David L. Cull, MD, delivers a captivating presidential address, laying bare his own challenging journey as a vascular surgeon and the hidden lessons on diversity, equity and inclusion his life story may hold.
Like nearly everyone else assembled, when Alan Lumsden, MD, took to the podium to deliver the customary presidential address preamble, he had little idea of the allegorical story that was to follow. Not even the program book quite captured what lay in store. “How my perspective on diversity, equity and inclusion has changed after I removed the log from my eye,” reads the entry under the presidential address in the 2024 Southern Association for Vascular Surgery (SAVS) annual meeting guide.
The title of the 2024 SAVS presidential address, a meeting highlight, of course suggested a diversity, equity and inclusion (DEI)-related topic, Lumsden—whose job it was as president-elect to introduce the sitting president—later shared. But what he and many others did not expect was the jaw-dropping tale of the lens with which 2023–24 SAVS President David L. Cull, MD, now looks at DEI through. Even for Lumsden, after he had just included in his introductory roast details of Cull’s early academic struggles, the presidential address caught him slightly off-guard.
For, Cull revealed—bringing the true meaning of “the log from my eye” phrase into focus—he has considerable experience of the benefits of gaining acceptance: he has battled a learning disability his entire life. Until this moment, it had been a battle that took place privately, concealed from most of those professionally close to him. Yet that in itself carried the point, Cull told those gathered. The challenges he worked to overcome were hiding in plain sight. In turn, the idiosyncrasies to which his learning disability gave rise posed a different kind of challenge to his colleagues. A couple of years ago, this led to an epiphany for Cull: his story represented that of a DEI beneficiary.
Cull, from the University of South Carolina School of Medicine in Greenville and formerly vice president of academic and clinical integration at Prisma Health, almost did not give the presentation. Tucked in his pocket as he followed Lumsden to the podium was an alternative address, there in case he decided to “bail” on the topic upon which he’d settled. As a Baby Boomer, a male and a surgeon, he has tendency not to share, he said. But the force of the moment, the divisiveness to which those three letters—DEI—can sometimes lead, helped compel him to overcome his discomfort.
Raised in rural Virginia, Cull said he grew up inculcated with the mantra that “hard work and success were strongly linked,” and insulated from the cultural shifts that began taking place during his formative years. By the time he arrived in Greenville to start practice, he brought with him that sort of bias, he said, and that formed the bedrock of his views on DEI.
“The segregated bubble in which I lived resulted in several biases which I carried with me to Greenville in 1997 when my vascular surgery practice began,” Cull said. “These biases dominated my perspective on DEI for the first decade in Greenville.”
Until 2008. That’s when he first took part in DEI training as he entered the leadership of his institution’s Department of Surgery. Lots of reading, conversations with his adult children and their spouses, as well as roles in DEI initiatives eventually helped shift his views.
Whereas before Cull held beliefs in keeping with the hard-work-yields-success mantra—such as people should fit and feel comfortable in a work environment, more women surgeons would harm the culture of surgery, LGBTQ discussions are uncomfortable and best avoided—now he’d evolved to adopt two core beliefs. “Systemic racism, sexism, and bias toward sexual orientation exist, and efforts to fix them are just and worthwhile,” he said. “And diversity strengthens businesses, organizations and our society.”
These were intellectual decisions, not based on personal experiences, and many surgeons of his generation and gender might have embarked upon similar journeys, Cull reflected. At this point, skeptics might object and suggest his transformation “was more an indoctrination than an education,” he continued.
Not long after his perspective on DEI reached a point of transformation, Cull also finally began to accept, within himself—if not publicly outside a small circle of close friends and partners—the fact he had a learning disability. Up to that point, he had developed a particular way of avoiding this explanation for his struggles. It had been long in the making: Cull was first diagnosed back during the latter part of his surgery residency at Wilford Hall Medical Center in San Antonio, Texas.
During his presidential introduction, Lumsden trailed the early educational struggles Cull had encountered in elementary and middle school. “He studied a lot, but that was not reflected in his grades,” Lumsden quipped, revealing report cards with less-than-flattering scores. “With scores like this he was probably not exactly destined for surgery, but a big turnaround was made academically.”
What Lumsden was not to know was the true nature and scale of the source of the issue.
Following him, Cull revealed all, detailing the learning disability from symptom to diagnosis to aftermath. What he had was expressive and receptive language processing disorder. The disability meant he struggled to translate thought into speech. That explained the need to write down even basic instructions because of an inability to follow verbal instruction. An inability, for example, to present off-the-cuff on rounds, or respond to even basic questions for which he knew the answer. The poor grades early on. The necessity to work harder than his peers to attain required levels.
Yet, at the point of diagnosis, he refused to accept that he had the disorder in question. “I considered a disability as uncorrectable, and if disclosed might be seen as an excuse for poor performance or something I was trying to use for secondary gain,” he told SAVS. “I found it more comfortable to accept I was on the lower end of the bell curve for intelligence compared to my colleagues.”
That’s where that early grounding in rural Virginia re-entered the lexicon: you overcome those shortcomings with hard work because “hard work is highly valued in the surgery culture,” he said. “I held tightly to this less-intelligent narrative for most of my surgery career.”
Despite at this point being unwilling to accept he had a learning disability, Cull had nevertheless already developed a retinue of techniques to help him adapt. Characteristics for which he would become well known were formed in this crucible. Extensive preparation. Meticulous planning. Never, ever procrastinating. Later, in leadership roles, he would similarly incorporate adaptive techniques aimed at thriving. “My partners would not recognize these techniques as adaptations to my disability because I had not disclosed my disability to them. Instead they would recognize them as endearing David Cull quirks,” he explained.
The era prior to the endovascular revolution lent itself well to Cull’s abilities. During the late 1980s and 1990s, he said, “vascular surgery only required learning 10–12 operations, and the indications were well established. This narrow focus was a factor in me choosing vascular surgery, for it was a field I felt I could master.”
The high case volume he experienced at Eastern Virginia Medical School during his fellowship allowed him to develop step-by-step instructions for every one of these operations. That lent him great confidence as he entered practice in Greenville and tackled the first few years of his career as a vascular surgeon.
However, the specter of the endovascular revolution loomed. Ultimately, the complex range of catheters, wires, stents and balloons, as well as procedural bailouts, it yielded was not an arena to which Cull could re-tool his adaptive techniques in order that he could continue to thrive. “My partners would tell you that after considerable effort and time with them in the endovascular suite, I was never able to advance beyond the most basic endovascular skills,” he said.
Instead, he found ways in which he could maximize his value to his group wherever he could, taking on “less appealing areas to my partners.” He found a home in the likes of vascular access and amputation, for instance, and thrived as a teacher.
All of which leads up to this moment of public revelation. “It has taken me more than 25 years to accept I have a learning disability, and I have been successful at hiding this disability from everyone except a handful of close friends and colleagues,” he confided. “Even today I have difficulty disclosing this, because, for my entire career, I have been inculcated into a surgical culture that hasn’t seen diversity as a strength, rather as a weakness.”
The year 2022 held an even deeper reckoning for the now retired surgeon. That was the year in which Cull realized his was a story of diversity and its benefits. In recent years, he recalled trying to explain to senior partners the characteristics of his disability that prevented him from being able to perform endovascular interventions. All he got in return were blank looks. After first being bothered by the response, he eventually came to realize they were unflinching because his value to the group had been long established. “They focused on what I could do rather than what I couldn’t do, and they accepted me as a full partner,” Cull noted.
He drew on an example of how this inclusion played out in practice. Whenever he took vascular call and an emergency requiring an endovascular intervention reared its head, those same partners, if in town, always would be on deck to lend a hand, Cull said. “How I was treated by my partners is what a diverse, equitable and inclusive environment looks like. I was fortunate to have landed in a practice where I thrived and gained fulfillment from doing what Bill Marston called the routine work of vascular surgery.”
Back on the subject of the title Cull chose for his presidential address, suggestive of a DEI topic but clearly representing something more, he explained how he settled on the particular wording. “The title came from the realization two years ago that my story is a diversity, equity and inclusion story, and I can use my experiences to gain insights into what it must be like in our profession and in our society to be a woman, a person of color, a member of the LGBTQ community or a disabled person,” he told SAVS as he came to the end of his address. “While my experiences have given me new insight, I can’t fully understand their life experience because I have had the advantage of being a White male who was able to hide his disability over a 30-year career—and was given the benefit of the doubt when I failed.”
