The days may be long, but a year can go quickly. Next week will mark exactly one year since I had the honor to become chair & DEO of Internal Medicine at Iowa. In my first weeks I was often asked whether my expectations matched my experience. It wasn’t just curiosity, but a genuine expression of just how welcoming Iowans are to new faces and new perspectives. I was surprised by the question’s continuous appearance even after I’d settled in. People were so generous with advice about even simple things like the proper footwear for cold weather or where I should sit in Kinnick Stadium to watch Hawkeye football. I had been the new kid on the block enough times that I could compare this kind of reception to other places. Iowa excels at concern for comfort even over other Midwestern institutions. What I continue to be impressed by is how this generosity and openness has sustained well past my fresh arrival. Iowans watch out for other Iowans, a real community that digs past the surface and reveals an investment in each other’s well-being. It’s a warm feeling and I feel lucky to be a part of it and to contribute to it. Those first weeks and months were such a whirlwind, it was challenging to come to any conclusions besides this enduring one that the people here are wonderful. But now that I am a year in, I think there are a couple of other lessons that my time here has shown me.

Photo for Reflection

When you are deep in the forest surrounded by redwoods, the horizon disappears and all you see are trees, trees, and more trees. Their size and the quiet they enforce can make you feel very small, but you also feel a great deal of awe and reverence. The idea of scaling one of these towering giants to find the horizon is a nice one, but it is not a plausible option for wayfinding. If you are off a blazed trail, you need to rely on your compass and your companions to find your path forward. Fortunately, anniversaries can remind us to pause, and we can metaphorically shimmy up the day’s redwood. We can make comparisons, draw our bearings, and assess how far we’ve come and what the path ahead might look like.

The first lesson I can draw from this last year is just how integral Internal Medicine is to nearly every component of University of Iowa Health Care. For more than a dozen years I was chief of an Infectious Diseases division, so I already knew how much other specialties need our consults. But our department truly has a footprint in almost every area of care that is delivered in adult medicine. The beautiful new facility in North Liberty for example may have sports medicine and orthopedics at its foundation, but our clinicians are a critical player there as well. Whether it is pre-surgical evaluation or infection prevention, management and consultation for co-morbidities like CKD or diabetes, or the post-surgical management by our hospitalists, without Internal Medicine none of the facility’s headline-grabbing activities could take place. Of course we are not the only specialty to cut across all lines like this. Anesthesia, Pathology, Radiology, and so many more are also underrated heroes in the story of the North Liberty campus success. But I think it’s important that members of our divisions like ID, Endocrinology, and Hospital Medicine get recognition for their contributions too.

On that same note, the next lesson I’ve had confirmed this year is the importance of strong teams. In complex environments, no one person can do everything, remember everything, answer everything. We need a diverse array of experts to cover all the complexities. There are some obvious examples that I remain very excited about such as the appointments of Drs. Josalyn Cho and Martha Carvour to new vice chair roles, refining our approaches to faculty development and to making sure quality measures accurately reflect the clinical excellence we already deliver. But I am also thinking of Dr. Christie Thomas and his leadership of a renal genetics fellowship, passing on what he and his colleagues have built to the next generation. I am also thinking of Dr. Yolanda Villalvazo, who after many years in the Division of General Internal Medicine, has joined the Division of Gastroenterology and Hepatology as a liver transplant fellow, a blend of opportunity and passion. I will have more to say about this next month at the Quarterly Department Update on October 16 at noon, but I am also excited about the research team-building we will achieve through the cluster hires. My thanks to the teams that Drs. Chad Grueter, Josalyn Cho, Phil Polgreen, and Diana Jalal are assembling for this critical mission. Group science conducted by smartly constructed teams is the future.

Upi’s “Oh, WOW” moment

My third discovery is not a new one, but a confirmation drawn from a collection of moments. When I look back over this last year, what I feel most convinced of is the critical need for recognizing and expressing joy. Two things can be true at the same time: our work is hard, often thankless, and we are lucky to get to do it. Every day we weigh evidence, assess the options, think creatively, gather advice from our peers, and then act. The stakes are often high. And there are often plenty of people waiting to tell us whether we made the right choice, people who have the luxury of time we did not have. And yet, as challenging an environment as this can be, there is joy to be found in the effort. We can choose to focus on the positive, those times when we ask just the right question to unlock a mystery and bring relief to a patient or a colleague in need. Those are moments where we can and should find joy, pride in achievement, and gratitude for being exactly where we are supposed to be. Fulfillment of purpose is one of those highest order needs and we must recognize and celebrate when it comes. This is as much a reminder to myself to as it is something I would encourage you to do as well. And definitely more than once a year.