Okay I hope you can hang around for this because this is a special treat. In your handout you'll see a special tribute to the Kennedy Lecture. I encourage you to look at that and it's my pleasure to introduce this year's Kennedy Lecture Dr. Darren Johnson. And so I have a few slides to share. Next slide please. Let's try two of them. Okay so this lecture is sponsored by a Kennedy Family Endowment and the American Journal of Sports Medicine and it honors the late John C. Kennedy who was a clinical professor and chair at Western Ontario, was on the Board of Directors for the American Journal of Sports Medicine, is a past president of both the AOSSM and the Canadian Orthopedic Association, and was Mr. Sports Medicine, now the Robert E. Leach Award. As you recall it was my pleasure to introduce the first Miss Sports Medicine, Ms. Sports Medicine, last the last occasion. So here are the past recipients and they're in your handout as well. So Darren Johnson trained in California, got his bachelor's degree from UC Riverside Medical School at UCLA. You see the bear theme. That all ended when he went to USC for residency and then did his fellowship in Pittsburgh. In fact I often tell people that Darren and I spent a decade in Pittsburgh that year. His practice since the fellowship has been exclusively at the University of Kentucky where he's a professor, head team physician, and was the chair for over 18 years. He's been on the Board of Directors for both the Academy and the Sports Medicine Society, was a traveling fellow for this organization, past president of the Southern Orthopedic Association, and is one of 16 standout North American sports knee surgeons in orthopedics this week. So I had a problem when I had to figure out who to pick for this lecture and I went back to my scrapbook and I saw this picture from our fellowship. We were both younger and more energetic and here we are at the Argentine Arthroscopy Association many years later and still constant friends. So the problem was easy and it's solved and so it's my pleasure and honor to introduce my friend Dr. Darren Johnson to give you the Kennedy Lecture. All right so this is a non-orthopedic talk so get ready and I usually don't give those a long time so I'm going to read a little bit and hopefully you'll enjoy this. So I want to thank all of you for your attendance this morning at the combined meeting of two great organizations AOSSM and ISSACOS. I'm truly honored and humbled for this opportunity to speak to you as the invited Kennedy Lecturer. I really want to thank my good friend Mark Miller, your AOSSM president, my colleague, as well as the leadership of both AOSSM and ISSACOS for this opportunity to share some thoughts. Before I give my personal thoughts during this address I want to express my feelings on what makes these organizations unique among all the other societies that we belong to. It is all of you in this room of course. It is the people in this room that make these organizations what they are. It is the friendly way we speak to one another. We stop to say hi and learn about you personally before all the professional stuff that we all spend way too much time padding our own personal ego. These groups are about relationships and friendship first and then scientific education and collaboration across many disciplines. These personal interactions we have with one another on days like today are the glue that binds us all. A special part of the AOSSM, a true diamond I think in our portfolio, is the Traveling Fellowship Exchange Program that is back up running again after the COVID shutdown. It gives us the opportunity to travel the globe and meet and exchange ideas throughout the world. We build friendships that last a lifetime. The exchange of information and thoughts is second to none. It is the fuel that allows for our friendship, collegiality, and scientific discovery globally. The majority of people that partake in this program rank it number one in their career education portfolio. Fortunately for me, I had the opportunity to participate as a Traveling Fellow in 1997 on my trip to Europe with my godfather, past president of both AOSSM and ISACAS, Dr. Peter Fowler, who we honor today. Pete was a great friend and a mentor to me for the last 25 years. I am grateful to him for making those four weeks we spent together a true highlight of my professional career. This summer, I am fortunate to be a godfather as we traveled to Southeast Asia for an exchange fellowship. All I can say is time flies because that fellowship I did was a long time ago, but I would just say a huge kudos to the AOSSM leadership that started this program many, many years ago. A true 100% home run. So I've entitled my address, The House That Builds Us. Faith, family, friends, mentors, patience. I think each of us, if we carefully look back at ourselves in a mirror and uncover or unwind those five pillars, it defines who we are and most importantly, our life journey. Each of us might prioritize them differently in our life pyramid of building blocks, but each one of them, in their own right, defines us, keeps us grounded as we travel down our own unique career path. Focusing on these five building blocks will keep your life centered with a strong foundation, for without these building blocks, it is easy for the house to fall or develop cracks in your foundation when storms come raging, and trust me, they will come. Life is full of unique challenges, hurricanes, house fires, family deaths, patient complications, many others. These building blocks will guide you through those difficult times. Your faith is probably most important for obvious reasons. For without the foundation of faith in believing in something bigger than all of us, there is nothing at the base of your personal core to build upon without the risk of it all coming crashing down and having to start over. It is the base of the pyramid of your life story. An analogy is understanding anatomy if you are a surgeon. If you are bad at anatomy, the practice of surgery is extremely difficult. We as surgeons are a unique, weird bunch. We are hardwired, driven to succeed, stubborn, hard-headed in my case, resistant to change. We like to have an explanation for everything that happens that is logical and verifiable by proven science. We want a randomized, double-blind study that Bruce Rider would love to explain everything. The gray area is not something we do well. The mystery of life experiences is something for many of us, particularly me, it's hard to wrap my arms around. There are reasons that we pick this specialty after all. I would imagine for many surgeons in this room, this gray area of life and challenges is something we wrestle with often. It is simply not in our DNA to like the color gray. Unfortunately, many of us in the game of life, it does not work that way. Life is one big barrel of gray. The older you get, the grayer we become. My fateful journey did not begin until I met my wife 35 years ago. Fortunately for me, she brought family to me and our 32 years of marriage. Without this faith, my own family and personal hurricanes that have occurred over the last 15 years would have left me empty, looking for answers and trying to make sense of the non-logical or non-unexplainable. When you find out your wife has cancer at the age of 40 and you live in Kentucky with three small children and no family around, when your best friend calls you, tells you to come to his office, he says, Darren we need to talk, sit down, and then tells you the Nessens hate to tell you this, but your only brother and sibling didn't wake up this morning. When over a five-year span, we lost my brother, both my parents, and my wife's only brother. That's hard. We have to explain to our three children in a category of grandparents as well as aunts and uncles. They didn't get so lucky. It's just how the dice go, I guess. That, my friends, is when you need faith at the foundation of your pyramid. For without that, the storms keep raging and your lack of ability to explain these events as well as the wise in a scientific, easily understandable manner, is that at this time you need to have very strong mental struts in your home, deep in the ground. What about a complication from a surgical procedure you performed when you believed it may have happened because you did not bring your A-game that day? Remember now, athletes have days off all the time. Last time I checked, Tiger Woods did not win every single golf tournament he played in. I would imagine as surgeons, we have days off as well. Remember, I believe in black and white, no gray allowed. Now fortunately over my career, I have not had many of these complications, but trust me, I remember every single one like it was yesterday. We as surgeons remember our failures forever. We often forget our personal success stories in the patients, but the failures stay with us a long time, often for life. It is for these mysteries of life you must have faith. I cannot explain these things in a scientific article or do a systematic review for these answers, but I can understand them and because of my faith I can accept it somewhat easier. It is not for me to understand each and every detail of life's journey. What better example, what better example of faith have we all witnessed recently directly in front of our eyes? What about DeMar Hamblin of the NFL Buffalo Bills? Wow, what a story and a true example of what faith can do. When he was on the ground and the entire team medical personnel of both the Bills and the Bengals were providing him outstanding medical care, everyone on that darn field kneeled in prayer holding hands, not to mention probably everyone in the stands as well as watching at home. The entire country came together in the power of prayer for that young man. Faith brought us together. While one might say we have many differences among us, this one tragic event brought us all together on behalf of DeMar Hamblin. Since that event over 60 million dollars has been raised to support the charities of DeMar and his family. What better example does one need to witness in the belief and the power of faith? Always remember God writes straight with crooked lines. God gives you what you need, not what you want. Famous Nancy Johnson two quotes, best two quotes she ever gave me. Friends are an important integral part of who we are. They define us, they shape us, they mold us. There's a famous line that says show me your friends and I'll show you your future. Wow, how true is that? I see it each and every day in the patients I see, teenagers in my office. Parents in the room today of middle and high school kids, meet each and every one of your kids close friends. You can learn a lot about a person simply by meeting their friend group. So for those young members in the audience, choose wisely. I would imagine if you did a study on young college kids trying to get into medical school or some other professional school, if you met their friends prior to reading their application, you may be able to predict fairly well who's going to make it and who might not based on their peer group. I have been quite fortunate since moving to Kentucky in 1993 to have made lots of great friends, both inside and outside of my profession. I think it is important to have friends outside of work and probably outside of medicine. While this is hard to do at times for many of us because we're quite busy in the game of life, I think it is important for your personal health and life perspective to develop those friendships outside of medicine. This will take time and effort on your part, but clearly worth it. Someday you will retire. Yes, you will. Those friendship you made over time will make your transition easier. My wife and I have a very unique dinner club that we belong to. For 25 years we have done this with three other couples, none of us work together by the way, and we rotate houses every two and three months and we have dinner. A wonderful thing. It is for these types of friendships that we cherish and appreciate so very much, particularly now that we are empty nesters. Your life experiences outside of medicine help us who you are and make you, I think, a better physician. I must admit, however, this takes time and effort on your part to cultivate those relationships. Our mentors and colleagues are also an important part of the fabric of our ever-changing DNA. Every single person, I guarantee you in this room today, can probably name a person or two that helped them develop that relationship. It was instrumental in the development of our professional dreams and goals. For without them in this profession, we would have no professional goals or dreams to strive for. For it is these giants I call them, many of them in this room, that come before us that help us find our own personal career path. If you see a turtle on a fence post, you know it did not get there by itself. Clearly as the turtle myself, I have had many mentors that helped me grow along the way. Unfortunately, many too many to mention in the time allotted. As a young medical student at UCLA, the late oncologist Jeff Eckhart was instrumental in teaching me that patients expect and should be treated how you and your family want to be treated. If you did not look like a doctor, act like a doctor, be professional in your wardrobe, even on weekends when he would magically show up, when you didn't think he was going to show up, you were simply sent home to return when you wanted to respect this wonderful profession we are fortunate to be a part of. Don Wiss, an orthopedic trauma at USC when I was there and then went to work at Cedars-Sinai, taught me about scientific discovery and attention to detail. There is no substitute for that in the operating room. I would imagine most outstanding orthopedic surgeons technically are at their most anal compulsive moment when it comes to details in the operating room. Mistakes happen simply because lack of that attention to detail when a patient immediately gets the room. Don Wiss taught me to challenge the age-old surgical saying, the enemy of good is perfect, rather the enemy of good is shitty. And never leave the operating room without doing your very best, not ever. There are no do-overs in surgery. These habits formed at a young age with respect to this unique trait that many of us have, our patients expect it from us. I would not be here today if not doing my fellowship at Pittsburgh with Mark, great picture Mark by the way, with past president, AOSSM, Enes Acas, Freddie Fu, who we honor today. His energy, passion, commitment, never accepting average, did I say ever, is the reason I'm here today. For when I arrived in Pittsburgh, we kept our house in Southern California and we were going to go back after my fellowship. I had never left Southern California in 30 years, never. Surely I would not start now. Well boy did he screw that all up. After four months in Pittsburgh, came home, told my wife I wanted to do academics. Probably can't tell you what she says or the look I got from her when I told her that, but I think she was a little bit surprised. That my friends is called mentorship. After four months in working with Freddie, side by side, each and every day, thank God for no cell phones, God thank God we didn't have cell phone Mark, right? My God, I can't imagine. Academics was not for me. The best quote I can give you about mentorship is that Freddie had the patience and for those that know him very well, I did say patience, I know you're shaking your head, did he say patience? Yes, you heard that correctly. Because he believed more in my ability than I believed in myself. Now think about that for a minute. He gave me confidence that I didn't have, right? That's a gift. That's a gift that you have. One of these giants in our profession that we recently lost was instrumental in my career, was past AOS's and President Champ Baker, a person well known to everybody in this room. He is the postcard of the true Southern gentleman. Over 20 years ago, Champ said, Darren, I want you to take over the Southern Orthopedic Association Southeastern Conference Sports Medicine meeting we have in the spring every year. So for 20 years plus, Champ was a great friend, mentor, and colleague. We all in this room today miss him dearly. I think for a young team physician, particularly at the collegiate or the professional level, it is important to not only have one mentor colleague on speed dial, but many. For myself and the Southeastern Conference, that one person on my speed dial was Peter Indelicato, another past president of AOSSM. He was kind enough to welcome me to the Southeastern Conference's Physician Club and always provided his thoughts to me after a particular injury on Saturdays and Sundays. When crap hits the fan in college football and everyone wants an immediate answer, return to play, they want it all on Saturday or Sunday. True story for those of you that do that. No one taught me more than he did about being a team physician, really is, and how to perform a job at a high level. Peter taught me these things you see on the screen there when you're trying to make decisions and everybody's looking at you nine different directions and how many different people can influence that decision you have to make. An important thing that Peter taught me is when you're treating that athlete, you know, the athlete thinks of you as the team physician until they're injured. I think a good way to think about that is when they're injured, you need to convince that athlete that you're not only the team physician, but you're their personal physician. Our founding physicians of the AOSSM over 50 years ago were all team physicians trying to provide the best care we could for these athletic injuries. Unfortunately for me, I am never afraid to reach out to my mentors for help and advice in the care of my patients. The majority of us in this room have the knowledge and ability to serve as a mentor for many of us in this profession. So please, to all of you, reach out and welcome that. You may be shocked to find out how you can change someone's life and career path like Freddie Fu did for me. My advice is to have as many mentors and colleagues that you can reach out to in the care of your patients. It is simply not to know, we can't know all the solutions to every problem that we see in our practice. Reach out to those you trust. Have many mentors. The older I get, even after 30 years of practice, I often reach out to those I know and trust for whatever care I need. Never be afraid to ask for advice in the care of your patients. It seems like each and every fall, I have some injury that I have not seen yet, even after 30 years of practice. Crazy you may think, but true. So this past fall, we had a foot injury in one of our players who will probably be a first round selection in the NFL draft. While I openly admit I am not a foot expert, in a 24 hour period, I got his MRI, I sent it to my friend Bob Anderson, Bob and I chatted, I sat down with the athletic training staff, athlete, both parents, and shared the knowledge that I had gained from Bob. So I am very grateful and thankful for Bob and his efforts to help me in the care of this athlete. I think I gained the athlete's confidence, as well as his parents, by reaching out to the expert in the field to gather all the information we have about the treatment of this problem. My own personal ego, your own personal ego, cannot get in the way of gathering all of this expert information on this injury. Have many Bobs in your contacts on your cell phone. Our patients also shape our lives, help us become better physicians, and in some cases, become part of our own medicine family. I have a patient family with three daughters, and the mom and dad have let me do five ACL reconstructions on those three daughters, five. Three daughters, five ACLs. I am humbly grateful for the trust they have put in me. They give us the utmost respect by allowing us to care for them quite invasively, given we are surgeons after all. There is no greater trust when a patient allows you to take them to the operating room. Think about that. There's no greater trust. You are the only one they remember from surgery that day. They really don't remember the anesthesiologist. They don't remember the truck. If anything goes wrong in that operating, they want to see your eyes. Remember that. Respect that. All they ask in return is your professionalism, communication skills, knowledge, and availability. I'm sure all of you have heard, patients don't care how much you know until they know how much you care. This picture, this kid last fall blew out his knee, done, nine months of training. This is September. I think if you look at the facial expression on the picture on the left, this was hard for this kid to grasp. Nine months, he's worked all year, summer, weight lifting program, and all of a sudden someone says to you, because he can't lie, I would not recommend that. If you know what he has, he blew out his extensor mechanism, he's done. What he needed was you put your arm around him, you grab his hand, and you say, I gotcha. That's all you can do. I don't know what else you can do for this kid. You feel bad for him, his parents are at the game, but remember, they don't care how much you know until they know how much you care. We must constantly fight for our patients' needs with the increasing administrative bureaucracy of medicine that we all deal with. Always remember, patients first, doctor from the inside out. I truly believe that each of us becomes better physician surgeons based on the experiences we have and learn from each year in our practice. So today, at the age of 61, I think I'm a better physician surgeon than I was at 51, simply based on my patient experiences and life experiences. Your patients will teach you, all you really have to do is listen and learn. Respect this wonderful profession that we have been so privileged to be a part of. It is not a job. I see many of our young physicians today picking a specialty of medicine based on work hours, no call, very little patient contact, maximal vacation time. In other words, it is simply a job to check a box when you leave the house. Certainly they don't want a pager to be bothered when they have finished their shift. I personally have never looked at it that way and never will. Call me old-fashioned and not with the times, but to me, to me, this is a calling and a profession and I will always be available to my patients. There are no worked out dirty duty hours. It is my responsibility to the patient to care for them when they need me. Now, has this personal philosophy come at the expense of my family time? You bet it has, right, from my wife and three children. I can only hope that they understand I was never choosing my job over them. It's simply a profession that requires that level of effort and commitment, particularly as a team physician. I will finish talking about the importance of family. Our family defines who we are. These are the people that you hold in your inner circle. A common quote, success is not the key to happiness, happiness is the key to success. Often your family unit outside of medicine determines your happiness. These are the people that will support you and comfort you in times of stress. Don't let anyone or anything break that circle of trust you have for each other. Does it take time and effort to develop that family and nurture it over time? Of course it does. Does that require you to invest in it as much as your surgical case the next day? Of course that does too. Is it worth it? You bet your ass it is. I can only promise you that the older you get, you will lean on it more and more in the game of life in this profession. I want to thank my family who continually shapes me to be a better person, husband, father, and physician. I just want to say, you know, a couple years ago, many of you know, many of you reached out to me when I had COVID and this was right before the vaccine came out. So those top two pictures are me and my daughter. So I gave it to my daughter. This is in December of 20. So my wife has me and her daughter, who's 20 weeks pregnant, in the hospital. She can't visit us, can't see us. My son is stuck in Chicago because he can't come home because my wife's got it. So here my wife is, right, with her husband in the hospital, pregnant daughter in the hospital, future granddaughter in the hospital. Whew. That's, that's dark, my friends. Honestly, I don't know if I could give this talk after going through all this. If you want to lose 20 pounds quick, get COVID and go in the hospital because I lost 20 in 10 days. You know, that's me coming home on the first day on the bottom right. Those two CT scans there, the bottom left was my CT scan where my lungs were full. You know, that's what ARDS looks like. And I was pretty sick. There was a time where, you know, one night that damn respiratory therapist came in and mentioned ventilator. And then I went, oh shit, I'm in trouble. I said, and I said, shit, I might not make it out of here. You know, those are dark times. I can tell you that the hardest part, and I think probably for many of us in this room would be, is you're in a room for 23 hours and there's only somebody in your room for about 45 minutes. So the nurse comes in with all the gear on. The doctor comes in with a total joint space suit who you can't even listen, you can't hear him. So you're isolated for 23 hours in that room. Your daughter's literally down the hallway. My daughter is down the hallway that I'm on, on the 10th floor at UK, right, and she's getting ready to go to the ICU because they're worried about her oxygen saturation level. I mean, I tell you, the only damn thing that I remember is that oxygen saturation monitor was right here over my right shoulder. I still think my neck's all screwed up from two years ago because I knew I was smart enough to know one thing. That was my lifeline. If that thing went south, shit, I'm in trouble, right? So I mean, I messed up all day, but we had a celebration for those nurses that took care of me. And I tell you, those nurses, I don't think they get enough credit. There's a lot of issues with COVID and people leaving healthcare, but those three nurses there in that middle picture on the bottom, I mean, they kept me alive. They gave me hope, you know, when I had none. And they said to me, Darren, you're going to make it. At times when I went, I might not make it. So I am forever grateful to those people that took care of us. And out of this, we got that girl, right? That's Emma Kate, our miracle COVID baby. Kelsey was pregnant with her. She's going to be two in April. But what a gift of having that and going through all this. And you definitely look at life a little bit differently, right? I'm sure I haven't gone through that with my daughter in that hospital. So in closing, I would say for all of this, if you love what you do and you do what you love, you will be successful in your career and life. I'm so very lucky to have a career I truly love. Make these building blocks we have talked about this morning part of your DNA. For it is these personal things that will have a great impact on your career, life, and medicine. And Freddie, I hope I didn't let you down. Thank you. Wow, Darryl, I don't know how you got through that because I had a hard time doing it myself. Anyway, this is for you, a gift from our society. We're truly honored for you to give that speech. And if you're in a melancholic mood, it's only going to get worse. So take a break for about 15 minutes and come back, and we'll have our tributes for our mentors, Dr. Fu and Fowler. Thank you. Do you want to have a good picture? Do you want a good picture? Do you want a good picture? Do you want to give this out?

Kennedy Lecture

Dr. Darren Johnson

John C. Kennedy

sports medicine

AOSSM

ISSACOS

building blocks