Author + information
- ∗University of Minnesota, Minneapolis, Minnesota
- †Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Jagat Narula, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, One Gustave L. Levy Place, Mailbox 1030, New York, New York 10029.
The past many months have been emotionally hard, and this Editor's Page is unlike most others we have written for iJACC. It is more of a personal epistle, mostly anecdotal, not connected to the science we have published in the current issue. It is, rather, the emotional equivalent of a mourning period; many of our mentors have started to retire, most often for health-related issues. Some have been incapacitated, and worse, some have passed on. This is a time to reflect on their legacy and how they shaped us.
Both of us have been blessed with an unusually generous bounty of mentors, and we fondly remember interactions long bygone. On deep introspection, most of our lives seem to be the sum of a patchwork of gifts from generous wayfarers on our journey. Mentors taught us many things, but the best memories we have are those that were given unassumingly; we learned what magnificent gifts they were only long after they were given, and they have shaped our view of the world. Some mentors were fleeting companions parting with their wisdom, while others remained ongoing, reliable buttresses for our future.
The mentoring tradition is a long one, even longer than the story of its namesake in the Odyssey. Many cultures have had teacher-student traditions far older than that between Mentor and Odysseus' son Telemachus. It is a feature of Talmudic lore (1) as well as the guru-shishya tradition, in which a pupil spent more than a dozen years in his guru's home for tutelage. In fact, a large vein of Sanskrit philosophy, the Upanishads, is dedicated to “sitting down near” an enlightened teacher to receive supreme instruction (2). Some of the oldest Vedic literature mentions this in 3 powerful words: “Aacaaryavaan purusho veda,” “Only the one with a true preceptor or mentor gains true knowledge.” Although some of this enthusiasm is quite obviously built on faith and homage, and we do not know how well this worked as it was not formally evaluated as we understand testing today, this concept is common to the ancient literature of many faiths.
More recently, mentoring has become a must-do feature at educational institutions and granting agencies (3), and high-powered journals are actively encouraging it (e.g., the Nature awards for mentoring in science). Some of these efforts are being incorporated into faculty development (4) and are being considered for credit as academic achievement. Formal evaluation metrics are being used to gauge the success of mentoring and have involved easily measureable endpoints (such as success in obtaining peer-reviewed funding, number of publications, H indices, etc.). However, one cannot help but get a sense that although everybody recognizes the importance of mentoring, many of the programmatic efforts are more pro forma in nature. Interestingly, despite the overwhelming enthusiasm for standardized approaches to mentoring, their implementation has been spotty at best (5), and the fervor possibly decays predictably over time (6). It appears that mentoring has had an inauspicious beginning since the time of Mentor, who was charged with teaching and nurturing Odysseus' son, arguably the first mentor with strong documentation, who may not in fact have been that successful after all despite giving name to this august tradition. The efficacy of formal mentorship programs, when considered using objective criteria, remains unproven at best; there is evidence both in favor (7) and less so (5) of the usefulness of such programs as currently implemented.
In our simplistic view, we can consider mentorship in 2 broad categories (which might overlap to some extent). The traditional approach is what may be considered as a “transactional” or “facilitatory” mentorship, in which the promise is that one sticks with a mentor, working hard with integrity, and the mentor will grease one's path toward academic success (first papers, then grants and networking, and finally an independent career or laboratory). This kind of mentoring is extremely important to attract students to the sciences (8) and help them succeed. It also seems to be the thrust of major mentoring programs (4), and expert advice about how to implement and improve mentoring seems to cater mainly to this type of mentoring (9,10); programs using or encouraging this approach are rightly lauded (7).
We, however, were the beneficiaries of yet another kind of mentoring, a more primordial form that is difficult to quantify and probably rarer to find. These mentors believe in their students, ignite a searing desire to ask questions, and make answering those questions a highly satisfying experience even if beset with dead ends. They truly believe that it would be a shame if talent in young students were wasted. Grants and papers, although on the horizon, are not central to this effort. The best gift to us, personally, was not primarily a ramp for our careers but that someone noticed that we were capable of something unique, lit the spark that showed us a whole new way of thinking, and fired us up to be investigators with “outside-the-box” thought processes. This indirectly translated into the philosophy that producing new knowledge is the greatest of human endeavors for a physician. As Theophrastus is said to have exclaimed, “Teaching is not pouring water into a pot, but lighting a fire” (11). These mentors changed us from our destiny as clinicians who were highly proficient at gathering facts and regurgitating them as needed to possible generators or curators of knowledge. It is our belief that such mentors are far fewer than experts in the more conventional form of mentorship and rarely are recognized using conventional metrics for evaluating their efforts. Recognizing them is even more difficult in the clinical sciences as opposed to the basic sciences, in which signposts for success are more clearly defined.
So what do we remember of the best of these luminaries? There are a number of well-studied indicators common to most excellent mentors (12,13), and it appears that mentoring can be improved with structured training. What we recollect here is a more unscripted version, something we found uniquely helpful in our mentors. There were many different individuals at different stages of our careers, and each provided us with a piece of generosity, their “je ne sais quoi” that served as a brick for building our futures. For one, they were very good at what they did and were confident in their convictions. We remember one master clinician who, when told that an echocardiogram had shown a small atrial septal defect, refused to change his diagnosis of an intact atrial septum, because he could not hear a soft systolic murmur at the upper sternal border or a fixed split. He was proved correct later; false dropouts on the apical 4-chamber view were a problem with early 2-dimensional echocardiographic machines. It was quite similar to Proctor Harvey challenging someone that he had never seen an atrial septal defect without a soft systolic murmur at the upper sternal border. These clinicians could stand by their findings and often did so boldly in face of high-profile opposition.
Second, they were unsparingly generous with their time. One of our most influential mentors would show up in the evening to discuss a paper, having just been on a long flight crossing more than one continent. Their enthusiasm was infectious. They communicated constantly and made demands that seemed both inordinate in scope and inopportune in timing. Yet we later realized that this taught us to stay focused on the end result and to be timely in execution. We have realized since then that we always paid a price every time we disregarded this principle and procrastinated; that lesson was learned very quickly. Another mentor would often take us to the concerts of the best classical Indian vocalists or instrumentalists; the focus always was an exposure to excellence in any form.
Third, they instilled in us a sense of history, the provenance of thought and ideas. One of the most precious gifts we ever received was to understand how a thought originated and how it progressed over many decades to its present form. The result was a delightful portal to understand something in great depth, allowing one to delve extensively into long-forgotten papers and the concepts that underlie what we do today (such as comparative physiology: Peter Harris's  paper on how blood pressure is preserved across species and how preserving it at all costs could be the stimulus to induce salt and water retention, à la clinical heart failure).
Fourth, primordial mentors made us ask questions outside our comfort zones and then related those to issues we would face in our regular practice. One question posed to one of us while we were in training whether all the causes of salt and water retention, including heart failure, have a common final pathway. This led us to read Baker's (15) (as well as Monge's) classic paper on human adaptation to high-altitude hypoxia, a seminal paper in Clinical Science about hill walkers in England who develop heart failure–like symptoms (16), and a report on the Hausa women of Nigeria who develop postpartum fluid overload when, per tradition, they sleep on heated beds as a part of their recovery from pregnancy (17). This then led to the unexpected but now seemingly logical conclusion that such a mechanism may be operating in fluid overload seen with severe anemia or cor pulmonale. To another of us, one question referred to the influence of mitral stenosis on the hemodynamic profile of constrictive pericarditis or in a scenario in which there was anomalous pulmonary venous connection with an intact atrial septum. The hemodynamic profiles of constrictive pericarditis and mitral stenosis were mutually exclusive, and that of the latter largely incompatible with life (18,19). It was both fun and challenging to solve these riddles. We were provoked as to why a failing heart with florid myocarditis in rheumatic fever would maintain normal contractility (20,21). These kinds of intriguing forays into the unexpected resulted in very rewarding years of science (22,23). The idea was not to smugly point out some minutiae but to get us thinking.
Fifth, there was an unrelenting emphasis on quality. Our mentors spent countless hours and late evenings with us in our younger years, helping us refine our slides and presentations before major meetings, and they genuinely believed that a flub on the stage reflected not on the presenting fellow but on themselves. The essence was often that “nothing comes from this laboratory, division, section, or department that is not of the best of quality. If you are criticized on stage, it is like I am being criticized.” This kind of attention to detail has been a great asset in our subsequent careers.
Sixth, we found that they let us cope with triumph and failure with equanimity, reminding us that once the mourning period is done, it is time to get back to work and find out why something did not work out as planned. It still comes in handy when our papers are rejected or our grants declined.
Last, one of these mentors' unique characteristics is that when the time comes, they set their students free, accepting them as peers and delighting in their accomplishments. One of the most delicate yet crucial rites of passage in an academic path is the need to show academic independence, and there are numerous examples of this going badly to the detriment of mentees. We uniformly found that the hallmark of great mentors is their ability to gracefully detach themselves from claiming credit for their mentees' achievements while maintaining a steadying hand on their careers. The best mentors fostered collaboration and networking with other scientists around this time so that their absence was replaced by the presence of other strong collaborators. Some of the most satisfying mentorship experiences we had were when our mentors later became outside collaborators on our grants, a perfect balance of letting go and helping out. Not surprisingly, their students stay in touch long after they have moved on in life to other opportunities. Both of us have regularly stayed in touch with our mentors past and present, to seek advice or to merely chat; they continue to be invaluable resources, even if the questions we now address are no longer within their areas of expertise.
So what is it that results in this excellent pairing? Although a lot depends on initiative on the part of the mentee, we cannot deny that a large part of it is the chance of crossing paths with such gifted mentors. It is sad to see them recede from our lives, for, as a Turkish proverb says, one is equally indebted to one's mentor and to God (24). Then again, they left us with something deep, in the true, time-honored tradition of the teacher-pupil relationship. We hope that we can pass on much of what we so generously received from them.
While we were in the process of finalizing this editorial, we received the sad news about the passing of Professor Raj Tandon. We both mourn the loss of our revered and beloved mentor: he exemplified the original “primordial mentor” and was one of the doyens of academic cardiology in India. Although we are immensely sad at his passing, we truly celebrate what mentors such as Professor Tandon gave so unselfishly to generations of students like us.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
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