Enthusiasm Is A Plus...

 

 

I am currently writing an opinion piece on the medical skills necessary for current and future psychiatrists.  I designed a table and sent it to my favorite internist for feedback – my brother.  He was concerned about my level of intensity and wrote back:

“In an ideal world this sounds good. In my experience most psychiatrists do not have your zest for medical knowledge. Enthusiasm is hard to teach.”

His response got me thinking about the enthusiasm factor in academics and medicine.  Is it teachable or can it be transmitted some other way?  What about the issue of authenticity?  Is the observable really enthusiasm or is it something else appearing to be enthusiasm?  Competitiveness is probably a good example and it is legendary in pre-med and medical school courses.  There appear to be plenty of people who adhere to the old adage about escaping a bear attack: “I don’t have to be faster than the bear – I only have to be faster than you.”  When I was in med school these people were known as gunners because on rounds with attendings they were gunning for you.  They would attempt to elevate their status by trying to make you look bad. In some cases that took on the appearance of just trying to look more interested than you.  I never really understood the mentality because after all we were in the presence of an attending who could make all of us look bad – and typically did.

My interaction with professors and attendings was the first real sign that true enthusiasm exists.  In college at every level there were professors with vast knowledge of their subject material.  At times they would interject their personal excitement about the subject matter into the lectures.  Anecdotes about the organic chemist who famously said that God consults him about molecules, the inscription on Boltzmann’s grave, or the mathematician who discovered group theory and then died in a duel at age 20 and the implications. Some of these professors would read the room and try to inject humor to invigorate the class and create some enthusiasm. And there were the obvious sacrifices like hanging in there as a professor or adjunct at a liberal arts college for substandard pay and benefits for the love of the academic field and the ability to practice it.

In medical school, it was even more obvious.  Most of the people med students interact with are attending physicians on clinical rotations who teach but also have their own productivity demands.  Physicians rounding on patients with a teaching team have their clinics or surgeries in addition to supervising trainees. They need an academic level of expertise in their field to maintain the teacher-student hierarchy.  A pediatric endocrinologist told me: “I must know the most about any endocrine subject in the room (referring to the mix of specialties on our ward team).  It is no accident that I know all about adrenal steroidogenesis.  I have to know it cold.”

Was that still about competitiveness and one-upmanship?  Possibly but highly unlikely.  After all an attending physician is not competing against trainees or anyone else.  If there is any competitiveness it comes down to internal standards.  As an attending for me that came down to a series of questions:

1.  Am I missing anything?

2.  Am I doing an adequate job?

3.  Am I covering everything that is important to cover and am I communicating what that is?

4.  Are there any problems with the staff or trainees that need to be addressed?

Competitiveness does persist post training and it is a largely undiscussed problem.  I once witnessed a confrontation between two very high-level academics where one commented that he would never be beaten by the other.  The rejoinder was: “I think the field is big enough for both of us”.   In the current American system, it is encouraged among front line physicians using several metrics like productivity (number of patients seen not papers read) and various scapegoating techniques in the corporate employee assessment. But I think most senior physicians get to the point where they welcome collegial discussion and consultation.  If you discussed it with them – their competition is most likely against high internal standards – some of which may be unrealistically high.

The psychology of enthusiasm has several dimensions. There are behavioral approaches to improve it – not the least of which is establishing predictable routines.  Athletes routinely push past nonspecific feelings of unwellness and notice that those feelings resolve and they feel much better with their workout routine.  This helps establish a long-term pattern of enthusiasm for high levels of exercise.  There is a social component that is used in sports for both the athletes and spectators involved.  Like all psychological phenomena there are rating scales that seek to describe the enthusiasm of teachers and work engagement in general (1).  In the age of burnout several studies have suggested that enthusiasm may minimize that problem.  It would be difficult to maintain enthusiasm in the face of moral injury.

From a psychodynamic perspective, identification with teachers, professors, and attendings is a largely unspoken but in my experience powerful process. In clinical medicine there is probably no better field to observe personal attributes of teachers and consciously or unconsciously incorporate them into your personality.  I was fortunate enough to work with so many enthusiastic and high energy physicians and teams and they had a direct impact on me.  The message was be compulsive, check and recheck everything, and do the research on the fly.  I have written about the last team I worked on in medical school.  Every person on that team from the intern to the 70-year-old nephrologist was interested in kidney disease 24/7 and we covered the largest inpatient unit I have ever seen (including transplant patients) and two outpatient clinics.  We worked at it from sun up to sun down and everybody was energetic and ready to work.  That team also showed me the importance of a sense of humor.  Everybody had it but one of the Internal medicine residents was practically a stand-up comedian.  On my last day of medical school, I worked until 10 PM with that team.  They were swamped with consults and asked me to do three after the clinic.  I was happy to do it and then skipped across the golf course like county grounds to my apartment a half mile away.  Even as an old man – I feel happy every time I think about that experience. 

As I am winding down this post, there is a moral dimension to enthusiasm at least as far as medicine goes.  People have been described as doing harmful things enthusiastically.  Enthusiasm has to be a positive force.  One of the derivations from the Greek is “possessed by God or divinely inspired”.  At times in history, it has been equated with madness.  Philosophers have written about it as both a positive (promoting desirable values and politics) and a negative (zeal overtaking rationality).  In the context I am discussing – it takes the form of improved focus on difficult to solve patient problems and espirit de corps.    

Identification only gets you so far – I don’t think anybody has ever mistaken me for a comedian.       

What about in the case I started this post with?  It was my brother responding to a compulsive table about what medical problems psychiatrists should be able to recognize, diagnose, and either treat or triage. Enthusiasm may be a part of that and I will admit to being very enthusiastic about medicine and neurology in general, but there is more going on.  I made most of the diagnoses in the table not just based on enthusiasm but at least three other factors.  First, I practiced across multiple settings and was often the only psychiatrist around.  When you are asked to see people in general hospitals, nursing homes, and outpatient clinics in the same week there is a good chance that you will encounter serious but vaguely characterized problems in all these settings.   That could range from agitation due to any number of underlying neurological conditions to a mother who wants her 3-year-old son put on stimulants because of uncontrollable behavior.  Second, neurologists are in shorter supply than psychiatrists.  That doesn’t mean that psychiatrists should practice neurology but it does mean that specialists who are trained in and expected to know neurology might do a better job with certain problems than primary care physicians. At the top of that list are recognizing aphasia syndromes, presentations of acute encephalitis and meningitis, movement disorders, and functional neurological disorders.  Third, there is always a group of psychiatric patients who see their psychiatrist as the primary care physician they prefer to follow up with.  I have been able to diagnose unrecognized illnesses just based on that difference in preference and communication.  Psychiatric liaison with primary care is a useful function.     

Heading into 2026, I hope that all the professionals reading this have been exposed to the levels of enthusiasm that I have during their career.  And I hope that the doctors I end up seeing in the future all have it.

 

George Dawson, MD, DFAPA

 

Some additional thoughts/anecdotes:

1:  One of the advantages of enthusiasm is embracing just how much you need to know in order to do a good job.  A long time friend of mine who ended up being an ophthalmologist showed me his standard 3 volume ophthalmology text and put it this way:  "Every specialty is covered in 2-3,000 pages.  It is what you need to know."  That always made sense to me but as a specialist - enthusiasm changes that task from last minute cramming to knowledge that is part of your personal identity.  It is knowledge that has to stay with you and you have to keep it current.  It can mean the difference between life and death.    

2:  When I was a PGY-2, I was staffing patients in a clinic with my attending who was a brilliant psychiatrist and researcher.   He was very enthusiastic about teaching.  He asked me this question that also turned out to be a thought experiment:  "Suppose you are done with all of the training and you are out at a cocktail party somewhere.  People come up to you and start talking. Do you think you will be talking with them like a psychiatrist or like somebody who has had no training?  That question seems very easy to answer at this point in time, but back in 1984 I was drawing a blank.  This blog is probably a good example of what that answer is.

3:  Obsessional behavior can be mistaken for enthusiasm.  Ar various points in my career I have seen physicians paralyzed by it and stuck in a loop of unproductive activity.  It has happened to me a few times.  If that behavior is related to patient care - there is aways someone in your field who can tell you if you are missing something or not.   If it is a case of administrative scapegoating - you can always move on though it may not be easy.

4:  The anecdote about how my nephrology team convinced me to work late the night before my graduation is humorous, but probably not in a way that I can convey in writing.  At about 5PM that night the senior medicine residents approached me with the idea of staffing 3 more consults. It went something like this: "Look George - we know you graduate tomorrow and probably want to get out of here but we are getting killed with consults.  Do you think you could help us out by doing three?  One last thing?"

To clarify - in teaching hospitals, medical students are not physicians.  As part of the learning process on a consult service, they see the patient, get the necessary historical, physical exam, and laboratory data and record everything in the chart.   Then they present it to the attending physician.  The attending shows interviews the patient, does the indicated physical examination, adds the additional insights of an expert for both the consult team and the patient, and adds to the note and countersigns it.  The medical student and residents need to come up with their own diagnoses and treatment plan for discussion purposes - but that is the ultimate responsibility of the attending. There is a progression in medical training that the initial work by the medical student or resident becomes either a much closer approximation or identical to what the attending would say as people progress from med student -> resident -> fellow -> attending.

The residents were trying to cajole me into doing the work but they did not need to.  When I said I would they increased the flattery to absurd levels and we all had a good laugh about it.    

5:  On the issue of competitiveness - I had no idea how bad it could be until I had graduated from college.  I attended a very small college and we did not have a specific pre-med track.  I was a chemistry and biology double major.  Long before I decided to go to medical school - I heard anecdotes about sabotage in the organic chemistry lab to either contaminate the products or reduce the yield of synthetic reactions.  As a former lab assistant that is probably not the best way to evaluate lab performance.  Organic chemistry was one of the feared med school pre-requisites.  There is even palpable bitterness about the course in some people who are practicing physicians. Sabotaging somebody else's lab results seems counterproductive in so many ways and it is difficult for me to see how that would work very well.  As a lab assistant I viewed my job as making sure everyone was safe (I did prevent 2 explosions) and knew what they were doing.      

References:

1:  Schaufeli WB, Bakker AB. Utrecht work engagement scale: Preliminary manual. Occupational Health Psychology Unit, Utrecht University, Utrecht. 2003 Nov;26(1):64-100.

 

Graphic Credit: 

Teaching hospitals of the Medical College of Wisconsin taken from the path walking from my apartment on 89th street.  The black and white photo is Milwaukee County Hospital shot in 1982.  The color photo is from the same spot in December 2025.  The two most visible buildings are the Froedert and MCW Center for Advanced Care (left) and the Froedert & MCW Clinical Cancer Center.  The Froedert legacy spread from the original Froedert Hospital that was there is 1982 - where I did 2 neurosurgery, a nephrology, and a neurology rotation.  B&W is shot with a Konica 35 mm and Ektachrome.  Color is an iPhone 15.

The Spiritual Journey From High School Football

About 2 years ago my wife said to me one morning “who is this guy who keeps texting me?” I looked at her phone and recognized the name immediately. He was the quarterback from my high school football team. More correctly it was the high school football team I was on when I was a sophomore in high school. I had the immediate association to his physical appearance and considerable athletic ability. To this day he probably was the most gifted high school athlete I had ever seen. He didn’t look like a high school player - more like a college player. He was also an excellent basketball player and sprinter on the track team. He was the fastest man over 100 yards in high school. Why was he suddenly texting my wife?

He was going to be inducted into the local athletic Hall of Fame. He was trying to organize a reunion of our 1966 undefeated high school football team. His plan was to get as many of us back there as possible - details to follow. There were 2 or 3 subsequent postponements of the reunion due to the pandemic. But yesterday on 6/26/2021 it finally happened. Twelve of the 22 players reunited for about 3 hours at a local bar. As far as I know three of my teammates are deceased and the remaining players could not be located or decided not come. The head coach was also in attendance. The assistant coach is deceased.  All of the attendees got baseball caps with their name and numbers embroidered on the back. The front of each cap simply said “Undefeated 1966 AHS Football”.

Unlike my high school reunion, I had the opportunity to say something to all my teammates. I remembered who they all were and details from our past. I know that many had significant problems in life including life-threatening health problems. I learned about their relatives who had similar problems. But most of all I learned about what that football season meant to the people who made it back to the meeting. I know that memories from over 50 years ago can get complicated and distorted. As we all sat around a table there was a collection of newspaper articles and photographs from 1966 to provide partial corroboration. There were some intense memories from the past that haunted some of the players. There was also active feedback from the coach about a few incidents where he realized that the plays he was calling were being ignored. My intention in writing this post is not to identify people with problems or criticize people, but to look at an event with obvious meaning as well as the meaning that may have been missed at the time.

Our quarterback started out with some self-disclosure of mistakes he had made during the championship season. Other players who were involved with those mistakes corroborated them immediately. Our center for example recalled a fumble on the opponents 1 yard line and the fact that it occurred on a silent count. For 5 decades our quarterback was thinking the fumble was his mistake, but our center let him know that he forgot the count. There were several other incidents involving typical football mistakes that people had been thinking about since 1966.  Resilience came up as an outcome of the coaches role in helping us overcome adversity.  

A significant injury was discussed. From the description it sounded like a traumatic brain injury, but back in those days any head injury with partial or significant loss of consciousness was referred to as a concussion. There was no grading system but persistent confusion or memory loss might eliminate a player from the game although that was certainly not guaranteed. More than one concussion led to a medical evaluation but again there was limited medical expertise in traumatic brain injuries. It led me to recall a lot of headaches from playing football. We would practice twice a day in hot weather hitting a blocking sled and doing full contact drills. There were days where the headaches just did not clear up.  I was also reminded of the only significant traumatic brain injury that I sustained when I ran into one of my teammates playing in a touch football league. In fact, I approached him at this reunion and joked that the last time he and I met - I was out of it for the next 24 hours. I had to explain that we were both defensive backs running full speed and I ran into a shoulder after diving for the ball. He did not recall the incident.

There was a strong underdog theme. At one point in the year, we did not have enough players to scrimmage so the coaches had to play defensive half backs. Many of the teams we played against had much larger players and significant depth.  That led me to recall our coaches quote to the press: “We are not big - but we’re slow”.  Our coach recalled that in some of the venues we were ridiculed for looking raggedy and not having many players. We were accused of running up the score against some teams to improve our overall ranking.  The coach found this humorous because there was no second team to put in.  At one point during the discussion, one of our receivers took over and talked about how he and one of his friends in the offensive and defensive line got psyched up for the game. He gave an inspiring and expletive filled speech about his love of football, how he liked physical contact, how he liked playing offense and defense. He presented it with such vigor that it seemed like he was ready to play - right then.

For some reason, I had forgotten how tough these guys were. We were almost all working class.  Half of us were from the East End and half from the West End of town. Some played with significant physical disabilities. It was the height of the Vietnam War and many would go into the Marines and the Army after graduation. Many would go on to play college football. I would just catch glimpses of their lives from time to time.  Everyone had a unique trajectory from that winning football season to where they were on June 26.  At one point a small group asked me what my trajectory was and I told them a variation of a story I have been telling for the past 10 years:

The only reason I ended up going to college was to play football, be a football coach, and teach physical education.  I had a football scholarship to a small college in the area, but within a few weeks, I developed a gangrenous appendix and was hospitalized for a week.  The coach came in and told me that the scholarship was mine even though I could not play anymore (I had a healing surgical scar in my side that was still healing after a drain was removed). I probably was headed to be a version of a hippy anyway. Another professor visited me and told me to forget about Phy Ed and football and concentrate on something else.  I had excellent chemistry and biology professors and knew that I wanted to be like them and know what they knew.  From there it was a change to biology and chemistry, the Peace Corps, a plant tissue culture lab and medical school.”

That’s the short version.  There are embellishments for comedic relief and more details if anybody wanted to hear it.  I leave out the heavy parts about being depressed to the point my grandfather showed up one day to encourage me to stay in college and not knowing what was wrong with me until I developed severe abdominal pain. I leave out the part about not taking a student deferment during the lottery for the draft.  A high lottery number rather than a conscious decision kept me from being drafted.  All part of the lack of a coherent plan. Nobody wants to hear about all of that. I never played college football.  The point is – I would never have stepped into that sequence of events culminating in medical school and psychiatric residency without that football scholarship. I never would have had that football scholarship without playing with this team and being coached by this coach. Some people will tell me that sequence of events would have happened anyway. That I would have made it happen through another channel. Whenever I mention being lucky on this trajectory, I encounter aphorisms like “Luck is just preparation meeting opportunity” and others.  But I really was not prepared to do anything at that point.

The only thing I was prepared to do in high school was play football. The teaching and guidance side was totally lacking. I can not recall a single piece of good advice that I received from a teacher or guidance counselor in those years. And the teaching was atrocious. You showed up, put in the time, did not create any problems and graduated from high school. The blue-collar ethos of education.  You did not have a plan until you got to the next stage. The modern-day stories of high pressure on high school kids to get into an Ivy League schools and parents going to extraordinary and in some cases illegal lengths to get them in - is lost on me. I am the poster child for getting into whatever college wants you and establishing goals after getting there.

Football was the initial pathway.  At the Reunion, the coach discussed some of his initiatives including the first strength training program at the school along with associated competitions. I remember summer training sessions including agility drills.  I excelled in agility drills and back and forth sprinting drills. In my senior year, I could equal or beat the fastest running back in the agility drill even though he would beat me by a mile in 100 meters. These summer sessions were something we all looked forward to and it was the only planned activity in my life for the 3 years of high school.  The Coach gave us a glimpse of what it took for him to implement these plans and all of the resistance he met along the way.  That resistance came in the form of administrators claiming that he was running afoul of certain regulations, personality conflicts, and suggesting that he should work the pre-season for free even though he was already undercompensated for the amount of work he was doing. Providing me with some structure to start to get my life together came at a considerable cost to the only guy who was doing it.

Several of my teammates provided additional stories about the immediate benefits of coaching. How to play against a much larger man with limited lateral movement.  How to make adjustments during the game, based on observations by coaches who were at ground level on the side lines, attending to the injured on the sidelines, and changing overall game logistics. High school coaching is a multi-tasking job and school districts get their money's worth from coaches.

One of the most important aspects of my life trajectory has been identifying with teachers along the way.  Most of that emphasis was in college at the conscious level. But did it occur in high school football?  I was never encouraged to play any sports by my father. I learned after his death that he was quite accomplished in baseball and softball in his early twenties. By the time I knew him well, he had been working a thankless job for twenty years. The only sports advice he ever gave me was: "Look - if you want to play sports be clear that you are playing it for you and not for me." He did live to see this football team and attended the end of season banquet prior to his death in 1967.  I never got the chance to completely understand his sports advice, but speculate that it was from having to fish every day during The Depression to supply food for his family of origin - whether he wanted to or not.  

Both of our coaches were young men, accomplished athletes, and had unique personas. I remember the head coach bench pressing a significant amount of weight even though he was a quarterback in college. For the rest of my family, sports were something you did into your early 20s and then you settled into a fairly sedentary lifestyle. Out of college and then again out of med school I embarked on a lifelong schedule of rigorous training for no reason other than being able to do it.  That continues to this day. Would I have logged all of this activity if I had not played high school football with this coach? Probably not. Was there a degree of unconscious identification with this coach?  Probably.

The developmental aspects of high school football are undeniable and the stage we were all at during the reunion was undeniably different from high school. High school male athletes are competitive either by choice or necessity. It was probably the most significant motivator. I can remember thinking about the difference between competing with myself and competing with others as I was running a long sprinting drill in the 90 degree heat that occasionally happens in northern Wisconsin. In that drill 5-10 players spread out across the field and run out to the 5 yard line and back and then the 10 yard line and back until they have reached the 50-yard line and back.  At some point during that drill you realize that competition is irrelevant because it really comes down to survival and in that sense you are competing against your own physical limitations.  That familiar mind set was with me for the next several decades of cycling and speed skating. With a single exception - I preferred to do both activities alone – just me and the rhythmic breathing and sweating of that familiar sprinting drill.

The competitive aspects of high school sports also play out in other ways. Clique formation, hazing, bullying, sarcastic comments, and various forms of acting out that are expected of teenagers who we now know don’t have fully developed brains for another 10 years. That was moderated to some extent by the shared suffering of football.  At the Reunion it was fairly clear that there were many accomplishments over the course of these lifetimes but also much suffering. We were all grateful to have survived so far and saddened by the loss of our teammates who did not.

55 years had passed and, in some ways, we were a better team.

 

George Dawson, MD, DFAPA

Postscript: 

If I am correct in my analysis (or not) - I am grateful to have had this experience in high school.  I am grateful for my teammates many of whom I consider to be friends but also the Coach and Assistant Coach who clearly did not get enough credit for what they did. I made the common mistake of also taking that coaching for granted until I realized that my entire career may have been based on it.

The commemorative cap:

Supplemental Qualifier:

I don't want to give anyone the impression that this is an endorsement for football or other contact sports.  Football is a collision sport and there is an expected morbidity associated with collisions. Chronic traumatic encephalopathy is one outcome that has received a lot of press. My speculation is that spinal problems also occur as the result of spinal compression and hyperextension movements that are harder to detect due to the high prevalence of spinal problems in the general population that does not play contact sports.  One of my teammates sustained a cervical spine fracture from football but it did not result in paralysis.  As a psychiatrist, I have seen a significant number of people with traumatic brain injuries and severe musculoskeletal injuries from collision sports.  The number of women with those injuries has increased as their exposure to these sports (soccer, lacrosse, ice hockey) has increased.  I have seen young men and woman in their early 20s with significant disabilities from these injuries. In some cases they have also had severe post-traumatic stress disorder (PTSD) from either the injury or the subsequent course of treatment. 

 

Muhammad Ali - The Social Context Of A 15 -year old

I occasionally post in a local political forum in Minnesota.  I generally try to avoid it because politics in science is interesting at severals levels but the politics of American political parties is not nearly as interesting.  The biases and political responses are always predictable. It is always a mystery to me why there are so few reasonable candidates.  A few friends who have run for office and not made it on party ballots have given me their opinions, but this post is not about that.  The other aspect of politics as I have stated hundreds of times on this blog is how it gets transacted in academia and professionally.  The biases are again evident.  In science nobody seems to take complexity into account on reproducibility issues or the unconscious biases of the researchers.  In looking at conflicts of interest, nobody seems to take into account that in many cases (like the price of pharmaceuticals) that there are clearly some conflicts of interest that trump most of the others.  But again, this post is about one aspect of politics and that is connectedness to the candidate.

Today - I was reading my e-mails from the political forum and I came across a statement about how Barack Obama did not connect well to the middle class.  I think that the research shows no matter where you end up in life, your class identification stays where you were when you grew up.  That would place me solidly in the middle class - in the lower half if socioeconomic status means anything.  I have seen a lot of Barack Obama and can appreciate his charisma, intelligence, ability to communicate and personality.  As a small "i" independent I don't always agree with his politics, but there is no doubt that this is a guy who I can relate to and I have very high regard for.  I want nothing but the best for him.  In thinking about why that might be, I reflected on another prominent American in the news this weekend - Muhammad Ali.

Listening to a lot of news this weekend about his passing - I like George Foreman's comments the best.  This is an excerpt of a CNN video of George Foreman on meeting Muhammad Ali in New York City sometime after their fight in Zaire:  

"....Everybody falls in love with him.  You can't help it. He was one good looking, lovable guy.  I was excited to meet him and happy to be his friend." -  CNN - June 5, 2016.

I never came close to meeting Muhammad Ali.  I have never attended a boxing match and even if I did, by the time I could afford it he would have been retired.  My initial experience was as an early teenager in a remote outpost in northern Wisconsin.  The communication in those days was primitive - just newspapers, magazines, radio and television broadcasted out from Duluth over the airwaves to your antenna.  There were three television channels and on a good day - you could see two out of three.  My grandfather would often say: "They've got kids running those TV stations." to describe the predicament.  It was a long time before they could send a clear signal.  Even in those primitive pre-Internet days, Muhammad Ali could dominate a long news cycle with his comments and the press and others reacting to those comments.  There were a long series of controversies.  As a young guy he was probably the most exciting sports figure to watch.  He was verbose at times, articulate, and he had a great sense of humor.  When he was saying something that many considered to be outrageous, he was smiling and I had the sense that he knew exactly what he was doing.  He would also not back down from an argument even when he was being videotaped.  No matter what he was saying, I found myself nodding in agreement with him.  The  other sports heroes I had at the time were shallow by comparison.  No other sports figure could comment at length on American culture, religion, and philosophy.  There were no other sports figures who had such an active relationship with their fans.   

But the most striking thing I remember, is that older generations of men did not react the same way.  Most of what Ali did made them very angry.  And of course at times they characterized him in very ugly racist language.  Racism was rampant at the time, and it was everywhere.  In rural areas, it wasn't obvious because there were no black people.  My father was a railroad engineer and as a special day, he would take me to the roundhouse with him.  The roundhouse was the industrial side of the  railroad.  All of the engines were housed in a roundhouse, just off a large turntable that allowed them to be rotated 180 degrees and connected with the main line.  There was a very plain locker room with various signs encouraging adequate hygiene.  In the room at the far end was an area designated for porters.  I asked my father who the porters were, but I never got an answer and I never saw a porter.  Passenger traffic had just about ended by then and the only thing the trains were hauling was iron ore, coal, and large bundles of scrap paper for recycling.

As a 15 year old, I had to bite my tongue while the old guys in the room cheered for anyone to beat Ali or while they criticized his boxing skills or just made outrageous comments.  But it was the 1960s and the culture was rapidly changing.  Young people were getting louder and norms that had been in place for a generation were no longer accepted.  It was easier at first to publicly agree with Ali's stand as a conscientious objector, but it soon became obvious that you were a fan of the athlete and then the man.  I heard some commentators talk about the tumultuous times when Ali first grabbed the national spotlight, suggesting that had something to do with his fame.  I would see it as being the other way around.  A lot of young guys like me identified with him.  At some level it was teenage hero worship, but unlike the other sports figures - he did not go away.  He was an example of a sports legend who became a great man and on this weekend those stories abound.  I found a kindred spirit where I work and we have been exchanging Ali stories, pictures, and clips for the past few years.  Most of these stories are after his retirement from boxing and it is an impressive body of work.

Those were my associations to the notion that Barack Obama does not connect well with the middle class.  It is easy to identify with charismatic, intelligent, articulate, and empathic people.  I am sure that I am not the only 15 year old that had his eyes opened to that.  

And I won't be the last.

              

George Dawson, MD, DFAPA

Attribution:

1967 portrait of Muhammad Ali by Ira Rosenberg [Public domain], via Wikimedia Commons at: https://commons.wikimedia.org/wiki/File%3AMuhammad_Ali_NYWTS.jpg

In 1967, I was 15 years old.