The question I didn’t ask Melinda French Gates

By S. Michelle Ogunwole, MD, PhD, Johns Hopkins Medicine

Every December, my coaching community for women of color in academic medicine gathers for an end-of-year retreat. We reflect on what the year held: what we gained, what we lost, what nearly broke us, and what helped us make it through. At the end of that retreat, we each choose a word to orient us for the year ahead.

For 2026, my word was generous.

It was not the obvious choice.

I was emerging from a season of pregnancy, postpartum recovery, parenting young children, and professional uncertainty. The research funding environment had fundamentally shifted toward chaos and instability, public trust in science and medicine seemed to be in rapid freefall, and communities were being targeted and torn apart under the notion that diversity and inclusion were somehow failure points. Many in academic medicine, especially those of us who led research in women’s health and health equity were trying to discern how to keep building when too little light illuminated a path forward.

So why was generous the word I had chosen?

I found myself revisiting that question during a recent conversation with Melinda French Gates hosted by the Johns Hopkins Center for Innovative Medicine. I had the privilege of asking one question, though I arrived with two. The question I asked aloud was about sustainability and stemmed from a question I often consider when conducting community-engaged research: “When we work with communities that have historically been under-resourced, how do we leave people and organizations stronger, more self-sustaining, and better able to build lasting capacity of their own?”

Her answer centered on partnership. It challenged the notion that meaningful change requires a paternalistic relationship between the giver and the receiver and instead emphasized the humility of accompaniment: walking alongside people, valuing their contributions, listening closely, and investing in the conditions that allow women, families, and communities to step more fully into their own power.

But her answer awakened another question I had been carrying for months—one that came from my chosen word.

Generous.

What does it look like to live generosity out loud? Not as an aspiration, but as a practice.

I never asked her that question. Yet, somehow, she provided the answer. The answer, I realized, had less to do with resources themselves than with the orientation behind them.

Many people have resources. Far fewer use them with consistency, clarity, and fidelity to their values.

Melinda French Gates exemplifies this distinction. Through her philanthropy, investments, and advocacy to advance women’s health, economic opportunity, and leadership, what stands out is not just the magnitude of the resources she deploys, but the intentionality and discipline with which she aligns them to her values.

When preparing for our conversation and reading more about her story, I suspected that such generosity must be cultivated long before it is expressed at scale. During the conversation, she confirmed it.

She reflected on how a commitment to service had been planted early in her life. She spoke about service as a lesson learned while attending an all-girls school: that to give is to serve, and that one person can make a difference.

What stayed with me was how expansive her definition of giving seemed to be. In many ways, what she described as giving was what I had been trying to understand as generosity. Certainly, money and material resources can be part of giving. But she also spoke about giving one’s voice, gifts, influence, time, and attention in service of others. Throughout the conversation, she returned to themes of partnership, advocacy, listening, promotion of agency, and the willingness to walk alongside people rather than position yourself above them.

The more I reflected on that conversation, the more I realized I had been working with too narrow a definition of generosity. Once I started looking for it, I realized it was everywhere.

I see generosity in a peer sharing a platform, opening a door, and creating space for another voice in a room where she could have chosen to keep the microphone for herself.

I see generosity in a mentor whose own scientific contributions are widely recognized, yet who still finds great fulfillment in amplifying the achievements of his successors, in being the shoulder upon which the next generation stands.

I see generosity in community organizations that never seem to keep score, but instead give with the confidence that generosity returns one way or another—often shaken together and running over.

Clinical medicine, too, is ripe with examples and opportunities to practice generosity.

While the systems we work in often ask us to move quickly, generosity asks us to slow down and move with greater deliberation, helping us to humanize the person in front of us.

Sometimes that looks like keeping notes on a patient’s life outside of medicine so you can ask, months later, about their grandchild’s ballet recital, whether the tulips in their garden bloomed, or if that 60th reunion outfit made them feel as fabulous as they had hoped.

There is richness in that.

Sometimes that looks like returning to the room of a patient you consulted on, bearing a gift of their favorite childhood candy that took two days to track down, and seeing the surprised delight of a promise kept.

There is richness in that.

Sometimes that looks like letting a veteran tell you about what he saw, survived, and learned as a young man, despite it having nothing to do with his current illness, and hearing him say, “No one has listened to me like that in a long time.”

There is richness in that.

To be clear, these gestures do not replace the need for structural change. They do not fix inadequate insurance, insufficient family leave, underfunded research, appointment lengths determined by billing structures, or the many ways our systems fail patients and clinicians alike.

People need funding. Families need childcare. Patients need access. Communities need investment. Clinicians need humane healthcare systems that do not rely on endless personal sacrifice. Those challenges, and the scarcity of resources that accompany them, are real.

But scarcity thinking is real too, and something entirely different. It is the temptation to make decisions from fear. To narrow our imagination to whatever seems immediately available. To abandon purpose because uncertainty convinces us there will never be enough.

And there is something defiant about giving and serving anyway.

Not giving without boundaries. Not giving until we disappear. But giving in ways that keep us connected to our values, our purpose, our communities, and our humanity.

I do not believe that generosity, by itself, will change the funding environment, fix broken systems, or illuminate the path forward with certainty. But I am increasingly convinced that generosity may serve as an antidote to scarcity thinking.

Generosity, in its most expansive form, resists the lie that fear, uncertainty, and injustice have to make us smaller.

Indeed, the choice to give and serve anyway may be its own form of resistance.

It may very well be how we survive this time and those to come.

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.