December 2, 2022
Dear Interested Readers,
The Long Good Bye To Joe
The response to my letter last week about the life of service that Dr. Joseph Dorsey lived was remarkable. Four of those responses came through the comments function of the newsletter, but the bulk of the comments I got was in emails or comments made directly to me at his wake. I was surprised and pleased to learn that the post had a wide circulation within our practice where there are still many who remember him fondly or know of him through his wife, Dr. Joane Wilkerson who continues to practice at the offices in Wellesley.
I don’t think that the response was about my writing. The response was a measure of how much Joe meant to so many people. Joe was such a unique person who touched the lives of so many healthcare professionals and patients that many people wanted to share their personal experiences with Joe. I think that Joe still has much to teach us, and feel that it is too soon to let him go. Like his mentor Dr. Ebert, I know that I will never be able to let him go. But, isn’t that a measure of a life well lived, and is it not the way we keep our foundation of professional values alive?
My wife and I drove down for Joe’s wake on Tuesday evening. We arrived early and ran into Lynn Markinac in the parking lot. Lynne is recently retired. She was a nurse practitioner for several decades at the Wellesley offices that were opened in 1980. I had the delight of sharing many patients with Lynne because I had at least one session with cardiology patients at Wellesley every week for almost thirty years. Like many people, she came a long way from her retirement home to pay her respects to Joe. After the wake, she posted an insightful comment that she heard as she entered the funeral home:
As I was walking into Dr. Dorsey’s wake last evening I overheard two gentlemen talking about him and [one[ said, “An ordinary man who did extraordinary things. He was very down to earth and so approachable.”
Calling Joe “an ordinary man” was not a dis. Joe always lived on the level where you lived. If you were the cardinal, the mayor, the CEO of a large corporation, or the governor Joe was with you step for step. If you were a toll taker on the Mass Pike or the janitor in a neighborhood school Joe was with you where you were and seeing your concerns through your eyes. I know if Joe could have heard that comment, and maybe he did, he would have been smiling.
Joe never presented himself as anyone who was “special” or someone who deserved deference. It would be a better world if more of our leaders could model Joe’s humility and willingness to put real sweat into the process of making the world a better place. If there was a job to do Joe would roll up his sleeves and do more than his fair share of the heavy lifting. I see a lot of similarities between Joe Dorsey and Joe Biden. They both had roots in the Irish Catholic community of Scranton. They both honor the quiet contributions that ordinary men and women make and give them the respect that flows from the belief that without community we have no future.
Joe’s wake was a wonderful reunion of dozens of people who could testify to the influence and inspiration that Joe had been in their personal lives. There were a few there like Dr. Steve Strongwater, the current CEO of Atrius, who had never worked with Joe but could testify to his influence on them secondarily through his continuing impact on the values of the practice. Because of the long drive back home to New Hampshire, my wife and I reluctantly left the wake as even more old friends and colleagues were arriving.
Another defining component of Joe’s personality and view of the world and his responsibility in it was his Jesuit education. On many occasions, Joe referenced to me his days at the Jesuit high school in Scranton and Holy Cross, a Jesuit college, where he went for his undergraduate education. I received an email after the wake from Peter Dreyfus who managed our practice in downtown Boston for many years that referenced Joe’s commitment to his faith and how he managed the tensions that sometimes occur between our secular and religious lives. Peter wrote:
…When I first met and began working with Bob Master — at Medicaid before I came to HCHP — he told me about Joe’s courage in both taking on and keeping faith with the Church. That always stayed with me as I got to know Joe in the 90s…
Bob Masters is a secular saint who is revered by many in Massachusetts. He founded and led the Commonwealth Care Alliance and served the poor and elderly populations of Massachusetts for many years. Click on the link to learn more about Dr. Master’s unique contributions to the care of the underserved.
Several comments like the one by Peter got me thinking about Joe’s relationship to the church and his Jesuit education. I asked the Internet about the principles that were the foundation of the Jesuit educational philosophy. Below is what I found. I have bolded what I saw in Joe’s approach to practice, patients, and colleagues. Joe learned his lessons well and put his faith into action.
What are the Jesuit values of education?
The values of Jesuit education are rooted in the vision of St. Ignatius, founder of the Jesuit Order (learn more about his life in the ‘history’ section). These values prepare students to be wiser and more compassionate as they take the next step in their life journey as men and women for others.
Cura Personalis. Jesuit education emphasizes the view that each person is a unique creation of God. Cura Personalis (meaning ‘care for the whole self’ in Latin) is demonstrated by personal attention in the classroom, a deep respect for diversity and difference and an emphasis on holistic care for the mind, body and spirit.
Discernment. Discernment encourages students to be open to God’s spirit as they make decisions and take actions that contribute to the greater good. Discernment is practiced through prayer, reflection, consultation with others and considering the full impact of actions from diverse angles.
Finding God in all things. A Jesuit education is one grounded in the presence of God, and encompasses imagination, emotion and intellect. The Jesuit vision encourages students to seek the divine in all things—in all peoples and cultures, in all areas of study and learning and in every human experience.
Magis. A commitment to the concept of Magis (Latin for ‘more’) is a hallmark of Jesuit education. It challenges students to go beyond what is expected, interacting with the world with generosity, excellence and empathy. Magis is modeled by personal accountability and high expectations of achievement.
Reflection. A foundational value of Jesuit education is the practice of reflection. Students are invited to pause to consider the world around them and their place within it before making decisions. This includes challenging the status quo, acknowledging biases and accepting responsibility for actions.
Service rooted in justice and love. Jesuit education cultivates critical awareness of social and personal evil, but points out that God’s love is more powerful. This value is illustrated through community service programs, service learning semesters, immersion experiences and various volunteer opportunities for students.
Solidarity and kinship. Students work together for the greater good. They develop relationships with their surrounding communities and share their talents and skills to help and serve others. This value is practiced through community engaged learning, where students work with community members to come up with innovative solutions.
Joe was an A+ student who carried every one of those attributes into his professional life. His love for his work, the mission to which he committed his life, his colleagues, his community, his church, his family, and most of all the patients he loved to serve was obvious to all of us who had the good fortune to know him and respond to the light that shown from him every day. I never heard Joe say he was tired or discouraged. He seemed immune to what we now call burnout. Perhaps of all the comments I heard or read one that sums it all up best was made by a long-time leader of the PAs in our practice, Noelle Lawler. Noelle wrote:
Thank you Gene… I miss you. Beautiful words about a beautiful human, mentor, clinician and leader. I will deeply miss Joe. I arrived at Kenmore as a newly graduated advanced practice provider in November of 1996 and had the good fortune of overlapping for a short while with the beloved Dr. Dorsey who presided in the office right next to mine. Though he was in his last few years as an outpatient primary care physician and very part time, he always peaked in to my office to check on me or pull me in to an exam room to show me a clinical finding… or simply to trade stories about our shared alma mater, Holy Cross. He called me “kid” back then and I liked that… It made me feel safe and confident, that he had my back when I was experiencing the nervous jitters of being a new provider. I didn’t fully appreciate just then who he was and all that he had paved the path for in our health care world. All I knew is that he was incredibly generous of his time and support without my even asking for it…. He just seemed to know when I was swimming in the deep end and needed a life raft. I later became the beneficiary of his office space, the very space where I continue to practice at Kenmore…. and the beneficiary a few years later of being his patient while he was rounding at the Brigham. I was in an isolation room waiting on results of what was presumed to be bacterial meningitis (thankfully it was not) and low and behold he entered my room with a big smile and big hug. He made me feel like I was his only patient that day. My deep admiration only grew from those few dear moments as I learned in subsequent years of all that he had achieved for patients in our Commonwealth and the delivery of care as we have come to know it at Atrius. It continues to inspire me every day and I am proud to work in a practice built on the vision and now legacy of Joe Dorsey.
Noelle’s experience with Joe was multiplied by thousands of others who I am sure had very similar experiences with him. What I wrote about last week was primarily my own special relationship with Joe. What was amazing is that everyone had that feeling of being special with Joe and that he was their exclusive mentor. Everyone felt that they were the center of his attention when they were with him. We were each his favorite colleague. He gave everything he could to everyone.
I think in this era of worry about “burnout” and the burdens that healthcare professionals must carry it is beneficial to reflect on a life well lived in the service of others. Joe’s life is evidence that one person can make a big difference.
One of the comments to me in a personal email this week came from Florida and was written by Warren Haskins whom I met many years ago in my son’s law office in Miami. Warren cares deeply about many of the themes found in these weekly letters. Attached to his email this week was an article by Eric Reinhardt, M.D. I think Warren saw a connection between Joe’s efforts and the issues described by Dr. Reinhardt in his article entitled “Medicine for the People.” I think that Joe would have made the connection. The subtitle of the article is “As more and more doctors awaken to the political determinants of health, the U.S. medical profession needs a deeper vision for the ethical meanings of care.”
I think that Joe would have understood what Dr. Reinhardt is talking about when he speaks of the state of practice in America today: Reinhardt writes:
Although they treat the sequelae of poverty every day, doctors in the United States have historically failed to use their collective influence to address political etiologies of disease. Now, for the last year, the pandemic has preyed on America’s racial and economic inequalities. This reality has awakened many more doctors to the political determinants of health—the fact that health is not just about health care and is inseparable from power and political struggle. It has also fractured the traditional medical objectivity that records politics as biological misfortune. During the pandemic, calls for equity, justice, and decolonization have grown louder within health care, echoing traditions of social medicine that have long been relegated to the fringes of American medicine.
Reinhardt’s analysis of a need for a great awakening in medicine fits many of us, but it does not fit Joe. He was always awake to the transformation that Dr. Ebert espoused and to which Joe dedicated his life. It would be a very interesting experience for me to sit in on a conversation between Joe and Dr. Reinhardt. I like the concept of “the political determinants” of health because most of the issues at the root of the social determinants of health are political and their solutions involve replacing political advantage with equity. Self-interest and the power of the status quo are drivers of politics. Joe understood these things and although he could tell us how things should be he knew few of us would listen to words and were more likely to respond to a living example so he used his life to show us a better way to deliver care and to be patient-centered. Joe is gone but what I have experienced this week convinces me that he is still working to advance what he cared about and instilled into many professional lives. Through those who were touched by him, he lives on still in pursuit of better healthcare with dignity for everyone.
Looking Back To Look Forward
If you are a regular reader of these notes you know that I spend a lot of time in the past, or at least writing about events from my past. These reflections that I so often inflict upon you are usually triggered by some current event or observation that grabs my attention. Today’s header is an example of that reality. It is the picture of the instant that guaranteed the victory of my alma mater, The University of South Carolina over our most important rival, Clemson University, the land grant college of South Carolina.
The Carolina-Clemson game has been played almost every year since 1896. In 2020 there was no game because of COVID. Clemson leads the series 72–43–4. Despite losing more often than winning, South Carolina has had some great victories like the game we won 17-16 in 1965 when Clemson bravely went for two points after they had scored with about a minute left on the clock. The Gamecock defense held and the majority of the 45,000 fans who filled every seat in the South Carolina stadium went wild. I was a second-stringer who had played on some of the kickoffs and a few scattered plays during the game. I was cheering from the sidelines during those last few tense minutes. If you look closely at the grainy black-and-white YouTube video you might convince yourself that you see me. I am number 54.
The clip begins as the Gamecocks score to go ahead 17-10. What follows is Clemson’s march down the field to score a touchdown with about a minute left on the clock followed by the failed two-point conversion. The next year was my academic senior year, but I was listed as a junior in the program for the Carolina-Clemson game because I had “red-shirted” during my sophomore year. This week I found a 65-page Adobe PDF of the program of that game in 1966 which was played at Clemson’s stadium. My name is misspelled in the roster, but you can see my 21-year-old image. My neck was thicker, and I was much bigger all around back then.
Clemson’s home field was built in a “trench” which was called “death valley.” In 1966 the Clemson stadium and our stadium both sat about 45,000 fans and were always full. Now both have extensive upper decks and accommodate over 80,000 fans and are still always full. College football is the favorite sport in South Carolina.
November 26, 1966, was my last game. We lost 35-14. Once we were hopelessly behind I actually got to play a little more than usual. I should point out that compared to last weekend’s game all the players on both teams were much smaller, and we were all white. South Carolina gave its first scholarship to an African American player in 1969.
Even before the game, I was ready to move on to the rest of my life. I had already been accepted to medical school at Emory and Vanderbilt. My interview at Harvard was scheduled for the following Saturday. Two of my teammates were also headed to medical school. Stan Juk who was one of our best defensive backs went to Duke and has practiced cardiology in Columbia for many years. Tom Wingard, a quarterback who like me was not a starter, went to med school at the Medical College of South Carolina before he was a surgical resident at Johns Hopkins and did a cardiac surgery fellowship at Emory. Before his death in 2021, Tom was a highly respected cardiac surgeon in Jacksonville, Florida where he performed over 30,000 operations during more than thirty years of practice.
Perhaps that is too much intro to last Saturday’s amazing Clemson- Carolina game, but before I describe the excitement of last Saturday’s game I should add that the week before the Gamecocks beat Tennessee which was ranked number five 63-38 which was amazing because Carolina’s play had not been so spectacular over most of the season. Their record was 7-4, but many of their wins were against colleges that were the usual “doormats” that more aggressive teams play to pad their schedule. Clearly, the Gamecocks had been improving. Clemson was 10-1 and knew that they needed to have a lopsided victory like the one I witnessed in 1966 if they were to have a chance at getting into the playoffs for the national championship which they had won in 2018 and 2016. Clemson’s coach, Dabo Sweeny is one of the highest-paid coaches in college football. Earlier this year, Sweeny signed a 10-year extension to his contract for 115 million dollars which should be reason enough to root against Clemson.
To be honest, I rarely watch South Carolina games. I have not been to a Carolina game since my last game in 1966, and I probably have not watched even part of ten games on TV over the last fifty-plus years, but something told me I wanted to watch this one. I was not disappointed. Click here for the three minutes of highlights.
South Carolina’s victory was largely due to the play of its “special teams” on punts. The South Carolina kicker consistently kicked the ball so that the Gamecocks could kill the ball near Clemson’s goal line giving them terrible field position. With about two minutes to play and leading by one point, 31-30, Carolina had to punt. A freshman Clemson back who had previously caught a pass for a touchdown caught the punt, but as he began his return he was tackled from behind by Nate Atkins a six foot three, two hundred fifty-pound monster of a man whose father is one of the South Carolina coaches. Atkins punched the ball out from behind. The header captures the image of the ball in mid-air as it exits the receiver’s arms. South Carolina recovered the fumble. With possession of the ball, all that Carolina needed to do to seal its upset was make a single first down which it did with a critical third down pass, and the victory was certain.
Is football or any other game a metaphor for life? Are there lessons to be learned? Maybe, maybe not. There is a lot about football that now causes me to look away. I feel lucky that I don’t have CTE. I sustained a significant concussion and the lights were out for about an hour in 1965 in a game at the University of Virginia, and that was not the only time my bell was rung, but every now and then sports do remind us of how a single unexpected moment can change the way we see the world.
I don’t want to read too much into that fumble or the teamwork that made it happen, but I think that South Carolina did a lot to create the critical moment that resulted in success. If there is any lesson to learn from sports, I think it may be that sometimes in life good things just happen, but it is much more satisfying when you can make those moments happen.
Somehow, perhaps without a logical line of reasoning, I connect my excitement with South Carolina’s victory and the effort it took to make it happen to the effort to improve the social determinants of health. Like the Gamecocks, there are many of us who have struggled to find meaningful wins. Even when things are not going our way, it is possible to turn things around. When victories come it is often because there are those who were willing to exert the extra effort to turn “the unlikely” into “the amazing.”
Joe Dorsey worked hard to make many amazing things happen. He carried the ball well and had many unlikely victories, along with a few disappointing losses. He believed in the dream that practitioners could find professional satisfaction if they were engaged in the effort to deliver better care for everyone at a sustainable cost. If we are going to ever improve the social determinants of health for the tens of millions of Americans who carry a disproportionate burden of disadvantages, then we will need a whole new generation of healthcare professionals who are willing to take up the banner that Joe carried. It is my persistent hope from the sidelines that “my team,” composed of professionals dedicated to outcomes that look like the Triple Aim might win the long game we have been playing. I hope we are rooting for the same team!
Be well,
Gene
