We Are All From Somewhere

“Home is where I want to be

Pick me up and turn me around

I feel numb, born with a weak heart

I guess I must be having fun…”

— Talking Heads, “This Must Be The Place”

Ah, yes, I know what you’re thinking: another rant about the death of the specialty and the apocalypse of medicine as we know it, or at least a barrage of holier-than-thou tales of woe from a washed-up relic who carried 80-lb bags of salt uphill as a resident while picking up everyone’s dry cleaning. Sadly, however, none of that applies this time as nostalgia wins out.

From my condominium in Milwaukee, I can absorb the lights and sounds of downtown and recount the days of joy and struggle, remembering the reasons I ended up needing to leave my home and move to California. The move brought me the joy of the bride and the boys, but home is still—and will always be—home. Many of our perspectives on where we are from, where we went to school, and where we trained often dictate our identities. Sports loyalties are usually the most revealing of the essence of our origins. There is rarely a day I don’t identify that I am from Wisconsin. I was in the marching band and still wear red to this day, and after 8 years of school and 5 years of residency here, as well as a decade of practice in town, I will always say, “I am from Wisconsin.”

One of my favorite icebreakers with patients is what I call “Area Code Bingo.” After first making sure it isn’t a birthday, I try to figure out where home is, based on the cell number. Because most San Diego patients are from somewhere else—especially my military patients—it reminds me with each encounter that everyone comes with rituals and traditions, as well as perceptions and misconceptions about their skin. Everyone really is from somewhere, and that is to be celebrated.

Everyone in dermatology has a story about where it all started and where choices were made to lead to the next steps. The common themes are baby steps, gratitude, and not closing the door behind them. However, I will be the first to recognize that—outside of starting and running my own shop—the more significant parts of my career, the majority of connections I made, and my career in research trials have been primarily a result of moving to the West Coast. In May 2024, I paid tribute to mentorship and how important it is to identify those who will carry the next torch for us, and now I remind us how critical it is for all of us not only to stick together but to remember the baby steps that allow growth. It is no different than when my boys would love to inhale all of their Halloween candy in one sitting; the lesson is that success comes with earning it one piece at a time and developing patience.

Still, others will do as they do and eat all the candy at one sitting when some patience would take them further. The first 5 years out of training are when we mold ourselves, get out of the shadow of the residency bubble, and find our place. Rarely will we be speaking at national meetings and serving on major committees and councils at that point (without some selective doors opening). I had doors open for me when my work was identified and respected, after a few years of the old guard asking, “Who is that clown?” while I paid my dues. Some of the pearls of mentorship that were taught to me included standing by your own work, knowing your limits, and speaking with quality instead of quantity and volume.

As I watch the dynamics of downtown from the window and remind myself who I was here and where life has taken all of us, all I can do now is hope traditions and efforts don’t get lost, and that support can continue to outweigh competition. I have met some great young dermatologists in recent years, and our future is bright with these rising stars at the wheel. Hopefully, we can continue rewarding hard work and effort while avoiding the trap of making quota a priority over merit. When we look at one’s training and accomplishments, and then look to label the basis for achievement as a product of the institution, haven’t we taken the individual out of the equation? In that respect, we should be proud of our paths upward, with our pedigree serving as background but not defining our identities. Truly, we all come from somewhere, and where we end up might be the place where our mentees start.

I have been fortunate enough to have some great colleagues, some doors open that I did not take for granted, the chance to create some new ideas, and the opportunity to serve the American Academy of Dermatology membership for years. Lisa would appreciate that it is exhausting always rooting for the anti-hero, so let’s try to be each other’s heroes and keep our family strong.