2018 Graduation Address

Cassy Salgado, MD,
MUSC Director of the Division of Infectious Diseases
2018 Fellows’ Graduation Address

Your friends are your heroes

Good evening to everyone and thank you. I really can’t stress enough what an honor it has been for me to spend this day with you. It’s hard to believe that 15 years have passed since I was sitting there and a lot has happened since then, things I would have never believed or expected, both in my academic career and in my life. So, its been nice to reflect on my time here and to perhaps try and translate how my experiences helped me along the way in an academic world that’s not always entirely friendly and what I could pass on to the graduating fellows.

Let me start by telling you how I ended up here at UVA. I knew early on in my residency that Infectious Diseases was the career I wanted to pursue. During medical school, I was fortunate enough to do an academic exchange program in Harare Zimbabwe. This program was led by a man named Ray Smego, an ID physician at my school, who would later go on to lead several medical mission trips, and open an orphanage and associated medical clinic overseas. Sadly, he would pass away at the age of 60 on the eve of assuming a Deanship at the University of the Free State in South Africa. Through our many conversations, he allowed me to understand this thing about myself which drove me to help others and to fully understand how important it is to help those who are vulnerable- something that seems to bring many of us together in the infectious diseases world.

His influence led me to start looking at ID programs with a strong Global Health section and somehow UVA did not make it on my initial list, even though I was sitting right above it in Morgantown, WV; however, during the interview process I went to Case Western and while there met Bob Salada. He was the program director at the time and at the end of the day he sat down with me and said, “Cassy, I think you are going to do great and if you want to come here, I am happy to have you, but after spending some time with you, I want to recommend that you take a look at the UVA ID program.” Honestly, I wasn’t sure how to take this comment but I decided to take it at face value and when I got home I looked at the program. It seemed ideal but the only problem was it was the day before the application deadline and it was back in the day when you actually had to print the application, fill it out by hand and mail it back in with a personal statement.

I ended up calling Lil Robertson, the program coordinator and she said “send it in, we might review it even though its late…” so I did and found out a week later that I was invited for an interview.

I loved Charlottesville immediately- I was met by the current fellows at the time, Carlene Muto, Tobi Karchmer, Chris Huston, and Dave Calfee. We went for coffee and later lunch and they were fantastic. I also remember my meeting with Dr. Petri who was so kind and helpful- in fact I still consider him to be the most gifted person I know in listening to people talk about what they want to accomplish and matching them with appropriate mentors. I remember meeting Dr. Guerrant and I will tell you that when I left his office, I was sure I had just had the most enthusiastic conversation about infectious diseases that I would ever have, but what sticks in my mind most is the interview I had with Dr. Mandel. Like most who are about to meet an icon in their chosen field, I was super nervous. He sat down behind his desk in an office crowded with books and journals and pictures on the wall of nature and underwater scenes that I would later learn he had taken.

He picked up my application and said, “I see you are completing a Med Peds residency. You know, I never really understood that. How could you possibly think you could learn everything you need to know about the two disciplines in such a short time?”—Oh no he hates my residency—the next thing he said was, “I see here you might have career interests in Global Health. That was never for me either but I guess those guys across the hall might get it.”—Oh no he hates my career choice—to tell you the truth, I don’t remember much else about what I said but at the end of the day I was certain I wanted to come to UVA for fellowship and equally certain that UVA wanted nothing to do with Cassy Salgado. I was fortunate, like you all, I did match here. I still have the printout from the NRMP that says

University of Virginia Health System
Infectious Diseases Subspecialty 

And I still have the letter I received from Dr. Petri, congratulating me on the match and a handwritten comment in the margin, “We got our top two!!”

I keep those in my cherished items box in my desk drawer.

Now I have to tell you about my first day on service. You all know I had just spent the entire first year doing research without a pager and I was rusty with wearing the pager, answering the pager, and also with my clinical work. Molly Hughes was the senior fellow who rounded with me that morning and we had a medical student on service with us. My attending was Dr. Donowitz. I noticed a few hours into the afternoon that we didn’t seem that busy and then I heard on the overhead paging system “ID Fellow please call…” Huh? Oh no, where’s my pager? I retraced all my steps and found it beeping like crazy in the women’s restroom. I have no idea how many pages I missed but what I do remember is that we had 8 consults that day.

Around 4pm Dr. Donowitz called and wanted to meet and discuss the ones I had seen, which amounted to one by me and one by the student. It was a complete disaster. Dr. Donowitz gave me a look (well a lot of looks) and said, “Don’t ever be unprepared when you come to meet with me and don’t ever, ever let the student present a case before you have discussed it with them and outlined a plan.” I never did again. I got home at 2am that night and was there bright and early at 6am the following morning and that’s the way it went for a while.

One more brief Donowitz story… later that month, I was called to see a very sick young man in the ICU. He had what appeared to be sepsis but no etiology had been found. After taking my history from the family, performing my exam and reviewing the labs, I was concerned that he had Ehrlichiosis. This was complicated because the patient had a documented history of severe allergy to doxycycline. I asked Dr. Donowitz to come over and see him since he was so ill and presented my thoughts. Dr. Donowitz was not so convinced about my diagnosis of Ehrlichiosis, in fact he thought the idea was a bit absurd. He stated, “If this patient has Ehrlichiosis I will get up on this table and shout it to the entire unit. I assure you this patient does not have Ehrlichiosis.” Voices were raised and people were looking. We didn’t recommend treatment for Ehrlichiosis but fast forward about a month later and Eric Houpt is presenting at Monday Case Conference. He presents this case of a young man in the ICU with sepsis and shows the blood smear revealing perfect beautiful morula… well, I never got to see Dr. Donowitz get up on the table in the ICU, that would have been cool, and that’s the way it went for a while.

As most of you know, I had a brilliant mentor in Hospital Epidemiology, Barry Farr. I was able to pay tribute to him at his memorial service last year and there are numerous stories I could share like how he we wrote my first abstract, my first research manuscripts- I’ll give you a clue, they practically broke track changes with all the red lines, how we prepared for conference presentations by holding ch’ ching sessions, and how to be a good mentor and colleague.

I do want to share a couple of things about Barry. I was working on a meta-analysis of CA-MRSA and was meeting with Barry in his office. I was explaining to him that according to my analysis that if you only focus on people coming into healthcare to see what proportion are colonized, you will overestimate by more than 2 fold the actual rate of colonization. He thought about that a minute and looked over my math, opened up his antiquated EpiInfo program and typed in the numbers, and a big smile came over his face and he said, “That’s my girl, that’s the power of epidemiology.” We later published that paper as the lead article in CID and looking back, I believe this fully validated my career choice and research focus.”

Another time with Barry also sticks with me. It was during my final year of training and Barry was giving a lecture to the fellows. He was standing in the front of the room and pointing to the screen and stepped backwards and fell over the projector cord. We all sort of giggled a little bit and honestly, I didn’t think much of that. Barry was always doing that kind of stuff and I just thought he was a little clumsy. Later that week, Barry called Dave, who was now a junior faculty member, and I up to his office. He wanted to discuss something with us that was important. He told us about his diagnosis of Multiple Sclerosis. He told us how he first noticed numbness in his right arm and how when he had his first major episode of paralysis he thought his career was over. He also talked about how he improved and mostly how his close colleagues here at UVA helped him through that, adjusted his schedule and allowed him to not only have a career but to have an extremely important and successful career. He also told us he was going to have to retire due to his illness but that this was ok and he wanted us to be ok. He was going to write a novel in retirement, he was going to watch his sons grow into wonderful men.  Barry was the best mentor, he was simply the best and I miss him.

Several years later when I was diagnosed with cancer, I had surgery, chemotherapy, and radiation and I was struggling a bit to come to work and be engaged and productive. I called Barry and we talked for a couple of hours. He said many things but one was very important, he said, “c- there will be dark days, you and I both know that, but you are going to come out on the other side of this a much better person, smarter, stronger, more resourceful.” That was true.

I have numerous stories about each and every one of the faculty and fellows- don’t worry I am not going to tell them all- I’m going to wrap up now by expressing how grateful I am to all of them, incredibly grateful. It’s rare that a week goes by that I don’t reflect on my training, my friendships, and the professional colleagues connected to UVA. I will ask the graduating fellows to look around at their colleagues, those who have been through this training experience with them. I can assure you that you will see them all succeed and that you will keep in touch and reminisce about your years here at UVA. The tough times, the amazing times. You are one of a very fortunate group, one that has a far reach and a loud voice in academic infectious diseases and beyond. Listen to this…

Carlene Muto- UVA fellow 1996-1999. Associate Professor of Medicine and Hospital Epidemiologist, University of Virginia. Former Associate professor and Medical Director for Infection Prevention of the UPMC Health System. Pennsylvania Governor personal commendation for tremendous efforts and aggressive actions against hospital infections. Editorial board member for ICHE and CID.

Tobi Karchmer- UVA fellow 1996-1999. Vice President of Global Medical Safety, BD, one of the largest global medical technology companies in the world.

Chris Huston- UVA fellow 1998-2001. Howard Hughes Scholar, Young Investigator Award from the American Society for Clinical Investigation, Physician Scientist and Associate Professor University of Vermont, Researcher of the year, University of Vermont.

Dave Calfee- UVA fellow 1998-2001. Jonathon Freeman Scholar, SHEA, Professor of Medicine and Healthcare Policy, Chief Hospital Epidemiologist, Weill Cornell Medical College, Deputy Editor, ICHE, Infection Prevention Champion for the greater NY Chapter of APIC, Chair of patient safety and quality improvement committee, SHEA.

Eric Houpt- UVA fellow 1999-2002. Jack Gwaltney Professor of Infectious Diseases and International Health, University of Virginia. UVA DOM award for excellence in research, Bailey K Ashford Medal, American Society of Tropical Medicine and Hygiene, National Tuberculosis controllers Association Robert Koch award and Division Director, Infectious Diseases University, of Virginia.

Molly Hughes- UVA fellow 1999-2002. Associate Professor, University of Virginia, Excellence in Teaching, DOM inpatient attending of the year, DOM outstanding mentor and the ACP academic teaching award.

Chris Parsons- UVA fellow 2001-2004. Former Professor of Medicine and Microbiology, Louisiana State University School of Medicine; Director, HIV Malignancy Program, Translational Tumor Virology Group, Louisiana Cancer Research Center.

Mike Ison- UVA fellow 2001-2004. Professor of Medicine and Surgery, Director of Transplant Infectious Diseases, Northwestern Feinberg SOM, DOM Excellence in teaching, American society for transplantation career development award and the Ernest Hodge Lectureship, Chair of the American Society for Transplantation UNOS working group and president elect of the Transplant ID Society.

Soon enough you will be finishing these sentences for your colleagues.

What have I taken with me from UVA?

  • Listen to that voice inside you
  • Allow yourself to have enthusiasm about what you do- it will certainly influence others along the way
  • Believe in yourself- and its OK to suggest a diagnosis of Ehrlichiosis
  • Hard work and dedication pays off
  • Always prepare yourself and others
  • Be respectful of others- you never fully know what others are going through
  • Know that the unexpected will come your way but that you are resourceful and you will be better on the other side of it
  • And most importantly that your colleagues, your friends, are your heroes and you will remember them in very special ways

Thanks again for having me- congratulations to the graduates