By Jane Lock
Packed inside Hiebert Lounge on orientation day, I remember Dr. Hughes, slight-statured and grey-haired with a sparkle in his eye, walking up to the podium to give his legendary virtual Boston tour. His quirkiness and distinct poise won over the hearts of many students that day, as it did mine. From the first day of orientation to graduation day, Dr. Hughes is a central figure in our education here at BUSM. Many of us know him as the course director of first year Human Behavior in Medicine or as the Associate Dean for Academic Affairs. However, few people know that his journey in medicine started from humble beginnings in the rural farms of Missouri.
Growing up on his grandparents’ farms in Missouri and Kansas, Dr. Hughes knew how hard life was for them. “Farming was a hard life, a lot of work,” he said, “and I wanted to get off those farms.” He would often jump trains bound for Chicago with his friends, dreaming of the big city life but never felt like he would quite get there. In fact, in high school, he took an aptitude test that told him he should become a farmer. He knew he wanted a different life, and education seemed to be the key. “The train didn’t get me out of there but education might,” he said. Aiming high, he applied and got into medical school at University of Missouri in Columbia, Missouri.
Tucked in a small rural town with familiar faces from home around him, medical school was a comfortable environment for Dr. Hughes, but it wasn’t always smooth sailing. The first hiccup happened early on in first or second year. “I took a physiology exam, and I failed the exam. I’d never failed any test. And back then, they would tell you when they were going to post the exam results. There would be a hundred of us waiting for the results, and they would come out with the list alphabetically arranged with everybody’s names. The students who had failed the exam, their names would be in red with the score, and this time, my name was one of them. I looked at that and I thought, ‘Well, I’m gonna be a farmer. I have to go back to the farm.’ I thought it was over for me.” But this was just a small blip in the grand scheme of things, and it was not enough to stop him from believing in himself. He adapted and came up with a solution: “I just had to study more strategically, focus more, work harder. I told myself that I could do this.” His work paid off, and he passed the course.
In his fourth year, he got the chance to do an audition elective at a prestigious hospital in a big city. He was excited to finally “get out of Missouri and go someplace”. Little did he know his roots would come back to haunt him. Hoping to start off on the right foot, he planned to make his grandma’s famous biscuits for his first day. “My grandma was known for her biscuits. She made them on Tuesdays and Thursdays, and everybody from the county would come around to visit her on those days because they wanted some of those biscuits. They were just so good. So I thought, I’m going to go and impress these people so I’m gonna learn how to make these biscuits.” With his hopes high, he brought them to work on the first day of his rotation.“I remember people were picking them up and looking at them. Somebody asked if it was a croissant, and I told them they were biscuits. They said, ‘You eat these in the morning?’ And nobody ate them!” His heart sank; this was definitely not the way he had planned to start off this rotation.
The next day on morning rounds, he remembers an attending who looked at him and, in front of all these residents, medical students and interns, asked him where he was from. “I said, I’m from Missouri. And he said, ‘So that’s why you talk like a hillbilly!’ Everybody laughed. It was funny because I thought they all talked like they were from England. To me, I didn’t think I sounded funny. I thought, this is really not going well.”
Just as he persevered his first year after failing his physiology exam, he tried even harder to make an impression at this hospital, but no matter how hard he tried at this big city hospital, nothing seemed to click. The rotation was just not going the way he wanted it to go. With time he realized, “You can really try to work strategically. You can really try and focus. That will work some of the time, but sometimes, it’s comes down to ‘fit’. And the fit wasn’t right. I wasn’t what they were looking for. And it wouldn’t have worked if I’d gone there for residency.”
When I asked him if it was hard to come to that realization, he said, “I realized that I had this really heavy Missouri hick accent, and I realized that on the east coast, people equated it with lack of intelligence. It was before people really embraced diversity, in the late seventies and early eighties. So I consciously worked to lose that accent.” Surprisingly, this accent came in handy in the emergency room when patients got angry and aggressive. “I used my accent on these patients. In fact, I amped it up. It worked like a tonic and it really calmed them down.” Dr. Hughes gave an example of what he would say, pulling on a thick Southern accent: “Now you all, you settle down. Don’t talk like that. You gettin’ er’body riled up in here. So you hush. You just calm on down.” He laughed, “They would look at me like I was from Mars. They were mesmerized by what I was saying.”
Sometimes our dreams and goals in medical school don’t line up with reality as Dr. Hughes found out the hard way. He emphasized, however, that life isn’t all about medical school, and that everyone has a different way of coping and balancing the struggles of medical school. For him, it was running, family, and friends. To keep himself sane, he ran. “I was into fitness. Eventually, I ended up doing these triathlons, but that wasn’t really until residency -- they weren’t really ‘big’ when I was in medical school, at least not in Missouri. But I found exercise to be enormously beneficial, and there was a group of us who would go for runs after exams. Exercise was probably my most important stress reliever in medical school.” Dr. Hughes also stressed the importance of his family: “Going back and seeing family was always really wonderful.”
Dr. Hughes eventually found his place in Boston City Hospital after medical school and has stayed here ever since. He had finally managed to successfully “jump on the train” and leave Missouri behind. However, he remembers his childhood and medical school years in his home town with great fondness. “I may be romanticizing it because it has almost been 30 years ago since I graduated, so I think I’ve forgotten a lot of the hardships. What I remember are wonderful moments and wonderful people. What’s funny is I wanted to get away from Missouri so much, but I’ve gone back there, and I realize it was a wonderful place to grow up. It’s changed a lot. The farm that my grandparents had is all suburbs now. It was so far away from Kansas City in its day, but now it’s just a suburb of Kansas City. I can’t even find the landmarks to know where anything was. But I never regret having gone to medical school there and I’m sure that there were hardships, but the benefits so outweighed anything. The moments of despair, failing that exam or not fitting in in that fancy hospital elective are the things that stand out now, but most of my memories are exceedingly positive."
I asked him if he had any last words of advice for medical students. He said, “I think every day you should work hard and study hard but afterwards, put the books down and have fun. Try to connect with somebody, and try to have a good laugh every day. Figure out where that fun is going to be. It’s really what life's all about -- it’s having fun and working hard.”