Northwestern University residency at the University of Michigan and fellowship at the University of Colorado. He served in numerous leadership positions nationally and internationally was the chair of the perinatal section for the AP chair the committee on fetus and newborn and and has been a principal investigator for the NI CHD neonatal Research Network for 20 years. He has been funded for his research by the NIH for over 35 years and has published over 300 Scientific manuscripts and edited several books. James and his wife Pam raised $3 million to build the Riley mother and baby hospital of Kenya in Eldoret, Kenya, where they now deliver 20,000 Babies annually of a 140 bed NICU, all directed by Kenyan physicians and staff. Dr. LeMans works on Kenya in Africa. Yes.


Unknown Speaker 6:09

No, because in the US, we have a tendency to name stuff after places where people came from, you know, so that's true. But that's, that's yeah, we'll talk about him. We'll talk to him, Kenya, all staffed by Kenyan physicians, so very neat. Dr. Lemons works on social justice issues locally and globally, including human trafficking, mental illness and addiction, orphans and vulnerable children deaf and hearing impaired children, poverty, environmental justice and interfaith cooperation. So we are very pleased to welcome Dr. Lemons to the show today.


Unknown Speaker 6:42

Dr. Lemons, thank you so much for being on the podcast with us today. How are you this morning? Terrific. Thank you for having me. Dr. Lemons, you have a you have a long career. You're an extremely accomplished neonatologist. We like usually to go back to,


Unknown Speaker 7:02

to the origin story of how did people become neonatologist? I understand that you grew up in a household where your father was an accountant and your mother was a nurse.


Unknown Speaker 7:13

Do you think that there's anything in your parents background that steered you towards medicine and neonatology specifically?


Unknown Speaker 7:21

Yes, thank you.


Unknown Speaker 7:23

For reaching back. Yes, I had four brothers have four brothers.


Unknown Speaker 7:29

One other went into medicine. I think it was largely driven by my mother.


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She's was a very


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an uncommon common person


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who didn't prioritize much in the way of material things.


Unknown Speaker 7:47

And really, as we grew up, we didn't appreciate the incredible values, I think the core values that she always had. So I I learned very early on the importance of helping another person seeing people appreciating small acts of kindness and trying to replicate that so I think I was always my brother's we've always been focused more on service


Unknown Speaker 8:13

is then we appreciated them the joy you get from from that. So I think that's always been a big part of mine. I lean toward the service, even ministry at one point.


Unknown Speaker 8:24

But this and I spent time in Ethiopia, actually for months.


Unknown Speaker 8:30

During med school, two of my best friends went to Israel for four months and I went to


Unknown Speaker 8:37

Ethiopia Ethiopian experience some of that


Unknown Speaker 8:41

development been country medicine. Yeah, don't don't jump ahead. We you're


Unknown Speaker 8:47

you're eating on our contact here.


Unknown Speaker 8:51

I'm kidding. But um, so I mean, it's interesting that you're mentioning service as a driving force for what really leads you towards medicine. I'm curious. I mean, there's many ways to find fulfillment in service and in helping others. Why in neonatology


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so in med school I


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like many third year students experience the wonderful relationship with a family with a


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five year old girl who developed leukemia and actually died during my time there


Unknown Speaker 9:23

that cemented my passion for or peds. And then,


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during internship, we were on call, you know, 36 hours off 12 for the whole year.


Unknown Speaker 9:37

You know, back in those days, but I I especially loved my time in the NICU in probably the excitement I wished I I was prophetic enough at the time to envision


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what I would like to look back on when I'm 70 like I do now, and I feel so lucky to have had many mentors who pointed me and told me, you know which direction to go


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And at that time, they


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affirmed my,


Unknown Speaker 10:06

I guess my qualifications, to do neonatology and sent me to Denver, which was the best part of the physiology program. And I did combine research with clinical.


Unknown Speaker 10:18

But it was looking back, I think it was more of the relation, it was the excitement of the emergency characteristics of a critical care environment. But I think, looking back, it is more the fulfillment that I felt, building those relationships. You know, in an instance, when you're dealing with sometimes life and death.


Unknown Speaker 10:42

And that's almost always the case in the NICU, from the parents perspective, regardless of the gravity of the condition of the baby.


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In their eyes, they see that so I, I really, I found out I was


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not only fulfilled, but somehow able to learn to listen better, you know, as you evolve over your career, is something you do.


Unknown Speaker 11:06

I think if you're,


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if you're good and work hard at it, it's something that I always tell students that you, you will get better and better at, it's hard to appreciate, think we're empathic now, but that can grow and then you can get better and better at understanding life. And


Unknown Speaker 11:25

its full range in the NICU is the crucible for all of those relationships and passions and extremes of emotion, I think.


Unknown Speaker 11:35

So it's a place where you get to experience I think the the, the full extremes of the of life, every, you know,


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socio economic status, every


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education, educational level, and every income level, every race and ethnicity. Race is probably not a good word to use, but in more every culture, every moral kind of habit.


Unknown Speaker 12:04

And trying to learn and appreciate people's upbringing in that crucible, it teaches us everything. And the few people I think get to experience human relationships with that full breadth of humanity. I think it goes through all the tragedies and the joys of it, it's quite amazing. I wish that's why I tell people, now students nice and you know, follow your heart. But,


Unknown Speaker 12:30

but also try to envision where you would like to be 70 years from now looking back? Yeah, and in a place where you've been able to utilize your talents and your passions? Well, you know,


Unknown Speaker 12:43

you've been in a place where you can advocate for those without a voice, if that's important for you.


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And try to, you know, see yourself a bit better than I did, I was lucky to follow the path, I think but


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but I think we have a much more mature young population that I think can can be more intentional about,


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you know, doing what really matters in their eyes. And if we can measure that and help them.


Unknown Speaker 13:11

That's what I love to talk about. I'm in the hammered hearing you you talk about neonatology that way because it's one of my it's one of my favorite parts of the job is walking with families. And and I wonder when I hear you talk about your upbringing, and the values that were so important to you, you know, connectedness, human acts of kindness.


Unknown Speaker 13:36

And medicine has changed a lot over the course of your career. And sometimes it feels like we're pulling so far away from some of those, you know, simple values that really still matter to families and patients. And


Unknown Speaker 13:53

I wonder if you can speak to that, about how that's changed over the course of your career, and how people are who are really still drawn to the humanistic side of medicine, like, how do we, how do we fit in and how do we not, you know, get overrun by all of the, you know, Manchester call and things like that.


Unknown Speaker 14:15

Now, it's a it's a good question. I, I remember, by the way, your comment about walking with families a


Unknown Speaker 14:24

few years ago, very recently, relative to my life, I


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was reading that New Age philosopher rammed us who said, We are simply walking each other home.


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And it's my favorite way of


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saying now just to give a mind's eye view of where I think we should be, you know, nobody's better and nobody's in front of isn't back.


Unknown Speaker 14:52

Just just but for the grace we know that could be our daughter


Unknown Speaker 14:57

in generational poverty or so.


Unknown Speaker 15:00

The Born blacks versus whites, you know, our


Unknown Speaker 15:04

white privilege is something we need to discuss and recognize, I think.


Unknown Speaker 15:10

But yes, you're right. It has changed a lot in organized medicine. I remember with our chair at the time, my best friend for 45 years with Shriner, who was is a neonatologist and, and chaired a department for 22 years while I ran our division. For that time, he kept talking to me about RV use, you know, that they're coming, relative value units of productivity, you know, for the fact I said, Well,


Unknown Speaker 15:39

don't talk to me about that I'm, we're not going there. And I kept pushing back for 20 years that I said, You'll never give a number to our faculty to assign a value. I said, everybody has their own. This, you know, you know, persona, and


Unknown Speaker 15:57

we have all different strengths and weaknesses, and but it eventually came and we're in one of the bigger health systems in the country, one of the more profitable quote, not not for profit health systems in the country here in Indianapolis. And


Unknown Speaker 16:13

it is,


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it is, I think, important to speak out.


Unknown Speaker 16:19

We have a handful of wonderful faculty in our department who were kind of birds in the saddle around this issue and speaking out of the importance of relationships in in the inappropriate prioritization and emphasis sometimes on


Unknown Speaker 16:39

profit, all the right words are always said, but when it comes down to it, it can be the bottom line, but I tried to


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encourage young people, residents and students and fellows and so on to, to look carefully at truly the important part. To me, there's no, there's no profession better than academic medicine.


Unknown Speaker 17:07

And you can carve your own kind of niche path. But in this environment of a large medical center, you meet so many people who has, you know, strive for excellence, and it raises the bar for all of us, it's just, it's important to make sure that one of those bars is, is the caring side and the


Unknown Speaker 17:30

advocacy side, you know, I think there are four, four legs to the stool, of course, the mother clinical care, the teaching and training, and then the research, but also the advocacy part we need, you can't be silent anymore, especially now we have to speak out


Unknown Speaker 17:48

and


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call out or name the issues that are problematic in caring for patients equally, you know, so I always emphasize, you know, that our job is to create a safe space for whoever comes into our care without judgment, to be as they are and begin there.


Unknown Speaker 18:10

And to be kind, you know,


Unknown Speaker 18:13

sorry.


Unknown Speaker 18:16

You can tell,


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I get a bit emotional thinking of all the 1000s and 1000s of patients, but you know, the young, young, African American teenager who just had a baby, but who shows up, you know,


Unknown Speaker 18:34

don't, you know, criticize her for having gotten pregnant, you don't discuss how you're going to discipline your child, if you're in generational poverty, living in an apartment complex, perhaps an abusive


Unknown Speaker 18:49

you know, parents relationship, or prostitution or whatever else, or drugs or whatever else is going on. You need to start there and compliment that young lady, and thank her for being there. And then


Unknown Speaker 19:04

listen to her story. And then always say something kind before you leave. Because I tell people that may be the first time a professional person


Unknown Speaker 19:15

has ever said a kind word to her and she may not have ever heard something affirming of value, never felt like she's seen or heard. And so this is something I think, really important in and it gives great


Unknown Speaker 19:34

reward. I think it's just in that relationship, the privilege of being, as you said, walking with his parents through whatever journey it is, is is a great the greatest privilege of all. And I think


Unknown Speaker 19:49

that to me, is where the fulfillment of medicine is now can you teach that can you teach genuine caring to simply caring for another just as you would


Unknown Speaker 20:00

For your own child or your, you know, your brother or sister.


Unknown Speaker 20:05

I don't I'm not sure when we say we have one of our faculty,


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academically studies, empathy.


Unknown Speaker 20:13

You know, so compassion I learned


Unknown Speaker 20:17

that, to me, the best definition of passion was taught to me by a professor of theology. And she said, Then, she said to me, here's a human at sea. This is, by the way, is the, this is the way we usually think about compassion. But she said, compassion is the recognition of the interconnectedness of all things.


Unknown Speaker 20:37

It's it's kind of the foundation of understanding compassion, that we're all connected, not connected just to each other, but to all life and all inanimate, to the cosmos. You know, so what we do ripples. I always say love should lead the way in any decision and, and the love ripples, we won't see 99% of what happens as it ripples, but it's going to generate some reaction and something good


Unknown Speaker 21:10

if it's genuine, but again, how do you


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mean we need to model that is how we treat each other, especially in a, you know, an environment like the NICU filled with so many emotions, and so many obstacles. And


Unknown Speaker 21:28

a long time ago, I started when I first came here, 43 years ago,


Unknown Speaker 21:33

I was on faculty in Colorado for a few years before deciding to come here and that we'd be here five years, and then another medical center, but we ended up loving what we could do, we had so much flexibility. But I started


Unknown Speaker 21:49

the parents staff seminar series. So I found a handful of couples that were maybe a year or two out from their journey, but articulate and insightful


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and invited them to come back and give an hour kind of interactive, talk with our house staff hoping that a lot of us elderly faculty would be


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accidentally listening and affected and learn a bit


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in sharing what was good and bad about their experience. And, you know, obviously, it was so different than what we as physicians and healthcare providers saw is important


Unknown Speaker 22:30

that I learned so much about


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the value in all parts of life of


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listening to people's


Unknown Speaker 22:40

journey in a ni I'm digressing a bit, but the best thing that ever happened to me probably was, we belong to a large Presbyterian Church and a few 1000 members. And I happened to we happen to rejoin there.


Unknown Speaker 22:58

At a time, maybe 20 years ago,


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when a class was just starting called faith in action. And I ended up


Unknown Speaker 23:06

kind of taking over the class and organizing it every Sunday for 10 years. We did every topic. And you can imagine from you know that some of the it? Yeah, it's interesting that I mean, you're saying you're digressing, but I don't I don't think you are, and I'm not sure if you're if you're familiar with this concept of called the overview effect. It is a it is a term that was coined by I believe, astronauts, and it describes this cognitive shift that happens to astronauts as they go into space and see Earth in the context of space and realize how humanity is just connected as one exactly as you were describing, actually. It's beautiful. And it's interesting that that it seemed from the description of what's been given of the overview effect that you have to go into outer space to see the earth standing alone in the universe to hanging in the void, as they say, right have to get this perception that humanity is is is interconnected. And somehow through neonatology and through your career, you've reached that overview effect. And I think that's, that's pretty neat.


Unknown Speaker 24:21

Thanks. Yeah, in some ways, it's kind of an interview.


Unknown Speaker 24:25

Overview. Right, right. Or an interview. Yeah, that's that's a beautiful thank you for


Unknown Speaker 24:32

I wouldn't, I was


Unknown Speaker 24:35

I was just wanted to finish that one thought


Unknown Speaker 24:38

about this class. So we would organize for Sunday's usually around a topic, like human trafficking or immigration or poverty or gun control or violence or whatever. And I learned and I always met, I don't know 20 or 100 people around picking those four speakers.


Unknown Speaker 25:01

But I learned, for example,


Unknown Speaker 25:05

in domestic violence and met a woman who was getting her master's in divinity, or at our small seminary, we have an Indianapolis, African American woman. And she began the series. After she spoke the next Sunday, the Superintendent of police may have spoken. And then the head of the women's shelter Julian Center here in Indianapolis, spoken in a psychologist in the children. But when she spoke the first Sunday,


Unknown Speaker 25:33

she spoke about her experience of domestic violence in, I thought I knew a lot about domestic violence, and what rape might be, I learned I knew nothing about it, until I heard her speak. And tell us what that really was. So it taught me that in all these parts of,


Unknown Speaker 25:56

of our lives, it's really a critical to value the person in the journey. And


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maybe we can help them through the journey. But at least we can learn


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and be able to share with others what that what that journey may be a little bit like, even though we're not in it.


Unknown Speaker 26:21

And then if we're going to do something about it, we know somebody who can help lead the way, that woman is the person that I would want her on board to help deal with domestic limits, because she and so in our in everything we do, that's what drives me nuts about corporate greed, etc. How many?


Unknown Speaker 26:42

How many corporations actually have that kind of balance with somebody who represents their clientele, teaching them teaching us how to do walk the walk the talk correctly, and recognize the leadership


Unknown Speaker 26:57

value anyway, it was a those 10 years that taught me and introduced me to so many 1000s of people that were kind of beneath our radar, usually, but to truly can,


Unknown Speaker 27:09

can lead our world if we would let them mostly women, by the way.


Unknown Speaker 27:16

I, I feel like I can take the liberty of asking you this question because you've, you've talked about your faith and your relationship with the church. And and I am always curious, for colleagues of mine who who are


Unknown Speaker 27:32

who have a strong faith. How do you deal? How do you reconcile sometimes your faith and the things that we see day to day in the NICU?


Unknown Speaker 27:42

In terms of there's a lot of things that happened in the NICU that that can make you question your faith, I believe right. And I think I think based on what happens to innocent children, the situation's they're placed in, and that I think, is very difficult sometimes to, to understand and process and I am wondering if your experiences throughout your career in the NICU have at times challenged your faith? Or has your faith allowed you to thrive and transcend what you were seeing in the ICU?


Unknown Speaker 28:16

Well, I've been thank you for asking that. That's a brave question.


Unknown Speaker 28:21

And it's something we don't talk about nearly enough. I think. I when I round, I will often ask the residents and students how do they deal with suffering, especially of innocent babies and children and that everybody and we all will face that as we go through life in one form or another obviously, but in the medical environment, especially critical care environment, we face it a lot.


Unknown Speaker 28:50

So it's really great that you raise this


Unknown Speaker 28:55

and I yeah, my personal experience. Yeah, obviously, I've struggled with that a lot. But when I first came to Indiana, I don't know after a couple years, I remember there was one or two weeks where we had a lot of deaths.


Unknown Speaker 29:13

And


Unknown Speaker 29:15

then of course you meet other families who may have faith based you know, foundations may be Muslim and may be Christian and may be Jewish, it may be Sikh, whatever.


Unknown Speaker 29:30

Can the in all variations in between? And maybe not maybe the atheists


Unknown Speaker 29:38

but I remember I was driving home, happened to go by our church and saw the light on


Unknown Speaker 29:46

our senior pastor, we have about eight or nine ministers, but senior pastors light was on in we were relatively new to that church at the time. But I decided to stop because I was feeling pretty depressed and


Unknown Speaker 29:59

you


Unknown Speaker 30:00

And they walked in and he was there. And I sat down, he welcomed me and sat down and I explained,


Unknown Speaker 30:09

you know, the challenges I was trying to understand better, how does, how does innocent suffering? How does our faith, how can we understand it, put it in some context. And he said, You know, Jim


Unknown Speaker 30:27

he was a brilliant, man after one meeting in the north X, as we were leaving with our three kids. Were very young, he remembered the next week, all of their names.


Unknown Speaker 30:37

Wow. He's very, very put together from that side. And he, he said I, before I went into ministry said I was the director of PR for the Baltimore Orioles and professional baseball.


Unknown Speaker 30:53

And he said it he said, I was pretty good at it.


Unknown Speaker 30:56

And he and he, they had him his wife had a son.


Unknown Speaker 31:01

And he was turned out to be a prodigy. And that's one reason I mentioned is memory and his ability to recognize faces and put this together because I believed him. He said that my son when he was just three, he started sketching, and drawing really, quite expertly that he played the violin, he got leukemia when he was five, he said, we had access to the best of care of Hopkins and so on. But he died a year later. And he said, Sorry,


Unknown Speaker 31:33

said,


Unknown Speaker 31:36

he said for quite a long time.


Unknown Speaker 31:40

He said, I was in limbo, I just


Unknown Speaker 31:44

kept asking the same questions you're asking. He said, How? If I really believe, and he happened, obviously to be Christian, during minister, he said, How


Unknown Speaker 31:56

can I understand this and he said, he said, ultimately, I said, in our case, in Christianity, but similar in most of the great religions, if you believe that the prime driving force of our Creator is love.


Unknown Speaker 32:12

And that love is more powerful than any anything. And if you believe that, he said that somehow, that love has to include my, my son.


Unknown Speaker 32:27

And


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so


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I've, that's what I've taken away.


Unknown Speaker 32:34

And if we can somehow demonstrate a little bit of that love and the way we care for each other, and for our patients, and staff, etcetera, etcetera,


Unknown Speaker 32:45

without judgment, and try not to understand we all came from different, you know, upbringings backgrounds, and that's what, and that's what kind of


Unknown Speaker 32:58

tattoos us with our beliefs. Hopefully, we're good enough to be open to learn and change. As we experience more and more of this, some of us are better than others at that.


Unknown Speaker 33:13

But that's how I look at the world, I guess, in the creation is


Unknown Speaker 33:20

as hopefully, trying to share that love is genuine, caring for each others, but especially in what we do in medicine.


Unknown Speaker 33:28

Just a little bit in the knowing that's, you know, kindness or listening better or, you know, sharing a tear with parents are sharing a laugh. It's appropriately known as smile. But being being demonstrably caring is really important things often that we're taught in medicine, you know, to be objective, well, it's fine to be objective. But that doesn't mean you can't


Unknown Speaker 33:58

hold somebody's arm or hand


Unknown Speaker 34:01

wrapped in a mental hobby. It's appropriate.


Unknown Speaker 34:06

Obviously, that gets a bit harder as we get into these recent decades, but, but I still do that a lot.


Unknown Speaker 34:17

And if it's genuine, you know,


Unknown Speaker 34:21

then I think,


Unknown Speaker 34:23

to me, that's, that's the best I can I can capture. Try to capture that. Yeah. Thank you for asking that. That's really something we should all be discussing and trying to help, you know.


Unknown Speaker 34:39

Help us understand our journeys better. This episode is proudly sponsored by Wreckit. Me Johnson. Recommend Johnson is dedicated to the research and development of nutrition products that help support baby development at every stage, including an extensive Enfamil portfolio for premature and low birth weight infants. Learn more at HCP dot meet johnson.com


Unknown Speaker 35:01

I, what I what I liked about your story is you actually started this by talking about


Unknown Speaker 35:08

physicians and healthcare personnel being involved in advocacy. And I think that word can be so vague for people can be so almost insurmountable seeming, but what you've really described as just kind of even individual advocacy, right, like taking an opportunity to


Unknown Speaker 35:30

fight on behalf of somebody else, a baby, a family, and kind of every day in the unit. So that's something we can all do.


Unknown Speaker 35:40

And at the same time, your advocacy has certainly reached beyond, you know, individual one on one, I mean, you were instrumental in the development of your program at Riley's. You were instrumental in the newborn screening program. And so I guess my takeaways are that being a one on one, individual advocacy can be just as powerful as you know, these large overreaching advocacy projects, and for some people even more, but also that you don't have to pick one or the other, that you can both be a humanistic physician at the bedside and do these big,


Unknown Speaker 36:32

you know, large scale projects that you don't have to pick one type of career or the other.


Unknown Speaker 36:39

I think that's, I think that's right. And well said, Yeah, I always try to point out the, as we're talking about an individual patient who might might be a mom with addiction, you know,


Unknown Speaker 36:51

we tell the story of big pharmacy, sometimes as,


Unknown Speaker 36:56

as the foundational cause of that.


Unknown Speaker 37:00

But we deal with the mom and try to help her journey through recognizing it's a disease may be the most difficult disease in the world. But while we're trying to care for her and understand her and learn from her, it's important to, especially for young people to realize that by appreciating her journey, we can begin to understand on a broad scale, the systemic issues and eyes emphasize you know, that as physicians, we're very lucky because we're in a position in our communities usually have some respect and some influence. And we should look for opportunities to address systemic issues.


Unknown Speaker 37:44

And if we can, in are lucky enough to get into leadership positions, and that was very lucky to be asked and invited often, you know, stepped into this, like the newborn hearing screening program with the American Academy of Pediatrics. And I got to travel a little over with my wife, presenting the evidence around the science around newborn hearing screening effectiveness.


Unknown Speaker 38:06

So that it became


Unknown Speaker 38:09

operationalized into law in most every Western


Unknown Speaker 38:13

country.


Unknown Speaker 38:15

And that was very fortuitous. It was an accident. Look at for me, but I just had was asked to write the statement for the American Academy and lead a taskforce and I was just when I was chairing the committee, and he just no more. So I was, you know,


Unknown Speaker 38:31

just lucky, I guess, to be in that position. But that's why I always say to young people


Unknown Speaker 38:37

say yes, say yes to everything. And I know that can be a bad habit. But I never realized until as you know, five years 10 years later you because you said yes to that you happen to meet somebody that 10 years later you reconnect with them, another opportunity comes up and you


Unknown Speaker 38:58

you know, try to avoid, you know, burning bridges, if you can avoid saying anything negative in the public arena, about someone that's very hard to do, but very important than what we do. You know, never criticize another physician.


Unknown Speaker 39:14

Publicly, lots of stories around them always try to look through positive way to assess but, but you're right, and


Unknown Speaker 39:24

it's all relational. I say sustainability is is relational.


Unknown Speaker 39:31

You don't have the relationships. It's like I work in Kenya, you know, I've been very lucky to be involved in sickle cell disease in Kenya. So tell us a little bit. I mean, I want to go back to to to some aspects of how you care for families in the NICU. But but we've been we've been teasing the audience about about your relationship with with Ethiopia, with Africa with Kenya. So my understanding is that you're


Unknown Speaker 39:59

the Indian


Unknown Speaker 40:00

She lives that you've taken on in Africa. They all started from a trip that you took that all started from a trip that you took as a medical student when you went to Africa.


Unknown Speaker 40:11

I am curious as to on that first trip, I'm assuming something must have happened at that time that really sparked something for you to then keep coming back. Because if the experience was negative, obviously, maybe you wouldn't have had such a prolific relationship with with these countries. But what happened on that first trip that really ignited this passion for for global health and global outreach?


Unknown Speaker 40:38

Yes.


Unknown Speaker 40:39

So my two friends who were Jewish in medical school said, let's, let's see if we can get permission to organize six months of elective time, because they wanted to go to study in Tel Aviv. And,


Unknown Speaker 40:53

and I said, Well, let me so my, my old time youth director of our church, when I was in high school,


Unknown Speaker 41:00

somehow she, she heard about it and said, You should write a grant to the Presbyterian Church. So I did and somehow got this grant. So I got to go there, I was very naive.


Unknown Speaker 41:10

It was more of an adventure. You know, it was right on a branch of the Nile River with these 20 foot long crocodiles. We weren't even in a village, we were 20 kilometers from a village and bite on the Sudanese borders, we saw lots of


Unknown Speaker 41:25

gunshot victims from the Sudanese Civil War that was ongoing, even now, but back then.


Unknown Speaker 41:33

And I was living with two surgeons in their families who had set up a clinic there.


Unknown Speaker 41:39

It was just the most remarkable experience, but I don't know that I processed it.


Unknown Speaker 41:46

You know, in a big context, a love to relationships with all the patients that came from walking through 100 kilometers, you know, with different


Unknown Speaker 41:57

issues, lots of crocodile amputations that we saw.


Unknown Speaker 42:03

Huge poverty, of course, and we visited many villages, but I saw the beauty of that land and


Unknown Speaker 42:12

understood the beauty of the people there. And they, they were more generous than, that's where I first learned, I think that


Unknown Speaker 42:20

sometimes the hearts of people who have very little materially


Unknown Speaker 42:25

have a much bigger than ours, and then they


Unknown Speaker 42:29

in a much more capable of, in some ways, leading efforts to address issues, if given the resources and a little bit of opportunity, and maybe some guidance. So anyway, it taught me a lot. And I don't know that I appreciated how much.


Unknown Speaker 42:45

And then when I returned home,


Unknown Speaker 42:49

eventually got married, and then


Unknown Speaker 42:53

in residency just after residency, and then we had our three children. And my wife was not keen on. I could hardly even talk about developing countries. He was not in that kind of an experience until our two youngest were in high school. And then she said, You know, Jim, this is the maybe now's the time.


Unknown Speaker 43:13

And so I had been the advisor of a medical student by biters. And I wouldn't go into pediatrics. So I thought, well, you're you're not worth continuing to support here. You're not going to do peace.


Unknown Speaker 43:29

You said, No, I'm going to do something in International Medicine. So I lost track of Bob for a few years. And then


Unknown Speaker 43:36

I walked across the street because I'd heard about this Indiana University Kenya partnership that had started it's now called the AMPATH program is the best relationship between two universities, medical schools in the world without question, it's unbelievable. How right it is, from the very beginning. It was founded on research and clinical care, and teaching and training. So they found out four of our faculty went over there to Kenya in 1989 found that they wanted to build a second medical school and they premises be there with a family, one family at a time with one doctor for a year at a time for 10 years with no cost just to begin to help teach because we only had like six full time Kenyan faculty. So that was 33 years ago. Wow. We've graduated.


Unknown Speaker 44:25

They have graduated


Unknown Speaker 44:28

1000s and 1000s of physicians, we've started residencies in almost every specialty now. We're just starting a newborn fellowship. There they are.


Unknown Speaker 44:37

Because I got involved in my wife, my wife, it was her idea to do this. So we we spent three months back in 1994. But then we come back every year since and usually two or three times, but we did we started.


Unknown Speaker 44:51

We're not about building buildings, but because of the relationships we had there is so amazing. I always tell people I probably have two or 3000 on my bed.


Unknown Speaker 45:00

As friends that I see for an hour, every three years or so,


Unknown Speaker 45:04

these are the kinds of things you understand that and


Unknown Speaker 45:08

and it spurred us to begin fundraising. So we did and we raised about two and a half million dollars to build a


Unknown Speaker 45:18

Women's Hospital and other baby hospital there. We got them to call it the Riley mother baby hospital and they're delivering now it open 2009


Unknown Speaker 45:29

It's the most amazing thing with what's transpired there. And they deliver about 20,000 babies a year. It's a small hospital. It's part of the medical school complex.


Unknown Speaker 45:40

We built it for about 30 babies in the NICU. We have 130 Babies annual census, I mean average daily census 130 babies at a time. We now have two Kenyan neonatologist, who are the best of the best. And they're the ones who are leading the effort now to begin this fall and unit Policy Fellowship for Kenyan pediatricians.


Unknown Speaker 46:02

And it's gone in 1000 directions.


Unknown Speaker 46:07

But the reason we built it was because


Unknown Speaker 46:11

they needed, they said we need to have some place safe and beautiful for patients to deliver, but also for the physicians to be proud of and practice


Unknown Speaker 46:23

and do the research and so on. And so Kenyans have led all of that we've had $150 million of NIH funded research that are with Kenyan principal investigators.


Unknown Speaker 46:36

And as Thomas


Unknown Speaker 46:39

kickable people all over the world are again, if given a bit of


Unknown Speaker 46:45

support.


Unknown Speaker 46:48

AMPATH says they they lead with care. That's how it started. I said well, as you lead with love, that's what your care is really. And it's genuine is all led by the Kenyan


Unknown Speaker 47:00

people through their trials, tribulations and obstacles, but they know how to navigate, they know what needs to be done. So they taught us


Unknown Speaker 47:09

so so so much. And


Unknown Speaker 47:12

I'm involved in many different parts of that now we did a universal newborn hearing screening study in Nairobi for 9000. Newborns, we're just about to publish that.


Unknown Speaker 47:24

For the first time, my friend is building a neural developmental children with this disabilities center, right, that will connect to the mother videos with the bridge. So that it's a comprehensive program for children with you know, so you see what can be done.


Unknown Speaker 47:45

And then it's all being done in the right way for the right reasons for the right people, but against themselves. I just say, you know, you can you can


Unknown Speaker 47:56

give a man a fish and feed him for a day he is you know, and you can teach them to fish feed him for a lifetime. And I said, Well, one thing even better, is to build


Unknown Speaker 48:06

and stack a clean pond where he can fish in perpetuity. That's what you do. When you build a school, taught by themselves for themselves. Even medical school in this case, but it'd be a nursing school. You know, that's what in sustain excellence and, and continue to ripple.


Unknown Speaker 48:27

I want to I want to ask you, I'm dying to ask you this question then. Because you're obviously a very bright man. And you say that we should say yes to everything. And there's no way that you take on these initiatives and feel like you're adequately competent to take them on. And I mean, I'm assuming there's a there has to be an impostor syndrome, at least when you're when you're being asked to go build a medical school in in, in in Africa, right? I mean, how do you what is your advice for, for us, the younger generation when we're we are maybe asked to take on projects that seem unreasonably difficult and we say who I'm not want to take this on? There's got to be somebody better? I think your career is a display of you just just succeeding at every turn, but also never saying no, but how do you negotiate this this internal conflict of like, Oh, my God, am I going to do this project justice? Am I the right person? I think this is very difficult sometimes to, to deal with.


Unknown Speaker 49:35

Yeah, it's, it's,


Unknown Speaker 49:38

you pose such wonderful questions. It's a bit like, you know, Brene Brown, and her wonderful


Unknown Speaker 49:48

TED talk on vulnerability and you know how we learned humility because you're right.


Unknown Speaker 49:55

I


Unknown Speaker 49:57

I learned the


Unknown Speaker 50:00

that it's against somebody has to do it. And


Unknown Speaker 50:06

I often felt like, you know, I'm not the right person and totally incapable of doing that. But I, but I was always surrounded by people who


Unknown Speaker 50:16

I knew had had the, you know, different talents and different expertise that together, we can, and it just takes somebody to, to kind of Jumpstart.


Unknown Speaker 50:30

And oftentimes, it's giving another person an opportunity to get involved in the leadership.


Unknown Speaker 50:36

Who may think exactly like if you're saying in that's the best way, if you can lift somebody else up in the process, you know, have them lift themselves up in the process and get the credit and value and vision that said, I do often say that I, I hate the business plans and strategic plans, five year strategic plans.


Unknown Speaker 50:58

Why is that? Yeah, yeah, because it's often too limiting. I tell people, you know, who could look back at the Empress program. And I wasn't one of the founders, but it three internist and a pediatrician who really started that whole program that Kenya.


Unknown Speaker 51:15

And


Unknown Speaker 51:17

I said, if they had laid out a five year plan, it was it would still be one, one little building.


Unknown Speaker 51:27

I said, yeah, yeah, lead with love. They would have sold themselves short. Yeah. So one of the more important things I learned was from a theologian at our church, we have an ever theologian in residence. And he started off as a very conservative young person, he said and grew into this more inclusive. And he's published now prolifically written several books, he calls it the kind of basic tenet is plurality of truth.


Unknown Speaker 51:56

Yeah, so we all, you know, come from our little part of a world with our perception of what's true.


Unknown Speaker 52:05

And he said, just in Christianity, he said, there are 25,000, more than 25,000 many denominations that people think they found the truth in this part of scripture or whatever.


Unknown Speaker 52:15

And he said, he said, maybe if we thought about all these diverse opinions and views in our humanity, which are growing and expanding, as part of the ongoing intentional creation, just like biodiversity, right? He said, he said, If we looked at it like that, and then, from a theological point of view, recognize the importance of seeing each other's little truth. But instead of building a wall, that's the only maybe like the six, you know, blind men and the elephant. Seeing it's different parts. If we could just collectively try to begin understanding each other's then maybe we'll come a little bit closer to the ultimate parts truth. So I took him on rounds with me once in the NICU. On our team. We had 15 very complicated babies in


Unknown Speaker 53:05

a very in several parents who are choosing courses of their babies that were different than we traditionally one would expect. Unless a baby a member with trisomy 18. And


Unknown Speaker 53:17

parents, the dads push a professor of math.


Unknown Speaker 53:22

At IU, mom's a high end defense software technician, they have six other children. They knew about the diagnosis prenatally and knew that she would maybe die in utero.


Unknown Speaker 53:36

My dad bursts my dad subsequently and they looked us out there they're they're kind of


Unknown Speaker 53:44

living wills for their for their daughter. And it turned out she weighed 1500 grams, that term birth was it room air,


Unknown Speaker 53:53

had a large VSD


Unknown Speaker 53:57

came over from our birthing center at that time to the NICU


Unknown Speaker 54:02

and had a male aminika seal which was known beforehand


Unknown Speaker 54:08

and say they want the elected to go ahead and surgery repaired the mind of an NGO seal ended up with a shunt and then we found the baby had suffered geometria with it.


Unknown Speaker 54:19

And they said well, she's still doing so well. Like her children are there six kids, you know, to get enough some time if possible to understanding she would die prematurely. So one of our surgeons laparoscopically


Unknown Speaker 54:34

endoscopically repaired and esophageal atresia. Yeah. And she did well