Duke GI Oral History: Joanne Wilson, MD

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Transcript

Dr. Bonike Oloruntoba: So I'm Dr. Oloruntoba and I have the pleasure and the honor to interview a distinguished faculty member at Duke, Dr. Jo Ann Wilson; who serves more as a mentor, a role model, a friend, and a colleague. I want to talk a little bit about her experiences here at Duke. So, Welcome Dr. Wilson!

Dr.  Joanne Wilson: Thank you, thank you. It's really a great pleasure to record some of the history at Duke, along with the people that have been here a very long time. I'm Jo Ann Wilson; Always, Jo Ann A. "People's" Wilson. I'm originally from Raleigh. I was born in Raleigh many years ago. I'm the oldest of seven kids. It was incredible growing up in a what was then, a small town. One would not know that today. It's a small town, in Southeast Raleigh, which was predominately African American. I went to parochial school there for all of my education, and it was really an impressive education.

My dad was actually an agnostic, and only went to 8th grade; decided that was the best education that his children could have. So all seven of us went to grade school, which was a mission school, interestingly. Most of us went on to the High School ... After college, I went on to the University of North Carolina Chapel Hill. I had gotten accepted to some of the fancier schools in the Northeast; like University of Pennsylvania, Sarah Lawrence and so forth, but they were really quite expensive. From early in grade school and high school, I had decided that I wanted to be a physician. There are no physicians in my family and I had wanted to be a nun and a medical missionary, actually. Going to India and Africa. The videos were really quite impressive.

But I kept the idea of being a physician throughout high school, and then on to college. I felt that the way I could do that would be through going to a school without incurring a lot of debt. At Carolina, I was a chemistry major, which I dearly loved. I became a BS chemistry major. It was again, the beginning of an experience where education; there were very few women, and almost no African Americans. In my group of BS chemistry majors, only 4 out of 40 were women, and we were all friends. Three of us roomed together our senior year. Ultimately, all of us have gone to medical school. Three of us have gone to medical school at different times. After college; I met my husband during college, and we decided to get married. I had applied to a series of medical schools including places like Harvard and Hopkins, and I had gotten in but made the decision that Duke was an excellent school, since my husband and I were different years, and there's no guarantee that you could stay together if you were trying to match on another year. So I came to Duke, and it was a great four years.

And medical school, it was unusual. I was only the 4th African American student to matriculate to Duke medicine. It was somewhat of a lonely existence in one sense; in that there were so few women. In my class, there were three women. There were no other African Americans in the class. But, the education was wonderful. I was embraced by many of the faculty and went on to finish at the top of my class, which allowed me then to go to fairly prestigious training programs; again, trying to match with my husband's education. He had gone to UNC medical school, a year behind me.

So, we ended up in Boston. I was at the Peak of Mount Brigham, and he did his fourth year of medical school there; and his second year, he did an internship in Pathology. But Brigham was really wonderful, and I met some great people there. Duke had a very strong presence in my year, because 3 of the 20 interns were from Duke. None of us had started Duke at the same time. None of us knew one another, but we became great friends subsequently.

I felt that I wanted to do Genital Medicine, having changed in medical school from an interest in OBGYN. We ended up, my husband matching in D.C. at George Washington, for halsted training. I did the same residency at Georgetown; but by that time, before I had even left the Brigham, had an interest in GI. GI was new and exciting. When I was a medical student at Duke, there was no mention of GI. It was primarily a research, primarily billiary; bowel salts and hepatology-types of research. But I had met a fascinating man at West Roxberry VA, who was doing endoscopy at the VA. I was instantly, for some reason attracted to him. And subsequently, through GI fellowship at the DCVA, which was a very active... a lot of research, a lot of clinical medicine.

After we finished our training, there again my husband and I are trying to match these careers with our life and marriage. We went to the University of Michigan. I had been recruited there by a doctor, Bill Kelley; who had been in charge of the AOA at Duke, when I was an undergrad medical student here. He was Chief of Rheumatology and was now Chief of Medicine at Michigan. So we went there when my husband did his fellowship and I joined the faculty, again building, or rebuilding, a GI division there. I became the only clinician, full-time clinician, when I first got there. It was a great situation. We ultimately recruited one of the top people in the country as the Chief of GI, who subsequently was Chief of Medicine, there. I was a clinical academic physician. I tried to do research at the same time, but that just doesn't work. We had our three children there. Three children in less than five years. My husband finished his fellowship, got research funding. I was ultimately promoted to associate professor with all of the funding. With all of the support for clinical medicine, there.

So it was an interesting life. At some point, we knew we needed to move for my husband's career, primarily. They were trying to develop, or revitalize the GI department here. Ian Taylor, who is a good friend of the Chief of GI at Michigan [inaudible 00:07:44], was looking for people; and I was one of those people. Low and behold, in '86, they offered both of us positions. Dr. Joe Greenfield, who is an awesome Chief of Medicine, forward-thinking fellow as he developed. So I came back here in 1986. I had been gone for 13 years and came back to look at helping revitalize our GI division, which I can say has been totally revitalized!

Dr. Oloruntoba: So what was it like when you came back in 1986, compared to when you left as a medical student?

Dr.  Wilson: It was bigger. They had gotten the new hospital. Due North Hospital. It was interesting. There were more people. GI was still pretty small. We had two clinicians; Dr. McCloud & Garved, and had people like Dr. Killenbourg, Dr. Horford, whom I had remembered from when I was here previously. Dr. [inaudible 00:08:50] was a researcher, as well. But GI was not the same as the GI at Michigan, which had already been a very big department with lots of researchers, lots of technicians; which I had been there for about eight years. We had built it at that point. So I knew that certainly could be done, but it was very shockingly different; both the institution was different. When I was here graduating in '73, we were still in a post-segregation era. Very obvious. Still, there were lots of outpatient clinics that were predominately African American patients, whereas the private diagnostic clinic had most of the people with insurance who were able to pay the full fees. So, it was still that hint of things, that we don't see obviously now. But, it was different and it was very different from the experience that I had in Michigan; which was a much more industrialized area with more 3rd party pay, and so forth.

When I first got here, I think some of the people felt that I was the African American faculty member, coming back and I had just received clinic patients, but that obviously wasn't what I had experienced previously and not what I intended to do, or what the people hiring me..it was trying to develop a comprehensive clinical program. I spent much of my earlier years directing outpatient clinic and helping with the fellowship. Several of our most notable faculty now, and some senior faculty were the fellows at that time. It was really fascinating.

Dr. Oloruntoba: So you've been here now, for about 32 years. So, what have you noticed that has changed since your tenure here at Duke?

Dr.  Wilson: Well when I first got here, I started the same time as Dr. Peter Cotton, who is an internationally-known endoscopic gastroenterologist, who had done a lot of the ERCP's and so forth. We added.. Dr. Ian Taylor added, Dr. Cotton, myself, many others, and then kept faculty and really developed the faculty with a lot of enthusiasm. We kept a lot of our trainees, and some of those are still here; like Dr. Branch, Dr. Joel, are still a part of our faculty. Leaders in our faculty.

I think the changes that we've had, is that now we have one of the leading programs in the country. We have succeeded in making it a very diverse program. The numbers of women are; percentage of women of the faculty, is greater than any.. most other programs in the country. I don't think there's any program. We've also made an effort to diversify the faculty, racially and ethically; so that we have many faculty who are African American, Africans, Hispanic, Latina, and so forth. That's been really gratifying. For many years, we had not trained African American fellows. Fellowships are very small, and it's hard looking at the numbers to recruit people, but to date we have trained a number of African American fellows who are now faculty & practitioners in other areas of the country. We have also had numbers of Hispanics, in more recent years. I credit some of that to the more recent faculty who have been able to recruit people for fellowship. We know that recruiting for house staff training, we've been very active in house staff training. Dr. Meur, who's our current Chief of Medicine, has vast experience working with house staff, from his earlier years on faculty, and able to recruit people to fellowship from the residency and keep people.

We've even recruited several of our students, which for a long time, we had a hard time doing because we had such great students that were being recruited. At [inaudible 00:13:43], the troubling aspects of diversity in our discipline, both medicine and GI, has been a stagnation in the number of [inaudible 00:13:57] who are entering medicine and subsequently on to fellowship. It appears that once people get to medical school, the numbers going in to medicine, with what we've seen in the majority of population. And then also, on to fellowship. So it doesn't seem that we're losing people there. Where we're losing people has been in our end of our recruitment in preparation for medical school itself.

I've been, for almost over 10 years, lecturing in the Duke Summer Medical Dental Education Program, which helps to prepare a ...of students for this journey through medicine or dentistry or research; and I've given the GI physiology lectures, and fortunately, fellows have helped in the past; Dr. Travis Cox, who was one of the ones. Dr. Julius Wilder, who has been a stalwart leader from the Duke Medical School, graduate school, house staff programs, fellowship, and as one of your colleagues in transplant, is just a model for trying to help students. The Duke medical students have done what I think is one of the critical areas, has gone back into the high schools to recruit people. And Duke GI has supported all of these programs. That's been the impressive part about our division, and especially recently. Strongly supporting.

And then especially the hepatology group reaching out to the community, which I think has an impact on recruiting fellows, recruiting students into medical disciplines.

Dr. Oloruntoba: I agree with you wholeheartedly. I think exposure is key. I think that of me and ,y experience at Duke, I was blessed to.. sometimes you take some of these things for granted to realize that you are in an apartment where you have several female African American faculty members who are full professors, who are associate professors. Who you can look at and say, "Okay, I can be that person in the future." I think that when I actually went on my interview trail for GI fellowship, I didn't realize how special Duke was, until I realized the faculty members at other institutions who did not look at all like me. One of the things I admire the most about Dr. Wilson is something that I don't think I can have the courage or the strength to be, which is a trailblazer. Every aspect of your life and your career; you've been the first of many.

And I always look at individuals like you, and I'm like, "I don't know how she did it. I think I'm very lucky and blessed that she already paved the way that I don't have to." But I appreciate what you have done for faculty members like me, faculty members who are coming up in the future. Medical students.

Dr.  Wilson: Well a lot of times, what I did was tot try to do what I thought was right for me and for my family. One of the things my husband was just posting was about Loving Day. We got married, we were an interracial couple. We got married in 1969, which was 2 years after the Supreme Court ruling, in Loving vs.. The State of Virginia. And subsequently also, trying to forward a career with the family held high in that whole endeavor, and trying to balance that out.

I've told several people in the past that when my daughter was born in Michigan, she was the first baby born to a female medical faculty member. This was 38 years ago, they didn't really know what to to because no one had had..a couple of fellows had, but not an attendee.

It's been really important to me to try and balance that as much as possible. I've been really impressed that my daughters have chosen to pursue a medical career, one MD and one clinical phycology PhD, and to pursue a career in academic medicine, at that. One of our former chiefs, Dr. Annamae Diels also had been a model in research and endeavoring to have a career and have a faculty. One of her daughters is faculty.

For me, one of the most impressive factors that I've been thankful is being able to advance a career here at Duke. I was only the second woman promoted to full professor here at Duke. It had been over 30 years since the last professor, Dr. Grace Kirby, who I had known when I was a medical student, had been promoted to professor of medicine. And for me, that was really a high honor. Since then, there have been many more women, and I expect many more in the future.

But the other thing that Duke allowed me to do, is it allowed to get involved in professional societies and to speak and to educate at national meetings; also at various institutions around the country. That comes from..as a person who's a clinical academic, not the typical path in the past for physicians. There were primarily researchers. But to publish, which I've done, in clinical topics to be involved in our professional societies. To me, many of the thought leaders in our discipline around the country and to be able to gain that knowledge to present to our fellows, our trainees, and our colleagues in practice, as well as training and educational in lay populations. I know that you've also been active in community education. My feeling is that if we're going to make a difference in a lot of the aspects of gastroenterology and health that we really want to do, we have to educate our population. Because, they are the ones to seek these further studies. I've given many talks at churches. Last year, one of my interests had been geriatric GI, and I gave one of the most rewarding talks to a whole audience of seniors. One of our doctors in the area has a foundation that he is able to do Health Day for seniors. They were just the most animated audience, with great questions. I stayed for almost 45 minutes after the talk, which was a 45 minute talk, answering questions about GI disorders in the seniors. We don't say elderly; in the aging.

Now there's much more information, much more interest. But when I first started giving these kinds of talks, maybe 20 years ago, there wasn't much interest in that area. So, it's been fascinating.

Dr. Oloruntoba: Switch topics, a little bit. Tell me about any stories, or any interesting stories or actions with previous faculty members or even current faculty members.

Dr.  Wilson: Well, it was always great. One of the ones, is Dr. Paul Killenburg, who served as one of our interim Chiefs of GI, but was this giant man. He's one that I would have loved to have interviewed, but he was just fascinating. A Hepatologist, who actually he and I had been the ones who had Dunlap [inaudible 00:22:34] before. Most of people now in GI, had never done medical agrostography, but he and I had done that in our prior careers; because that was the only way to biopsy the liver, or directed biopsies before there were ultrasounds or CT's. People think there was no such time! But he was really a fascinating man, very passionate about hepatology, but also about a lot of community service, and his church was very active in plow shares. And then we lost him a few years ago. I actually had decided that he should receive a distinguished faculty award, because I had been on the Duke Medical School Alumni Council, and sent out requests to like, 20 people who had been at Duke previously. I didn't ask him, I just told him I needed his [inaudible 00:23:35], and I got 20 out of 20 responses; people that went pretty far back in their training. Everybody was just incredibly enamored.

It was great initially, coming on and working with..I was working with an all male faculty when I got here. And so, it was an interesting endeavor. They were receiving and warm and welcoming, as we sorted out our various practice ideas. Most of the people were probably about 10 years older than I, because I was the youngest faculty at the time, when I came on board; which was kind of interesting. That had been the way my career had been the whole time. I was the only woman on House staff and fellowship, I was the only one when I joined the faculty at Michigan. But quickly, added other women at Michigan. It took a little while, here at Duke, to get other women on board. Subsequently, [inaudible 00:24:56], who has been an awesome faculty colleague and friend. I work very closely with her, even now. So, it's been great.

One thing I was thinking about this morning; one for colleagues, but also for other workers who are here at Duke. I remember when I came back and joined the faculty, there was one man who had been a groundskeeper or something, and I saw him in clinic. I was doing his procedure and he said, "You know, I remember you." And I'm like, "Oh, from when? I've not seen you before." He said, "When you were a medical student." He was a delightful, real Southern Caucasian man. And subsequently, when his grandson got sick, he said "I want you to see Dr. Wilson because I've know her for many years." It had become a very different relationship but I had taken care of him and then now his grandson is still my patient.

Around 2000, my house burned down. The warm out poring from faculty, from staff, was just incredible. Several of the women faculty in other divisions got together to form a potluck.. not a potluck but a casserole schedule, so that they brought food. The all of the people in the endoscopy unit, like colleagues, giving us things.. it was just incredible. It sort of made you know that Duke GI, Duke Medicine, the medical center is a family.

The other important aspect of being here with me has been reaching out to the university. I've served on the academic council for a number of terms, and got to know people over on the campus. Also, the other was I was on the executive committee council, which met with the higher administration at the university. And for me, that was a big advantage. You're in a medical center, you're in a medical school, but you're also in a university and all of those people are working together. So, it was really eye opening to know what's going on over on campus. And we've continued that in our division to date, with recent work in biomedical engineering, and so forth; for our division to be embracing other schools within the University. It's been really fascinating.

Dr. Oloruntoba: What have you enjoyed the most about being at Duke, and the department of Gastroenterology Medicine, and just the university in general?

Dr.  Wilson: I think what I've enjoyed most is other people, and seeing the growth and development of the people as well as the division and the department. For me, being is medicine is about people. Sometimes people say, "Well how do you just do colonoscopies day in and day out?" I say, "Well you don't do them day in and day out on the same person." Everybody is different. And the same with the interaction with the fellows. I love teaching fellows and residences procedures; clinical medicine, more than anything else. Early in my career, someone said, you have to have a specialty within your specialty. One of my feelings was that I wanted to be a very good general gastro..and have very broad knowledge. That feeds into my own personality, because I like to know a lot of different things about GI, about people, about the world, to sort of know and sort of collect the facts.

It's been really gratifying to be able to that, but I think also to see people..I don't like to have people leave. I like to see people staying and developing and see our division growing with various sites. One of the things that I have stressed, is I want people to come back. I don't want to have them off in some other site and never coming back to what I call, "The Mother Ship"; but to spread the warmth and the culture and the education, because I think it's about taking care of patients and taking care of people, more than anything else. And you know, helping our whole area develop has been really fascinating.

For me, it's been great to be back here because I am a North Carolinian. I have relatives. Mostly in Raleigh, a ton of them in Durham, and one of my distant cousins will be matching here; will be starting in pediatrics. It's just been really fascinating being there. There's a family reunion this Summer, that will have 600+ people or more, from both sides of my family and some other relatives. It's really been great being back in North Carolina. I have some apprehensions about whether the state or the area will change so much that it won't be the same, and I've seen that. Where, the southern way of doing things may be lost as we look more like other areas. But many people have loved this area; the graciousness and the warmth. But, I do want us to continue to diversify, and whatever Duke can do..because we've got major universities, we've got great neighborhoods; but to work with the public schools, work with our high school students to get students interested in medicine. Particularly the under-represented minority students that we have here. The numbers that they were presenting at our meeting were sort of daunting.

I have devoted a lot of my career to under-represented minority committees, women. It's hard to stop. And then I think now, more women as mothers in medicine, fathers in medicine, just an effort to make medicine look just like the country. There's no reason why it shouldn't. The plumbers, and the electricians have succeeded from most part in doing that. I think that for us, it's really critical; given what we do. I strongly support the accomplishments of several people who have made here..[inaudible 00:32:36] new well-funded endeavor. Dr. Armstrong's years of work with medical students. And with undergraduate students have all been..subsequently we end up with people like yourself to carry on very enthusiastically.

Dr. Oloruntoba: Actually, one of my favorite places to go to in the hospital..I feel like Duke does a good job with pictures. Pictures tell the history of the department. Up on the 8th floor, they have the pictures of the past Chiefs of Residency, where you can see how it has eventually changed with time. The surgery department, they have a wall up with all of their former Chief of Residencies and it's the same thing. And also here, before we come to our conference room we also have a wall of all faculty and fellows. It's just amazing how much things have changed! I know that there's a lot more that can be done, but I feel like we've come a long way.

What do you think Duke will be after and if you ever decide to retire? What do you think Duke will look like?

Dr.  Wilson: I think I'll be pleased. It will be a place that has developed and grown, and it will look great. We have been so embracing of our people, that the people that we have trained have not all left. We have certainly populated the country with incredible gastroenterologists from Oregon to Minnesota to Louisiana to New Orleans, D.C.; I mean, they're everywhere. Atlanta, and also around the world..Australia, England. I think that Duke will be left in great..I know that's the feeling that others that have retired; Dr. McCloud, Garbit, have felt the same way. I love what I do, and I love working here, so it's hard to leave. I've come back some, but it's hard to leave the endeavor as long as you know you have something to offer. I feel very happy.

But, I am somewhat disappointed that the numbers aren't greater. I want to reflect the population. I want medicine to reflect the population and I want anyone who is involved to be embraced in an equal fashion. We still haven't gotten there in this country. I think we've done a better job in our particular division than many other areas have, but we can only do so much if we don't have students coming in to medical school, and coming in to medicine. So I think that we have to continue the struggle, in a sense; and continue the work. My hope is that we will get to that state, but it is continuous. It continues, it is a work in progress, so to speak. I don't think that we ever rest on our morals, and it is a work in progress. I think things are moving.

Dr. Oloruntoba: Well thank you very much! We'll continue to pass the baton, and make progress in our department.

Dr.  Wilson: Okay, great. Thank you!