Gina Kaye (Host): Welcome to Vital Signs, candid conversations with providers who care. I'm your host, Gina Kaye.e Our guest today is Dr. John Hackman, a retired neurosurgeon with Jackson Hospital and Clinic.

We are having a legacy conversation on precision, leadership, and transformation in neurosurgery, exploring Dr. Hackman's distinguished career at Jackson Hospital. We will focus on how neurological care and surgical innovation have evolved in Central Alabama, including his perspective on Jackson's future, while also highlighting why today's physicians should consider practicing in Montgomery and contributing to the next era of care at Jackson. Welcome, Dr. Hackman.

John Hackman, MD: Well, good morning. How are you?

Host: Good. Thank you. We're so happy that you're here today. You spent your career in neurosurgery at Jackson. What first drew you to this field and what led you to build your career here in Montgomery?

John Hackman, MD: Well, I went to medical school at University of Kentucky. Along the way, I've had two areas of medicine that I thought were very, very interesting. One was orthopedic surgery and the other was neurosurgery. At that time, I thought neurosurgery was more interesting than orthopedics.

Since that time, orthopedics has evolved a lot. And at this point, I may have chosen orthopedics instead. But at that time, I thought neurosurgery was the most interesting part of medicine, being able to work on not only spine, but brain, and peripheral nerves, but especially brain surgery. When I finished up at University of Kentucky, there was a malpractice crisis in the state, actually all over the country, but especially in Kentucky, And it was impossible to buy a new malpractice policy. I had several opportunities to go into practice in the Lexington area. But I couldn't get a new malpractice policy.

So, there was a neurosurgeon i in Montgomery, Alabama who had practiced in Lexington, and he recruited me very heavily. That's how I ended up in Montgomery, Alabama. I ended up at Jackson Hospital.

Host: Perfect. So, neurosurgery has advanced dramatically over the years just as any other, you know, medical career. What are some of the most significant changes you've witnessed throughout your career?

John Hackman, MD: Well, the advancement in neurosurgery basically has been imaging. Back when I was first in neurosurgery, we did not have MRI scanners. We did not have CAT scanners. We had X-rays. We had arteriograms where you could inject dye into the arteries of the neck and take serial pictures of that going through the brain and use those pictures of the arteries to see if anything is pushed out of the way or if any arteries were blocked off.

We could also do a pneumoencephalogram, where we'd do a spinal tap and inject air into your spinal fluid and have that go up inside the spaces of your brain and use that to see any kind of deviation and tell where problems were. But we did not have things like CAT scans.

I finished up in 1976. That's when I started at Jackson Hospital. And in 1976, we were still eight years out from having a CAT scan or a MRI scanner. We did have a thing called an EMI scanner, which you put the head inside of a water bag inside of a big coil, and it would give you some pictures, but the CAT scans where you could put a whole body in were several years out. And it wasn't until the mid 80s that MRI scans appeared on the planet. So th,at's the biggest change that we had, was imaging.

Host: It's interesting to think that not only did you need to learn how to be a neurosurgeon, but then you had to keep up with all these advancements over the years.

John Hackman, MD: Absolutely.

Host: Yeah. So looking back, are there particular cases or milestones or moments that defined your career or stand out as maybe especially meaningful to you?

John Hackman, MD: The one case that not only I but a lot of people in the hospital still remember was a little four-year-old girl who her head was run over by a car. They pretty much declared her dead in the emergency room. But sort of a last-minute thing. Somebody called me and I went in to see her and, Her scalp had been pulled back. A number of pieces of bone were missing from her skulland, over her eye. There were leaves inside of her head I guess it was about 5:00 in the afternoon when I took her to surgery. We didn't finish up till, about 3:00 or 4:00 in the morning. She was in the hospital for probably six or eight weeks because she had some bad infection. I had to take her back to surgery several times. She not only survived, she finished up college. She stopped by to visit just before I retired, and has done very, very well. That's probably the biggest one that not only I, but a lot of people in the hospital still remember.

Host: That is— Wow. Over the years, what aspects of practicing medicine did you find the most rewarding?

John Hackman, MD: The biggest thing was being able to help people and have people come in with a problem and to fix it. There's a condition called a brain aneurysm, which is a like a bubble on the side of a blood vessel,an. If it ruptures, you've got a high chance you're going to die right on the spot. You only have about a 10% chance you're going to come out normal. And probably, the most fun thing was spending a couple hours in the operating room and fixing one of those and realizing that you have just cured a fatal disease. That's a great feeling.

Host: That is very rewarding. Absolutely. So, you trained and worked alongside many physicians throughout your career. What qualities did you value most in colleagues and young physicians entering the field?

John Hackman, MD: They have to just enjoy what they're doing. If you go into medicine, you're not going to be happy with the field, unless you enjoy what you're doing. There are some people that get pushed into medicine by their family, or they get pushed into medicine because they think that, "Gosh, that's going to be a lucrative field." That's not a good reason to be in medicine. The reason to be in medicine is that you enjoy it and enjoy going to work in the morning.

In the literature now, frequently talk about physician burnout. I think physician burnout is just people that don't enjoy doing the job, and I feel sorry for those people because I loved going to work in the morning. And if you like going to work in the morning, you really don't work any day of your life. You enjoy everything.

Host: That's fantastic. I was just going to mention that quote that people talk about all the time, if you find something you love to do, then it's not really work, right?

John Hackman, MD: Exactly. Exactly.

Host: Yeah. So as Jackson Hospital celebrates 80 years, what memories or moments best reflect the hospital's impact on the Montgomery community?

John Hackman, MD: Jackson, when it started out, it was pretty much a family hospital. When I came to Montgomery, you only went to Jackson Hospital if you had one of the Jackson doctors as your primary doctor. The emergency room was up on the fourth floor. And to get into the emergency room, you had to go into a little side door on the hospital and go up the elevator to the fourth floor. So, we didn't have people that just showed up off the street or anything like that. It was really family hospital. Everybody knew each other. The patients knew the doctors, the doctors knew the patients. It was a really family thing.

When Medicare came in, they changed that hospital completely. Jackson Hospital back at the beginning when I was there, which is, gosh, 50 years ago, they had a beauty shop in the hospital. So that if you had a woman that was in the hospital for a few days, she could go get her hair done before she went home. We had a wonderful restaurant in the hospital. It had wonderful food at good prices. It was a nice enough hospital that a lot of people from Maxwell Air Force Base would go there for Saturday night for their great meal of the week. When Medicare came in, they felt that things like this were extravagant, and Medicare made us close down facilities such as that.

But the other thing that Medicare did is it pretty much opened up Jackson Hospital to the rest of Montgomery. It was a much more personable place than any other hospital I'd been in. And the patients enjoyed it and they got great care.

Host: Hearing you talk about that makes me think about we didn't know back then that those were the good old days.

John Hackman, MD: That's right.

Host: But they really were, right?

John Hackman, MD: They really were.

Host: So as you reflect on your career, what advice would you give to young physicians entering medicine today?

John Hackman, MD: Be nice to the nurses. When I was finishing up neurosurgery, the previous chief resident was a fellow named Fred Christensen, who ended up in Scottsdale, Arizona. And I went to Fred because I was the new guy coming on, and he was the old guy that was finishing up. And I asked Fred that same question, you know, "What do you recommend? Do you have advice for me to make medicine better?" And he said, "Be nice to the nurses."

And by that, what he was telling me is that the nurses who've been working there for a long time, they have a lot of experience that you don't have yet. They can make your life wonderful, or they can make your life miserable. They can go a long way as far as helping you take care of patients. You know, I had a lot of experience in neurosurgery at that point, but they had a lot of experience with taking care of sick people in the hospital. So, that's a very, very strong thing. And a lot of young doctors just have not figured out that a nurse can make the big difference. So, that's my advice.

Host: I love that. I really appreciate you joining us today, and it's been great talking to you.

John Hackman, MD: Thank you.

Host: Thank you for joining us today. For more information on Jackson Hospital and Clinic, please visit us at jackson.org. And to consider joining forces with the new Jackson Hospital, please visit our careers page. And this has been Vital Signs, candid conversations with providers who care.