Final Exercises Remarks of Sunday Keynote Speaker Dr. Taison Bell

Dr. Taison Bell, an assistant professor in the divisions of Pulmonary and Critical Care Medicine, and Infectious Diseases and International Health, and director of the Medical Intensive Care Unit at UVA Health, delivered the following remarks (published as prepared) at Final Exercises on Sunday:

It was also a complicated day. I was sitting beside Kristen Scott. We met on move-in day, first year. She lived on the floor above me. For four years we had a platonic friendship. We were both stuck in the friends zone and we were happy with it!

But between finals ending and graduation, we had nothing but empty days and minds full of thoughts, and we confessed that we actually had deeper feelings for each other. So, 17 years ago today, we were just trying to figure out what to do.

It’s funny how so much can change yet some things stay the same.

Today, much like before, we’re at commencement, we moved into a building together four years ago (a house this time), and we find ourselves with these weird roommates who can’t seem to pick up after themselves.

The only difference is, today, our roommates call us “Mommy” and “Daddy.”

I emailed Residence Life about it, but they told me it was an off-Grounds residence and not their jurisdiction!

But let’s not focus on roommate issues. I want to deliver a good message today, but I’m a clinical educator here and – like a good UVA faculty member – I take my job seriously. So let’s have one more class before you go: ICU Physiology 101. I promise it’s the last science lesson you’ll receive before leaving here. And I made it tuition-free.

First, I’ll tell you the purpose of the course. Then we’ll talk about the core concepts, which are teamwork and flow, and then we’ll conclude. Sound good? All right, let’s go.

So first, why this course? Part of the mission of UVA is to serve the commonwealth, the nation, and the world by developing responsible citizen-leaders and professionals.

It’s ambitious, but it’s simple. You take the best and brightest, make them even better and brighter, and send them into the world to make it a better place. But you and I both know that life isn’t simple, and making the world a better place is not simple either. So let’s talk more about that.

I’m a physician, so my part of the world is in health care. Which, on the surface, also seems complex. The human body has around 600 muscles, 206 bones, and its blood vessels – if arranged in a straight line – would circle the Earth about two and a half times. We have hundreds of procedures at our disposal and over 1,000 medications that we use to nudge the body closer to a healthier state.

But on a basic level, what we do is simple. We maintain flow for our patients. It could be the flow of air to the lungs, the flow of blood to the organs to deliver oxygen, the flow of bile from your gallbladder. That’s essentially what we do.

When flow suddenly stops, it can be a dire emergency. If the heart stops, we call this a code blue and we have to work quickly to try to re-establish blood flow.

In a code, the first few minutes are crucial and there’s a lot to do. You can easily have up to 30 people suddenly converge in one place. You have folks:

• Lined up to give chest compressions.
• Putting pads on the chest that can deliver a shock.
• Placing IVs.
• Drawing up and delivering meds.
• Keeping track of the time.

Now imagine all of it happening in a 130-square-foot room – 13 by 10 feet.

It is utter chaos.

But there’s something interesting about watching these teams in action. No matter your background, I bet if I took any of you along with me to observe, you could distinguish a high-functioning team from one that wasn’t.

In a high-functioning team, the chaos eventually calms down, people fall into their roles and help each other. Communication is seamless. People don’t have to shout over each other. The team itself flows.

And, just like in the rooms where I’m called to serve, in your life you have to achieve flow. You have to make progress. And the world has to make progress. And, more often than not, progress needs to happen in an environment full of chaos.

So how does flow happen? Well, turns out it works in life the same as it works in physiology. We’re moving to the core concepts portion of the course now.

Mathematically, the flow between two points is equal to the change in pressure over resistance. Which means pressure is directly proportional to flow, and resistance is indirectly proportional to flow.

Now I know that many of you were out late last night and this is a lot to take in right now. Let me break it down for you with a teaching aid.

This tube was made by Melissa Goldman in the A-school Fabrication Lab, (or the Fab Lab). I’ll tell you its story later but, for now, imagine this tube as a conduit for something: a blood vessel, or a straw, or really anything through which something needs to move from one place to another.

It’s a journey. And that journey can be as simple as blowing air from one side to the other, to as complicated as working towards your life goals or impacting your community.

That journey – or flow – depends on two variables.

First:, pressure, which is directly proportional. This means that a higher pressure on one side will cause more flow to the other side. Hopefully that makes sense.

Second, resistance, which is indirectly proportional. When it’s high, it’s harder to move from one side to the other. Imagine a blockage in the tube or if the tube was more narrow. That’s higher resistance, less flow.

I want to talk about pressure first.

Most of us tend to perform best when we’re under a little pressure.

I know that some of you here are the kind of folks who never procrastinate. You always complete your assignments ahead of time. You’re never up late against a deadline. If that’s you, just know that we see you. We smile at you, but we secretly resent you. Sorry for that aside, it had to be said. Let’s get back on track.

Now I grew up in Lynchburg, just a short distance away but in a neighborhood that may as well have been worlds apart from UVA. During the school year I lived with my great-grandmother and I would visit my parents in Dorchester, Massachusetts, over the summer. In the third grade, my teacher, Ms. Pugh, realized that I needed more pressure. She polled the class on topics we wanted to learn about. A typical third-grader, I wanted to learn about dinosaurs and outer space, but someone said that already.

I decided to write something different. I wrote, “Shakespeare.” I’m pretty sure I spelled it like “shake a spear” (and I was only one letter off!). I remember hearing his name in a candy bar commercial and I looked him up. I learned that he wrote these things called “sonnets.”

So when Ms. Pugh asked why I wanted to learn about Shakespeare, I told her, “Well, I was thinking maybe we could read some of his sonnets in class.”

Now I actually had no desire to do that back then. I continue to have no desire to do that now.

But soon after this, Ms. Pugh recommended that I apply to the GO Center, the city’s elementary magnet program. It served the entire district for fourth and fifth grades, but I was one of only two Black boys there.

I had a new set of classmates, but I recognized many of their last names because they were the same last names as the doctors, lawyers, business owners and politicians in town. I started taking accelerated classes working with students for whom college was an assumption, rather than the dream it was for me.

I wish I could tell you that was it, but by 11th grade, I was not on the right path and my performance was poor.

My civics teacher, Ms. Frazier, pulled me aside one day and turned up the pressure. She told me I needed to get my act together, and from then on, I was going to take advanced courses and make A’s in them.

And that's actually what I did, because she didn’t make this seem like it was optional.

The next year she encouraged me to apply to UVA and I was accepted with the help of her letter of recommendation and some late-breaking all-A report cards.

So a little pressure definitely benefited me. And what’s interesting is this concept of pressure for performance is true in human physiology as well.

For example, if a patient is placed on a ventilator, we have to apply a minimal level of pressure to the lungs to prevent them from collapsing. When lungs are open, they can gather oxygen for the rest of the body.

Likewise, Ms. Pugh and Ms. Frazier opened up my future and I was able to succeed in an environment that more often suffocates potential.

So the lesson is, if you want to have flow, if you want to make a difference, you sometimes need a little pressure to unlock your potential.

But it’s not that simple. Increasing pressure isn’t always a good thing. In the ICU we know that if the lungs receive too much pressure, we can actually cause damage.

During my third year here, I had a moment where I felt the pressure was building up too much. I was a pre-med, I was a chemistry major. And I was studying for the MCAT (the med school entrance exam).

I wasn’t doing well in my biochemistry course, so I went to see my professor about withdrawing. We sat down and he told me, “Look, I’m going to sign this withdrawal form for you and you can do what you want with it. But I believe in you and I know you can do this. I hope you throw it away.”

And I have to tell you, it was a good pep talk. I was inspired.

I was inspired to walk even quicker to the registrar’s office and withdraw. It was too much pressure!

I eventually dropped the chem major altogether and chose African American and African studies. I “departed from the script,” as Dr. Claudrena Harold so eloquently described yesterday. I even took a class with her. And I found a journey that, for me, was much more fulfilling.

Avoiding pressure overload is vital to success. But there’s something we need to address.

Many of you are the first generation to grow up with social media, where a curated version of someone’s life can be presented as if it’s reality. We forget that when there’s a light shined on someone, we don't see the shadow cast behind. As a result, there is this increasing amount of pressure to be perfect in everything we do.

And when you feel like you don’t measure up, it’s hard to realize your value. We’ve seen too often the consequences this has had on mental health and well-being.

The lungs can literally burst if they experience too much pressure. The air escapes from the inside and collects in the chest wall, where it compresses the lung. It’s an emergency. We have to stick a needle or tube into the chest to suck the extra air out and decrease the pressure.

The lesson is, if you want to have sustained flow, don’t let the pressure get to the breaking point. Give yourselves some grace. Ease up and rest when you need to. You will fail from time to time. But progress is the goal, not perfection. Most importantly, if you need help, seek it before it becomes a crisis.

OK, that’s pressure. Let’s talk about the second variable, resistance.

Remember high resistance impedes flow, low resistance makes flow easy. But, as you can imagine, it’s not that simple.

A common procedure in the ICU is an intubation, where you place a breathing tube down the patient’s throat. Right after the tube goes in, you connect it to a bag that you squeeze with your hand to pump air into the lungs. We’re taught that if the squeeze feels too easy, you could have an air leak in the system. Because the lungs are elastic, they naturally resist expansion.

In other words, if you feel no resistance, you can get great flow, but you’re delivering air back to the room instead of into the patient’s lungs.

And in life, too, you need to feel some resistance. Sure, it makes problems harder to solve. It makes them more complex. But it’s also what makes them worthy of being solved. The lesson is, you can have flow if things are very easy. But if you want to do good in the world and have meaningful flow, expect to meet some resistance along the way.

There was one time I intubated a patient and it was incredibly hard to squeeze the bag. I squeezed harder, using both hands. But after a couple of minutes my hands started to cramp up so I passed it to a colleague to take over. We alternated like that until we eventually solved the issue.

How do you overcome high resistance?

There are two main forms. The first comes from your personal and professional challenges. This is where mentorship is vital. Mentors try to give you good advice and lower the hurdles you face.

During my second year of medical school, I had this big test coming up and I locked down to study. I even told family and friends that I wasn’t going to call much. The test actually went well. But when I called Grandma afterward I could tell that something was wrong.

She had been skipping meals and didn’t tell me because she wanted me to focus on the test.

Like many other first-generation students, I had to work to support my household in high school and continued that in college. Winter was always the tightest time of the year because the energy bills went up.

The problem was I couldn’t work in medical school and, that winter, energy prices had risen 10% from the year prior. This broke Grandma’s finances. She was not the kind of person who asked others for help. So she had the choice to be cold or to be hungry. She chose the latter.

I wasn’t comfortable talking to anyone about this, but my classmates noticed that I seemed down and had stopped engaging. Someone told my dean of diversity, Dr. Hilda Hutcherson.

She called me into her office and I broke down. I told her I didn’t know if I could continue on and that I just wanted to go back home.

I was up against the structural forces that resist the progress of so many first-generation students, and I was near ready to tap out.

Right there on the spot, she wrote a check for $1,000 for me to send back home.

And now, not only do you know how incredible this woman is, but I’ve now confessed to thousands of people that I owe my med school diversity dean $1,000.

I hope she’s not charging interest.

The second kind of resistance takes form in the barriers to solving society’s critical problems, like racial injustice, health disparities, climate change, decreasing economic mobility and the growing influence of disinformation.

When I think about these high-resistance problems, I think about the heroes I studied in the classrooms right behind me. People like the folks my children are named after: Professor Julian Bond, Dr. Alain Locke, and Ruby Bridges.

A few days ago, I watched a commencement address by John Lewis, where he told the story of the Freedom Rides throughout the Deep South and how they were beaten on a bridge in Selma on Bloody Sunday in March of 1965.

He describes these acts of civil disobedience as “Good Trouble.” What he meant is, sometimes when resistance to change is high, you have no choice but to act and dial up the pressure.

I like his example because the math checks out. When you have a fixed high resistance, in order to achieve flow you have to increase the pressure until you can ease those systemic barriers. In this case, they protested (pressure up) and got the Voting Rights Act passed (decreased resistance).

But here’s the thing: You can’t keep pressure up on your own. You need people to pass the bag to, like I did in the ICU. When my heroes recalled their experiences, they were quick to point out the people who were with them.

There’s power in working with others. But we can become so siloed in our careers and personal lives that sometimes the resistance to progress is from the lack of collaboration itself.

I saw the power of collaboration early in the pandemic. We were running low on masks and other personal protective equipment, or PPE. Jessica Denomme, one of our nurses, sent an email to Will Guilford in the E-School asking about 3-D printers and other ideas to help solve this problem.

An initiative formed including folks from the hospital, the E-School, the A-School and the Ed School. We needed help with logistics, so I pulled in my Darden classmates – Tiffany Pillifant and Andrew Harris – along with Rebecca Steele, a nurse in the community.

All told, we produced face masks, face shields, nasopharyngeal swabs and other items that went into our local community and throughout the commonwealth.

And remember, this was before we had treatments or vaccines. PPE and testing were all we had.

The tube I showed you earlier is signed by several faculty and students from the project. They’re from the very schools that are here today. And I have no doubt that there are people who are alive today because of what happened here.

This is the power of collaboration and diversity. When people with different skill sets and points of view come together, the unimaginable can happen.

The magic of this day is you get to go out into the world and join the UVA family as alumni. For only a part of UVA’s power exists right here. Most of it comes from the network. Those who sat here before you and are changing the world out there.

The lesson is, when you’re tackling high-resistance problems, you need others on the journey with you. They can help you sustain the pressure to overcome, or cut down, the resistance to flow.

So there it is. Flow depends on pressure and resistance. Simple, right?

Well I hope you’ve picked up on the theme, “It isn’t so simple.” There will be times when you feel like you should have flow, but you’re still stuck.

One day when I was 6 years old, it snowed and the older neighborhood kids came over to sled on the hill in my backyard. I was trying to keep up and climb up the hill on my own, but each time I slid back down. I just couldn’t do it. I was so frustrated I sat down in tears at the bottom of the hill.

Grandma called me inside and I must have looked a mess. I had the thing where the tears were mixed with the snot from my nose, and it was starting to freeze into a germ goo.

She sat me down, cleaned me up, and gave me hot chocolate.

She noticed that each time I tried to go up the hill I was so focused on the top I wasn’t looking down to see where my feet were going.

She said I could stay in if I wanted but, if I went back out, I should focus on where to take my first step. And then the next. And then the next.

I went back out and tried again. This time recalling the many times I had climbed that hill in fair weather. Remembering where some of the rocks, roots, and divots were where I could get a foothold. I didn’t make it on the first try, but I kept trying, and I finally made it to the top.

I want to close by asking you this question: What did Grandma change for me to achieve flow?

She didn’t add pressure. She made it my choice whether I wanted to continue.

What about resistance? Did she make the challenge any easier? No. Same hill. Same gravity.

There is a variable in this math that I haven’t accounted for. What was it?

I think it was the power of belief. Her belief in me made me believe in myself. I had a new strategy, but belief gave me the confidence to try again.

And, reflecting back, what was it that made John Lewis get up after he was knocked down in Selma? What was it that made Ms. Pugh, Ms. Frazier and Dr. Hutcherson take the extra effort to help me stay on my path? What was it that kept students and faculty up all hours of the night to help a community in need?

Belief.

Belief in the cause for justice, belief in your ability to change the life of a student. Belief that your skills can make an impact. That’s the difference.

Mr. Sampson talked about the power of a positive attitude on Friday. Belief in yourself translates to your attitude, your effort, and your will.

You may have to try again, you may have to try in a different way, the goal may change. But belief will make you try. It’s what makes you take those next steps up the hill. It is immeasurable.

The biggest mistake I made early in my journey was I thought I had to carry my burdens alone.

And when I stumbled, I didn’t let the belief others had in me reinforce belief in myself.

And, despite my accomplishment 17 years ago when I sat where you are, I didn’t fully believe in myself. I felt purely lucky to be here, rather than both lucky and worthy.

If that sounds like you, promise me something. You don’t have to remember anything else I’ve said. But do this: Promise me you’ll work on believing in yourself today. Right here, and right now.

Because today, you finish this stage of your journey in the Academical Village. No matter your circumstance, you’ve worked hard to make it here. You’ve had to climb. You’ve overcome challenges. You did this during a pandemic.

Now it’s time to use your talent to do some good in the world. I’m putting a little pressure on you to unlock your potential (but not too much). I urge you to tackle challenges that are worthy. The ones that have resistance. And when that resistance is high, use the power of your mentors, your friends and your colleagues to turn up the pressure and lower those barriers.

And when you’re feeling like you’re stuck, or that you’re not good enough, or you're not deserving, or you’re not worthy to take on the challenges of our time, I want you to regroup, remember that you have a family, a University and a community that believes in you. And I want you to take those next steps.

Thank you very much, and congratulations!