From coat to coat: A look behind the scenes at the day-to-day life of MUSC's president 

There’s a moment in the story when he’s finally found the correct aisle.

His job – the sole task that his wife has given him that early spring morning – is to get one simple item. Though trust is a foundation of their 32-year marriage, evidently it doesn’t apply to the grocery store.

About halfway down, on the left-hand side, he sees it. At the same moment, just a little farther down, he notices someone waving at him. As he gets closer, he realizes the smiling man is a high school football coach. He knows this, not because of anything he’s wearing or because he’s seen him on TV, but because, years ago, he saved the man’s life.

From the front passenger seat of the SUV, the storyteller pauses a moment, looking out the window at the trees streaking by in the early afternoon light. “It was colon cancer,” he says, almost as if he’s forgotten you’re there. “But we got it.” 

Then he continues.

“So, we’re talking, you know, just catching up,” he says, when another man, a little bit younger than the two of them, comes along. He’s one of the coach’s former players. The two men embrace. The coach tells him, “This is Dr. Cole. The guy who fixed me.”

The former player hesitates for a moment before chuckling in amazement. “Small world,” he says. “You fixed my mom, too.” It’s a moment MUSC President David J. Cole, M.D., FACS, says he’ll never forget. 

“It’s not why we do what we do,” he says, now turning slightly in his seat to catch you out of the corner of his eye, “But yeah, it was an incredible feeling. That’s as good as it gets right there.” 

Even though he must be tired, he smiles. He’s at the tail end of a nonstop Regional Hospital Network tour – Florence, Marion, Black River. Over the past 36 hours, Cole has set foot in three different MUSC Health hospitals, toured countless units and met hundreds of doctors, nurses and staff. It sounds like a lot because, well, it is. But it’s a fair barometer of what a typical week looks like for the still-practicing oncology surgeon who just also happens to be the big boss to nearly 25,000 people across six colleges, 14 hospitals and 750-plus care locations statewide.

 

Back in the Mount Pleasant Publix, the three men – surgeon, coach, player – share a few more laughs before eventually shaking hands and going their separate ways. And that’s when he sees her. Rounding the corner, coming down the canned vegetables aisle. Greeting her with the warmest smile he can muster, Cole attempts to explain to his wife Kathy what just transpired. It was a moment, he explains. Like something out of a movie. But it doesn’t matter. Because right now, he’s not the respected surgeon or prestigious university president, he’s simply the empty-handed husband.

With a tight smile, Kathy bends down and grabs it off the shelf. 

“One job,” she says. 

“Honey, you don’t understand,” Cole recounts, stepping right back into that very moment, his voice raising an octave – no doubt exactly the way he would have said it to her then – “this was bigger than green beans!”

For several weeks, spanning November and December of last year, MUSC writer Bryce Donovan and photographer Sarah Pack shadowed the man entrusted with keeping a $5.4 billion a year train on the rails. From the wood-paneled walls of board meetings to the bright lights of the operating room, they watched as he handled his colleagues, patients and everything in-between with a level-headed calm that’s made him the perfect fit for a position he’s held for the past nine years. 

This is a sneak peek inside the life of MUSC President David Cole. 

Rubbing elbows

With the sun fading to indigo and high tide sparkling among the marsh grass, David and Kathy Cole stand on a nearby veranda, shaking hands and trading smiles with legacy donors. Events like this are crucial, because even though MUSC is considered a state-funded organization, less than 4% of its annual budget comes from the government. That means people like these – the ones who the Coles are on hand to celebrate on this unseasonably warm autumn evening at Alhambra Hall – are key players in the growth and success of MUSC. 

 

The schedule of a university president can be brutal. The meetings. The phone calls. Financial and personnel decisions. But for all the long hours and the stress, there are a few perks to the job. Like the big corner office. The ear of influential people. And nights like these. Because – and most university presidents will begrudgingly admit this – in hyper-specific circles, they enjoy a celebrity status of the highest order: the higher-ed equivalents of Taylor Swift.

So it should come as no real surprise that the hundreds of people milling about the black-tie event – some mingling, some dancing to a jazzy rendition of a Hall & Oates song – all have the same two things in common: a financial dedication to MUSC and the desire to talk to Cole. Even if some of them aren’t 100% certain which one he is. 

At that very same moment, on the opposite side of the event space, a woman waiting in line for a drink strikes up a conversation with a short, bearded man. They laugh a bit, enjoying a rare warm Charleston evening with no sand gnats. The small talk ends with him getting a glass of wine and her applauding all he’s done for MUSC. With a look of bewilderment, the man walks away to rejoin his friends at a nearby table, and with a wry smile says, “Please refer to me as Dr. Cole for the rest of the evening.”

Checking in

 

It’s 11:09 a.m. as the gray SUV pulls out of the parking lot at Colcock Hall, a building Cole and other top-level MUSC executives call home base. Dating back to the Civil War, the red- and brown-brick structure was originally built to house small arms and do cannon repairs. Nearly 160 year later, the weapons have been replaced by computers and conference rooms. But at its core, the building still has the feel of a place where high-stakes preparations are made. 

As Colcock Hall shrinks in the rear-view mirror, Cole, sitting in the passenger seat, grabs a folder and begins to leaf through his agenda for the next two days. It consists of meetings with staff, dinners with prominent members of the community, facility tours – medical university president-type stuff. He turns his attention to his talking points for the first of several of meetings he’ll have over the next 36 hours, only occasionally breaking the silence to share anecdotes on food courts or motion sickness. 

Three hours and eight minutes later – with a quick bite to eat and a story involving his mother and her fascination with skim milk in between – the road trip culminates in front of MUSC Health Florence, one of four South Carolina hospitals purchased by MUSC nearly four years ago. Cole makes it a point to visit these locations as often as his schedule will allow. Those visits aren’t lost on the people who work there. After an informal Q&A with some of the Florence medical staff, one nurse tells Cole that before MUSC purchased the hospitals, previous leadership was never around. “So, for you to come from Charleston and check in, it means something,” she said. “We feel heard.”

 

Over the course of the next several hours, Cole, along with MUSC Health Florence CEO Jay Hinesley, chief operating officer Jason Cox and chief medical officer Rami Zebian, M.D., makes the rounds. Along the way, the group checks out a new bronchoscope, some handheld ultrasound machines and a giant imaging system that looks like something right out of a Ridley Scott movie. Cole’s eyes light up as he learns about each – a not-so-subtle indicator of his love of medicine. 

Later that evening, at a dinner attended by MUSC Health Florence leadership and several key community members, Cole shares his central tenet as president of MUSC: “As long as I’m in this role, above everything else, the patient is going to be the center of what we do.”

He’s a medical university president, sure, but a physician first. 

“These are O.R. shoes.” “Oh, are they?”

 

Leah Ladue can’t hide her nerves. Lying helplessly in the hospital bed, her parents at her side, she knows the next few hours of her life depend on the man sitting to her right. With his arms resting on her bedrail and a blue surgical cap covering his white shock of hair, Cole searches her eyes, trying to ease some of those fears. 

“Questions? Concerns? Mysteries?” he asks gently.

 

Thirty-one minutes from now, Cole and his team will begin a right mastectomy on Ladue – the entire procedure will take about three hours – removing multiple cancers in the process. It’s a serious surgery – the breast tissue will be removed all the way to the muscle – but one Cole has performed hundreds of times in his career. 

“Will I have to spend the night here?” is all Ladue can manage, dozens of heavier questions no doubt lingering behind those scared eyes.

Cole smiles, nods and then turns to her parents and says, “We’ll take good care of her.”

Moments later, as he walks back to the operating room, his wedding band and Apple watch carefully tied into the drawstring of his scrub pants and his black surgical dress shoes softly clicking on the linoleum – “A lot of surgeons wear those clogs,” he says. “I prefer these. My son calls me an OG surgeon” – he chats amicably with a surgical resident and physician’s assistant Jennifer Ridgeway, both of whom will be assisting with the procedure. The stakes couldn’t be higher now, and yet, Cole seems the calmest he’s been in days. 

But it’s not really a surprise, after all, this is where he’s happiest. Where it all began.

Following his heart

 

The basketball court in his driveway confirms what you already suspected. Yes, the six-foot-two New Mexico native loves hoops. Played power forward for his high school team, even got a few junior college offers. But the sport never really defined him. So when he instead chose to go to New Mexico State University – a school that didn’t offer him a basketball scholarship – it was with the mindset that his future lay somewhere off the hardwood.

At NMSU, he was on it. He graduated with honors and was named a Rhodes scholar finalist. Then it was off to Weill Cornell Medical College in New York. From there, things kicked into high gear. He did a residency at Emory University Hospital in Atlanta. Worked his butt off. Fell for a pediatric bone marrow nurse named Kathy. 

 

Four cities, three kids and several decades later, Charleston eventually became home court for the Coles. Recently, they’ve even recruited two new players to the roster: granddaughter, Emily, and six-month-old Cairn Terrier, Sassy.

The story was mostly roses until 2019, when a medical issue forced Cole into one of the scariest moments of his and Kathy’s lives: he would need major surgery to address a congenital heart defect. It was a gut punch to the family, but like all obstacles they had faced before, they would meet it head on. The hours-long open-heart procedure kept him out of commission for a while, but in the end, life got back to normal for the Coles. Only this time it came with a few lifestyle changes and some welcomed perspective. 

Four years later, he still carves out time twice a week in his busy schedule to get to the Wellness Center and squeeze in a 60-minute workout.

“I love working with him,” MUSC trainer Alicia O’Connor says. “He’s fun because he’s an athlete.” Cole momentarily stops doing squats to interject: “Yeah, yeah. I just think she needed a reclamation project.” 

A new shrine

 

Almost symbolically, a lone sailboat navigates the Ashley River out the window below as Cole stands in a corner, gathering his thoughts. He turns and takes his seat at the table. 

The room is filled with doctors, a few children and lots of men in fuzzy red hats. The reason they have all gathered on the 7th floor of MUSC Health’s Shawn Jenkins Children’s Hospital is to announce the South Carolina Pediatric Burn Center, a joint affiliation between MUSC and Shriners Hospitals for Children. 

 

Cole’s job on this overcast morning is to welcome everyone and kick things off with a light anecdote. Making partnerships like this work are rarely as seamless as the events held to celebrate them make them seem. Oftentimes, years of planning, discussions and negotiations have gone on behind the scenes to make them a reality. And it can be a delicate balancing act. Sometimes it works out, sometimes it doesn’t.

But as president, that’s Cole job: to navigate the waters of diplomacy. Though admittedly more at home in a clinical setting, it’s this dance, this tightrope between friendships and business partnerships, where the man really earns his paycheck. 

Today is a win, he says. A game changer for the people of South Carolina. On its face, it might sound a bit idealistic, but when you’re the pitchman for his particular product – saving people’s lives – there really isn’t such a thing as hyperbole. It’s just flat out true. When health care improves, a community benefits.

Another day begins

There’s just something funny about a grown man in a suit cleaning up after a dog. Maybe it’s the absurdity of it, the blatant dichotomy. Or maybe it’s just reassuring to be reminded that that even the successful have to deal with, well, stuff.

It’s 5:51 a.m. on a Tuesday morning, and Cole stands in his front yard, dressed to the nines, pleading with Sassy to go to the bathroom. 

“Sometimes this feels like a pointless exercise,” he says, trying to sound tough, his smirk betraying how much he loves this tiny furball.  

After finally hitting the jackpot, the duo head back inside, where Cole is greeted by his wife, wearing bedazzled, fuzzy slippers, gingerly nursing her coffee. His morning routine consists of a handful of variables – this morning, it’s unloading the dishwasher – but always a few constants: morning news on the TV and making his own lunch. Today it’s pimiento cheese on Captain John Derst’s bread. And, of course, there are the cookies – Lorna Doone, shortbread. Loved them since he was a kid, he says. 

 

Kathy escorts him into the garage before kissing him goodbye. He tosses his bag in the back seat of his car, hops behind the wheel and fires up the engine. He throws the transmission in drive and puts on a pair of mirrored aviator sunglasses. The only thing missing is the “Days of Thunder” soundtrack. Instead, from the radio emanates a mellow number by Boz Scaggs, probably more fitting, even if a tad disappointing. 

As he deftly navigates the morning rush-hour merge onto the Ravenel Bridge, the sun shines brightly on his face, marking the beginning of another long and arduous day rising on the horizon for the man running MUSC. 

“This job can be exhausting,” he says a few minutes later, as he backs into his parking spot at Colcock Hall. “But I’m constantly reminding myself we’re trying to make a difference in people’s lives. And that’s not an easy thing. So I try to focus on the journey, the path to changing people’s futures for the better, because that’s what gets me up in the morning.”

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