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“Speak up. Be bold!”

Section Editor(s): Bushardt, Reamer L. PharmD, PA-C

Journal of the American Academy of Physician Assistants: August 2014 - Volume 27 - Issue 8 - p 9–10
doi: 10.1097/01.JAA.0000451862.25577.88

Reamer L. Bushardt is professor and chair of the Department of Physician Assistant Studies at Wake Forest School of Medicine in Winston-Salem, N.C., and editor-in-chief of JAAPA.





Transitions are inevitable. We are reminded of this as summer heralds warmer weather and graduation season. About a week after my PA students were graduated, the country experienced another transition. Actually, I would call it a great loss. In fact, it was not far from the scene of that Wake Forest University graduation that acclaimed author, poet, and activist Dr. Maya Angelou died in her home on May 28. Through her life and words, I believe she can inspire and empower every generation of PAs.

Let me tell you a little about her. She was born Marguerite Ann Johnson in St. Louis, Mo. She later moved to California to study dance and drama. She played Ruby in Porgy and Bess in the 1950s; a touring role that carried her across Europe. These travels exposed her to a world beyond the racial segregation of the United States in the 1950s.1 She faced and overcame enormous adversity in her life, including the horror of rape at age 7 years, to become one of America's most celebrated contemporary writers. She defied the odds and faced her fears, choosing to live with an open heart and an ever stronger voice.

As PAs, we will all encounter patients who face the relentless burdens of illness, attempt to cope with the loss of a loved one, or struggle to find their voice amidst great adversity. Some of us effectively position ourselves with adequate objective distance and offer our care. Some of us are more open, allowing a patient's story to touch us in a more personal way. Most of us live in both of these spaces at various times during our career. I have learned from the life of Dr. Angelou that the choices we make in these moments—to observe or participate in our patients' stories—sculpt our professional identity.

Since her death, I have followed the flurry of newspaper clips, magazine articles, and television bytes remembering her. In an interview with Charlie Rose filmed in 1993, she discussed the influence of music on her writing. Dr. Angelou frequently reflected on experiences in church and time spent with her grandmother; her famous lines often were inspired by songs from her childhood. At times, she would answer a question by singing verses from African American spirituals that her grandmother performed in church. The pastor called upon her grandmother every Sunday morning for nearly 10 years, Dr. Angelou shared, and every time her grandmother would react with surprise at the pastor's request, then swiftly deliver a crowd-rousing performance. As Dr. Angelou sang a few lines from one of her grandmother's favorite hymns, her eyes welled with tears, conveying a deep personal connection to family, music, and spirituality. As PAs, I think we can draw strength from the stories, expressions, and songs of our patients. It takes courage to open ourselves enough to be affected by our patients, to resist the type of detachment that may make difficult moments easier to bear.

As a young child, Dr. Angelou was slapped across the face by a schoolteacher for refusing to speak. Dr. Angelou's grandmother returned with her to school and gifted the teacher with a slap across her cheek. When young Dr. Angelou returned home, she was greeted by one of her grandmother's homemade caramel cakes—her favorite. “She knew just what to do for everything,” Dr. Angelou remembered, “and it would always have to do with food.” I was struck by the way Dr. Angelou recalled this experience: by her appreciation for the hours it took for her “momma” to craft this delectable treat, which was viewed as the ultimate expression of love for her granddaughter, and the power she attributed to this homemade sweet treat to heal a broken heart.2 In the moments we share with patients, do we regularly exercise small acts of kindness? Could the words of encouragement we offer a patient be the only ones they receive?

Arguably, the most famous work by Dr. Angelou, I Know Why the Caged Bird Sings, speaks to the horrific trauma she faced during her childhood. The work also gracefully portrays the courage and resilience of Southern black women. I find it poetic that the once-caged bird was later honored with the Presidential Medal of Freedom. Since 1982, Dr. Angelou served as professor of American studies at Wake Forest. In her course, “World Dramatic Poetry,” she tasked students to memorize and recite poetry with bravado and passion. She believed words should be spoken and felt. In a recent article, one of her former students recalled Dr. Angelou instructing a classmate, who was reciting a poem with a rather small voice. “Speak up. Be bold! [She] said that when you speak small ... it lets a brute know there's a victim in the neighborhood.”3

The Maya Angelou Center for Health Equity at Wake Forest (http://www.wakehealth.edu/MACHE) serves to advance the cause of health equity. A few years ago, we began the MACHE Bowl to bring together interdisciplinary teams of graduate students from across our region to address complex issues of health disparity in a competition before a live audience. PA students have been a part of this interprofessional collaboration since its inception, and the event demonstrates the enormous potential that can be realized when diverse teams come together, share their talents and varying perspectives, and center their efforts at the unique needs of a patient and a community. The power of this competition is how it celebrates diversity and encourages us to listen to our patients' stories with open hearts. Just as Dr. Angelou instructed her students, we can teach our patients to be bold and speak up, especially when they face adversity or endure confidence-shaking life experiences. To honor her life, we can fight for equity and move past assumptions to help create a world where every American has the opportunity to achieve optimal health.

I am regularly influenced by several of Dr. Angelou's words in my personal and professional lives. I hear her husky voice reminding us to be better, kinder, and more forgiving. She said, “People will forget what you did, but people will never forget how you made them feel.” I have often shared her words with a discouraged patient—“Nothing can dim the light which shines from within.” Her writings and her life are expressions of sustained courage. As PAs we often encounter opportunities to create positive change and lead others within our communities. We can seize these opportunities, or we can let them quietly pass us by. Dr. Angelou calls us to seize them, “Courage is the most important of all virtues because without courage, you can't practice any other virtue consistently. We can't be kind, true, merciful, generous, or honest.”

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1. Operavore. Maya Angelou appeared in touring production of Porgy and Bess. http://www.wqxr.org/#!/story/maya-angelou-appeared-touring-production-porgy-and-bess/. Accessed May 29, 2014.
2. Brown C. Welcome to the poet's table: Maya Angelou tells the stories behind her favorite meals. Los Angeles Times. November 3, 2004. http://articles.latimes.com/2004/nov/03/food/fo-maya3. Accessed May 29, 2014.
3. Dewitt D.A teacher who could write: Maya Angelou at Wake Forest University. http://wunc.org/post/teacher-who-could-write-maya-angelou-wake-forest-university. Accessed May 29, 2014.
© 2014 American Academy of Physician Assistants.