Johns Hopkins University

Fall 2008
Vol. 6, No.1


>Focused Intent

Cosmic Gamble

The Speech

Civil Solutions to Boorish Behavior

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Focused Intent

Kurt Herzer has accomplished more in his first 21 years than most people do in a lifetime — or two. Don't look for him to slow down anytime soon. Time is just too precious.

"Success is the ability to go from one failure to another with no loss of enthusiasm."
— Winston Churchill, as quoted by Kurt Herzer in his medical school application.

Legally blind—unable to distinguish small objects directly in front of him—Herzer doesn't mountain-bike, but he's an avid cyclist on wide, clear stretches like this one 
in Baltimore County.

Certain things can be taken as a given. The buttered side of the bread always hits the floor. People who start sentences with the words "to tell you the truth," generally don't. And students who attend Hopkins are really, really smart. And driven. And disciplined.

These truths we take to be self-evident. Which brings us to one Kurt Herzer. Even by Hopkins' superior standards, Herzer is an overachiever. He can barely drink legally, but he already has an eight-page C.V. It's not full of luft either, but seriously impressive accomplishments. Truman Scholar. World Health Organization researcher. Woodrow Wilson Fellow in Hopkins Medicine's Department of Anesthesiology. Sole student on the university committee tasked with finding President William R. Brody's successor. He's even published his first paper as lead author in the Journal of Patient Safety: "Designing and Implementing a Comprehensive Quality Patient Safety Management Model: A Paradigm for Perioperative Improvement."

All this, and there are not yet any letters after Herzer's name. No master's. No bachelor's. Only a burning curiosity. In this he is no different from his peers.

He is, however, legally blind. In one sense, this has made him an unwilling poster child for those who annoyingly insist on defining his accomplishments through their perception of his handicap. Herzer tosses down a copy of a publication trumpeting his achievement as a USA Today First Team All-USA College Academic. "Guess which word I objected to," he asks an observer, who quickly scans the text, noting that Herzer's academic, volunteer, and athletic achievements (a 2006 Maryland Taekwondo Championship) are described as having occurred "despite" his genetic retinal condition. Asked if that's the magic word, Herzer says, "Bingo!"

Herzer is not motivated by his limited eyesight—at least not in the way one might think—but it has made him unusually self-aware of how his mind works, in much the same way that someone who learns how to drive a stick shift really understands the mechanics of the car, as opposed to someone who just jumps in an automatic, guns the engine, and flies off.

Call it a glimpse into a mind hell-bent on excellence, a verbal topography of achievement. Better yet, think of it as psychological paper. Let's call it: "A Case Study in Self-Actualization."

"The personal challenges I dealt with in my youth have allowed me to become an advocate for others"
— Herzer, from his H. Truman Scholarship Foundation Application, noting the lobbying he's done on behalf of people with disabilities. This included testifying before the Maryland General Assembly on a bill he helped research, ensuring that visually impaired students receive large-print textbooks at the same time as their peers, rather than weeks later, or not at all.

Scholarship Foundation Application, noting the lobbying he's done on behalf of people with disabilities. This included testifying before the Maryland General Assembly on a bill he helped research, ensuring that visually impaired students receive large-print textbooks at the same time as their peers, rather than weeks later, or not at all.

Doctors told the Herzers not to expect too much from their son. But they had already seen Kurt's capabilities. He exercised his adaptive muscles the way a body-builder works his glutes.

It can be one of the hardest lessons for a parent to learn. When does dad jump in, give direction, impose his will on a child? When does mom protect her son, clear the way ahead, shield him from the realities that strip innocence but forge self-reliance? And when do they both step back and just let it be?

To this day, Kurt Herzer can't quite figure out how his parents danced that dance, but he acknowledges they did it with a great deal of finesse. He's not the first member of his extended family to have the condition known as x-linked retinoschisis—it's genetically linked through his mother's side, and two cousins also have the condition—but he wasn't diagnosed until first grade.

Doctors told the Herzers not to expect too much from their son. But they had already seen Kurt's capabilities. At age 4, he took to skiing on a family trip. "For the longest time we didn't know he had a problem," says his mother, Patrice. "Most likely if I had known about his vision I would not have put him on skis because it would have been my fear. But we didn't know." Karl and Patrice Herzer decided early on to let Kurt set his own boundaries. They soon found out he had none.

"My parents had a good sense of how to and how not to intervene," says Kurt. "They knew that even though they could step in and 'fix' something, I would be much better off if they let me sort of struggle with it because I needed to figure it out for myself."

The condition impaired his distance vision; even sitting in the first row, he struggled to make out what was directly in front of him on the blackboard. Anything off to either side was a fuzzy blur. Into this void would step what would become Herzer's greatest asset: his imagination. Life became like a giant Sudoku game; given a few clues, Herzer would engage his creativity to solve the puzzle.

He exercised his adaptive muscles the way a body-builder works his glutes. Match that with a love of challenges and you've got a formidable combination. Herzer's father had been an outstanding lacrosse player at Penn State. Kurt took the game up as well. The docs? They said he should avoid any game involving small flying balls. Herzer didn't mind their opinion. He just didn't agree with it. "I wasn't trying to prove them wrong. I was more introverted than that. It was much more personal," he says. "The doctors saying I shouldn't do that…until I prove it to myself, it's on the table."

Herzer discovered what he lacked in sight he more than made up for in speed. "The first month, I found I had a last-minute reflex [to catch the ball]. I was extremely fast. I could really move the ball across and down the field." When another coach saw his quickness and tried to get him to jump to the track team, Herzer demurred. "I was adamant that I would finish the season just so I could learn from this. How, in a situation where I'm definitely not physically maximized for it, could I find a way to contribute and make that contribution valuable to the team as a whole?"

It didn't matter the nature of the challenge—athletic, academic, musical—Herzer tore through each like a dog with a sock. "We called them 'The Phases of Kurt,'" laughs his mother. When Kurt glommed on to something, he became, by his own admission, consumed. He visited Disney and became fascinated with animation. So he applied for a job in the cartoon division. In fifth grade. They sent him a nice letter back, saying they'd keep his resume on file. "I had phases, hobbies, where I was intensely, intensely fascinated. I'd eat, sleep, and breathe the hobby," he says. "It ranged from an obsession about hot air balloons—how they're built, how they work, I wanna buy one, I wanna fly one—to Bonsai trees, violin, oil paintings." Though his parents supported him (No, they didn't buy him the hot air balloon. But they did buy a lot of books), Herzer says, "I saved up to fund a lot of things." Like so many intelligent kids, Herzer was trying to find his passion. In the process he discovered his voice. Early on, he realized he had to advocate for himself, and that the various systems he encountered only thought they understood his needs. Initially he battled patriarchal types who thought they were being helpful, without ever first asking him what assistance, if any, he required.

One counselor gave him a handheld mariner's telescope, presumably to help him see the board more clearly. Its magnification was so ridiculously high, if Herzer's hand moved in the slightest, it looked as if an earthquake had hit the classroom. Though he appreciated the gesture, the telescope as a tool was useless. Left to his own devices, he improvised, educated, and cajoled. And sometimes, he lectured. In Spanish class, a teacher wrote vocabulary words on the board. When he politely explained to her that he couldn't take notes on what he couldn't see, she offered to give him a copy of her worksheet. From the back of the room, a classmate familiar with Herzer's situation snickered, mumbling, "That's not fair!"

He wheeled on the student and fired an aural missile. "This is the only way I can learn these words and make useful time of this class the way you can," he explained through clenched teeth. "If I could be writing these myself, believe me, I would. You can go to a ballgame, the movies, and see what's going on. I can't. There's so much you don't even get in what you're saying."

Herzer was intensely competitive—but mostly with himself. His drive for accomplishment was often misinterpreted, even by himself. He knew he was a perfectionist, but it took him a while to realize that much of his motivation came from a deeper source. Knowledge bought comfort, a sense of understanding, control. "I'm much less likely to speak about anything if I'm not well-studied in the area," he says. Until I've done my homework. You should be certain of what you're saying. I need that. I don't really know why."

A powerful intellect. An insatiable thirst for experiences. A fighter's mentality. A joyous zest for life. Add to this the energy of a hummingbird, and Herzer quickly learned that managing others wasn't nearly as challenging as managing himself. By his sophomore year of high school he had a schedule that would tax a Fortune 500 CEO. "I'd sleep two or three hours a night. I'd get up at five or six, go for a run, go to school, do a 12-mile [cross country team] track run, then work until 2 or 3 a.m. Sometimes I'd do an hour or two of violin practice, too. People commented about it," says Herzer. "They said, 'This might not be healthy; it'll stunt your growth,' and I said, 'I'm fine. I'm happy. It's working.'"

For Herzer, knowledge brings comfort, a sense of control. "I'm much less likely to speak about anything if I'm not well-studied in the area," he says.

Until suddenly, one day, it wasn't. The huge hours of studying—Herzer taught himself entire curriculums such as calculus from books because the blackboard lessons were useless—the go, go, go pace he enjoyed and endured had a price. His mother, who used to wake up at 3 a.m. only to see the light on in his room, had begged him to get more rest. His school chums also warned Kurt about burning the candle at both ends. But Herzer was like the kid who is sure that there's at least a gallon of gas left after the gauge hits "E." His tank ran dry, forcing him to lay low for a few weeks. It gave him time to think and to get the lesson. "I learned my limit. It wasn't sustainable. I need to get regular sleep. Part of why I now have such a regulated schedule that I stick to religiously is exactly that reason: Sustainability," says Herzer, who balances his studies with an active social Hopkins life revolving around a core group of friends interested in opera and fine dining. "I exercise an hour a day. I have to get that energy out. If I miss a day, you'd be peeling me off the ceiling. And at night, before bed, I read a book that has nothing to do with research.

"I've learned to manage myself."

The results have been spectacular.

"I was looking into this guy's stomach, seeing all this anatomy. Someone had told me to step out if I felt nauseous. It didn't occur to me. I was having the time of my life."
—Herzer, on his first observation experience in a Hopkins Hospital operating room.

Every act of inquisition, every byte of data gathered, had led to this moment. After his junior year of high school, Herzer came down to Baltimore, a student in Hopkins' summer pre-college program. For Herzer it was supposed to be a dry run in a new city, a chance to reconnoiter the campus and the lecture halls, plan learning strategies, get a comfort level going.

The trip would change not only his life but perhaps save thousands of others. Prior to the summer, he had e-mailed some 40 Hopkins surgeons, asking if he could spend time watching them work. One, Kurtis Campbell, agreed. Herzer was still on the fence between business and a medical career. From the moment he walked into the operating room, the die was cast. "I was so amazed about the way the place looked," he recalls. The environment energized all his senses. "The shiny instruments. The steady rhythm of the anesthesia machine. The temperature of the room."

A lecture by anesthesiologist Lynette Mark entitled "What It Means to Be a Physician," only added to Herzer's excitement. "It had a little bit of a 'save the world' flavor, but she told her story straight," smiles Herzer. "About how she waitressed, then went to med school and became an expert in managing difficult airways as an anesthesiologist. She went through everything, like how to maintain a marriage. It was so honest. It connected me to what I saw in the operating room."

Through his work with Hopkins anesthesiologist Lynette Mark, whom he approached as a freshman, Herzer began carving out a niche in patient safety and outcomes.

At the end of the talk, Mark casually tossed out that she'd be glad to have anyone come by to check out her work. The next summer, Herzer, who had begun taking classes as an incoming freshman, showed up. Mark, who hadn't met Herzer at her talk, laughs at the memory. She was swamped at work, with no time for a wide-eyed neophyte. "All I kept trying to figure out was how I could get him to go with anybody else. So I said, 'OK, Kurt, go in there and stand.' And then the next day he showed up again and I was like, 'OK, Kurt, go in there and stand.' I couldn't quite get rid of him. And then he was standing in one room and I asked him what he had done, and he said, 'Oh, I read a surgical textbook.' Then I went on vacation. September 1 comes and he says, 'I'm back. I'm ready to volunteer to do some work with you.' Honestly, I had no idea what he was all about."

Mark was soon to find out she had a student with an insatiable hunger to learn what she knew. After checking his transcripts—as they say in the Army, "trust but verify" —Mark threw the door open to her patient safety efforts, which later included creating an Airway Rapid Response Team. "From that point on, everything I did, he wanted to do."

Herzer's break came when Mark took a course in Lean Six Sigma, part of a systemwide effort at Hopkins Medicine to incorporate best business practice models common to engineering and manufacturing into a health care setting. Mark let Herzer take the course, too, and with Herzer's interest in biostatistics and computer modeling, Herzer quickly began carving out a niche in the field of patient safety and outcomes. At the time, it was a field still groping for its first gold-standard models. Mark soon introduced Kurt to Hopkins physician Peter Pronovost, one of the pre-eminent leaders in the field (earlier this year TIME named him among its "100 Most Influential People in the World" for his innovations in patient safety; more recently, he was awarded a MacArthur "genius grant.")

Pronovost, sensing a kindred spirit in Herzer, began working with him, building on his ability to organize the reams of data that need to be crunched to create better safety models. He showed Herzer the proper language and methodology for creating journal articles. Herzer embraced the opportunity, and soon found himself tasked with going to London on a joint World Health Organization/Hopkins project to help analyze the U.K's medical error reporting system, considered to be among the world's largest and most advanced.

When Pronovost first proposed Herzer for the assignment, some of the anesthesiologist's colleagues strenuously objected. "Several people said, 'Peter, he's an undergraduate. This is the WHO. We're trying to build a relationship. Get PhD-level people.' To be honest, I squashed that and said, 'I have confidence in Kurt. It will be a great experience for him. And I'm really comfortable with him being a representative of us.' Of course, I also told Kurt, 'You'll have a great experience, but you have to deliver, you have to produce.'"

Clearly he has. Sitting between Pronovost and Herzer is like being a bird on a high-voltage wire and praying the insulation doesn't suddenly give way. The energy is that palpable. The two look alike, talk alike, think alike…in short, the perfect mentor-mentee relationship. "Kurt is something magical," says Pronovost, a man not given to hyperbole. "I say that because he has an unsuppressible enthusiasm, and he executes very well—so it's not just talk, he delivers. But most importantly, he's a visionary thinker who sees the end game and worries about the bumps along the way as something to be managed. When I see that kind of thinking, it really resonates with how I view the world. I love being around people who see making a huge social impact on the world as their primary mission."

For Herzer, it will be a lifelong mission. He's applying for Rhodes and Marshall scholarships, normally two- to three-year programs, and medical school looms as well. X-linked retinoschisis stabilizes during adolescence, but Herzer is conscious of the impact that normal age-related vision loss may have on him. So he's eager to learn as much as he can and get the medical training he needs to launch himself fully into the business of making a difference.

And if, later in life, things change?

"I'll adapt," says Herzer.

On that you can bet.