Faculty Reflections: Raymond Givens, MD, PhD

Please tell us about your background and the evolution of your research and clinical work.

I'm currently an assistant professor in the Department of Medicine. I am a cardiologist. I work as a cardiac intensivist in the cardiac intensive care unit, and for the last year I have been the Associate Director of the unit.

When I came here in 2011, I had the idea that I was going to be a geneticist. I thought that there was a lot to be learned about the genetic underpinnings of differences between ethnic groups in terms of risk of heart failure. At some point while I was trying to figure all that out, my mind just changed. I didn't really envision myself being in a lab anymore.

Honestly, around 2013 or 2014, there was so much going on; the incidents of police brutality were increasing, or they were more prominently publicized. I guess I was struggling to find a direct relevance of the work I was doing to the world outside. Certainly, that work is relevant, but it didn't have an immediate emotional connection for me. And that's kind of what I was looking for. I think certainly a pivotal event in that respect was when Eric Garner was murdered on camera in 2014. Obviously, it was by no means the first incident of a police killing that I'd seen—but it was very heavy for me.

Part of it may be the very personal nature of that videotape. It wasn't just somebody who was just shot to death; he's being choked and begging for his life, and it was just horrifying. And it was all the more so because, at that time, my wife was pregnant and near term. And my first son was born a few weeks later. While we were in the delivery room, we were watching news coverage from Ferguson, Missouri, about the unrest after Michael Brown was killed. I started thinking more about how I could involve myself in things that really reflect these events. I was really overcome with this—lots of anxiety and lots of distress—thinking about how I was going to protect my son from these types of developments.

And so, part of changing my path was trying to find a way to quiet that internal storm. I left the lab behind and started focusing on using Big Data to refashion the way that we see the world and maybe point us to better solutions for how to equalize the playing field.

In your shift from the lab to the clinic or the bedside, what was different for you?

We obviously have some very sick people here in the CCU. The disparities, if that's what you'd like to call them, exist despite the fact that we give them very good care here. Nonetheless, there are lots of hurdles for patients before they even get to us. Then there's the world that we're in. If they happen to leave this hospital alive, which most of our patients do, we’re still returning them to the world that they came from. And you find yourself having a hard time really making progress because you helped this individual person in this particular situation, but you haven't changed the matrix of barriers that they face. 

I had to acquire skills that I wasn't trained for. I was trained to be the guy at the bench, pipetting and running gels but now I had to figure out how to use large streams of data. One element that was useful is spatial analysis, to really be able to do a deep dive into people's neighborhoods to pinpoint various elements that may be contributing to their risk of disease and the outcome. It's taken quite a while to really learn those skills and figure out how to operationalize and to produce data products that will inform how people think about these issues.

I can imagine that it goes without saying that when the pandemic hit things changed; can you describe your experience?

For lack of a better term, it was wild. COVID-19 just exploded across New York City. Here in the CCU, we were inundated with the sickest of the sick. In the very beginning of this crisis, none of us I think had ever been in a situation like that before; you're facing this enemy that is coming at you so quickly and you don't know what to do about it. You don't know what works. You're kind of desperate and reaching for all kinds of things. And, the unfortunate part of it is that we lost a lot of people in the beginning because they were just so sick.

We were borrowing our best knowledge from other disease states. It was a very bizarre time. Obviously, our personnel have been stretched. I certainly was admiring of our nurses before, but with this, I was just awestruck at their abilities and their tenacity and their teamwork. You know, I really give all the credit to them. I was just someone who happened to be there. And, in this neighborhood, the people that you see dying in this unit are almost exclusively black and brown people. It really puts it right in your face. And you know the disparities that were unmasked by this pandemic were just really exaggerated here.

Then in May, we had George Floyd's murder. When the video came out, my wife asked me what I was feeling about it, and my thought was that we've seen this a million times before. I'm just so busy thinking about this wave that we're just starting to get over that I don't have time to be upset about this. But the truth is that it took me months to admit to myself how floored I was by what really were back-to-back crises…that it upset me and disturbed me and set me on this path of feeling that systemic change was truly necessary. We have to push the leaders, push the systems, beyond lip service and beyond slogans and be ready for the fight. I've gotten myself into some fights.

I noticed that you tweeted “George Floyd's murder did something to me that I’ve been trying to fix since then.” Can you say more about this?

I think that it broke something in me. There's a lot behind why I reacted in the way that I did, but it's very bound up in personal history and family history and cultural history. There are a lot of people who have reached out and said how much they really support what I'm doing … they're happy that somebody spoke up, but they didn’t want to do the work themselves.

Why was I the one to say, well, okay, then I'll do it? And it was because this was my story. I felt like this was it. I felt, you know, I have a choice: I can try to break the system or let the system continue breaking me.

Are you a little bit banged up, or are you still intact?

I look back at my Twitter feed—who was that guy? I can see with the perspective of some degree of distance. Now I can appreciate the frenzy. You know, I recognize that that person was so unnerved and so disturbed. Hurt. He was just reacting out of almost a sense of panic that something has to be done here. George Floyd was killed in an identical manner to Eric Garner, which I think pushed me back into that same space of panic and helplessness in which I found myself when my first son was born in the aftermath of Mr. Garner’s murder. I mean, I just felt restless, I couldn’t sit still. The first thing I attended to was the issue of the (Samuel) Bard name, which was not brand new information to me.

To be quite honest, I had known about that from a coworker, who had given me this information, probably around 2015 or ‘16, and at that time I felt uncomfortable but I didn’t think I could do anything because I was just joining the faculty and didn’t want to jeopardize my career by entering into a controversy. And so I buried it, like a lot of just those types of things get buried, and decided to try to just do my job.

I have a particular connection to the Bard name. Since 2011, I have lived literally in the shadow of Bard Hall, which I can see from my kitchen window. The chairs of my department, Medicine, have held the title Samuel Bard Professor of Medicine. When I was a cardiology fellow I received the Samuel Bard Young Investigator Award from the Department of Medicine. My older son attended the Medical Center Nursery School, which is on the third floor of Bard Hall.

After George Floyd, I said, [Bard Hall] was just the low-hanging fruit. But it was symbolic of just the bigger issue: why do I have to stay silent to preserve my place here? Why do I feel that this is required of me? So, I reached out to our Chair of Medicine and about the Bard professorship and, after a bit of back and forth, he announced that it was going to be dropped. But what he told me about Bard Hall was that I was kind of on my own. That set into motion this saga dealing with the administration. What I will say is that the experience of being ignored or the refusal to speak to me directly about it, caused me additional upset, although I knew I had gotten the message across. I try to always keep my ego in check, you know, but again, I think it's worth noting that I'm a faculty member, I'm a leader in my division. I was Physician of the Year, but I can be ignored. That person, with that resume, who tries to bring it before the University, can't get it an audience. If this is true, what hope would a student have?

The President of Columbia finally announced that Bard Hall’s name was being changed, and he didn’t mention my efforts, that this started with me.

But I trained for over ten years to become a faculty member here, a cardiologist, with two doctoral degrees, all of that. And the message seems to be that it doesn't matter; all of your efforts are worth nothing. And that for me was a devastating part of this emotionally. But, but at the very least, the announcement that the name would be changed was something of a release.

Now, looking forward, you have this amazing Seed Grant project with Andrea Duran and Donald Edmondson at CBCH entitled Keeping the Momentum. Could you give us an overview of the project and what you collectively hope to accomplish?

The Center for Behavioral Cardiovascular Health, which really began as a behavioral medicine unit devoted to research, has grown to encompass so many different areas. It’s really a research collective, almost like a hippie commune of researchers. Don Edmonson (the CBCH director) is a really forward thinking leader, and he approached me about the pandemic and George Floyd and everything that's going on this year.

He has been asking repeatedly, what can we do, how can we make things better? Systemic change is clearly needed. Andrea Duran, who is new to the faculty, was really the lead, keeping the momentum of our Equity, Diversity, and Inclusion initiative. She really deserves all the credit, to be quite honest.

We began by taking an inventory of how things were in the CBCH, and it illustrates how unique this group is. There is a willingness to look inward and ask, what are the things that we're not doing well and what are the ways that we're not serving all of our people? Let's ask the hard questions. Let's be willing to hear some things that we may not want to hear that might be upsetting for us. They certainly spent a lot of time crafting survey instruments. We were upset with some of the data, but got to work to try to address those items. While we are a very multicultural group, and inclusive of not only race and ethnicity, but gender identity and sexual orientation and everything else, there were quite a few people who felt left out. We got to brainstorming about how we could improve.

Part of that was applying for the grant. Now, with the grant in hand, we are trying to take what we've learned and use the same approach with other groups to do this inventory. We hope it'll be helpful for not just opening up a dialogue, but also moving things forward.

Now that you've done this analysis, what are the action steps that have emerged?

We are starting to think about where this survey instrument needs to be deployed; we are looking for units to approach. We know that particular stakeholders will need to be engaged, and we are getting a sense of the frequency of administering something like this, doing a baseline assessment. After the group designs an intervention based upon what we find, there is a follow up instrument to see that the intervention actually moves the needle in terms of the sense of belonging, the sense of equity among everybody involved.

In so much of this work, people ask how to measure their progress and this seems like an opportunity to do just that.

Yes. Again, I give the credit to Andrea and Donald. So many people are talking about equity, diversity, and inclusion, but what's missing is metrics—the science, the measurement. This is what has been frustrating for me. Everybody has learned to say that Black lives matter and people can talk about equity, diversity, and inclusion. But as a physician, you can't just say, heart failure patients matter. Cancer patients matter. Then I'm just going to get quiet, and I'm waiting for you to say So what are your outcomes? What's your trajectory? Are you getting better or are you getting worse? How do you compare to your peers? What are the specific metrics that demonstrate that you really value these people? Our approach really emphasizes measurement. These metrics will be very helpful.

I should also give a shout out to Allan Schwartz, my division chief in Cardiology, who has been a real champion. After George Floyd, he called me and a few others from the faculty to ask what we could do. I had the expectation that people would momentarily engage, but that the interest would fade. Allen has been a fighter; he has kept a focus on what we need to do and has put resources behind the efforts. We are trying to diversify our cardiology fellowship, to diversify our faculty, to diversify the speakers that we invite for Grand Rounds, to broaden the whole division’s mindset.

If there are faculty members who want to get involved in antiracist work, but don't know where to start, what action would you recommend that they take?

First, I think that it's helpful to define, if you can, what exactly you're looking for. What is it that you're truly looking to accomplish? Somebody says, oh, gee, we should change things. We should make things more equitable and diverse and inclusive. To be frank, that is too broad and nonspecific and doesn't move the needle quickly enough to the change that is required. Start by trying to figure out a specific metric that you'd like to target.

The first thing you want to do as a researcher is to define a problem. Then you figure out a way to break it down; you simplify and operationalize it and then that allows you to attack it. You can't write a grant that just says, hey, I want to cure racism or I want to cure high blood pressure, You have to you know get down to the meat: here's a very specific problem and these are the questions or hypotheses. Then you find an intervention.

To learn more about Dr. Givens, visit his Seed Grant project page, view his faculty profile, or send him an email.