Transcript of Chancellor's Last Lecture 2012

April 30, 2012

UCSF students selected Chancellor Susan Desmond-Hellmann, MD, MPH, among other faculty for the honor of delivering the University's inaugural "last lecture," which she did on April 19. Here is the entire transcript from her speech:

Introduction: Hi, everyone. Hello and welcome to UCSF's Inaugural Last Lecture. Thank you so much for coming out here tonight. A special thank you goes to our alumni who are here tonight as part of UCSF's Interprofessional Alumni Weekend.

When I first chose to come to UCSF as a medical student, I was told very simply, "Neha, you'll be inspired here." I know I speak on behalf of all the students here that the inspiration is something that you find in every one of our faculty members, in many a lecture, and definitely in our clinical experiences. It is humbling, to say the least, but also always leaves us curious to know just a little bit more.

The Last Lecture series is a part of the curiosity. In January, all of our students were emailed a voting ballot consisting of faculty members from across our schools. We heard from hundreds of students, and Chancellor Desmond-Hellmann was chosen to give the lecture for this year.

Chancellor Desmond-Hellmann first came to UCSF for her clinical training in internal medicine and medical oncology. As part of that training, she spent two years studying HIV/AIDS and cancer as a visiting faculty member at the Uganda Cancer Institute. She holds a master's degree in public health from Berkeley and worked for two years as a medical oncologist before turning to clinical research.

Prior to joining UCSF as chancellor, she spent 14 years at Genentech, serving part of that time as president of Product Development. There, she led efforts to bringing a number of breakthrough cancer medicines to the marketplace.

Forbes Magazine has called her a "hero to legions of cancer patients," as one of the world's seven most powerful innovators. Chancellor Desmond-Hellmann undoubtedly has many stories to tell us about this trajectory. And so, on behalf of all the students, faculty, and alumni present here tonight, I propose to her the question: If you had but one lecture to give, what would you say? [Applause]

Chancellor Susan Desmond-Hellmann: Thank you very much, Neha, for that nice introduction. And I wanted to tell all the students who were here what a deep honor it is for me for you to select me to give this lecture. I will tell you it is both a deep honor and a source of high anxiety. [Laughter]

Upon hearing of my nomination and selection, I immediately went home and shared with my husband, Nick, this news that I would be working on this last lecture. And Nick, of course, in his own way, said, "Are they trying to tell you something?" [Laughter] And I reassured him that, in fact, at least to my knowledge, there wasn't something embedded in this request like, "We wish it were her last lecture," or, "On your way out."

So having been supported fully at home — in giving this lecture, I can tell you that — I wanted to share with you a little bit of my thoughts and how I approached this, and how I'm going to approach giving the Last Lecture.

First of all, I took great inspiration from two of the individuals on this slide who I think are iconic in the area of Last Lecture. And so in the case of trying to do something I've never done before, I'm a strong believer in benchmarking. The upside of benchmarking is that you can really go deep on, "What worked well?" in these lectures. "What did they do? What were the approaches they used that made these so iconic?"

The downside, of course, is my anxiety only increased. How on Earth could I live up to such iconic lecturers? And so I wanted to point out to you a couple things that I really admired about these. And for any of you who have not already been one of the millions literally on YouTube who have viewed either Randy Pausch's or Steve Jobs' lectures, I would highly recommend them.

Ironically, something they both had in common is pancreatic cancer. Two different types, two different pathologies, but cancer of the pancreas robbed both these individuals of their lives.

Randy Pausch gave one of the most amazing lectures I've ever, ever watched, more than an hour, a really remarkable lecture at Carnegie Mellon, a Last Lecture, really clearly facing in the near-term his demise, which did happen less than a year later. And what I loved most about his lecture was his childhood dreams. And so I took that as one thing I wanted to include in my lecture. I loved the part about his childhood dreams.

Steve Jobs, on the other hand, it wasn't a formal Last Lecture he gave. He gave a 14-minute commencement address in 2005 at Stanford. And I do believe it's the best commencement address I've ever heard. For someone who always seemed so private, it was as if he invited you to participate with him in thinking about the meaning of life. So really inspiring.

And it was also really sad, because he thought he was all better, you know? He thought he would have decades of life left. But his reflections on death and the meaning of life given death were really inspiring to me. And what I liked about his commencement address is he used three stories to tell what he thought was important. And so I'm going to tell you three stories.

So I thought I'd take a little bit of each of these from these lectures. But let me just start with something that — again, because I choose to believe you didn't choose me for my Last Lecture for real — I thought I'd start with my life expectancy. [Laughter]

So this is true. There is a Web site. Dean Foster, who's a faculty member at Penn, has put together a really nice tool that you can get on the Web that is your personal life expectancy calculator. It's in the spirit of thinking about insurance policies and life tables, but it's also in the spirit of wellness and healthy habits.

And so I immediately went to the life expectancy calculator. And I will reflect to you that this occasionally reminds me a little bit of a few years ago when BayBio, a local biotech organization, gave me a lifetime achievement award. And in my speech that I gave at that lifetime achievement award, I asked if I could be given a second half of life lifetime achievement award, that it just seemed to premature.

And so I'm reassured by my life expectancy calculator results — not that I take this as gospel, but my mean life expectancy would be 93.97 years. I love going to the hundredth figure. And the lower quartile, 87.24 years; and the upper quartile, 102.62 years, which is frankly frightening. [Laughter] So I hope that this will be true. I hope that this life expectancy will be true. But in this spirit of the last lecture, I really did challenge myself to say, "If this was it, if this was the last lecture, what would I want to tell you?"

So let me start with childhood dreams. I loved the part of Randy Pausch's lecture where he talked about his childhood dreams and how they came true. And I will tell you that I feel the same way. The picture up on top on the left is not only evidence of my continued fondness for color coordination — I'm in the middle here. Note the green socks.

This was when the family moved from California. So my dad is a pharmacist. He was born and raised in San Francisco. But after becoming a pharmacist, he moved to Napa. And I was born in Napa. With three babies, mom and dad moved the family to Reno, Nevada. So while I'm a native Californian, I consider my hometown Reno. So the three of us moved with mom and dad. And I love this picture. Note also the continued color coordination. That's me.

This is grandma and grandpa. And this picture is there to remind me to tell you that one of the great people in my life who was and is a part of my childhood dreams coming true is mom. So note mom with her smart hat and only four kids by then, all dressed to the T on Easter.

My mom, like my dad, was the first in her family to go to college. But not only the first in her family to go to college; my mom is truly a coalminer's daughter. Her dad died in the coalmines in Wyoming when my mom was 14. My mom went to school not speaking English. She spoke Slovenian, being the first in her family born in the United States, and later became an English teacher, which I've always thought really remarkable.

Grandpa was a San Francisco police detective, and grandma was a maid and then worked at JC Penney's and lived down in the Sunset.

So this was a terrific childhood. And I cannot explain on the surface how this crazy kid — that's me again; this is at age 10 — decided my childhood dream was to be a doctor. That's what I was going to be. Now, my sister Teresa, who's seen this picture more often than she'd like, is convinced that — I think this picture shows how early I wanted to be a doctor. She thinks it shows how early I was bossing everyone around. [Laughter] And she's probably right.

But the four became seven. And this is a picture of the year I started college, the same year the seventh kid was born, which made a big impact on, I think, how I approached life and my ability to achieve my childhood dreams. But I wanted to mention on the childhood dream front somebody who I think helps to explain why even though I was a nerdy kid, why by the age of 10 — and it predated the age of 10 by several years — that I knew I wanted to be a doctor. And that's Dr. Noah Smirnoff.

Dr. Noah Smirnoff was my family doctor. Dr. Smirnoff was one of these really special people in life who didn't shout about what he cared about, just lived what he cared about. I love what was said in the book about Dr. Smirnoff's life in medicine, which ended at the age of 102. "He was the ultimate family physician. He cared. That was his whole thing. The more patients he could see, the better, as far as he was concerned.

Sometimes he would see up to 90 patients a day. He was making house calls until he was too old to make them anymore. In a 2004 interview on his hundredth birthday, Smirnoff said he simply loved helping people feel better. 'I never turned anyone down regardless of their medical situation or financial situation. Poor people hurt just as much as rich people. That's been my policy for 75 years.'"

One of my favorite stories about Dr. Smirnoff is a good example of interprofessional work, not just education. My dad and Dr. Smirnoff talked every day, usually several times a day. One morning when all these kids were scrambling to go to school, very unusually my dad had the flu and was in bed and had called his partner and said, "I can't come to the drug store. I'm really sick. I got a fever."

We're all getting ready for school, scrambling, grabbing lunches. And there's a knock on the door and it's Dr. Smirnoff. He just said, "You always come to work, Frank. I figured if you didn't come to work, you must really be sick. I'm going in and checking you out." He just showed up at our house. [Laughter] That's a cool doctor.

I think both my dad's experience at being a retail pharmacist and his relationship with Dr. Smirnoff and what that meant for the patients had a big impact on my childhood dream to become a physician.

So you heard in the introduction that I did my training here at UCSF. And like so many of you, UCSF was my first choice. I didn't go to medical school at UCSF. I went to medical school where I grew up, in Nevada, and came here for my internship, residency. I was a chief resident. I was a fellow in hematology/oncology, went back to Berkeley and got a master's degree in public health, and then joined the faculty.

Because I joined the faculty at a time of the HIV/AIDS epidemic, I worked on Kaposi's sarcoma. But I want to tell you the first story that I think really impacted on some of my life's lessons. And that is going to Uganda. Just to give you the context of how crazy it was for me to end up in Uganda, there was no Global Health program at UCSF in 1988. I had never been actually to Chicago, Boston, New York City, much less East Africa. Yet, UCSF already had a great reputation in our ability to understand and work on HIV/AIDS.

So the Rockefeller Foundation approached UCSF. Merle Sande and Dick Root were the co-PIs of a project that Rockefeller funded. And at the time, they were deeply concerned about heterosexual transmission of HIV in East Africa. They weren't actually sure that it was true that there was heterosexual transmission. There were many stories, "Well, maybe it is actually related to sexual transmission and people are embarrassed to talk about their sexual behaviors, or maybe there's something else going on in Africa."

But Rockefeller wanted to understand it. And so Rockefeller asked UCSF to study this. And UCSF loaned my husband, also a physician and infectious disease doctor, and I to Makerere University in Kampala, Uganda. So we sublet our flat, we sold our Honda Civics, and we literally packed up as big a suitcase as we could find and moved to Uganda.

One of my colleagues who was an oncology fellow and training with me here, Bob Cohen, who I later worked with at Genentech, gave me this advice. He said, "You know, Sue, I don't think you should go to Uganda. You're going to ruin your academic career. It's going to be bad for your academic career. People will forget about you. You'll be off in Uganda. This is bad for your career." I'll come back to that later. [Laughter] Hold that thought.

So let me tell you about where we worked in Uganda. This is a picture of the Uganda Cancer Institute, and this is from a review in the Journal of the National Cancer Institute in 2007. The Uganda Cancer Institute opened up in 1967. The first director of the Uganda Cancer Institute was Professor John Ziegler of UCSF, who worked at the National Cancer Institute at the time. And he was the director from '67 to '72.

The first part that opened up in '67 was the Lymphoma Treatment Center, which was meant to care for children who had Burkitt's lymphoma, a very important cancer. And later, in 1969, the Solid Tumor Center opened up, focused on endemic or African Kaposi's sarcoma and liver cancer.

Now, many of you have probably read about life in Uganda in the '70s and in the '80s. Milton Obote and then Idi Amin ruled Uganda in a reign of terror that's truly unsurpassed in some of the terrible stories about life for people in the world. But in the '70s, despite troubled times, patients and their families would take great risk to travel across Uganda to get to the cancer institute. And this is just a group of some of those patients.

We set up shop to do our studies, for me to study Kaposi's sarcoma in its both endemic form and epidemic form; and my husband to look at the sexually transmitted disease epidemic along with HIV/AIDS. Our headquarters were at the Uganda Cancer Institute.

So what's shown on this slide is a picture of some of our colleagues. What we found when we got to the Uganda Cancer Institute with our ambitious Rockefeller-funded project, filled with ELISAs, Western blots, specific aims and great ambitions, was that we had no electricity or running water. So that was not going to be an easy thing to do.

What we also learned was that the key to success in Uganda was something that we hadn't anticipated, not all of all this great education and learning and technical expertise that we had brought from UCSF, but, in fact, the richness of working with these colleagues from Uganda who had literally gone through this amazing and awful experience of a war-torn country.

So the first time we went to Uganda — and this picture on the bottom left here is myself with Edward Ambidi and David Serwadda. Edward Ambidi and I were the two certified oncologists in the country of Uganda from 1989 to 1991. I always said when I left we halved the population of oncologists. Edward was terrific. He had suffered polio. Occasionally it was tough for him to walk, but he was an amazing leader and a great orator.

David Serwadda was younger than Edward but had embarked on a career that led him ultimately to be Dean of the School of Public Health at Makerere University, which was the teaching institution associated with Mulago Hospital. These two colleagues taught me so much about how you persevere in the face of unbelievably difficult circumstances.

But not only these colleagues and the leadership there, but the colleagues that I worked with at the Uganda Cancer Institute were really remarkable; the sisters, which is what we called nurses at the Uganda Cancer Institute, and the medical officer, the trainee Alex Coutinho who traveled with me monthly near the border of Kenya to care for even more patients with Kaposi's sarcoma. These were remarkable colleagues who had persevered through tough times. Notice the starched white uniforms, very much the British system.

If you look up here, the Makerere University-UCSF Collaborative Health Project was mostly notable for the number of locks we had on everything, so that things would not go missing. But it was a remarkable experience. The most important thing I learned — and this is our little going-away party — for the students in the room, behind us — that's student housing. Two medical students lived there and cared for the patients at the cancer institute overnight.

The most important life lesson that I learned from working with these colleagues at the Uganda Cancer Institute and on the project to look at HIV/AIDS was to approach life with an attitude of humility and gratitude.

I told many people when we came back from Uganda that I would never again turn on the water without feeling so good that I could brush my teeth straight from the faucet, or flip on a switch and the lights actually came on; and what it's like to try and learn, to stay healthy, to have a life without those basics of life had a huge impact on me; and the way that the rest of the world lived also had a big impact.

I also want to tell you that in addition to humility and gratitude as being the big life lessons I learned in Uganda, I also started thinking about, "What's my metric for success?" My metric for success when I went was those specific aims: understand HIV, address heterosexual transmission. What does Kaposi's sarcoma look like in Africa today with HIV? My specific aim became sustainability.

So I'm very happy to tell you that, in fact, my husband's not here in my lecture today because he's actually in Uganda today. He is at the Uganda Cancer Institute and the Infectious Disease Institute. In fact, two UCSF professors are also there, Warner Greene and Paul Volberding, because now, all these many years later, there's still a UCSF commitment and project in Uganda, and that's because the leaders in Uganda studying HIV/AIDS are Ugandans.

The most important thing we did was education and training. So learning that humility and gratitude, and making sure your specific aims are appropriate to the place you're working in, was a really important life lesson for me. And I'm so grateful that I had the opportunity to work at the Uganda Cancer Institute.

So my second story is about Genentech. By the way, did I leave off the part about my academic career? [Laughter] That was a bad thing for my academic career. I did leave UCSF, didn't publish enough papers, and wouldn't change it for the world. I recovered later. [Laughter]

Let me talk about Genentech. As you heard, I went into private practice. And by this time, my husband and I are married. We had gotten married after our fellowship. And while we were in practice, Nick was recruited to go to Bristol-Myers Squibb. And I followed as the trailing spouse.

Things went well at Bristol-Myers Squibb. And I had achieved some sense that people thought I knew what I was doing in oncology clinical trials. So Genentech recruited me to come back to the Bay area in 1995, and Nick was the trailing spouse.

But I will tell you something that I think is a really important thing to think about when you make life choices, and that is that Genentech was thought to be a company that had seen a lot of promise but was very risky.

So I went to Genentech in 1995, and Genentech was founded as the first biotech company in 1976. It came out of science that was done at UCSF by Herb Boyer, professor of biochemistry, and Stan Cohen at Stanford. And this is a picture of Herb Boyer and the late Bob Swanson, a businessman who, over several beers, plotted out the formation of Genentech.

But 19 years into it, the company had three approved products, and it was largely felt that the company hadn't achieved up to the promise of biotechnology or recombinant DNA. And the company had ambitions to become a cancer company.

So one of the important things to know is at the time that I went to Genentech in 1995, I left Bristol-Myers Squibb, the nation's number one oncology company, with working on the Taxol project as the team leader, the nation's number one cancer drug, to come to a company that had no cancer drugs and was nowhere in oncology, but had ambitions to turn the science into something special.

So that was a very risky thing to do, and it wasn't at all clear that that was a good risk. But I thought the company did good science and had good values, and so I said yes when they asked me to sign up to come as a clinical scientist.

So fast forward many years later to having become a manager and a leader at Genentech. This is one of my favorite pictures from the time that I was at Genentech, and this is a picture of me, as usual, giving a talk. I think half the pictures of me anywhere in life I have a microphone on. [Laughter]

So this is a picture of me with Mia Weber, and Mia Weber is a mother of seven who was told in the mid-90s that she had non-Hodgkin's lymphoma and was at the end of all the potentially useful therapies, that there was nothing else to try except for a new experimental therapy, rituximab, a new monoclonal antibody that was designed for patients with lymphoma.

She was in one of the earliest clinical trials. This is a meeting of my team, the larger Product Development team at Genentech, and I'm introducing Mia Weber, who had not only been in one of the very early safety trials of rituximab, but many years later was surviving and thriving, having done really well on this brand new medicine.

By the way, she said with great glee that the company IDEC, who discovered rituximab, had to create a new case report form because she outlived any of the ends of the limits of their case report form. And I just loved hearing her tell that story.

But let me tell you why I really love this picture. I always feel like when I look at this picture I'm looking at her, because she's just such a hero to me. To have had the courage to sign up for a clinical trial, to have done that and contributed so much for others who now benefit from rituximab, I was really excited to see her, to introduce her and hear her story. And in turn, she's looking at me like her hero, because I was part of a team that helped save her life.

And I think that sort of says in a nutshell why I love doing clinical research and why it was such a wonderful thing to be at Genentech during these times. And so the meaning behind what we were doing was a really important life lesson to me. It really mattered what the work was.

And although many companies have a lot of professional branding and marketing and many fancy things to put slogans together, one of the things I'm really proud of is that the team that I led at Genentech in product development put together our own slogan. No consultants were paid or consulted for this, and we put together our slogan that we really loved and I to this day love: Imagine what's possible for patients. That's a really important part of what I'll come back to as a lesson that I learned at Genentech.

When I went to Genentech, it was thought conventionally that you had to go more and more aggressive to treat cancer patients. Bone marrow transplant was in vogue for patients with breast cancer. Radical mastectomy. You had to really be aggressive. It was thought that you to nearly bring every patient to the brink of death and then rescue them with other medicines in cancer chemotherapy in order to help that patient.

And so treating patients with monoclonal antibodies, this very different novel approach, defied convention. And I never imagined, until I saw what could happen, that it would actually work.

So the other thing I learned at Genentech is also a very important lesson, and that's the power of teamwork and culture. So pictured here is the team that I left at Genentech, the Product Development team. Some of you may recognize somebody who's now here at UCSF. A fantastic team who were experts in business, science, clinical, engineering, finance. The power of this team came from the diversity of the team, all different backgrounds mixed together.

The other picture I really like from Genentech is Richard Scheller and I trying to explain to people what our jobs were through our t-shirts. I had a small goal when I went to Genentech, and that was that everybody always said, "Genentech has the best research." My goal was just now and then to hear, "Genentech has the best R&D," that clinical could add incredible value, and that my belief that basic science was necessary but not sufficient would actually play out. And I think we did that.

Part of this lesson, though, was the power of teamwork wasn't nose-to-the-grindstone; do, do, do; work, work, work. It was fun. It was the culture. Part of the culture was dressing up on Halloween, letting your hair down and pulling off silly stunts like showing up at Amgen and being nearly arrested. [Laughter] We weren't arrested, or I wouldn't be telling this story. The other part of the culture was practical jokes.

So things went really well. Genentech did become the number one cancer company in the U.S. through these new ways of treating cancer. And the employees got really scared, said, "We're getting up over 5,000 employees, 8,000 employees. We're growing too fast and we're going to change. The culture is going to change. It's going to get lousy around here. And we're not going to be able to be as innovative or creative or wacky as we aspire to be."

So on one weekend before April Fool's day, the CEO, Art Levinson, and I decided that we needed a good practical joke to reassure people that the culture wasn't goofed up. And so we worked together with just a very tiny group of people sworn to secrecy, and we put on the company's intranet these pictures that are shown here.

This was the first picture, and this was called "Unapproved Genenwear." This was a picture to demonstrate to the employees that times were tough, we had to buckle down, we're getting to be a big company now, and this sort of attire was unacceptable. It would no longer be allowed. And I can tell you it took us a long time to get this picture, especially since I kept cracking up. I could not do that serious look for long. [Laughter]

But this picture was meant to be the "Approved New Genenwear." And for those of you who love t-shirts, they were only acceptable if you had a shirt with a collar underneath a t-shirt. [Laughter] This was approved G-wear. Well, I show you this because -- you saw it on the Web site and then you clicked, and the click of course said, "April Fool's! Gotcha."

And we got the best note from one of the employees that I just loved. And this was also a part of the culture. It was, "Dear Art and Sue, 9:01, boot up my computer; 9:02, see approved and unapproved G-wear; 9:03, call mom and dad and say, 'I need a loan to go to Banana Republic. I need an upgrade on my attire.' And mom is saying, 'Don't worry, we'll figure it out. We'll go after work today.' 9:04, clicked on the thing. Got me." It was great. Totally got him. [Laughter]

Now this is the world's largest double-helix, human-made double-helix in South San Francisco. So I show you these pictures because I think that what I learned at Genentech is several things that are embodied by this picture. Everyone makes a contribution. When you have the right culture, everyone makes a contribution. The leaders are a part of the culture and drive the culture through how they think about the environment for everyone. And authentic leadership really matters.

Before I went to Genentech, I thought I would need to be somebody different than my normal self to be  a leader, somehow a personality transplant or something. But what I learned, and the experience I had and the mentorship that I received, taught me that the best leadership is tapping into what you do well and making a contribution through that. Your authentic leadership self.

So the most important lesson I learned overall was the power of aiming big and establishing a culture that brings out the best in everyone. 

Now, I talked about the metric of sustainability when I went to Uganda. My metric for success when I was at Genentech leading Product Development was to rewrite the medical textbooks. I thought if we were really doing great R&D, it needed to change the way people thought about treating patients, to rewrite the medical textbooks. And the power of the culture and everyone being part of those solutions was amazing.

The third story I want to tell you about is coming as chancellor to UCSF. This, I have to say, was the hardest of the three stories to tell, because I feel like it's, I hope, unfinished.

So I came in August of 2009 as the ninth chancellor of UCSF and the first female chancellor at UCSF. I wanted to tell you why I took the job as chancellor of UCSF, because I think it puts into context the most important life lesson I learned both in terms of how I think about how you pick jobs and what I hope that I can learn from the experience so far at UCSF.

When I left Genentech after being president and having 14 years there, I had a really great selection of opportunities that I could've chosen to do next in my career. I came to UCSF because UCSF matters so much. I think all of us have life talents, different things that we may be able to do well. And that lesson that I learned about everybody pointing in the same direction and making spectacular things happen was a really powerful lesson for me.

I like leading. I like defining my success by the success of others. I like managing. And I like thinking big. Change the world. Make a big difference. And what I saw at UCSF, and continue to see at UCSF, is that opportunity, an opportunity for an academic medical center, a graduate-level school, a university, a public university in the 21st century to change how people think about two areas right now that aren't good news items in our country and in the world, and that is healthcare and higher education.

So when I came to UCSF, I hoped and aspired, as a leader and as chancellor at UCSF, that I could contribute and make a difference.

So here's just a few pictures of experiences I've had in the less than three years I've been chancellor at UCSF. I want to tell you a couple things about these pictures that really make me think about UCSF and the bigger meaning of being chancellor at UCSF. The first thing that I would point out is — and it's perfect for this lecture — is the opportunity to be around students is fantastic, and it is one of the things I miss most in being in industry or in practice.

One of my favorite questions I've been asked by a student, more than one student: What does the chancellor do, anyway? [Laughter] The subtext of that that people are too polite to say is, "Is any of my tuition paying for you?" I think that's great. That is a great question. What does the chancellor do, anyway? UCSF is a big place.

One of the things the chancellor does is celebrate. The chancellor celebrates. So you see some commencement pictures here, some Nobel Prize award pictures here. I think the chancellor helps UCSF anchor our values, and doing that through celebrations, participation, decision-making, one at a time, but they add up to really be the most important thing to me, which is anchoring the values of UCSF.

Now, one of the pictures on this slide is a picture that I really like. It's not actually a good picture. It's got like this little blurry thing in the back of it. But it is a picture of Holly Smith, who was Chief of Medicine in 1982, and two of his interns from 1982, me and my husband. And I like this picture because it definitely make me reminisce about 30 years ago coming to UCSF as an intern, and what a role model Holly Smith was and is for me.

And I learned a lot by thinking about Holly and Bill Rutter, who in the clinical and research realm made a big difference at UCSF. And so I think that what this slide allows me to reflect to you is, as chancellor, I think like many of the jobs that are leadership jobs, there is a sort of narrow scope of what you do day to day, and it's very broad and may seem to people very fuzzy.

But the most important thing that I learned and continue to learn as being chancellor at UCSF is relentless pursuing excellence is the single most important thing that I can do every day.

If it's the clinical mission, the research mission, the educational mission, the community service, our aspiration to make a difference in the world, that that's the job of the chancellor. And doing so not to be popular, not to have a good day or an easy day, but being relentless about the quality of UCSF and what people can expect when they come to UCSF is the single most important thing.

So what's the metric for success at UCSF in this relentless pursuit of excellence that I think and believe I'm signed up for? Well, I like advancing health worldwide, and I love our aspiration to be the world's leading health sciences innovator. So what does that mean? How do we measure our impact?

I think in the end, the way I think about impact at UCSF is how UCSF's efforts, no matter what those efforts are, how they impact on the world, how any human being from a patient, a person, a community member, a population, or how people think about what it means to be a health professional -- everything we do makes an impact on that. And that is what I find so inspiring about being at UCSF, and that is something that I think, if this was my last lecture, I would be giving you serious homework.

And the homework would be that, given that I'm only less than three years into the job, that I'm counting on you for that, because that the other thing that I think I learn in reflecting on, "What does that mean, excellence?" Again, I go back to, "What's the environment that allows everyone at UCSF to thrive, to bring out the best in themselves and others? And how does everyone at UCSF make a difference in the world?"

That's the job of the chancellor, and that's the job of all of us as members of the UCSF community. One decision at a time. Where do you show up? How do you spend money? What do you value? We demonstrate our values as an institution and each of us as individuals.

So those are my three lessons, to approach life with an attitude of humility and gratitude, the power of aiming big and establishing a culture that brings out the best in everyone, and relentlessly pursuing excellence, and measuring that excellence by the impact you have on others. Those were the lessons that those three stories taught me during my journey through Uganda, through Genentech, and now at USCF.

But I feel like I wouldn't be doing justice to the Last Lecture if I only talked about those life lessons and not some of the how, some of what I feel like has helped me in my life journey. So I wanted to talk about three other areas that I think are really important and have been sort of globally important for me throughout my life.

The first one is carpe diem. Notice it doesn't say "work/life balance." I'm not really sure I get that. This balance thing feels like it's equal measure, and on one day you do this, and you have to measure the output in another way.

I think the most important thing for me, and I suspect for many others — at least the people who I respect and admire have in common — make a decision to be happy and healthy. Make a decision that you will be. Then do everything in your power to be happy and healthy. Now, sometimes life comes in ways that you can't control, but it's remarkable how much you can control about whether you're happy.

So these are some pictures that are pictures that I just put on this slide because they make me happy. They do kind of have some commonalities. [Laughter] And they remind me to tell you that you'll be different than me. For sure what makes me happy is being outside, doing something sporty, getting on the bike, having a hike, being up in the mountains, skiing, being with my husband.

Sports. I'm about to get a Matt Cain t-shirt. I don't know about you. [Laughter] That makes me happy. It makes me happy to get my head up above water, to forget the troubles of the world and of me and others around me. And I think when you're at UCSF, when you're top of your class, smartest kid, get good grades, overachieve over and over again, it is really easy to be, in fact, the award-winner for "most pitiful." [Laughter]

I'm telling you guys. Raise your hand if that's you. [Laughter] Really, really important. Do not be the award-winner for "most pitiful." Reject that. Reject that. How would you like to be sick? How would you like to be sick and the vibe coming off your caregiver is that he or she is the most pitiful person you've met? That award comes with a consequence.

I love the thought that if I interact with a student, an alum, a faculty member, staff member, member of our community — and they interact with me, chancellor at UCSF — most pitiful? For goodness sakes. I wouldn't be representing you well. If they say, "Man, she's excited about UCSF. She's having fun. She's around colleagues she respects and admires" — for me, carpe diem isn't just letting your hair down, work/life balance, taking a break; it's a part of how I operate. If I have fun every weekend, boy am I better on Monday.

So make a decision for yourself that you're going to be happy and you're going to be healthy, and then do everything you can to achieve that.

Did I mention I'm the first female chancellor? The other thing I think is funny. One of the funny things about being a woman leader, either executive or chancellor, in that case, I always like when people say, "So you decided not to have a family." First of all, it's a little weird, because I might not have decided not to have kids. But in fact I did decide not to have kids. So this is my family. At home, this is my little family of two. But I have been so immensely privileged to have the greatest family.

So I showed you the seven kids before. Here's another shot of the seven of us. This is Nick with his brothers and the first grandkid Hellmann, our nephew. So the Hellmann and Desmond families remain incredible fertile, I'm happy to report. [Laughter] Now there are 20 nieces and nephews. I'm one of seven. My husband is one of seven. And we have 20 nieces and nephews. And I derive intense joy every time I'm around all of them.

So in addition to making sure you get to do things that are fun, really value your family. I often wonder what gives people the courage to take risks. Many of the stories I told you today involve me taking risk. And I am very convinced that I've been able to take risk because of the joy I have always derived from my family. They are always there for you. They're always your backstop. And don't neglect how important they are, whether that's you and one other person, whether that's you and your siblings/parents.

I'm also really thrilled to tell you, in the spirit of Holly Smith and Holly Smith quotes, my dad and Holly Smith actually met several years ago. And my dad now is the source of a Holly Smith quote, which I'm very proud of. That is Holly was going to some award thing where I was getting an award, and unusually my parents were there. And Holly and my dad met each other, which was really fun to introduce them.

And Holly said to my dad, he said, "You must be so proud of Sue." And my dad said, "I'm proud of all my children." And Holly just loved that. I mean, it was just like a great dad. Well, he is and was a great dad, and mom. And the grandkids, the nieces, the nephews, the siblings, it's all good. And you'll have your own family.

But if you want to take risks, if you want to make a difference and do things where you might look like you failed, or you goofed up, nothing is better than your family to always love you and allow you to take those risks in your career, in what you want to achieve. And I think that's, for me, been a really powerful lesson that early in my career I don't think I recognized as well as I do today, the importance of family.

So this is my last slide, and this is a slide that I hope can allow me to take you back to my first slide, my childhood dreams. So when I watched my dad in the pharmacy, or I observed Dr. Smirnoff and the interactions he had with his patients, and his role in the community as a family physician, I thought that my childhood dream was going to be one patient at a time and that I would be a good doctor. And when I came to UCSF and went through the internal medicine and oncology fellowships, my aspiration was to be a good doctor.

I will tell you today, my most important metric for success remains what's shown by some of the pictures on this slide from patients who have sought their care at UCSF. I think and thought, and it remains true today, it's an enormous privilege to be a healthcare professional, to be a clinician. Think about how scared, uncomfortable someone is who's sitting across from you or talking to you about things that are their deepest worries: their health, their family's health, their life.

It is an immense privilege to be part of that. Whether I was here as a trainee, in Uganda, at Genentech, or now as chancellor, if this was my last lecture, I would measure ultimately whether or not I feel good about it by the metrics that are revealed by the people on this slide. What did I do on a broad scale, and hopefully the broadest scale at UCSF through many of you?

What were the actions I took where someone was well, was cured, suffered less, had hope for their future? How did I treat that person? How did they feel after the interaction with me? Did they feel better? So when I go back and I look at what was said about Dr. Smirnoff after 75 years, those are pretty good metrics. Did I make a difference? Did I cause someone's outcome in life to be better as a result of my efforts? So I sure hope I did.

And I think if there's one most important thing I would tell you, it's try and figure out your compass, because that's my compass, is, "Do my efforts result in that outcome?" And I think if you figure out your compass, it takes a lot of complexity, whether it's at UCSF or anyplace else that you are, and it simplifies it. Are my efforts making a difference to the benefit of human health?

So thank you very much for inviting me to give this lecture. Thank you for listening and coming. It's been a privilege. [Applause]

Closing: So once again, a big thank you to the chancellor for coming out and giving such a wonderful lecture to all of us. Thank you all for coming, and we hope that you all join us outside for the reception.