Long before darkness had given way to sunlight on a recent Friday morning, Dr. Wayne A. I. Frederick was already in the operating room at Howard University Hospital, gearing up to operate on his 86-year-old patient.
Working with Dr. Terrence Fullum, the interim chair of th Department of Surgery at Howard University College of Medicine, the 48-year-old surgeon was doing laparoscopic surgery — a minimally invasive procedure to repair a hernia in the patient’s groin area.
About a decade earlier, this patient would likely have spent three to five days recovering in the hospital. But after two hours in the operating room and dissolvable sutures that eliminated the need for stitches, the man was sent home the next day with instructions to follow up with Frederick for a routine checkup some four to six weeks later.
Though it’s hard to say for certain, it appears that Frederick — president of Howard University — may be the only U.S. college president who actively sees patients and conducts surgeries despite a punishing schedule as the leader of one of the country’s most prominent HBCUs, which is located in the nation’s capital.
There have been other physicians turned college presidents, like Dr. Michael V. Drake, a board-certified African-American ophthalmologist who took the reins of The Ohio State University in 2014, but Drake no longer practices medicine. In the 1980s, there were at least a handful of physicians who had been tapped to lead colleges and universities but the numbers have since waned.
The desire to practice medicine was so important to Frederick that when he was offered the job as president of Howard in 2014, after first serving as provost and later interim president, he told his lawyer that a clause had to be added into his contract that would enable him to still operate on patients. And he didn’t want to do surgeries on an ad hoc basic either.
“This was a major negotiating point when I was offered the job,” recalls Frederick, who is a triple alumnus of Howard. “At the time when I got heavily into administration, beginning with the provost position, I was very, very busy [with my practice].
“It would have been akin to going from 100 miles an hour to zero. I was concerned about how I would wind all of this down and to do that abruptly wouldn’t have been a great idea.”
While there was no outright opposition to what Frederick had proposed, he remembers there may have been some trepidation among a few of the university trustees.
“I’ll be honest, I don’t think they wanted me to be as busy as I was,” he says, noting that adding the provision to his contract allowed for clarity on limitations and ensured that everyone was on the same page. “At the same time, you don’t want to lose your skill set. It’s not one of those things you can just stop doing five and eight years and then go back and pick up. Most of the traditional routes to the presidency, you can go back to the classroom or research, that’s not the case with surgery.”
That makes sense to Fullum, the surgeon who works with Frederick and has known him throughout the years.
“You train forever, and I understand him not just wanting to walk away,” he says. “The touches we have with our patients make for very special relationships. I can understand that even though his leadership ascension took him to the president of the university, he would still want to practice.”
Having finished surgical oncology fellowships at the University of Texas MD Anderson Cancer Center in 2003, Frederick worried that had he completely walked away from his initial calling when he was selected to become provost in 2012, he would have only practiced medicine for about a decade.
“I felt a moral obligation to pass on that skill set to the next generation,” he says, adding that training and mentoring residents has become a highlight of his ongoing work. “Operations are pretty complicated and there are things that residents don’t see.”
Having served as division chief in the Department of Surgery, director of the Cancer Center, associate dean in the College of Medicine, and deputy provost for health sciences, Frederick is in the operating room about once or twice a month, often completing complex surgeries on patients that have gastrointestinal, pancreatic or esophageal cancer.
“Sometimes in months when I look at my calendar and I am not traveling as much, I may do it more frequently or there are months for one reason or another I kind of get bombarded by several patients who show up who I have had since I’ve been here and they insist on seeing me,” he says.
During a recent procedure, he had to make an incision in the neck and the abdomen of a patient, cut the top of the stomach, take the esophagus out through the neck, push the stomach up through the chest so that it was at the base of the neck, remove the cancer and put everything back together again. And then there was the Whipple procedure, in which Frederick had to remove part of a patient’s stomach, intestines, bile duct and head of the pancreas before piecing them back together in a complicated replumbing of sorts.
That work is even more meaningful for Frederick who finds himself confronted with the gross health inequities plaguing the city which has now become his adopted home.
“D.C. is very unusual because it’s the nation’s capital but the disparities in this city are unbelievable,” he says. “If you are an African-American male and you live in Ward 7 or 8, your life expectancy is almost 20 years less than if you are a White male and live in one of the wards on this side of the river. And that’s absolutely shocking.”
Moreover, D.C. leads the nation in the highest incidents of renal disease, making treating cancers with chemotherapy particularly challenging if a patient’s kidneys aren’t working well.
The hospital as classroom
As a youngster growing up in Trinidad, Frederick became familiar with medical treatments at an early age. Diagnosed with sickle cell disease at birth, he was in and out of hospitals.
“I kind of feel like I grew up in a hospital,” says Frederick, whose mother was a nurse. “I feel like I know them well.”
Unlike most people’s experiences with hospitals — not that anyone wants to be hospitalized — Frederick’s time in medical school and later as a physician forced him to see the operating room as a sacred place.
“I do feel like I take on a different demeanor and it’s a calming place to be,” he says. “What’s taking place there between you and the patient as you try to impact a patient’s life is a really, really special opportunity. It does have a sacredness to it.”
Still, the intense nature of the physician-patient relationship means that Frederick is often delivering sobering news to those that he treats.
“Taking care of patients and providing care is the most thankful job in the world, especially when you take care of cancer patients,” he says. “Sometimes I’m giving people the worst news that they have ever heard outside of the death of a loved one; telling someone they have cancer is a devastating diagnosis and then working with them through that process as you attempt to bring them better health, bring them a cure.”
Sometimes there are bumps in the road and the cancer either spreads or returns, but “regardless of the circumstance, the patients and their families always display courage like you’ve never seen,” says Frederick. “So, it gives me perspective because of that gratitude. Even people facing the worst thing, they get up and hug you. Sometimes I come up to the room and I don’t have great news and I go and meet with the family and tell them that, it still ends with them saying, ‘Thank you. We know you tried everything you could.’”
It’s those special moments that Frederick wants the hospital residents he mentors to relish as they continue in their roles as physicians. His interaction with them is akin to a professor training his students in a science lab.
“I think they do enjoy it,” he says of the residents. “It’s unique for them to be able to interact with a president of a university so that’s unusual for them. Because of the operations that I do, they get excited about what’s going to happen in the operating room.”
Frederick readily admits that not everyone is happy about the time he spends in the operating room, although the Board of Trustees remains deeply supportive. There have been some rumblings among members of the faculty senate throughout the years who argue that the soft-spoken surgeon should consider retiring from practicing medicine altogether and focus all of his energy on being a university president.
That, however, isn’t likely to happen.
“I’m a faculty member first and foremost. I try to remind everyone of that,” he says. “I came through the ranks as a faculty member here. So, it is essentially my classroom because I get to teach anatomy in there …. I try to do a lot of clinical care I can discuss with students and residents.”
That interaction is in addition to the lectures he gives to medical students and surgical residents each semester as well as a course he teaches each spring for an educational leadership program called “The Presidency.”
“The operating room kind of brings all of those pieces together in one place, while obviously still appreciating the joy of operating and giving back to our patients who in a lot of circumstances really don’t have other options,” he says.
Dr. Clive O. Callender, Frederick’s longtime mentor, isn’t surprised by Frederick’s successful rise through the ranks of academia while also maintaining a deep connection to the medical community.
“I recognized early on that he had a gift that made him different,” says Callender, a transplant surgeon and professor of surgery at Howard University College of Medicine and one of the nation’s leading experts on minority organ donations. “He had an uncanny interest in almost everything I was doing. He was always watching. He noticed everything. He was a busy bee and the only resident who wanted to know about everything I was doing.”
Early on, Callender recognized that his former student turned colleague had a natural gift for administration, and unlike himself — who served in the administrative ranks as chairman of the Department of Surgery — Frederick seemed to enjoy it.
“His surgical practice was at the top of everything,” says Callender. “He’s a person of compassion, caring and kindness and has always kept that at the forefront despite the administrative tasks.”
Callender understands why Frederick continues to practice five years after he’s been university president.
“Once you stop using the aspect of that gift, you are likely to lose it,” he says. “He has persisted and he has gifts that allow him to do both with excellence. Most of us surgeons don’t have the patience and temperament that he has.”
That was most pronounced, Callender says, when hundreds of students staged a nine-day protest in 2018 to air a litany of campus concerns ranging from the school’s sexual assault policy, inadequate student housing and rising tuition costs. They stormed the administration building and initially called for Frederick’s resignation, though they later backed off. The administration and student leaders later struck an agreement that resulted in a series of firm commitments from the administration.
“He was the patient voice keeping everything calm,” remembers Callender, who says that Frederick embodies “equanimity under duress,” the phrase coined by retired surgeon Dr. LaSalle Leffall who argued that one of the best attributes of a surgeon is to “maintain that degree of calmness and tranquility because that will allow you to do what is appropriate in any circumstance.”
Callender notes that surgeons, by nature, are equipped to respond quickly. “We usually associate with quick fixes because we operate in near-death situations all the time,” he says. “If we do that, the patient will stop bleeding. If we do this, the patient will be well.”
But ongoing crisis at the university level often requires a different approach.
Lessons from the operating room
Frederick says that his time in the operating room and engaging with patients has made him a better university president.
“When things are really going haywire and you’re in the midst of a crisis in the operating room — some blood vessel has gotten away and is bleeding profusely — I don’t get to yell and scream and throw some instruments around the room and stomp my feet,” he says. “I actually have to become more focused. I have to become even calmer to manage that crisis. I have to find that blood vessel, get control of it and make sure everything is okay.”
Frederick says he understands the value of remaining focused when a crisis strikes.
“I probably get more calm than everybody else,” he says. “And the worse that it gets, I feel like I get more focused to reach a decision because you can’t be distracted by the noise.”
It’s that kind of thinking and trained experience that makes one wonder if colleges and universities might consider hiring more medical doctors to lead their institutions, particularly in an age when academia is taking a hard look at individuals who don’t fit the traditional academic mold.
“Surgeons typically make good leaders,” says Fullum. “Every day of our lives is spent in a team symphony,” working with the anesthesiologist, the nurses, technicians “to receive the best outcomes.”
Surgeons, he adds, learn how to “maintain under duress and come to the right conclusions, the right outcomes in what we do every day.”
“Hospitals are complex organizations,” says Frederick, who sees parallels in how universities are structured.
From his vantage point, he gets an up-close view of how Howard University’s hospital is operating because he spends so much time there.
“I get to see what is actually happening there. No one has to tell me secondhand,” he says. “If there is an operation, I get to see if everyone is in place and where they should be. I get to see the mechanics of it. I get to interact with the people there. I get to take out my ID and show my ID like everybody else. I have to put my lab coat over my scrubs. I get to see them upholding all of the rules and they get to see me doing the same.”
For many longtime hospital employees, some of whom have been employed at the hospital for more than three decades, there is a beaming sense of pride that the young man whom they observed as a student and trainee and who sought their advice and guidance has now gone on to become their college president.
Training tomorrow’s physicians
Back in the operating room, Frederick speaks softly to the team of physicians who is working to repair the hernia of the 86-year-old patient who is under general anesthesia. He steadies the instruments and monitors each move from a screen that hovers over the operating table.
Standing nearby are three first-year undergraduate students.
They’ve gotten up at 4:00 a.m. on this morning to see their president in action. Each year, Frederick speaks to the students enrolled in a first-year seminar class and issues an invitation for them to reach out if they’re interested in watching a surgery in action or shadowing him on a given day. There is always interest.
Once selected, they’re put through a mini training program where they are oriented on topics ranging from HIPAA laws to patient confidentiality.
“Have you guys seen an operation before?” he asks the students who are in the operating room.
The experience is surreal for Madison Pina, 18, who is studying to be a nurse at Howard and is from Gilbert, Arizona. Her mother went to Howard and her grandmother worked as a nurse at the Howard University Hospital many years ago.
“Being here and getting to see this is something that you can’t experience by reading a textbook,” she says.
A few weeks earlier, pre-med student Faith Okani had a similar experience.
“I didn’t think I would be able to go into an operating room until I got to medical school,” she says. “So, this was an amazing experience.”
It’s that kind of mentorship that Frederick welcomes.
Howard has a surgical residency training program that has been lauded as one of the most successful in training more African-American women surgeons than any other institution.
And still, there is reason to be alarmed, particularly about the declining number of Black physicians and African-Americans entering medical school.
“I think there is a crisis and that crisis is worrying me,” says Frederick, who noted that, in 1978, there were more Black males who applied to medical school than in 2014.
“I still don’t think the country grasps what that means,” he says. “The number we’re talking about is only 1,500 in a country of 300 million people. And not all of them got in.”
He says that if you divide up all Black male graduates from medical schools in the country, there would be about seven Black male doctors for each state.
“That’s a crisis. When you look at disparities and outcomes, you’re taking away a level of cultural competency,” he says. “Every Black patient does not have to see a Black doctor, but you want enough Black physicians in systems that then influence that cultural competency.”
As if being a university president isn’t demanding enough, Frederick’s added responsibilities in the operating room have made a hectic schedule even worse.
“A big part of it is being ultra-organized and having a really great team around you,” he says, adding that he leans heavily on his nurse practitioner who is key to making things run smoothly. “Sometimes it’s extending my day either on the front end or back end to make sure that it works.”
After completing the early morning surgery and a series of meetings, Frederick caught a late-night flight to Atlanta that same Friday evening to run a 5K on the following day. He does these runs every month to raise awareness about sickle cell disease.
Still, his priority remains with his family. When he returned from Atlanta, he immediately headed to his son’s varsity soccer game and the two later spent time at the concluding World Series game.
The same was true a week earlier. After returning from an exhausting business trip that took him out of the country, he went straight to his daughter’s volleyball game to cheer her on. His wife was teary-eyed when he arrived. Anytime he shows up, she told him, both children seem to play their best game ever.
“I really try to make them the priority and build all of the madness around them,” he says.
Like most of his students at Howard, Frederick must study. He keeps pace with the changing technology and new advancements in medicine. In between travel, meetings and surgeries, he spends time on the computer working on continuing medical education credits. D.C. has a robust licensing program that requires ongoing education in order to have a medical license renewed. His current license is good through next year.
For now, Frederick continues to do what he loves best: running a world-class university, preparing the next generation of leaders and tending to his patients, some of whom have been with him for more than a decade now.
The operating room “is the only place where no one tells me what to do,” he says jokingly. “It’s a different kind of euphoria. It’s more of a calming experience.”
Jamal Watson can be reached at firstname.lastname@example.org. You can follow him on Twitter @jamalericwatson.
This article appeared in the November 28, 2019 issue of Diverse.