MUSC President David J. Cole: The man behind the title

Cole settles into one of the roles he loves best, as a surgical oncologist. In this case he’s helping a young woman, a breast cancer survivor, get rid of a new tumor from her chest wall.

He sketches out a quick diagram on the patient’s drape to help a resident spatially visualize the best angle to cut out the tumor. Job efficiently mastered, they hand the mass to a medical student. Cole watches as the student places a stitch in it to help the pathology lab better analyze cancer margins.

“The less you use your fingers around a needle, the more likely you’re going to have a better day,” he quips. “Don’t work small. Remember? We talked about this.”

It’s advice Cole certainly follows. The former chairman of the Medical University of South Carolina’s Department of Surgery steps into the role of being its seventh president this month.

It wasn’t an easy decision because of his love of research, and clinical and surgical practice, but there’s one lesson he’s learned in life.

“Life is rare with its opportunities. You need to be prepared to step forward,” he said, later reflecting on why he opted to seek the top administrative spot.

That’s why third-year medical student Simone Marybin said she sought an opportunity to work with Cole on a surgical rotation because she knew she would be challenged. The rumor was she’d be expected to know what a resident rather than a medical student might need to know.

It didn’t bother her, though, because she also had heard Cole, though extremely busy, is never too rushed to teach his residents and students. “You can’t say that about all the surgeons. He always takes the time to teach us what we need to know. I was excited about doing this service.”

Elise Morrison, R.N., said he’s thoughtful and direct. “He thinks everything through. You can see the wheels turning constantly. He’s got a great sense of humor. I love working with him. He’s all about the patient.”

Early today he already was calling to check on the cases for the day, even though he has 25 things going on, she said. “He’s just a fantastic surgeon. He’s business-like, but then he’s cracking jokes. I’m happy that he’s president, but I hate that we’ll lose him full time in surgery.”

Cole said he will continue to practice surgery on a limited basis because it will help him remain grounded as a health care leader in addition to maintaining his personal sanity. Becoming president is a natural progression in his career path, though. “The contributions I’m going to make will be on a different level.”             

Cole’s leadership roles have grown through the years. His research lab investigates novel anti-cancer approaches, including adoptive T cell and gene therapies. In 2013, in addition to being chairman of the Department of Surgery, he served as president of MUSC Physicians, the faculty practice plan for MUSC.

On a personal note, he and his wife, Kathy, have been here 20 years and raised their three children in their Mount Pleasant home that’s nestled on a Lowcountry pond. It’s not by happenstance that they’ve not moved. “MUSC is very meaningful to me.  It’s been our home. We’re part of the community – it’s who we are.” 

MUSC is at a threshold in terms of its momentum and capability, and Cole sees an opportunity to shepherd its growth through an important transition. “We’re in the middle of a lot of transitions nationally aimed at providing better health care for less, reshaping and facing significant challenges in health care systems are a part of our future.  So part of me says, ‘I can either stay at my level and complain about it, or I can embrace moving to a level where I can have a bigger impact.’”

As his past history has shown, Cole is not one to back down from a challenge.

“For me to have the opportunity to be a leader of an institution that’s very meaningful to me, at a time when there’s a chance to make a mark in terms of how we should do this or how we should look toward health care in the future, I find very compelling. MUSC is a great health care institution, but in many respects I think in the last decade, we’ve done a good job of hiding our light.  We’ve got a lot of capable people and commitment to excellence.  We need to shine our light.”

Cowboy Heritage

Nicknamed “cowboy” when attending medical school at Cornell University Medical College in New York, Cole said he was the token Westerner in his class. Mostly, fellow students were just fascinated that he was from Albuquerque, New Mexico, the land of enchantment and wide-open skies, he said, a hint of wistfulness in his voice.

Although not a horseman, there is something of the cowboy in Cole and his family. His parents, originally from Kentucky, decided to pick up and leave home to resettle in New Mexico. His father, an aeronautical engineer, raised Cole and his three siblings to always do their best.

“My parents are very grounded people.  My dad is in no way pretentious.  In fact, if you were pretentious, I think you would have gotten the wrath of my dad.  You need to be real about who you are and what you do and have integrity and follow through.  Those values I think are probably part of my DNA.” 

His mother, “the glue of the family,” taught him determination and what it was like to be loved unconditionally. She’s a very stubborn person, he added. “I don’t say that in a bad sense.  If my mom wants something to happen, it would be sort of like standing on the beach and stopping the tide from coming in. The things she wants to have happen are the right things to have happen, so you’d better be ready for an unstoppable force of nature. That’s just how it is.”

Cole admits he may have inherited that from her.  “I hate to use the term stubborn, but I have an internal drive and if I know the right thing to do, I’ll get it done.” 

His wife of 26 years, Kathy, nods. “Yeah, I agree 100 percent.”

Cole smiles. “I think there are significant benefits to being consistent and seeing things through.  I’d say that’s probably what I got from my mom.”

It took Cole awhile to find the right path. He played varsity basketball and trumpet in band in high school. “I was mainly worried about sports, girls, somewhat school.”

When he went to New Mexico State in Las Cruces, he decided to veer from the family tradition of engineering and majored in biology. Between his sophomore and junior year, he landed a job as an autopsy technician at the New Mexico State Medical Examiner’s Office. When he showed up, he found out that they had cancelled the funding for the position so he volunteered to do it anyway for the experience.

Cole would watch the news the night before going to work because he knew anybody who was killed would end up in his office the next day. Unfortunately his first week on the job, there were riots at the New Mexico state penitentiary involving some gruesome deaths – fairly memorable for a 20 year old.

Cole learned he didn’t want to do that for a living, but that he loved medicine. The following summer, Cole got a job in an immunology lab as part of a summer research program, which was an important first exposure to his research path that’s immunology-based.

Though Cole landed a 4.0 GPA, his advisor discouraged him from applying to prestigious medical schools. True to form, he ignored that advice and went on to become a Rhodes scholar finalist and to accept an offer from Cornell University Medical School, which was a big transition for him culturally. He found the diversity and competition inspiring, though, and he ended up graduating in the top 10 in his class.

Then came a lesson in humility.

Cole spent two months in India on an Ida Scudder scholarship and saw such poverty and a wide spectrum of diseases, such as leprosy, that he’d never been exposed to before. There was so little he could do to help, it felt overwhelming. It taught him how much he still had to learn and not to take things for granted, he said.

“That sort of reset my thought process, at least in awareness – there’s such a huge need in those domains that you can never totally fix.”

Back in the States, Cole interned and did his surgical residency at Emory University Affiliated Hospitals in Atlanta. A period he describes as physically and emotionally demanding, Cole often logging about 110 hours a week with every other night call. “I grew up at Grady. Being a General Surgery Resident at Grady Hospital was trauma, trauma, trauma, trauma. If you survived Grady, you’ve seen it and done it all somehow.”

Somehow in the midst of all that he met his future wife, who was a nurse. Cole proposed to Kathy at the Plaza Hotel in New York at midnight on Valentine’s Day at the end of his third year of residency. They describe each other as soul mates. When they first got married she was working night shift, and they barely saw each other. They made it work, though. “We’ve always felt very connected.”

Not one to take the traditional path, Cole decided he was interested in surgical oncology and he matched for a three-year fellowship at the National Institutes of Health, National Cancer Institute in Bethesda, Maryland, which was largely a research-based program.  Though he had colleagues who questioned the move, Cole said he’s grateful for the experience as it gave him the right tools to be a research investigator. “I found that at the end of the day, I needed two skill sets to be successful as an academic surgeon. I understand both sides of the street.  I understand the clinical application of medicine, I understand patient needs, and I understand the research dimension.”

Eagle Scout arrives

Cole came home one Friday night to tell his wife he had gotten a call from Dr. Fred Crawford to come to MUSC for an interview to take a position as a surgical oncologist and researcher. Hollings Cancer Center was brand new and they needed a surgeon and someone to set up a research lab. Cole had just that set of credentials.

Over the weekend the couple weighed the options and prayed about it. They picked up The Washington Post travel section on Sunday.

“I’m not making this up – it said, ‘Charleston, the place to be.’” 

Kathy nods,  “Front page.”

Cole grins. “That’s what it said.”

According to Cole’s oldest brother, James Robert “Bob” Cole, his brother is lucky to have made it, period, given all their father’s wild adventures hiking and camping. He recalls one spring backpacking trip they took where they ran into such deep snowdrifts they ran low on food, and had to backtrack to find passable trails. Then there was the whitewater canoe trip when they capsized and their father had to do a miraculous rescue of Cole, who had gotten trapped under the canoe, lodged between a boulder and tree.

It was kind of a Wild West childhood growing up in Albuquerque. Bob, as the older brother, did his part to toughen up Cole, who was tall for his age and a very smart kid. Cole liked hanging out with Bob and his friends. Of course, sometimes they took advantage of his youth.

A lover of practical jokes, Bob and a friend painted a giant boulder gold and even went to the lengths of breaking it in half, painting the inside gold and gluing it back together. Then he took Cole, 6 at the time, out and they talked about all the gold that still can be found in the area, and sure enough, Cole noticed a portion of gold rock sticking up, dug it up and split it open to make sure it wasn’t fool’s gold.

Bob laughs at the memory. “He was rich at that point.”

Of course, Cole taught his brother some lessons, too, such as don’t get in front of an archery target when your brother has a drawn bow. “He accidently released an arrow and shot me in the stomach, but it wasn’t with enough force to do any damage. He was 6.”

Bob said he’s proud of his brother, even though he’s known as the black sheep of the family. Of the four siblings, two are mechanical engineers and their sister, a computer specialist. Bob’s not sure how Cole got on the medicine track. “He kind of went to the dark side there. I guess he’s done OK, though.”  

All joking aside, Bob said they are a tight-knit family. He, Cole and their father and Cole’s oldest son, Andy, all are Eagle Scouts. “Our father was very firm, but he was a very fair-minded man. That ingrained a sense of integrity that David has. David is a very direct, straightforward person. What you see is what you get.”

Being a middle child has taught him how to deal with people, and he reads people well and treats everyone with a sense of fairness. Another feature Bob likes about his brother is that he’s down to earth.

“He’s a humble guy. He understands what he knows and he understands what he doesn’t know. He has the confidence to make a decision, but he also is smart enough to know when he needs to consult with someone else. I truly believe he wants what’s best for the university. I don’t think he’s out to make a name for himself personally. I think that’s a rare quality in today’s world."

Kathy, agrees. Despite his busy schedule, he always takes time for his family and makes time to attend their three children’s events. The two work well as a team. “He’s caring, supportive, and he’s a great dad.  He puts me and the family first, always - no matter what - which is awesome.”

Kathy doesn’t see the new position changing him. Whether it’s his cancer research, surgery or now the presidential role, he is motivated to help people.

Cole said he wants to know he’s made a difference in life by the paths he takes. “People who are maybe naive in terms of what surgical oncologists do, say, ‘My gosh, how could you be a surgical oncologist?  Isn’t that depressing?  You’re dealing with hard things.’  You know, I take the opposite view.  Even if you can’t, quote, ‘cure something,’ you have a very real ability to tangibly improve – even if it’s for a period of time – in a meaningful way somebody’s life.  You will never run into more grateful people.  What a privilege to be in that position.”

With the role of the presidency, he will be in a position to make contributions on broader levels and has an exciting opportunity to continue MUSC’s momentum, taking advantage of a community that is forward thinking and inclusive, he said.

When asked if he thinks the job will change him, he shakes his head.

“I don’t think the core person who I am will change.  I don’t think a zebra ever really changes its stripes.  But I hope that – there are different dimensions I’ve yet to explore, in terms of who I am and what I’m capable of.  That’s the hopeful part of me.  We’ll see.  If it changes me, I’m hoping it will make it a bigger, better version of who I am.”