The Importance of Five Minutes

Originally published in July 2019 edition, ASA Monitor (citation below)

‘Unexpected death of a colleague,’ I read in the subject line.

As I combed through the remainder of the email, I came to learn that a second-year resident had died in a car accident near his hometown. It was his name that gave me pause.

Just a few weeks prior, I entered one of the campus cafeterias for a meal. There, I noticed a young man sitting alone wearing a navy-blue jacket. A University of Pennsylvania Perelman School of Medicine crest was stitched on his chest.

“Hey, man – I happened to notice your jacket. Did you attend UPenn?”

“Yeah, I did. I’m Joe! Nice to meet you.”

“It’s nice to meet you, too. A few of my closest friends also graduated from there!” I replied.

A conversation started, just pleasant banter that danced around the east coast versus west coast biases, shared colleagues and friends, Portland’s city designation with its small-town charm, and our respective medical specialties. The dialogue was short but delightful and lasted approximately five minutes in total. Before I left his table, I suggested we take a photo together to send to our mutual friends.

Our smiles are in my phone now.

In the five minutes when we spoke, a connection was formed, a foundation of trust laid. Unlikely as it seemed at the time, this simple exchange was similar to the swiftly created bond that forms when an anesthesiologist talks to their patient prior to surgery.

When I was a fourth-year medical student, I told my family and friends that I had applied to an anesthesiology residency program. Their responses varied. Most were happy but they had questions too, specifically concerns that my communication skills would be “wasted.” Knowing how much joy interacting with people brings me, they were disappointed that I would spend most of my medical practice with unconscious patients. My answer: there is a unique responsibility born in that five-minute interaction prior to surgery. In those five minutes, I may have the ability to connect to a patient, gain trust and portray a sense of safety to a complete stranger in a way someone else may not. My communication skills could be the difference between someone entering the operating room with wild fear or measured ease.

When I was a fourth-year medical student, I told my family and friends that I had applied to an anesthesiology residency program. Their responses varied. Most were happy but they had questions too, specifically concerns that my communication skills would be ‘wasted.’

I am not alone in feeling this way. “I have five minutes to convince someone I can take care of their life,” Dr. Marshall Lee – Oregon Health & Science University (OHSU) attending physician – stressed during residency orientation. This time restraint is a challenge that should be decorated for anesthesiology rather than seen as a reason to choose another specialty. A patient waiting in the preoperative area is possibly in one of the most vulnerable states of their lives. Patients may find themselves anxiety-stricken for the surgery itself, fearful regarding the aftermath, pained by the financial burden of the surgery and concerned for the risk of death. Most encounters we have with our patients are brief and delicate. A patient in this highly vulnerable state – concomitant with a short window of time – clings to every word from our lips. After a postoperative call to verify the patient is recovering appropriately, it is probable you will never see nor hear from them again. This does not detract from the memory of how you made them feel – one they may carry with them for a lifetime.1 

When recalling my conversation with Joe, I can no longer remember the nuances nor the minute details, yet I felt more connection and delight upon walking away from the table that day than after many hour-long discussions with others. As anesthesiologists, we only have a few minutes to gain the trust of the patient and family member, positively frame one’s outlook prior to their surgery, and provide the sense of comfort and reassurance they are seeking. During this brief encounter, we must gather information, set expectations and address concerns a patient may have – several factors underlying high-quality patient-physician encounters.2 One underestimated key is non-verbal communication – a grounding component of a therapeutic patient-physician relationship.1 And one example of this is evidenced in a study which demonstrates that sitting over standing is highly favored by patients as it creates a less dominant environment and more empathetic space.3 

As I embark on my anesthesiology journey, I will recall my feelings after I left Joe and the impact of a high-quality conversation – regardless of its brevity. It is a remarkable challenge that is requested of an anesthesiologist. At OHSU, attending physician Dr. Miko Enomoto is known for her saying, “the safest anxiolytic one can administer to a patient is their time, their attention and their care.” Let us never forget that in five minutes we have limitless influence on a patient and their family during one of the most vulnerable phases of their life. They may not remember the details of the conversation, but they will most certainly remember how we made them feel.

References:

  • Ha JF, Longnecker N . Doctor-patient communication: a review. Oshcner J. 2010;10(1):38-43.
  • Simpson M, Buckman R, Stewart M, et al. Doctor-patient communication: the Toronto consensus statement. BMJ. 2010; 303(6814), 1385–1387.[Article]
  • Strasser F, Palmer JL, Willy J, et al. Impact of physician sitting versus standing during inpatient oncology consultations: patients’ preference and perception of compassion and duration. A randomized controlled trial. J Pain Symptom Manage. 2005; 29(5):489-497.[Article][PubMed]

Jason L. Campbell; The Importance of Five Minutes. ASA Monitor2019;83(7):44-45.

 

Visible Man: An Illumination of My Black Father

“I am invisible, understand, simply because people refuse to see me.” The subtle yet remarkable line from Ralph Ellison’s book Invisible Man published in 1952 continues to be a declarative voice in today’s society: Black men do not play a role in raising their children. There are so many, including my grandfather and my own father, who have proven this stigma to be incorrect.

Despite being considered invisible, black fathers have remained beautiful statues to emulate for their children. It was the year 1972 and a young black man, trunk packed and ticket in hand, boarded a bus headed towards Philadelphia with his parents’ directives echoing in his head’— “Work hard and good luck, son.” For the first time in his eighteen years of life Thomas Campbell was leaving home in pursuit of a college degree—the first of his siblings.

The opportunities many black fathers have generated are now profoundly evident in the accomplishments of their children. One of eight children, Thomas Campbell was born in 1953 in the Northeast corridor of Washington D.C. A year after his birth in 1954, the Supreme Court reversed Plessy in Brown v. Board of Education of Topeka declaring segregation in public schools unconstitutional. Fifty-three years later, I was graduating as one of a few African-American students from a private high school in Washington D.C.—a vicarious atonement of what may have been for my father had his parents been able to afford the tuition when he was accepted to a similar school. “I wanted you and your sister to have more than I could have ever dreamed of as a kid. When I grew up my family never had a car and never went on family vacations,” he remarked.

There are a multitude of young black men changing the world owing the qualities that have made them successful—dedication, commitment, and perseverance—to their black fathers.

“Jason, remember you can be whatever you want when you grow up.” As he tightened my tie on that Easter morning looking his ten-year-old son in the eye. “If you put your mind to it, then it’s yours.” Nineteen years later as I climbed the six shallow stairs in the auditorium at my medical school graduation ceremony my father’s words reverberated. A story nothing short of recurrent and delivered dreams: receiving a private school education followed by three more degrees—the last one permanently attaching the initials MD to my last name. What even I struggle to fathom is what my father must have felt when I walked across that stage and was declared a ‘Doctor.’

The magnificence of my achievement truly belongs to my father. Despite having grown up in a home where his own father could neither read nor write he journeyed to earn his law degree. Subsequently, he cemented a path for me and my sister to earn five degrees between the two of us. My father’s example serves as a declaration for my sister and I that boundaries do not exist.

Grown J and dad

Like a multitude of black fathers, Thomas Campbell exemplifies a vision of the world where the finish line is not dictated by the starting line.

Once invisible men—now visible. They are black fathers.

I’m a Black Student-Athlete Turned Physician: What Colin Kaepernick and Nike Really Mean

Please see below for my Op Ed published on 9/14/18 in THE OREGONIAN.

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I sat in a football stadium for the Ohio State Buckeyes vs the Nebraska Cornhuskers game on Nov. 5, 2016, three days before the presidential election. About 108,000 screaming fans surrounded me, but I only remember three.

To my right were two white gentlemen wearing “Make America Great Again” baseball caps. This was the first sporting event I attended since Colin Kaepernick, former San Francisco 49ers player began kneeling during the anthem in protest against police brutality against African-Americans.

I stood up. I removed my hat. These actions were done not because I didn’t vehemently stand against police brutality, but because I felt standing for the anthem was the ‘right thing to do’ for me.

Yet all the while, I could imagine all eyes on me.

As I stood, there came laughter from behind, a few seats to my left. An older white gentleman, likely in his 50s, yelled over at one of his buddies, “Hey, hey, look at me. I’m going to kneel,” mocking me and all of what Kaepernick represented. I suddenly felt alone and exposed, maybe even a little afraid. Being there, supporting a team and university that had given me so much, no longer felt like home. The sporting event took a new form as my attention turned from the football game to the underlying game.

The same man who mocked Colin Kaepernick’s kneeling cheered for each move the young black male athletes made. The same men, celebrating their support of then-presidential candidate Donald Trump, clapped enthusiastically as the young black male athletes scored point after point for their beloved team.

Supporting and voting for President-elect Donald Trump is not supposed to be incompatible with supporting black athletes, but with recent events, one naturally must question the growing disconnection. The truth is, many of us black males cannot feel calm as we have to constantly look outside of ourselves in order to visualize how our present and future actions might be perceived by others. It’s part of growing up as a black male in America.

Growing up as a black male athlete in America adds more complexity — and becoming a black male physician even more.

As a black male I am unnerved by the stories I read about current or former athletes sustaining injuries leading to a fall from grace. That leads to a harsh realization that they are no longer “needed,” with little to account for all of their hours of dedication. Basketball courts, tracks, football fields and athletic arenas are bursting with black men excelling every day, rain or shine.

The time has come for us to redefine our own values and to focus our potential in different ways. With the right direction and guidance, that same excellence and discipline can easily transition into the libraries, research laboratories and clinical rooms where we are currently sparse.

The beauty lies not in the fact that we have to choose one over the other, but in what I believe and personally know to be true: Black men can excel in both realms. It is time that we stop letting others limit us as we move forward.

That’s what Nike and Colin Kaepernick mean.