When I found out that I was going to have the rare opportunity to meet President Bill Clinton, many things ran through my mind: What would I say? What would I do? What would I wear? The only thing I was sure of was that I wasn’t going to wear a blue dress. I am betting that would be considered “poor form” in the Clinton circle. So, I slapped on this season’s most fashionable color and headed to the tunnel that would take me across the border from my home in Detroit, to Caesars Casino in Windsor, Canada. Bill Clinton would be speaking at an event for the Essex Region Conservation Foundation, and I was one of 20 or so lucky “golden ticket” holders. I affectionately referred to my ticket as the “Billy Wonka Golden Ticket”.
Having spent my entire adult life in Detroit, I am no stranger to Windsor. Prior to acquiring our own casinos, residents of Detroit would frequent Windsor on the weekends for gambling and nightlife. It is the ultimate paradox. Detroit is the big city, with tall skyscrapers, and a population close to a million … BC (Before the Crash). It is the site of the world’s first freeway, the world’s first traffic light, and the world’s largest auto industry … again … BC. Yet, the steel and twisted metal that the city was built from make it a little too rough around the edges for a night on the town. Only half a mile across the river stands the unassuming little town of Windsor, Ontario. It offers no skyscrapers, no major landmarks, and no major role in world history. Yet, its peaceful atmosphere, sidewalk cafes, and European ambiance pull Detroiters across the river like a magnet.
As I stand in Caesars of Windsor, waiting for the secret service to clear us, I stare out through the wall of windows and marvel at how beautiful Detroit appears … from a distance. Once in line to meet President Clinton, a million questions ran through my head. I had been informed that the President would not be giving any interviews, so I was trying to come up with a quick, profound, thought provoking, earth shattering, question that would make Woodward and Bernstein proud. I was going to blurt it out quickly as he shook my hand. Instead, at the moment of reckoning, I think I blurted out something like, “I’m a surgeon … I am also a freelance writer … ummm …Wow… President Clinton!” To which the President responded, “Good for you!” Then in a brilliant move which explains why he was President, and why I shouldn’t quit my day job, President Clinton proceeded to ask me a series of questions: “What type of surgeon?” “So, you have a career which fights obesity?” “What do you write about?” ….. The interviewer had become the interviewee … well played Mr. President. Touché.
So, I had blown my big chance to become a Pulitzer Prize winning journalist. No worries. I decided to enjoy the moment, sit back, and relax while I listened to the President speak to the sold-out audience that night. Having been too wrapped up in my career during his presidency, I must confess that I had never heard any of his speeches, which earned him the reputation of being a world-class orator. However, that night he had me captivated as he spoke of his conservation efforts and his experience as President. But, it was his answer to a local Canadian elementary school student that floored me. The question was, “If you could go back and do one thing differently, what would you change?” At this point, the President took a long, thoughtful, if not somber, pause and then started talking about Rwanda.
It is widely known that the delayed US response to the 1994, three-month genocide of Rwandans permitted an estimated mortality rate of 800,000. It is also widely known that Bill Clinton famously apologized to Rwandans for his slow reaction to the crisis. Clinton blames his delayed response on his distraction with Bosnia, Haiti, and North Korea at that time. However, the story he told next was not one that I had heard before; and, it made me see the people of Rwanda in a whole new light. President Clinton described his trip to Rwanda, to formally apologize to its people. During that trip, one may have expected the President to be confronted with hostile attitudes and blame. Instead, he received a warm and grateful reception. One Rwandan citizen was asked why people weren’t angrier with the President. The resident replied, “Because he apologized ….. and he didn’t commit the killings.”
What a simple explanation. It makes so much sense, yet it took me aback. What if medicine were like that? Here is the scenario: A general surgeon has a 65-year-old patient with known galls stones and a past medical history of CHF, CVA, and chronic renal insufficiency who presents with ascending cholangitis. While treating his sepsis, a family member suggests a full body scan to rule out cancer. The surgeon instead follows a course based on medical science, and treats the patient with IV antibiotics followed by a cholecystectomy with cholangiogram. The patient recovers and goes home. The patient is later diagnosed with advanced renal cell carcinoma. Now we all know how this story would end in our current world of medicine: Lawyers-1 : Surgeon-0. Now, let’s play out the scene based on Rwandan philosophy:
General Surgeon to Patient: I am so sorry that you have renal cell carcinoma. At the time that I was treating you, there did not appear to be any reason to suggest that you had cancer. Even though your family suggested a full body scan, my focus was on treating the illness that was threatening your life at the time. I treated that illness to the best of my ability.
Response of Patient with Rwandan Philosophy: I accept your apology. I understand that you did your best to help me. I also understand that you did not give me cancer. I know you are human; and I know that medicine is not an exact science. I also know that hindsight is 20/20.
This is a dramatic example to make a point, but you get my drift. What would a career in medicine be like if this common sense philosophy prevailed over the current state of blame and defensive medicine? I am betting that there would be no such thing as a career in “non-clinical medicine”. There also probably would not be a critical doctor shortage, which is growing more critical by the day. Does growth of a nation lead to such a growth in expectations that humans are held to superhuman standards by which they are ultimately bound to fall short? As the mighty fall all around us, from Wall Street to Washington, and apologies are flying through the air with the greatest of ease, I find myself asking, “What would the Rwandans do?” Although I will admit that, every time I see a bank being investigated for fraud, or an oil spill that could have been prevented, my first instinct is to lay blame and to get angry. After hearing President Clinton’s story though, I am instead trying to look beyond what has happened, and look toward ensuring a better future.
As I make the drive home, across the Ambassador Bridge, I see the humble town of Windsor getting smaller in my rear view mirror. It is a town, which stands in the shadows of the dramatic, powerful, steel skyscrapers of Detroit. But I will not forget the lesson I learned there while listening to a story about Rwanda: Great expectations may lead to disappointments, but forgiveness, understanding, and a desire to move forward is what makes a great nation.
I would like to take credit for planting that little 10-year-old girl in the audience to get the interview I so desperately wanted, but I can’t. However, for being able to get a column out of our brief encounter, all I have to say is, “Checkmate Mr. President”. By the way, thank you for coordinating your tie with my dress. Have your people call my people and I will see if I can arrange an exclusive interview for you.
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Dr. Deol is a self-employed, board-certified general surgeon.