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This is a story about failure and disappointment; hope and encouragement; and whether we can ever really know someone's true character. First a bit of background (feel free to skip this section if you want to get right to the meat of the story)

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The  Virginia Tech Carilion School of Medicine (VTCSOM) along with the Carilion Clinic Children's Hospital (CCCH) are in the process of beginning a pediatric residency training program. We have successfully completed all preliminary tasks, had a very positive site visit performed by the pediatric residency review committee (RRC) in the spring, and anticipate word from the Accreditation Council for Graduate Medical Education (ACGME) in November allowing us to start the program in July of 2012.

As we prepare for the residency, of course we are developing all of our specialized curricula, goals and objectives that will turn out exceptional pediatricians. A huge part of producing the kind of pediatricians we would each want as OUR CHILD'S doctor, however, depends upon choosing the right kind of person to accept into the program.

Many articles in the medical and educational literature describe ways to predict and train for medical competency. Recently, there has been more focus placed on working with residents and medical students to develop skills of resiliency, self-care and empathy; workshops on effective communication, reflective writing, and so on. Recently, the VTCSOM was featured by the New York Times in an article about an innovative interview technique called the MMI, which helps to identify the softer skills of the candidates, and has been shown to correlate with overall success as a physician in later life.  I don't want to dwell on those topics right now, or I will never get to the point of this story (yes, there is one, I promise you).

Ever since I was in my own pediatric residency, I have participated in planning for and teaching the "next generation" of physicians, especially pediatricians. I believe that I am a good judge of character. I have interviewed scores of individuals over the past three decades, and have helped to make decisions to accept or reject them based on test scores, academic accomplishments, letters of recommendation, and character. I have mis-judged a few, who turned out to be "duds" when they reached the program, but my failure as a judge usually became clear within the first few months, and resulted in intensive remediation or a decision that the individual and our program were incompatible, at which point we parted ways.

Only once, to my knowledge, have I been "duped" (or was I?) over the long term, discovering what may have been the "true nature" of a physician I helped train, mentor, and support (with letters of recommendation and career guidance) long after he left the training program.

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"Kirk" was a stellar resident. He was very smart; had an excellent bedside manner; seemed unperturbed by long hours and hard work. Despite having a chronic medical condition himself, he never complained, but put his patients and their families first, and was destined to have a great career, or so we all thought. Kirk was chosen from among the elite group of our top residents to hold a special position for a year prior to going on for an advanced fellowship at a highly respected children's hospital, based, in some part on my personal verbal and written recommendations as his teacher and mentor. When he left us, I admonished him, as I always did in such circumstances to "make us proud."  And he did.  Having excelled during his fellowship he went on to subsequent training in yet another field of medicine, and achieved a faculty post at a prestigious medical school, based on past performance and numerous positive professional and personal recommendations.

Then, seven-and-a-half years after he left, I heard his name on the radio, but missed the connotation. When I found it, I was shocked to learn that he had been arrested for possession of child pornography.

At first I couldn't  believe it, but eventually became convinced when I heard the details of what was found on his computers and in his apartment. Then I felt soiled by prior association with this man, in whom I had invested years of mentoring and professional support. Then I wondered how in the world I had not been able to see such tendencies in this person with whom I had worked so closely during the early years of his training. Then I wondered how many other prior proteges had turned out to be bad. Then....well, it kind of went on and on. I started to second guess my ability to judge character. I wondered whether there had ever been any inappropriate behavior during his tenure with us, that I did not perceive. Would I have had a system in place to identify anything that might have helped me to know Kirk had a problem? And what was that problem? Did he have the problem when I knew him or did it develop after he left us?

Kirk was convicted in a criminal trial. He lost his license to practice medicine in all states. He was sent to prison for five years. At trial it was revealed that there was never any direct contact between him and any of the children in the photos. It also was revealed that he was suffering from depression, which started following a medical intervention performed for his chronic health condition, and that the depression was not present when I knew him. He was unable to cope, he turned to pornography and drugs. During his trial he was remorseful and apologetic. He stated he knew he needed help but didn't know how to get it, so it (the label of mental illness) wouldn't ruin his medical career.

I know I am not responsible for what happened to Kirk. I know that many physicians have trouble coping with the stresses of their professional and personal lives. I know that many docs develop mental illness, and many turn to drugs. Yet, deep down in my heart, and in my belly, I still feel that I could or should have seen something, that I may have failed this young man by not anticipating where his life would lead.

Those of you who know me personally, know that I have often been criticized for being "Pollyanna-ish" in my eternal optimism about human nature, and the world in which we live. Despite seeing frequent examples of bad behavior in society, I prefer to believe in the good to be found in just about everyone, and I am (almost) always willing to give others a second (or third or fourth) chance. Yet,  I never spoke to Kirk after his trial. I have no idea what he is doing now. Obviously he is no longer working as a physician, and would be required to register as a sex offender.  A part of me feels that I should track him down and let him know he is still important to me; that I wish I had been there for him when he was feeling alone and didn't know where to turn.

The good news is that I believe that our residency program  will do things better. [I have to believe that--I am Pollyanna, remember?] We will teach our residents how to manage high levels of stress. We will engage them in techniques like reflective writing to help them not only in their coping skills but also in their ability to develop empathy and compassion. We will be a place they can always seek out for warmth, comfort and advice, if and when its ever needed, even after they have gone on to the rest of their careers.

Because of Kirk, I will work extremely hard to make it so.

Why did I share this story?

  1. Its another "confession" albeit not about patient harm and telling it has made me feel better.
  2. Its one way to help you to get to know me better--what might be driving some of my passion for creating a superb children's hospital here in Roanoke.
  3. I want you to see that I am convinced we can recruit and train physicians who will be great, and who will do good.
  4. I am hoping you will help me. I want to hear your tips on how to best judge character, so I and my colleagues can feel we are on the right track as we move forward. The residency program we develop will, after all, belong to the community.

[Many thanks to Mark W Schaefer, whose blog {grow} inspired this post. As he was lamenting the increasing frequency of bad behavior on the web, I started to think about bad (reprehensible) behaviors I have see in real life and how we are influenced by it. That lead directly to thoughts about Kirk, and here we are.]

Postscript

After I wrote the first draft of this post, the social media world was shocked by the death of one of its true leaders-Trey Pennington, who committed suicide over Labor Day weekend. Many blog posts have been written about Trey and how he influenced others, as well as how his death has called into question how well anyone can actually "know" someone else if the only contact has been via blog comments or twitter posts. Mark Schaefer was profoundly affected and another of his posts: " The problem with personas" is also very closely related to the story I have told here. I would urge you to read it because of its honesty and humility. Mark is rapidly becoming one of my very favorite people, and I look forward to meeting him someday soon in (as they say) "real life."

Recent Comments

I've tried to pen an appropriate response to such a thoughtful post. The situation surrounding "Kirk" is so unfortunate.

Reading about it reminded me of one of my favorite scenes from Dexter (his dark passenger speech), especially the first 30'ish seconds.

John,
Thanks for the comment. This situation was, indeed quite unfortunate. Dexter's behavior is so wrong, yet his character is strong, deep and not altogether evil. He operates within a strictly defined ethical paradigm and avoids injuring innocents. I do understand, however, how the "dark passenger" could manifest itself in different people in varying ways. For many, the ethical paradigm is broken. So, do you think the "dark passenger" can remain hidden for long? When will Dexter be seen for what he is?

Agree. You can't be responsible for the future behavior of everyone. I think it is ok to wonder about him though and to still think about him. You cared about him, that doesn't change...the fact that you do wish you could tell him that says a lot about your character.

Heather,
Thanks for your insightful comment. I know I am NOT responsible for everyone's future behavior yet isn't society in some way "responsible" for how individuals turn out, and isn't society really just a collection of individuals? There is a fine line between individual and societal expectations, I think.

That is the kind of behavior that sometimes a person's own spouse, parent or child cannot identify. One should not blame themselves for not "catching" it, since it may be virtually impossible. But then, who is responsible if no one "catches" it until it is too late?

Becca, thanks for your thoughtful comment. I agree that the behavior can be very well hidden. Should we (society) develop a better way to discover inner tendencies that have not yet surfaced? Or do we let them alone until they appear? What if someone is physically or psychologically damaged because of that tendency? What if Kirk had turned out to be a murderer or a rapist? What if he had abused one of the critically ill children for whom he was providing care? These are all questions that I contemplate with some frequency.

Profound, personal, enlightening, thought-provoking. Blogging at its best. Great job, Alice!

Thanks so much for your kind words, Mark. They mean a lot to me

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About Dr. Ackerman

Alice Ackerman, MD, MBA, FAAP, FCCM is the Chair of the Department of Pediatrics at Carilion Clinic and Professor and Founding Chair of Pediatrics at the Virginia Tech Carilion School of Medicine. Dr. Ackerman is recognized nationally as an expert in pediatric critical care.

She has been at Carilion Clinic since June of 2007. Her primary goals are to enhance the health care of children in the Roanoke Valley and Southwest Virginia, and is actively working to do this both as physician in chief of the children's hospital, as well as through involvement with many state-wide initiatives.

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Carilion Clinic Children’s Hospital
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The AAP website for parents
Just the Vax
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Roanoke Times Medical blog
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