Surgeons general are regarded as America’s doctors. They have also been working physicians and, as became apparent at a rare gathering of the top public health experts past and present, they have families and struggles like everyone else.
They shared some of those challenges—and joys—with a rapt, appreciative audience at Dartmouth. Here’s some of what they said.
Richard Carmona, a U.S. Special Forces Army combat veteran, moved many in the audience to tears as he, struggling to remain composed, told the story of his son, a 21-year Army veteran who he said “has crippling PTSD” after serving in Iraq. He said health care should not end for veterans, just because the wars they fought are over.
Carmona was surgeon general from 2002 to 2006, when, one day, family members couldn’t locate his son, who it turned out had spent two days in a catatonic state in a corner of the family’s house. Carmona’s daughter, a critical care nurse, found her brother. He was “screaming ‘Incoming, incoming,’ ” Carmona said. Through his son’s journey through the VA—at first being told he couldn’t be treated because he was still on active duty—Carmona began to see “the cracks in the system.”
He soon showed up with his son at a VA emergency room—where the chiefs of all the medical services and the head of the hospital were lined up waiting for the surgeon general. The experience left him deeply concerned. “What happens if that soldier’s father is not the surgeon general? Our system is failing these young men and women. … It’s personal to me. … I live it every day because I see him and through him I see thousands of others that we need to do a better job for.”
Jerome Adams, who was surgeon general from 2017 to 2021, talked about increasing access to health care, including using teletherapy, especially in rural areas. “While I was in the White House, my brother was in a prison cell 25 miles away in Jessup, Md., due to crimes he had committed to support his addiction. … I’m surgeon general of the United States and there’s nothing I can do to help my own brother who’s struggling with addiction. He just got released from prison two weeks ago, he’s in rehab right now, but he’s in a rural community where there’s not a lot of access.”
Adams, an anesthesiologist, said we must “resist the temptation to feed hatred.” He recalled getting a patient ready for surgery. The patient, a white man, had a sheet pulled up to his neck that he was reluctant to lower for Adams, who is Black. Adams asked the man to lower the sheet so he could attach EKG pads. When the man did, Adams saw that the man’s chest was covered in Nazi tattoos. And then he noticed a tattoo of a child’s name and asked the patient about his child.
“We had a conversation about his kids, and you know what’s interesting about that exchange is had I reacted coldly and harshly it would have fed into his stereotypes about people like me,” he said. “I have no illusions that I magically changed his mind, but you know, maybe that interaction showed him that not all Black people are the way that he thinks of them. … If we can look at things that way instead of ‘you need to hate this person because of what they said or who they are,’ then I think you’ll be in a much better situation, and I think it will spread positively throughout our country.”
Regina Benjamin, who in 2010 was awarded an honorary degree from Dartmouth while she was surgeon general, said her trip to campus was the first time she has visited Dartmouth without spending time with former surgeon general C. Everett “Chick” Koop ’37, her mentor, who died in 2013.
“I have this conversation with my son. He’s 17, he likes to work out,” she said. “You go to the gym to get stronger, you don’t go to the gym because you’re hurting. It’s the same thing for mental health. We need young people to understand that we can do things like meditation, we can do things like making sure we have peer groups that we can connect with what will build our resilience up, our mental muscles, so that we can be stronger. … We want to recognize when people have problems, but we also very much want to recognize that there are things that we can do to make ourselves stronger and to build resilience.”
Joycelyn Elders, a pediatrician and at 90 the eldest of the surgeons general on stage, recalled treating LGBTQ patients before such an acronym existed. “I just spent the rest of my life really wanting to do the right thing for young people. I wanted to make sure they grew up healthy. I wanted them to be educated. I wanted to make sure that they had hope.”
Elders, who in 1993 became the nation’s first Black surgeon general, recalled that as a girl, every school day included four hours of home economics. “What I was being educated to do was be a good maid. … That’s what they taught Black girls in schools.” But then, when a young Black woman—the first doctor Elders had ever seen—visited Elders’ college, that woman, Dr. Edith Irby Jones, lit a torch that still burns in Elders. “I spent the rest of my life wanting to be just like Dr. Jones and I tell people now, if you don’t have a mentor get one … because you never know the real difference it can really make in your life.”
Antonia Coello Novello called for better treatment of women in medicine, who she said sometimes fall behind if they take time away from their careers to have children. “I don’t want to disappoint the women who are trying to come into medicine, but please make sure that you recognize (their) gender differences,” she said. “They have different circumstances that put them at risk, gender inequity, and the comments that they get for their looks, for their sexual harassment, and the overload that they have. … ”We have lost self-care. We don’t sleep, we don’t eat, we don’t do social interactions and on top of that we basically have a home, a husband, and children to take care of.
Kenneth Moritsugu said next year’s election cycle is going to be “an extremely stressful period.” He asked that people take care with facts and trust science and he called on Dartmouth President Sian Leah Beilock—who has made creating venues for people to talk across differences one of her priorities—to provide outlets on campus for such discussion. “We as an academic community and we as a nation have got to address this and try to find a potential solution,” he said.
David Satcher, who couldn’t travel to Dartmouth and addressed the audience in a video message, raised mental health as a priority 24 years ago when, as surgeon general he issued the first advisory on mental health in 1999. “We need to build public awareness regarding mental health and effective treatment. We must address the serious shortage of mental health providers,” he said.
“We need to tailor treatment to age, to gender, to race, and to culture. We need to facilitate entry into treatment. We need to remove the financial barriers that create complexity and restrictions within our health care system. In order to eliminate disparities in health we need leaders. Leaders who care enough, leaders who know enough, leaders who will do enough, and who are persistent enough until the job is done.”
The surgeons general, who seemed thrilled to be able to spend time together at the panel discussion and in other gatherings during their time in Hanover, said they strongly support Vivek Murthy, the current surgeon general, in his use of the position’s bully pulpit to call attention to the mental health crisis, and to the issue of loneliness, which Murthy has made a centerpiece of his service.
Said Carmona, “We consider it such a privilege, we all feel once a surgeon general, always a surgeon general. We are part of Vivek’s army now and we back him up in everything we do.”
Murthy, in closing, spoke to the many white-coated medical students in the audience—and to everyone else, urging them to see the humanity in everyone.
“I worry about the polarization and division that we have in our country. It’s hard to hate people up close,” he said.