Dear Anxiety: But Still I Stand

medicine

I scurried across the campus to the bricks that housed the Department of Psychiatry. Sneaking in the back door, I hurried to the elevator. Fifth floor, the sign read. Sweat coursed down my back as nerves ran up my spine. A conversation with this doctor was going to determine if I would be allocated an additional four to six weeks to study for my step one board examination. This is the board examination one must pass to transition from a second year to third year medical student and begin clinical rotations in the hospital. That is what they tell you. They do not tell you this is the score that almost entirely dictates what type of physician you can become. A lower score on this exam and Ear, Nose and Throat (ENT), Orthopedic, Cardiothoracic, and Plastic surgery are subspecialties you can surely kiss goodbye because these residency programs will likely never see your application.

In the corner of the waiting room, I hid behind one of the partitions set up to enhance patient confidentiality. The psychiatrist greeted me prior to ushering me into his office. A dimly lit room, a couch and two chairs welcomed me. This felt more like an audition than an appointment. My heart was not beating, it was throbbing.

Globally, approximately 1/3 of medical students are being treated for anxiety or have been diagnosed with anxiety by a clinical practitioner. For me, I had never experienced anything like this before; sleepless nights, a lack of appetite resulting in substantial weight loss, an inability to focus, tears streaming down my cheek for no apparent reason and an unending catastrophic feeling surrounding my studies and upcoming exam. At the time I felt alone. Many years later I have come to know there are many who share this story.

At the conclusion of our visit I thanked him for his time and left down the elevator and out into the cold Midwestern evening. Staring into the distance the Ohio Stadium stood proud, a gladiator’s coliseum, while a shell of myself stood frozen in the night. He would either agree these symptoms were inhibiting my studying or he would not. The fate of my future was in his hands—this man I had only met only 60 minutes prior.

The next morning my cell phone rang.

“…We are granting you four additional weeks for your studies…”

In his report, the psychiatrist had noted the anxiety levels I was experiencing dramatically hampered my ability to adequately study.

A sigh of relief set in.

The throbbing within my chest had now decreased to a dull roar that would allow me to finally sleep for the first time in weeks. I made my way to the couch and as I began falling asleep, my mind started retracing my steps to medical school.

Abruptly, I woke up to my cell phone ringing. This time it was the pharmacy—my new prescription for anti-anxiety medications was now available for pick-up.

The journey to medicine is unique to each individual who embarks on it. One commonality is that it indirectly teaches success through repeated adverse conditions and failures—it teaches perseverance. Many of the leading educators and clinicians I have met in this sphere maintain an intrinsic motivation that far outweighs their innate level of knowledge. This intrinsic motivation increases their aspirations, knowledge and purpose; aspiring to serve as a physician, understanding that knowledge precedes healing, and a purpose dedicated to caring for others.

In essence, these men and women are the ordinary ones. They are you and me. They were once pre-medical students with a dream who became medical students embarking on a journey, then resident physicians gaining the skills and knowledge to become attending physicians. Ultimately, these attending physicians continuing to turn dreams into reality for anxious pre-medical students.

This is the journey.

The Importance of Five Minutes

anesthesiology, medicine

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.

 

From Beacon to Shadow: The African-American Community is Waiting…

adversity, medicine, politics, Race, Uncategorized

“‘More blood! Stat!’” I read. The first line in “Gifted Hands.” As a 15-year-old African-American student aspiring to one-day practice medicine I could barely put down the book my mother gave me. The story of Ben Carson MD—many believed to be the guiding light if you were poor or African-American or academically challenged—was the beacon illuminating a journey from adversity to achievement. The first words in “Gifted Hands” by Ben Carson, MD sets the scene within an operating room in 1987 at the Johns Hopkins Institution in which a medical milestone occurred. Two 7-month-old conjoined twins requiring copious amounts of blood, twenty-two hours of procedure time, a seventy-member team led by him and gifted hands resulted in a successful separation of two Siamese twins—Patrick and Benjamin.

 For Dr. Carson—one of the most academically impactful members of the African-American community—the fall from grace has been anything but subtle. When questioned on May 21st, 2019 by Congresswoman Porter he was asked to define a basic housing term—an REO (Real Estate Owned)—a term used to describe a class of property owned by a lender after an unsuccessful sale at a foreclosure auction. Seemingly unknowing of the term he responded with “Oreo?” at first to which he needed clarification—a surprising response in his position as Secretary of the United States Department of Urban Housing and Development (HUD). Dr. Carson once pillared his accomplishments on the power of knowledge. Now—dismissivae of a fundamental term a person in his position should use commonly this is in stark contrast to the image the black community grew up honoring. One contemporary of the once-esteemed surgeon noted he knew firsthand what Dr. Carson went through and it was nothing short of incredible. But watching his devolution has been a pitiful sight to see.

This playbook has not changed and still illuminates the story of a poor black kid from Detroit overcoming multiple barriers—poverty, academic strife, and a system constructed against him—to become director of pediatric neurosurgery at the Johns Hopkins Hospital and perform the successful separation of 7-month-old Siamese Twins when others said it could not be done. Few African-Americans, in any field, have come from very little to achieve such success. In the last chapter—entitled “THINK BIG”—Dr. Carson writes how each letter illustrates an important piece to success. The ‘K’ stands for ‘Knowledge’ which he defines as “‘… the key to all your dreams, hopes and aspirations. If you are knowledgeable, particularly more knowledgeable than anybody else in a field, you become invaluable and write your own ticket.’” Where have these words now gone? Once so important he wrote them in a book to inspire generations to come.

A man who once changed lives with words and saved lives with actions has now perished to an online trend seemingly devoid of the basic knowledge required in his current position. The surgeon who changed history in 1987 in that operating room in Baltimore, Maryland will forever be remembered by the African-American community, but the man we see today appears to be a shadow of his former self—at best.

This is a perpetual discussion intertwining history, race, culture, politics and medicine. Some of my colleagues may not agree but I desire a return from the former Ben Carson MD.

I declare to you Dr. Carson it is never too late to give a young woman of color, who once wrote to you because her mother like yours was a maid, hope and promise that she too can make something out of very little. I declare to you Dr. Carson that there is a young black male facing academic hardship who needs you now. I declare to you Dr. Carson that the African-American community is waiting…

 

A Beloved Team & A Beloved Mentor

Mentorship

The last time the Cleveland Browns won, I texted Dr. Kevin Olson.

During the 2016 season, I arrived very early one morning, to a small clinic on the West Side of Columbus. As I knocked on the side door, I was greeted by a middle-aged red-headed woman named Tina. This was Dr. Olson’s right-hand woman–sweet as pie but tough as nails–knowing exactly how to give Dr. Olson a dose of his own medicine. She tried to prepare me for what would happen next, but none existed. The back door to the clinic flew open, entering a man yelling what I heard as offensive football play-calls, and the more I got to knew him, it became the most accurate assumption. After he sat his black briefcase down in his office, I went to greet him. “Good morning, sir. My name is Jason Campbell.”

“Jason Campbell, the quarterback?” he posited.

“Something like that, sir” I smiled.

I felt automatically accepted. Jason Campbell, my namesake, had played for the NFL Cleveland Browns at one point in his multi-team career. From that day forth, I was the former QB from his beloved football Browns—young Jason Campbell—as he referred to me. Each day Dr. Olson would share a piece of Browns’ history, which included rattling off the entire list of players who once carried the reigns for the Browns.

Sipe. Kosar. Ryan. Graham. Couch. Nelsen. Phipps. Plum. Anderson. Testaverde. McDonald. McCoy. Weeden. Frye. Hoyer. Kizer. O’Connell. Holcomb. Quinn. Ninowski. Dilfer. McCown. Garcia. All men who have hurled the pigskin for the Browns for at least 10 games and Dr. Olson knew each one, their college institution, and their NFL winning percentage (occasionally off by .1).

Every day in clinic was filled with yelling, laughter, frustration and insight. Once, after we had addressed a patient’s rotator cuff tear with multiple physical exam maneuvers, the patient went on to list four or five more problems he wanted Dr. Olson to assess. “You just tore up, from the floor up, aren’t ya?” Dr. Olson said, aloud. With no delay, the patient responded, “Yes sir. I am!” Dr. Olson’s patients had come to love his lighthearted demeanor interwoven with the knowledge of a medical savant.

For me, these little moments have become threads of memories, which are woven into a picture that show the legacy of a great man. A man who embodied the true character of a doctor. Family physician trained, Dr. Olson received a master faculty appointment by Ohio University for his exceptional contributions to clinical training in this sphere. But there was more to Dr. Olson than any award could describe. He made his patients feel whole even when they were the most ill, just like only a die-hard, ever hopeful Browns’ fan could. I walked into countless patient rooms where the entire family had been treated by Dr. Olson—grandmother, daughter, and granddaughter. This all-encompassing trust was shared by more than a few in the community.

If I wasn’t sure of it before the memorial service, I was absolutely certain of it after. Lines and lines of people flooded the funeral home: from the bustling main hall, the filled lobby, and through the parking lot. Multiple photographs of Dr. Olson and his wonderful family, friends, and colleagues were on display. The most lasting one…the one of him in his Cleveland Browns sweatshirt.

A beloved physician proudly representing his beloved team.

A few weeks ago, as I watched Baker Mayfield perform in his splendid brash manner, as he had done for the Sooners of Oklahoma, I knew a cheerful Dr. Olson was reliving the 1986 days of Bernie Kosar, with an incomparable grin on his face. Finally, his team looked like the team he grew up loving.

For me, Thursday September 20th, 2018 was more than a football victory & more than a team overcoming the weight of the world; it was manifested joy by a beloved and unforgettable man.

After his passing, it is near impossible to fathom a Browns’ win without imagining Dr. Olson’s excitement. I always had difficulty understanding his love for the Cleveland Browns with what I saw to be their errors, burdens and faults. But, now I realize those were the exact human qualities that made him love his team and his patients. As a physician, his passion for his patients—through their sickness, addictions, and infections—gave him purpose so, they too, would heal again.

 

“Every Scar On My Face Is Worth It”

adversity

In London, an unexpected head injury led me into the hands of a plastic surgeon.  When I was rushed to the hospital via ambulance to receive the services of the National Healthcare System—the very institution that I had come to England to study—I felt nervous and frightened.  Countless questions swirled through my head as I attempted to assess the trauma I endured.  All of my questions were ultimately answered by the confident and charismatic plastic surgeon who ultimately mended my lacerated head.  The way in which he explained each step before executing it gave me much needed comfort that night.  His passion for his job and his expertise were evident, but even more so was his ability to treat me as an individual. I have no recollection of this doctor’s name nor could I spot him in a crowd; however, my perception of this man epitomizes a good doctor—someone who is passionate, a healer, and gives positive reactions to unfortunate actions.  I will not only be forever grateful to this physician, but I will forever remember what he did for me in hopes that I can do the same for someone else.

“Code99.” I heard on the overhead speakers in the hospital. Politely and quickly, I excused myself from the patient I was interviewing. Rushing to the front of the Emergency Department, I met my attending physician who had just grabbed the orange airway bag. Together we began rushing to the elevator as a set of nurses followed briskly behind with the stretcher and backboard. He clicked the basement button, and moments later the elevator doors opened. As I stepped out I saw a man on his knees, a puddle of blood adjacent to his limp body.

“Jason, Jason, are you ok?” I flashbacked to that night in London where I had received my very own head injury, when it was my shock, my limp body on the floor with blood adjacent to me.

“Does anyone have a pair of gloves,” I yelled down the hall as more people began gathering around to see what all the commotion was about. “Yes, Doctor… here,” a gentleman handed me a box of latex gloves. I put the gloves on and removed my stethoscope as I asked one of the nurses to hold it for me. Coming up behind the gentleman, I introduced myself and told him I was there to help him. I pulled him up and onto me as I laid us both onto the stretcher. Once he was safely on, I slid myself out moving to the head of the stretcher where I supported his neck as we rushed up to the ED triage area. After we stabilized him, we sent him to the CT scanner to ensure there was no internal bleeding in his head. As he came back from the CT scanner, he was now more lucid but still unsure of what had occurred. I explained to him that we observed the video footage in the hospital and it was highly possible he had suffered a seizure. I moved the loose gauze that was covering his head wound and ½ of his left eye. A 5 cm wound 2 inches above his left eyebrow looked back at me.

“Hey, I’m one of the plastic surgeons here. I hear you had a little accident. Don’t worry, I’m going to fix you right up.” One of my classmates held my hand while my mother was on the speaker phone with another one. The plastic surgeon began numbing the skin to circumvent the wound he was about to suture on my left eyebrow.

“Hello sir, I am Jason again—one of the new resident physicians here. You’ve got a decent size gash above your left eye, but don’t worry. I am going to fix you right up,” I told him as the nurse began cleaning the wound. I extracted the bupivacaine with one needle, then switched the needle on the syringe to one I could use to inject the numbing medication emulating the plastic surgeon from nine years ago. Then I grabbed the nylon suture, the needle driver and began. One suture at a time, I worked diligently and judiciously as my attending peered over my shoulder with a look of approval on his face. Five sutures later I was proud of my work. Well, I was truly proud of the many attendings, residents, and senior medical students who took time out of their hectic schedules to teach me, show me, and create for me the ability to succeed that day.

When I was done, the patient stretched out a smile on his face—he told me I had done a good job today and thanked me. His wife thanked me. And I thanked him for his service to our country and for allowing me to take care of him.

I peered back over my personal statement from medical school when I got home. I read, “I will not only be forever grateful to this physician, but I will forever remember what he did for me in hopes that I can do the same for someone else.” Today was that day. I did what he did for me.. for someone else.

Three Men, 1 Goal

Uncategorized

“Our chief want in life is somebody who will make us do what we can.” 

— Ralph Waldo Emerson

All the success I’ve had in the past, present, and future, could not and cannot be done without the love and support of my family and friends. The special ones who have guided me are true mentors. Here’s how I met one of them.

I could barely make out the back of his shirt that read, “Princeton Track & Field,” but I didn’t need to read it to know this gentleman was a runner—his telltale build and strut as he left the track were clear as day. Unsure if I’d see him again, I slowly jogged behind him until I was within hearing range. “Hey, did you run track for Princeton? I’m an 800 guy here at Emory!” He responded, “I did. Now, I’m a med student here.”

I’ve learned many different things in my life, but one thing I hold to be true is there is no such thing as coincidence. Immediately, I asked if we could meet up as I told him he was exactly where I wanted to be in a few years. How rare is this? To have a future you stand in front of you willing to meet, and as I would find out in years to come, equally willing to help. But what if I hadn’t chased after Alexis (Dr. Tingan) in that moment? What if I had hesitated? One slight moment of doubt could have closed the path to a guide and friend, one never to be crossed again. My strong desire and willingness to become a physician may have led me there alone, but as the parable goes, ‘a man once believed he’d survive flood waters because he prayed to God to save him. After turning down a boat, a canoe and a helicopter he sadly died and when he arrived at the gates of heaven, God told him that he sent those people to save him.’ God puts people in our life with a purpose. Lex was one of those for me. Our shared interest in running and passion for medicine established a natural relationship, and he has been able to help me choose the appropriate undergraduate class schedules, select medical schools that would be a good fit for me and to navigate the medical school application process. Having run the same events in college, we shared in our perils, our accomplishments, and our goals.

For success meeting a mentor: establish a relationship first, know your weaknesses and your strengths, be cognizant of the schedule of your potential mentor and be clear in outlining one’s needs.  Fast forward…

The lessons I learned from Alexis were put in practice for someone else. Preparing for a lengthy heart physiology and anatomy study session at the library, I couldn’t help noticing a young African-American undergraduate student intensely studying at the adjacent table. It was about 9:30 PM on a Saturday night and it was obvious he had been at that table for quite some time. Peeking over his shoulder as I walked to the bathroom, I saw him writing down notes from an organic chemistry book. Before I returned to my seat, I excitedly approached this young gentleman and through our conversation, learned that he aspired to attend medical school. Without hesitation, I offered to mentor him through the long and arduous process from the pre-medical courses to the application and interview process. He hesitantly gave me his email and a few days after, I emailed him to which he eventually replied. I am not sure if he was shocked by a stranger approaching him or by the idea of having a stranger offer to mentor him. As we grew closer, he admitted to me that he had never had a mentor. I don’t know if he was afraid to ask before, lacked the self-confidence or simply had never had someone offer their assistance? But I knew if he had made it this far “alone” then, within, lay had an incredible self-drive. Growing up in Houston where he attended public school and then matriculating to The Ohio State University where he earned merit-based scholarships, he progressed without anyone in the form of a mentor. How many others feel this way? Black? White? Male? Female? Mentorship is hard to obtain, but easy to bestow upon someone if it’s in your heart. As the application cycle approached for Phil, he showed me his list. There were good medical schools on the list, most of which were in his home state of Texas, but after seeing his stellar GPA and multiple leadership/volunteer experiences, I looked him in the eye and told him, “You’ve got to apply to Harvard School of Medicine! Whether or not you go there, there aren’t many of us who have ever been granted an interview at such a prestigious institution.” I also added other schools to his list opening his horizon, reminding him to believe in himself and to believe in his potential. Phil has just finished his first year at the University of North Carolina School of Medicine—a renowned and highly regarded medical school.

Phil emphasized, during a recent conversation: “Jason, without you, I never would have applied here…” I could only reply “Phil, together we go farther. Remember that!”

 

Sent From My iPhone

Uncategorized

“We have reviewed your application once again for admission to our school of medicine and we regret to inform you that you have not been granted an interview at this time.” I scrolled down & it was signed by the Director of Admissions—a name with M.B.A behind it. And then I scrolled down further and read the signature…

“Sent from my iPhone.”

A tear streamed down my right cheek. I felt like a volcano that had erupted—full of frustration, anger & sadness. I was devastated. The words, “Life is hard for those who dream” kept scrolling through my head. I was in the downstairs bedroom of my parent’s home. At that moment, it was very likely that my mother was upstairs above me, just a few feet away. I don’t know for a fact, but I felt like there was a mirror image of myself upstairs at the dining room table in the form of my mother. Of all people in the world, she was the one I did not want to disappoint desiring so badly to carry on the legacy she has scuplted.  The first African-American woman in the country to receive a Ph.D. in Epidemiology. Despite her many accolades, at that point in time I think the only care in the world she had was for her son to be accepted into medical school. When I had graduated from Emory and was enthusiastically off-track, if you will, she spoke with one of her colleagues; a medical school advisor she knew well asking that he bestow upon me guidance and direction. And was it too simple to think the University that she works so hard for so many hours of the day, leading their mission of improving health disparities would at least offer an interview to her son? By title, She is the Associate Dean! If having one’s parents as alumni can help secure legacy status, what was going on here? Was that not customary? I rolled back onto my bed in the fetal position. What’s next? What could be next? This is the institution where I envisioned my white coat ceremony, match day ceremony and graduation occurring. But all I can remember is the thoughtlessly blasé “Sent from my iPhone.”

I was like many other pre-medical students at the time. I felt that since I had gone to a stellar, well-known undergraduate institution, the same would occur for my medical school education. But one thing I had to recognize was that your undergraduate institution doesn’t automatically lead to the medical school you enter—nothing is guaranteed. I have learned many things as I approach thirty years old, but nothing as sincere as the notion that entitlement is precarious, perhaps even dangerous. We fall into these easy expectations and if they do not come to fruition, we fall apart & don’t know how to pick ourselves up again. The moment you feel like you deserve something is the moment it slips through your grasp. In that very moment when you look up wishing & praying a leaf falls that was meant for you to catch, it may or may not but let me tell you about my leaves. I interviewed at Ohio State on January 22nd. Heading to the airport, I looked back at the large OSU Wexner Signage feeling as though I was actually leaving my home rather than my interview. A few weeks later, I signed into my newly-created Ohio State portal only to find a “wait-listed” next to my name. Many months later as I was tutoring a high school student, my phone began buzzing on the desk. I quickly uncovered it and saw a number with a 614-area code. There it was, the call I had been waiting so impatiently for. The director of admissions at Ohio State College of Medicine asked me, “Jason, are you still interested in Ohio State?” “Yes,” I exhaled. I felt like I had been holding my breath for 5 months and finally I could breathe again.

I drove home one breath at a time.