Remembrance: Public Health Lessons From The Janitor And The Melon Lady
Dr. William J. Bicknell, the founder and chair emeritus of the Department of International Health at Boston University's School of Public Health, died Tuesday evening after a long battle with cancer. He was 75. This remembrance of Dr. Bicknell and his "last lecture" comes from his former student and teaching assistant, Kate Mitchell. She earned her masters degree in public health from Boston University in 2009 and now works for the Maternal Health Task Force, a project of the Women and Health Initiative at Harvard School of Public Health.
By Kate Mitchell
Bill Bicknell adjusted his red helmet, climbed onto his Segway and cruised across the Keefer Auditorium stage at Boston University. Navigating a couple of laps in front of several hundred cheering students and colleagues, Bicknell was grinning wildly, waving in perfect Miss America form.
The founder of BU’s Department of International Health was known by his students for teaching with his eyes closed, and by nearly everyone for his clear-eyed assessment of weak arguments. His technical term of choice: “Horseshit.”
After a few more laps around the stage in front of the lunchtime crowd gathered for his May 2 lecture, the 75-year old physician and professor climbed off the Segway and presented a bouquet of yellow roses to his fourth wife, Jane. On the offchance that anyone in the audience would take him too seriously, he placed a jar of salt on the podium.
[module align="right" width="half" type="pull-quote"]'Many ups, a few downs, a couple of lateral who knows what, but, at 75 I'm deeply happy and ready for my biggest trip.'[/module]
Between the Segway and the salt, the packed auditorium laughed hard and — it seems crazy in retrospect — almost in harmony. Students of Bill, colleagues of Bill, friends of Bill — for the next 90 minutes we'd all be grateful to Bill. For his groundbreaking scholarship and work in public health, sure, but also for the community he'd built among us.
There were also tears — tears of fear, partly, at what we all knew would likely happen soon. (Just a month later, on Tuesday evening June 5th, Bill died peacefully at home, surrounded by his family.)
[module align="left" width="half" type="pull-quote"]'Such a remarkable tribute to a life lived so well and so damned irreverently.'[/module]
One day just over two years ago, Bicknell stopped by Boston Medical Center for help with what he figured was just a case of postnasal drip. A chest scan showed a lesion on his upper lobe – lung cancer that later showed up in his hip and brain.
Bill rode a series of cancer treatments through setbacks and bounce-backs. Along the way, he shared updates on a website called Caring Bridge. He used the site to document his cancer battle as well as share his latest insights on the state of medicine and health systems in the U.S. and abroad.
While not billed as any sort of “last lecture,” Bill’s presentation reminded us that his time was growing short (his final slide listed his contact info as 1-800-Who-Knows). His Caring Bridge profile, meanwhile, made it clear that his journey had been good:
“No evidence of disease 17 months after diagnosis, then it's back! Let me begin by making it very clear. I have lived and been privileged to enjoy one hell of a great life. Many ups, a few downs, a couple of lateral who knows what, but, at 75 I'm deeply happy and ready for my biggest trip.”
On Nov. 30, Bill marveled at modern medicine:
“Today was nearly beyond belief. A small metastatic brain tumor, a bit left of midline, just under the dura, between the parietal and occipital cortices needed to be removed. I opted for the Cyberknife rather than conventional open neurosurgery. No pre-medication, no sedation, duration about 43 minutes, no side-effects. Walk-in, walk-out and after the procedure walked to the hospital cafe for a late lunch with Jane. Neurosurgery 2011 is simply amazing!!!! Now to Bali and Jakarta with Jane for the Holidays!”
Not all of his updates were clinical:
“Yesterday I bought a Segway (see pic). I’ve ridden a few hours and had excellent training. This afternoon I zoomed into the house off the patio and clipped the doorframe as I was going into the spa. Oops! Result: 5 stitches, black eye, negative head CT scan. Lesson 1: Helmet, always, indoors and out. Lesson 2: A bit less exuberance.”
Some of his readers talked back:
I read your Caring Bridge missives voraciously and I realize that you have become my daily inspiration. Your journey is so full of love and humor and hardscrabble reality, and a rare and awesome wisdom. I stood in the back of Keefer today and marveled at your unique magic. I had never seen so many people in that auditorium, nor had I ever seen them so captivated. You were simply beyond description and I felt so honored and so privileged to witness such a remarkable tribute to a life lived so well and so damned irreverently. You were majestic, and as Albert Schweitzer said, your life has been your argument. Thank you for everything you have done for so many of us in Boston and throughout the world.
Peace to you.
As engaging as Bill was online, he always appeared most at home behind the Keefer podium where he taught generations of public health students the intricacies – and implications – of global health management, finance and policy. Always with eyes closed. It’s a quirk students have been unable to resist, most notably when an entire class stood and exited single file while Bill continued to lecture. A few moments later, Bill opened his eyes to an empty auditorium.
I took Bill Bicknell’s course in the Spring of 2008 and then served as one of three teaching assistants the following Spring.
He began each semester with his definition of public health: “The art and science of deciding who dies, when, and with what degree of misery.” Another frame for public health, he would point out, is ”the art and science of deciding who lives a longer, less miserable, happier life.”
Then he’d offer a warning: If you approach your work with the second definition, you often forget the consequences of what happens when you fail. Always keep the first definition in mind.
Bill’s course wrapped up with the most unusual final exam I have ever taken. The assignment: Write one question, answer it, and then join me and the rest of your class for boxed wine.
As I drafted my question, all I could think of was one of Bill’s many warnings: Bad doctors are dangerous because they kill people. Bad public health professionals are really dangerous because they kill populations.
My question was simple: What factors contribute to poor public health systems and how can I avoid being a bad public health professional?
My answer was longer. I wrote nine pages discussing many of the stories and lessons learned from Bill and his impressive line-up of guest lecturers — including Dr. Jim O’Connell (Bill’s online correspondent and the director of Boston Healthcare for the Homeless). I wrapped up my final exam with a commitment to do my best to remember one ‘Bicknellism’ in particular: “With careful attention to detail, sound understanding of basic principles, healthy skepticism, and robust personal and institutional honesty, you can help a few people die later and happier.”
Bill’s Segway-assisted lecture, titled "Thoughts on Health and Development: Lessons Learned from a Life in Public Health," was his first after several months of medical leave. It was prompted by an invitation from colleagues seeking some of his lessons, stories, and snapshots from a career that included stints as Senior Physician for the Peace Corps in Ethiopia and Director of the Boston-Lesotho Health Alliance.
My favorite: A story Bill often recalled from his time as Commissioner of Public Health for the Commonwealth of Massachusetts.
Bill was new on the job and working long hours. One evening as he was leaving the office, he noticed several perfectly good melons in the dumpster in the parking lot. Bill walked over, examined the melons and, after a healthy diagnosis, decided to bring them home to his kids. After a few more evenings of snatching free melons from the dumpster, a janitor approached Bill. He said, “Commissioner, you may not know this, but there are women who rely on this dumpster. They come here every evening looking for food.”
Every time I heard Bill tell this story, he concluded by opening his eyes, looking out across the auditorium, and declaring, “Let the melon lady be your guide.”
Another professor might have simply pointed out that, as global health and development decision makers, we have a moral obligation to consider the person not at the table — and to think critically about the far-reaching implications of our actions.
Leave it to Bicknell to hammer home the point with the story of the melon lady.
And the janitor.
Working for Bill as his teaching assistant, I got a sense of just how willing he was to listen to voices not always heard (including mine.) But there’s nothing like visualizing him accepting the janitor’s reprimand to understand how willing he was to acknowledge mistakes and learn from everyone around him.
At some point during the lecture, Bill described, with great exuberance, the current professional climate for global health and development professionals as “a time of electric excitement.”
I am not exactly sure what he meant by that — but my guess is that it had something to do with the growth of political will and funding for global health and development in recent years.
As a public health professional during this time of “electric excitement”, I know I’ll make mistakes. But I hope that, with Bill and the janitor and the melon lady in mind, I’ll manage to help a few people die later and happier.
“It is worth doing,” Bill said at the close of his lecture. With eyes still shut, he added: “Good luck.”
Further reading: William Bicknell, Iconoclastic IH professor, 1936-2012. The May 2 lecture on YouTube:
This program aired on June 7, 2012. The audio for this program is not available.