The Interview: State Rep. and Emergency Physician Jon Santiago

State representative and emergency physician Jon Santiago on how Boston can survive the winter COVID surge.

Photo by Michael Swensen/The Boston Globe/Getty Images

Jon Santiago first caught Bostonians’ eye when he defeated the beloved 35-year incumbent Byron Rushing for a seat in the state House of Representatives two years ago. Since then, the energetic ER doctor has been spending his days and nights Ping-Ponging between Boston Medical Center and the State House as he battles the pandemic’s fallout in Massachusetts from multiple front lines while also remaining on active duty with the Army Reserve. We caught up with him in Kuwait, where he’s currently deployed, to talk tragedy, triumphs, and why he’d beat the famous surgeon Atul Gawande in a stamina contest—no coffee required.

First off, how do you see yourself, as a doctor or public servant?

That’s a great question. My life’s really been all about service, whether it was as a Peace Corps volunteer, a physician, or someone serving in the U.S. military. I’ve always asked myself, “How can I best help my community, and particularly those who are the most vulnerable?” So I look at myself as really just a servant, and I try to play that role in whatever manifestation I can.

Do you fit the stereotype of an ER doctor as an adrenaline-junkie cowboy?

Very much. It’s in our DNA. When you look at the biographies of most emergency medicine doctors, they have tons of energy, are very curious, and very much want to be in on the action. I love the job. In emergency medicine, it’s the jack of all trades, master of none. But what I also love about emergency medicine is that you’re interacting with so many people. Not just patients, but security, police, clerks, nurses, people coming in from the streets. If I wasn’t an emergency room doctor, I think I would have gone into social work.

Who would win in a stamina contest: you or Atul Gawande?

Me. Hands down.

Okay, that’s scary.

Let me clarify. I have a lot of respect for Dr. Gawande. I’ve read several of his books. I think he’s done an incredible job in bringing medicine into the public sphere. But I just have a lot of energy.

As an ER doctor, how have you seen the pandemic evolve?

When the epidemic started, we quite literally had no idea what the hell was going on. I remember that first weekend when things were picking up. I was coming to the hospital at night, and at first, we were telling people to intubate early, and no steroids, right? Maybe give them hydroxychloroquine. And to think now of how things have changed. We don’t intubate early. We give steroids. It’s data and science. We try things. We learn. We hypothesize and make improvements. I think this was the first time that a lot of people outside the medical establishment really began to understand what science is and what medicine is—that we don’t always have the answers. We make corrections. Now we’re at a place where we’ve lost more than 200,000 lives and things are worsening, but I trust in science, and in medicine, and I trust in the process and in our profession to be there till the very end.

Give me three adjectives that best describe Anthony Fauci.

Intelligent, compassionate, and empathetic.

What’s the most scared that you’ve been during the pandemic?

I don’t think I’ve been scared. I think I’ve just been sad. I’ve taken care of young, old, healthy, and unhealthy. I worked every weekend during the surge, every Friday, Saturday, and Sunday, from the very beginning. I doubled my hours in addition to picking up my legislative work, and while I was exhausted, I felt like there was nowhere else I would rather be. But I recall, particularly, taking care of a young man close to my age. I’m in my late thirties. And he was relatively healthy. I admitted him to the hospital, expecting him to recover. This was before we knew much about COVID and its manifestations, and to find out two days later that he was on, essentially, dialysis, and then that he was intubated, and then that he ultimately passed. It was sad. But it fortified my desire to stay in the game and to work those crazy hours.

Do you have the most demanding day job of any member of the House?

Who am I to judge? I think if you asked them, they might say
yes, but to each his own. I enjoy my job, and working at the emergency room is a break, sometimes, from political life and some of the policy discussions. And vice versa.

Have there been conflicts, when you were needed at the State House but you were in the emergency room, or the other way around?

No. The great thing about emergency medicine is that it’s shift work, so you know exactly when and what days you’re working. I work usually on the weekend or overnight, and then I bounce back to work in the State House or wherever. I live a couple of blocks away from the hospital, and just about a mile and a half away from the State House. I don’t have a car. I walk to the hospital, and I take public transportation to Beacon Hill.

Prior to his election to the Massachusetts House of Representatives, Jon Santiago spoke at a rally outside the State House to protect the Affordable Care Act. / Photo by Jon Cohn

Tip O’Neill famously said, “All politics is local.” Would you say that all politics is medical?

Well, sometimes people like to pin me as “the healthcare guy,” but it’s important to note that so much of what drives healthcare are the social determinants of health, like access to good food, a clean environment, and job and economic opportunities. So when I look at medicine, you can’t separate it from what’s going on in our daily lives. When I see a gunshot wound in the emergency room or a heart attack, when I see someone who can’t afford their medications and has some sort of complication from diabetes, it’s related to what’s going on in their community. That’s why I decided to get involved in policy and politics: to create change.

If Joe Biden asked you to join him to help fix the Affordable Care Act, is that something you’d jump at?

I’m really committed to my constituency, and the city and state. I have friends who practice international medicine, who work for these big organizations and institutions, and I admit I found the job prospects interesting. But I’ve always been more focused on local issues and local matters.

You feel like you can have more impact that way?

I do. I’ve lived for short periods in other places, including France and Africa, but I wanted to find that one place that fit me and had the things I was interested in. Boston is that place, and I’m very committed to helping improve my community, my city. There remain persistent gaps in income, opportunity, healthcare, and treatment, and those are inequities that I want to address.

How did you end up working at Boston Medical Center?

I’ve wanted to work there since I was a kid. I’m a Puerto Rican kid who grew up in urban Boston, and my family was poor, living in a community of color, and we got care there. The reason why I ultimately wanted to be a physician and work at a place like Boston Medical Center is because of the experiences of my family, particularly my uncle, who was a Latino man infected with HIV, and he ultimately passed from AIDS. This was the ’80s or early ’90s. And that really piqued my interest, not just in public health, but also in the inequities of our society. He was just a stone’s throw away from the best hospitals in America, but he couldn’t get the care he needed. And so, the day I entered medical school, I knew I wanted to be an emergency medicine doctor, and I knew I wanted to work at Boston Medical Center.

Not the usual path for a newly minted Yale MD.

No. The majority of my medical school classmates went to places like MGH, or the Brigham, or San Francisco. I was the only one in my class to go to Boston Medical Center, and that was looked upon like, “Why would you go there?” But over the course of the next couple of years, I was able to bring some other Yale med students to BMC, because we’re really interested in changing lives and improving communities.

So is Yale Medical School better than Harvard?

One hundred percent.

What, exactly, do you do to unplug, and where do you find the time?

I’m very fortunate that my wife is French. She’s taught me how to enjoy life, in more ways than I could have ever imagined. When I lived abroad, I would take these trips and have these very tightly scheduled days. And the first time I took a vacation with my wife, she said, “What are you doing?” She was like, “Quit scheduling! Let’s just hang out at the café for four hours and watch people.” She keeps me relaxed. I’m a big believer in having a date night once a week, going to one of our favorite restaurants. We do that once a week. And I try to read. I run. And that’s what keeps me intellectually and physically active.

What keeps you up at night?

I’m always asking myself, constantly, “What am I doing to make the world a better place, and is it enough?”

Politician or leader you most admire or respect?

I don’t want to sound like a cliché, but Alexander Hamilton was an all-time favorite of mine, long before the musical. I could relate to parts of his life story. Like him, I was born in the islands, and when I left and came to the mainland, I watched my family struggle and work our way out of poverty. So he really captured my interest at a young age, and when I found out that a musical had been written about him, I was incredibly excited, particularly because it was by Lin-Manuel Miranda, a Puerto Rican guy. My mind went crazy. So my one claim to fame is that I saw Hamilton on its opening weekend on Broadway, all by myself. I had great seats, too.

What do you consider your best feature?

My best feature is that I cannot name my best feature.

Grey’s Anatomy, House, Scrubs, or St. Elsewhere?

Grey’s. Team McDreamy all the way, although St. Elsewhere was based on BMC.

What one thing do the emergency room and the State House have in common?

Despite our imperfections, and the time one has to wait for either a diagnosis or a policy to change, I think that in my heart of hearts, the people in the emergency room and the people in the State House really want to do what’s best for the community, for the city, and for the state.

Do you ever wear scrubs to the State House?

Never. No. I don’t even wear a white coat. I’m a very informal guy. My patients call me Jon. No doctor, or captain, or representative. Just call me Jon.

What’s something politicians could learn from doctors?

Some objectivity. We live in a post-Enlightenment period, where we can exercise rational thought, produce hypotheses based on evidence, and really make sure that the policy interventions we’re trying to put into place are evidence-based and driven by science.

What’s the worst thing you ever had to treat yourself for?

Myself? Nothing, but you’ll appreciate this. The day before the primary, I’m challenging a 35-year incumbent. It’s about 1 o’clock in the morning, and I have to get up at 5 for election day. And one of my campaign volunteers comes by the house. He cut himself, really badly, hanging one of my signs. He was bleeding all over the place. He was scared. I had some supplies in my house and I just pretty much sutured him up. I think I got two hours of sleep that night.

Photo via Getty Images

By the Numbers

Boston 911

How have the area’s emergency rooms been coping with the crisis? The data says it all.

Number of Newton-Wellesley Hospital ER patients tested for COVID-19 in March.

Number of Newton-Wellesley Hospital ER patients tested for COVID-19 in October.

Average daily number of ER visits to Brigham and Women’s since the pandemic started.

Age, in months, of the youngest child admitted through the Boston Children’s ER with confirmed coronavirus.

Percentage of Mass General’s ER patients who are sick enough to get admitted to the hospital in normal times.

Percentage of Mass General’s ER patients who were sick enough to get admitted to the hospital during the spring surge.