Perhaps no American city has been more often or more closely associated with the word “hope” over time than Chicago. In both, or all, directions. On one end of the spectrum there are the daily – hourly – dashed hopes of travelers scrambling to catch connecting flights at O’Hare. On the other end one finds the patiently nurtured hopes of generations of Cubs fans to bring the World Series trophy home to Wrigley Field. When it finally happened in 2016 some saw it as a sure sign of the Apocalypse. And who, reading this letter two years later, would say they were wrong?
No art form traffics more often or more shamelessly on hope than TV medical dramas and soap operas, and no city has been fictional home to more of these than Chicago. In the 80s and 90s, when doctors duked it out with lawyers over who would rule the network airwaves, the three top doc-dramas were Boston-based St. Elsewhere, featuring a young Denzel Washington, Chicago-based ER, featuring a young George Clooney, and Chicago Hope, featuring neither.
Sidestepping Reality TV to consider “Reality” itself, no American city is home to more associations and boards dedicated to monitoring and warranting the medical profession’s aim and claim to offer “hope” than Chicago. You know them: the American Medical Association, the American Academy of Pediatrics, the American College of Surgeons. The list goes on. A more narrowly focused list, tailored to child neurologists’ tastes would include the Accreditation Council for Graduate Medical Education (ACGME), the American Board of Medical Specialties (ABMS), the American Board of Psychiatry and Neurology (ABPN). Real foci of real power, authority and influence. And “hope”. Or so one hopes.
What the CNS has or offers….is hope. Real, genuine hope. Which might seem like a strange claim to make for a specialty practiced by those well practiced – too well practiced – in breaking the bad news to patients and parents that there wasn’t a lot of hope to be had.
Which is where the Child Neurology Society comes in. Not because it wields power or influence. It doesn’t. Whatever power or influence it may have is linked to partnerships with larger allied organizations, principally the AAN and AAP. What the CNS has to offer, is hope. Real, genuine hope. Which might seem like a strange claim to make for a specialty practiced by those well practiced – too well practiced, and for too long – in breaking the bad news to patients and parents that there wasn’t a lot of hope to be had.
But that’s all changing. Child neurology and the Child Neurology Society are changing. “Hope” has lately become child neurologists’ favorite four-letter word. Nowhere, and perhaps at no other time, has this been more evident than last October in – where else? – Chicago. I have three reasons for making this claim, two of them based on public perceptions that anyone attending the CNS Annual Meeting at the Hyatt last October might have easily made, and a third based on a highly personal, autobiographical notion that I think binds all three together.
Unprecedented Hope, Unparalleled Promise
CNS President, Dr. Jonathan Mink opened the 47th Child Neurology Society Annual Meeting by stating unequivocably, “This is a very exciting time in child neurology. We have disorders we can treat today that we couldn’t even diagnose 5-to-10 years ago. There has been an explosion of knowledge and the real opportunities for therapies that change the course of the diseases of the children we care for is astounding.” Jon cited a number of highlights to follow in the coming days as part of a high quality, highly diverse scientific program organized by his colleague at the University of Rochester, Dr. Erika Augustine; these included seminars and symposia on precision medicine – “the next frontier,” neurocritical care, neonatal seizure trials, telemedicine, and “Contemporary Management of SMA: transitioning from reactive care to proactive care in the molecular era.” Building on his comments, Erika noted that in addition to being “a place to come to reunite with old friends, to reinforce knowledge of foundations of child neurology and neuroscience, a place to come and catch up on what’s new, to become up-to-date with the latest advances in our field, I also think of this as a plac e to have important conversations as a field about ho w we want to move forward.” The CNS Annual Meeting, she emphasized, presents “an opportunity, perhaps even a responsibility to think about changing our paradigms for clinical care, to think about new approaches and new solutions to the challenges ahead.” To think, that is, about where to look for, and how to responsibly sustain and deliver real hope.
The Next Generation of Neurologists has Arrived: “35 under 35”
It is as important to note as it was impossible to miss that the largest gathering of child neurologists in North America to date (by far) was also the youngest and most diverse (by far). Fully 35 percent of the 1,350 attendees in Chicago were roughly 35-years-of-age or younger, meaning they were enrolled in med school, child neurology and neurodevelomental disabilities training programs, or newly boarded or board eligible child neurologists just starting out in their career. One could not help noticing that even before the traditional CNS meeting got underway with the Neurobiology of Disease in Children symposium and the high energy Welcome Reception hosted this year by Ann & Robert H. Lurie Children’s Hospital of Chicago (a real Chicago hospital), there was a pronounced “youth and diversity movement” afoot. Over 100 residents gathered to attend either the 3rd Annual retreat of the NIH-funded Child Neurology Career Development Project or the 3rd Annual CNS John M. “Jack” Pellock Resident Seminar on Epilepsy. I spent much of the ensuing week listening to faculty members for each marveling at how gifted and grounded these residents were and how brightly – and hopefully – the future shone in their faces.
Hope Lost & Found on the Streets of Chicago (and Rochester)
Which brings me to a closing personal observation. I remember how as a 14-year-old going to junior high school in the shadow of the Mayo Clinic in Rochester, MN, I paged through a library copy of Life magazine in September 1968, angered and dismayed by its vivid witness to what I had watched in horror on black-and-white TV two weeks before: the raw brutality of Chicago policemen busting and bloodying the heads of the raging, rioting, defiant youth gathered outside the Democratic National Convention. The gaping wound that opened up in my heart and soul that year with the weekly casualty reports and body bags coming out of Vietnam, the shocking assassinations of Martin Luther King and Bobby Kennedy, the physical and psychological beating brought down by older generations of Americans on their children and grandchildren on the streets and in the parks of Chicago, has never really stopped bleeding.
The bleeding slowed and hope revived now and then through the years. There was that brief respite on election night in 2008 – in Chicago again, in Grant Park, where policemen beat up kids (and journalists) in 1968 – when Barack Obama celebrated what many dreamed might be a renaissance of hope and meaningful change. But hope is a fragile and elusive thing, its evanescence sending one back to find clues pointing to where, why and how it got lost, and for those who refuse to abandon hope, how it might yet be found, reforged, and renewed… for a while, anyway.
Retracing my steps 50 years later, in the summer months during which I prepared for the CNS Annual Meeting in Chicago, I thought again of how, in the dark shadows of 1968 following the seeming death of hope in Chicago, I had turned for solace and found hope along the tree-lined shores of Walden Pond. I recalled how I left the library that September afternoon when LIFE drained me of all hope, walked three blocks past the Mayo Clinic to the Lucy Wilder Bookstore and bought a copy of The Portable Thoreau, discovering in its pages the hope I thought lost. What I didn’t know then, but know now, was that in walking to the bookstore I walked right by the spot where earlier that summer the hidden seeds of a new hope, a multiplicity of hopes, had been planted. For, in the summer of 1968, when the American Board of Psychiatry and Neurology (ABPN) was still housed in Rochester, MN, three blocks east of my junior high school, the ABPN issued the first 15 certificates in child neurology. Of those original 15, only one remains with us: J. Gordon Millichap, MD. “Naturally”, he still resides in Chicago. And “naturally,” his son, John J. Millichap, MD, lives and practices child neurology at Lurie Children’s in Chicago. But why stop there? John Millichap, it turns out, presented at not just one, but two sessions during the CNS meeting in Chicago. (You can’t make this stuff up!)
And there, I suppose, I should let my story end. But I can’t. Not without leaving you with one more last echoing note about Chicago Hope.
In his masterful study of Thoreau and his contemporaries, The American Renaissance, F.O. Matthiessen talks about “the Possibilities of Life in America” – “PLA” as I came to refer to it in my writing, including a piece published two years ago in CNS Connections. He was talking about “hope,” just as I was in describing those two venerable Virginians, Jack Pellock and Rob Rust as practitioners whose work contributed to “the Possibilities of Life in America.”
Matthiessen quotes at length from Louis Sullivan, the greatest of all 19th and early 20th century American architects, “the father of skyscrapers,” whose buildings define the look and feel of downtown Chicago: “If as I hold true scholarship is of the highest usefulness because it implies the possession and application of the highest type of thought, imagination and sympathy, his works must so reflect his scholarship as to prove that it has drawn him toward his people, not away from them; that his scholarship has been used as a means toward attaining their end, hence his. That his scholarship has been applied for the good and enlightenment of all the people, not for the pampering of a class…In a democracy there can be but one fundamental test of citizenship, namely: Are you using such gifts as you possess for or against the people?”
For me, child neurologists pass that basic test every day. They are not saints or heroes (although some come close). But they are “Citizens,” in the highest sense, as Sullivan defines it. The research, training, and direct care for patients to which they dedicate themselves daily is very much “for the good and enlightenment of all the people.” Together, CNS members explore, open up, and make more readily – and democratically – available the most essential pathway toward realizing the Possibilities of Life in America: a healthily functioning child’s brain. They offer hope. Badly needed hope. Hope that is needed now more than ever.
In 1968, I hoped and dreamed after reading Thoreau to spend the rest of my life writing. And I have, off and on, though not in a way that put food on the table or children through college. I didn’t know 50 years ago, even under the shadow of the Mayo Clinic, the answer to the question most Americans still don’t know today: “What is a child neurologist?” I didn’t know, let alone hope or dream, that I would be “kidnapped” and stolen away from writing by a strange and obscure cult of pediatric specialists who would have me do their bidding for the next 30 years. And I certainly didn’t know that I would find among that strange cult, and in Chicago, of all places, a redeeming sense of possibilities – of hope – I thought had been lost there 50 years ago.
“It’s a great time to be a child neurologist,” Jon Mink keeps saying. It’s a great time, as well, to be working for them. I am grateful.