Vulnerability and Where to Find It: A Doctor’s Tale

Medicine

Some patients we never forget.

She was a middle-aged white woman with brown hair and arms only a frequent gym-goer could possess. She walked through the clinic doors accompanied by her newfound love—newlyweds. My attending physician introduced himself and then it was my turn as the third-year medical student on the rotation.

She smiled in response, followed by a courteous, “Nice to meet you.” 

I had perched myself at the corner of the room against the sink at the base of what appeared to be an isosceles triangle. I was one of the bases, the neurology attending the other, and the patient and her husband represented the tip.

Here, I observed from my perch.

In her next few sentences she described how one morning, upon awakening, she noticed she was slurring her words of which she attributed to the notion of having suffered a mild stroke. In her mind, how could it be anything else? She was in her early 50s and unlike many of her friends she maintained a strict diet, a daily gym routine and a mentality to match. 

After multiple questions, some mild laughing with intermittent smiling even, the neurologist paused. He clasped his hands together as he let out a slow breath of air. 

“I firmly believe you have Amyotrophic Lateral Sclerosis (ALS), and the slurred speech is the beginning of this process. This is not a stroke, I’m sorry.” 

I do not know which came first—the hopeless shriek or the cascade of tears. She knew she had just been given a death sentence and despite her husband’s best efforts there was no consoling her. A tear fell from my left eye as I quickly tilted my head back looking up towards the ceiling hoping gravity would play an effect and somehow the tears would roll back into my head rather than onto my white coat. From the actions and demeanor of my attending physician it was evident he had given this news before—one too many times. Two thoughts filled my mind as sadness filled the room. 

First, I thought about the disease process itself, which I had read about the night prior characterized by “a progressive loss of motor neurons in the brain and spinal cord.” ALS is a progressive, disabling, and ultimately fatal disease of unknown cause starting with a gradual muscle weakness and wasting in the upper and lower extremities, muscle fasciculations and inevitably difficulty swallowing, phonating and breathing.1 This degenerative process continues until respiratory failure will most likely claim her life as it has so many before her.1

As my attending and I stood there watching her cry, the clock stood still. 

Why her? As time stood still, I kept asking myself. Why not her husband? Why not my attending? How would she spend her remaining months before the disease would cripple her into a wheelchair and the permanent requirement of mechanical ventilation would ensue? 

As physicians, too often, we are sculpted to believe we are invincible. We care for others at their most vulnerable time and it is always them—that is the vernacular. The patient’s tears made it clear she was not ready for such a diagnosis; she was not ready to die. I do not know if in the moment she was frightened by the certainty of death or death was far superior to the alternative life that awaited her. 

I, too, am scared of death. I am scared of being forgotten. After an obituary in a newspaper, a funeral, stories shared, beautiful words produced and dark clothing worn with covered eyes, life continues for everyone except the deceased. I wonder if any of these thoughts coursed through her mind at a rate similar to her tears.

Once her tear ducts seemingly dried up, she asked how she could obtain a second opinion. The attending told her he recommended she go to the Cleveland Clinic if she desired. She gathered her things with one tissue in hand and bloodshot eyes. As she stood up, my attending, gave her a hug she most deserved. A hug I will never forget. Once we were alone, he asked me if I was ok? “Yes, I’m ok. Thank you for asking,” I promptly replied. I thanked him for allowing me to join him in clinic then quickly left. 

I went to my car and I cried. 

I had lied. 

I was not ok. 

References:

  1. Zeller JL, Lynm C, Glass RM. Amyotrophic Lateral Sclerosis. JAMA. 2007;298(2):248. doi:10.1001/jama.298.2.248

Pay Collegiate Athletes If It Is Tied To Their Education: Former Black Student-Athlete Turned Physician Weighs In

Athletics, Race, Sports

There is a script I continue to watch unfold: A young African-American male heralded in college as an elite athlete raises large amounts of money for his university. He then leaves this Mt. Olympus-esque world prior to obtaining a degree for the dream of playing in the National Football League. A few years, seasons and many injuries later this same young man is 30 years old, financially unstable with little to count for his past triumphs but some old newspaper clippings, ESPN highlights found on YouTube and unending aches and pains in his joints. I propose that if the NCAA provides financial compensation under a strict framework of academic compliance and encouragement, multiple issues can be resolved. I am a 30-year-old African-American medical school graduate, a current resident physician, and a former division III track and field All-American.

In 2011, I graduated college and returned to my hometown of Washington D.C., while a savior was moving in from Waco, Texas. Robert Griffin III the former Baylor University QB—nicknamed RGIII—had just been drafted #2 overall by the Washington football team. Each Sunday he had the crowd roaring, game after game, night after night, under the lights and loudspeakers. He was the second most popular person in town next to then President Barack Obama. Years later, as RGIII and I—nearly identical in age—look into the future, divergent futures stare back at us as his career lights are dimming while mine are beginning to illuminate.

Recently, California Governor Gavin Newsome signed the Fair Pay to Play Act allowing collegiate players to be financially compensated for name recognition and to hire agents beginning in 2023. If one steps back, this bill can serve as an opportunity to embolden student-athletes to increase their academic focus for a more enriched future. The financial burden for some players and their families is evident and demands consideration. For many of these families, they send their sons to elite football powerhouses with the hope of winning a national title and the goal of one day playing in the National Football League changing their familial financial landscape. The Fair Pay to Play Act or any bill of this magnitude can be utilized to promote academic compliance through financial compensation. Enforcement of class attendance in conjunction with assignment completion would hold these players more accountable. I propose there be an allocated amount of money a player be eligible to receive on a weekly basis. Yet, missed classes or assignments would result in a weekly reduction or removal of the financial stipend. Daily, the notion of a student-athlete loses its values with certain sports as institutions refuse to hold their student-athletes accountable in the classroom as much as the coaches are holding them responsible on the athletic field.

In 2015, according to Tuscaloosa News, Alabama’s football program earned nearly $46.5 million for the school during their 2015 championship season. Shockingly, this number was nearly $7 million less than the year prior. In the same breath, the organization pushing vehemently to deny these young men the chance to profit from their dedication—the National Collegiate Athletic Association, or NCAA—averages nearly 1 billion dollars in revenue annually. These earnings come from exposure and marketing derived from competition and winning, from the coaches who recruit the talent, and from the talent who sacrifice their beings and future. Financial compensation based on academic compliance would allow the players to send money home to their families, to save money and most importantly to better invest in their futures through educational attainment.

I can no longer bear to see former student-athletes holding onto memories everyone else has forgotten not daring to dream of more for their futures. Most NFL players have finished their career by age 30 with no college degree, dismantling financial instability and lasting damage to their bodies. This has to change. There needs to be more retired NFL players becoming businessmen, news personalities, and even coaches. A bill of this nature can create this narrative for these current and future young men. The compass needs to be realigned moving from viewing athletics as the highest point of ones life to utilizing sports and academics to more lifelong achievements.

The importance of sports and athletic prowess is not in question but without a push for education, we are the hurt ones—the men of color.

Writing A Personal Statement: Who Are You and Who Do You Want To Be? Tell Me!

Mentorship

Every time I hear someone mention they are lacking a mentor or guidance I cringe. One of the true disadvantages in this world is having no one to call a mentor. Many applications require personal statements and without guidance this part of the process can be very daunting. I hope my personal statement from 2018, below,  for a residency position in a department of anesthesiology might help. Here’s my essay:

My first experience under general anesthesia was terrifying. A whirlwind of emotions taunted me as I laid in the pre-operative suite. On one hand, I was excited to finally get my torn labrum repaired; however, I was anxious about the anesthetic aspect of the operation. The anesthesiologist also recommended a nerve block to help with postoperative pain control. Even as a first-year medical student, attempting to understand lower extremity anatomy and the mechanism underlying local anesthetics was unnerving. Despite feeling unsettled due to my limited knowledge of the procedure, the anesthesiologist gained my trust only after five minutes of interaction. His demeanor, empathetic manner and smile—a very caring one—gave me the desire to pursue a career in anesthesiology. I admired his ability to swiftly ease my fear of receiving general anesthesia. This reminded me of my experience with AmeriCorps (City Year DC) in which I worked countless hours with students on various English and mathematic assignments. During my year-long experience, I helped the students grow more comfortable with their studies, their public speaking and increased their desire to learn. This service year required many hours of multi-tasking, working as a team player, and working well under pressure. These attributes will translate into the field of anesthesiology, allowing me to excel.

I have known for a very long time that I wanted to be a physician, yet I was unsure of which specialty.

Following my surgical clerkship, I began a rotation at Nationwide Children’s Hospital in pediatric anesthesiology. I love children thus I entered this rotation excited for the opportunity to serve this patient population. Small in stature but powerful in their own right, the pediatric patients undergoing surgery left a lasting impression. I realized that caring for the pediatric population is more than an “interaction.” The young boys and girls were scared as they minimally understood their situation except that they were being separated from their parents. The ability for the anesthesiologist to simultaneously calm these patients while placing the parents at ease was nothing short of an art. In a way, the pediatric anesthesiologist is forced to bridge the gap of the health care provider and friend. This evidenced the notion that trust is not earned by who we are but rather by what we do. I watched as Dr. Whitaker sat on a patient’s bed and inquired about the name of the stuffed animal she was cuddling tightly. She did not care too much about Dr. Whitaker’s occupation, but rather her newfound excitement was directed at his most recent question. At that moment–eager to experience that same level of patient interaction one day–I began contemplating a career in pediatric anesthesiology.

The pediatric patients from Nationwide Children’s Hospital shaped my desire to not only serve, but illuminated how a life in service to children is a life worth living. It is incredible to fathom that the face of the anesthesiologist is the last and first person a patient sees before and after a surgical procedure, respectively. Although–quantitatively limited in patient interaction compared to other specialties, from a qualitative standpoint an anesthesiologist’s interaction highlights the importance of compassion and enthusiasm. These are qualities that I possess and will afford me the ability, if given the opportunity, to fully care for my future patients. This specialty will allow me the flexibility to pursue being a highly competent clinical-educator, to conduct minority health disparities research analyzing anesthesia-related outcomes on various ethnic populations and to augment the relationship between anesthesiologists and surgeons to improve the overall patient outcome. Observing Dr. Whitaker and the pediatric patients has shaped my desire to pursue a career in the field of anesthesiology.

 

 

LeBron James is right – the classroom is where the future is, including for athletes. I know. I lived it: Jason L. Campbell (Opinion)

Race, Sports

*Published online at Cleveland.com on Dec. 28th, 2017*

PORTLAND — “Nothing is given. Everything is earned” is the motto of NBA icon Lebron James. It’s also a pillar for his newly created I Promise School.

By intertwining a family-first ideology with a rigorous science, technology, engineering and mathematics (STEM) curriculum for students in the 1st through 8th grades, the beauty and irony are evident. Someone who has made his entire life putting an orange ball into a hoop understands that a lifetime of success originates inside a classroom — not outside, on a basketball court.

“Nothing is given. Everything is earned in the classroom … first,” might serve as a more accurate descriptor of LeBron’s theory.

As we survey the majority of African-American communities, there lies a common denominator in how society views athletics — as the main mechanism by which blacks rise to success.

In primary schools, a factory-like process is pushed on many young black boys: Perform well on the basketball court in grade school; join an out-of-school team; earn a scholarship or invitation to attend a top athletic preparatory school; become a star recruit at a Division I athletic program; and keep your mind and eyes on the coveted title of “professional athlete.”

As these young boys become young men, there is an industry of coaches and recruiters who look for talent at an early age without valuing the young person themselves.

However, it does not need to be that way. As a young physician and former collegiate student-athlete, I had coaches who instilled values in me and goals on me to succeed in both the athletic and educational realms. If not for them, I would not be where I am today.

These coaches are a rare breed but need to be the common numerator.

The hard truth is that becoming a basketball player in the National Basketball Association is exceedingly difficult, almost like playing lottery odds. In the 2016-2017 school year, according to NCAA.org, there were 550,305 high school participants in men’s basketball, and 18,712 became NCAA participants. Thus, the probability of competing in NCAA collegiate basketball was 3.4 percent for male high school basketball athletes desiring to compete at the next level.

Only 1.2 percent of these NCAA student-athletes make it to the major professional level.

Neither of these aforementioned statistics account for longevity or success as a professional athlete. Suddenly a small fish in a big pond, some players end up in the league even if only for a single game or less. Despite these numbers, families and coaches are emboldened to push their young student-athletes to fight for careers in professional athletics.

However, what happens if we channel the same passion into pushing these young men to concurrently focus on exploiting the educational mission for long-term success?

National studies from 2012 demonstrate that black physicians comprise only 4 percent of active physicians, 6 percent of trainees in graduate medical education and 7 percent of medical school graduates.

If the same fury, encouragement, and will were instilled into young black men in the classrooms, what might be the possibility? Moreover, how much stronger would our entire country be with such a paradigm shift in priorities?

The right direction and guidance — similar excellence and discipline — used to excel at sports can be transitioned into the libraries, research laboratories and clinical rooms where black men are currently sparse. We often see black athletes but, in certain areas of this country, we rarely see black physicians. Pushing oneself to an exemplary level in athletics is nothing short of amazing, but enhancing your knowledge of a certain subject matter is one of the most self-fulfilling achievements in this world.

Lebron James has initiated a conduit for lifelong success for the black community in his hometown of Akron.

He evidences two of the most clichéd sentences in society, and as we know, most clichés ring true:

Home is where the heart is. Classroom is where the success is.

As my 30th birthday approaches, as a young trainee in an anesthesiology residency program, my career is in its infancy. In contrast, for my contemporaries in the world of athletics, most of their careers are in the terminal stages. Excluding environmental occurrences and certain medical conditions that may occur, we all will live at least another 50 years.

In truth, there are many successful athletes, like Lebron James, who have pushed beyond the limited box of athletics, recognizing that the seeds to the future success of the black male are in the classroom and not at the basketball courts or the football fields.

Today we plant the seeds.

And watch them grow.

—————————————-

Dr. Jason L. Campbell, a native of Washington, D.C., is a recent graduate of The Ohio State University College of Medicine and a former Division III All-American track and field athlete at Emory University. He is currently a physician resident in the Department of Anesthesiology at Oregon Health & Science University in Portland, Oregon.