Interview with the Dean: Embarking on a Career of Service
I'm Dr. Laurie Glimcher, dean of Weill Cornell Medical College. We're just a heartbeat away from the 2012 graduation ceremonies where this year's student commencement speaker will be David Nissan. I had the pleasure of meeting David recently after he returned from a four-week fellowship at the Christian Medical College in India. Once you meet David, it's very clear why his peers voted for him as their representative.
LAURIE H. GLIMCHER: David, it's good to see you again.
DAVID NISSAN: Good to see you, too.
GLIMCHER: How was your fellowship in India? What kinds of experiences did you have with patients?
NISSAN: So we spent a total of four weeks there. The first week in oncology, and then a week each in the rural and urban poor settings, and then finished with a week in psychiatry. The most powerful experience was actually going in to the villages and seeing how they lived in those environments. I am very grateful I got that opportunity to see that institution. It's, I think, a model for the way a lot of hospitals can strive to be run.
GLIMCHER: What made you decide to become a doctor?
NISSAN: In college, I was in the ROTC program and did five weeks aboard a submarine where I met a naval doctor. I was in the Navy already, and he really convinced me that being a doctor of a small amount of people who you are deployed with — the teamwork I saw there — really inspired me. That was the moment that convinced me to become a doctor.
GLIMCHER: What's your next step in your life and your career?
NISSAN: So I will be doing a residency here at [NewYork-Presbyterian Hospital/Weill] Cornell in psychiatry, which is wonderful for me. I get to keep working with Dr. [JoAnn] Difede and Dr. [Judith] Cukor and Dr. [Megan] Olden. It's wonderful for my wife, who is a graduate student at Sloan Kettering, so we don't have to be separated.
GLIMCHER: Well, you've chosen psychiatry. How did you make that choice? Was there a pivotal moment?
NISSAN: Yes. Through most of my third year in medical school, I was pretty set on applying in surgery with the goal of becoming a trauma surgeon in the military. So I did psychiatry here and absolutely loved it. Met a mentor that I will continue to depend on for the rest of my career in Dr. Joseph Murray. It was really that experience that opened my eyes to psychiatry as a career. Before that, I really didn't think about it at all. Soon after that I did a rotation at Walter Reed in a surgery group there. And while I loved working with the people — I had no negative experiences — I began to feel like this was not the job I wanted to do. The most powerful moment was meeting a young man who had stepped on a landmine and lost both of his legs. I felt that the time interacting with him as a surgeon — very quickly in the morning to look at his wounds to make sure that he was doing well — didn't fulfill me and I really felt like I wasn't doing enough to help him. So it was actually in the middle of that rotation I called Dr. Murray and said, 'I'm going to switch,' and didn't look back.
GLIMCHER: I have a son who is in the military. He's a second lieutenant in the Marine Corps, graduated from Harvard just a couple of years ago, and he has now been deployed to Afghanistan where he is commanding a fleet of light armored reconnaissance vehicles in Southern Helmand province. I thought he was going to be a history professor. [Nissan laughs] But he surprised us all by doing marine officer training. How did you begin your career in the military?
NISSAN: In my senior year of high school, I met with a recruiter to talk about applying for ROTC. Being a naval officer and serving my country appealed to me very, very strongly at that point. And I made the decision rather naively. I really didn't know what I was getting into. I thought ROTC was kind of a club that you did during college, but it was more significant than that, certainly.
GLIMCHER: [laughs] I understand you will be promoted to lieutenant. You were born and raised in Ridgecrest, Calif., which is a small town with a very active military presence there. Your dad worked for the Department of Defense and your mom was a nurse, so you grew up with military and medicine around you. How did this influence your choice?
NISSAN: So my dad worked as a chemist for the Navy. He wasn't active duty. He was in the Department of Defense, a civilian working there. But I had a number of friends growing up that were sons and daughters of active duty, and it didn't seem to be an unusual experience at all. It was all I'd ever known, and it elevated the standing of the military because certainly they were held in very high regard in our community. It helped influence me on that path because it was held in high esteem, and that helped me a lot [in] making the decision. My mom initially tried to get me away from medicine. She wanted to make sure the motivations were strong enough. She looked at it as a very hard career. She had moved a lot in a lot of jobs, but she was incredibly supportive after an initial testing, I would say. And especially now, as I've become more knowledgeable about the field — though I am very early — listening to her clinical experiences and the impact she's had on peoples' lives was something that makes me very proud. So I talked to her quite a bit. We did home visits in India and that's what she spent a larger part of her career early on doing. She appreciated that that I got to see her job, be it in a different setting.
GLIMCHER: What do you see yourself doing when you do return to military service?
NISSAN: Upon graduation from residency, I will have eight years of military service with the Navy. It's unclear what the world will look like at that point. If we are deployed at that time, I would like the opportunity to serve as a psychiatrist in a forward deployed unit. Seeing my friends who have graduated from college who are entering their fourth year [in military service] and the experiences they've had, I feel a little guilty spending so much time out of that. I'd like to get back in and help them. And after that, I don't really know. We'll see what's in the cards.
GLIMCHER: And if we're not in war?
NISSAN: Which hopefully we won't be.
GLIMCHER: Which hopefully we won't be. What will you focus on in the field of psychiatry as it relates to the military?
NISSAN: So at this point, and its hard for me to predict so much in the future given how I've changed my mind recently, but seeing the problems that post-traumatic stress holds currently, both the economic burden of having so many people return with that, and the fact that we don't have truly effective treatments right now, that area holds an immense array of issues to deal with. I'm not sure which ones I would like to focus on initially, whether it's clinical research or more policy driven things, but I think at this stage I would like to focus on that disease.
GLIMCHER: So you were voted by your peers to be commencement speaker. Why do you suppose they picked you?
NISSAN: When I became [Weill Cornell Medical College Medical Student Executive Council] president, I was initially serving as the class president for the class of 2012. It was a job I really enjoyed. I got a lot of close contact with my classmates. I didn't make overtures to try to do this. I honestly thought they were going to pick other people. Very humbled that they chose me.
GLIMCHER: As the new dean of Weill Cornell, this is my first graduation as well. I remember when I graduated from Harvard Medical School many years ago; I was terrified of becoming an intern. It's a very steep learning curve. How do you feel graduating?
NISSAN: [laughs] It's pretty scary, you're right. It's measured with a fair bit of excitement. I think the opportunity to be a person's doctor and have a group of patients that are yours, that you're responsible for, that's what I'm most excited about the transition.
GLIMCHER: What's your experience been like here at Weill Cornell? Is there anything that stands out?
NISSAN: My favorite activity at Weill Cornell was the Weill Cornell Community Clinic. It's a free clinic that was established by a bunch of M.D./Ph.D. students. It's built as a comprehensive primary care clinic. The opportunity I had to be a senior clinician: teaching first and second-year students about how to do an interview, about the diseases that patients have, working in close contact with an attending physician and finally taking a position on the executive board there and helping the entire organization. It's one of the best educational experiences I've had.
GLIMCHER: I visited the clinic.
NISSAN: Oh really?
GLIMCHER: It really is a spectacular place. Did that experience give you an extra edge in preparing yourself for what's to come in the next couple of months?
NISSAN: Absolutely, and it's because of the one-on-one time with the attending. They're volunteering their time and they're able to pay attention to the students more than they'd be able to on the floors because it's a more relaxed atmosphere. There's a psychiatry clinic as well where I interviewed patients with an attending psychiatrist in the room. I couldn't believe the one-on-one tutoring the attending offered, and she gave me really good insights on how to improve my interviewing skills. My preconceived notion was that it would be a lot of immigrants or people with low socio-economic status, and I think the financial climate over the last three years has really changed the demographics of the clinic. We saw a surprisingly large number of working professionals. The one that sticks most in my mind was a law student. He had graduated two years before but couldn't find any work and had really no option to get medical care. It was eye opening to see who the uninsured really are. It's not who I would think.
GLIMCHER: Can you give us an idea of what you're going to say when you give your graduation speech?
NISSAN: Um … I don't want to give away too much of it. I'm very proud of my time here, and it will be a very positive speech.
GLIMCHER: Great, I look forward to it. And thank you very much for taking the time to speak with me. It's been a real honor, David.
NISSAN: Thank very much. The honor is all mine.
GLIMCHER: I congratulate you on your graduation. And wish you the very best of luck in your career.
NISSAN: Well thank you very much, Dean Glimcher. I very much enjoyed talking with you and glad I got this opportunity.