Stories of surgery, clarity, and grace [PODCAST]

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“My mother, bless her ninety-year-old heart, is slowing down. The things that made her happiest — getting to church, visiting friends, taking walks, and wandering the aisles in the grocery store —are increasingly difficult. She worries that her lack of energy will soon make every activity impossible.

It is 2005 and she is living alone in Chicago, about ninety miles from where my wife and I live. My father died suddenly the year before, and she is settling into the life of a widow. She has always been very healthy and upbeat, but she’s become more and more fatigued. ‘What do you think it is?’ she asks. ‘Do you think it is my heart?’

‘Let’s find out.’ We arrange an appointment with her internist. Sure enough, her heart rate is uncharacteristically slow and does not speed up when she walks or moves about.

‘I believe you need a pacemaker,’ her doctor confirms. ‘I’ll arrange a visit with a cardiologist.’

This gives my mother something new to worry about. ‘I’m too old for any procedures, don’t you think?’ she says. ‘Do you think I could tolerate having a pacemaker?'”

Bruce Campbell is an otolaryngologist who blogs at Reflections in a Head Mirror. He is the author of A Fullness of Uncertain Significance: Stories of Surgery, Clarity, & Grace.

He shares his story and discusses his KevinMD article, “Mom’s new pacemaker: a story.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on our show we have Bruce Campbell. He’s an otolaryngologist and the author of the book A Fullness of Uncertain Significance: Stories of Surgery, Clarity, and Grace. There’s an excerpt from that book on KevinMD titled “Mom’s new pacemaker: a story.” Bruce, welcome to the show.

Bruce Campbell: Thank you, Kevin. Great to see you.

Kevin Pho: So we’ll get into your book and excerpt a little bit, but first off, can you share your story and journey to where you are today?

Bruce Campbell: I started working in a hospital when I was about 15, as a volunteer initially, and I was an orderly in an emergency room and operating rooms back in the Chicago area, where I grew up. That let me see medicine from all sorts of different perspectives: the surly surgeon from the perspective of the emergency room orderly, and all my time through medical school and then residency and finally fellowship. Just lots and lots of stories.

That’s one of the things about medicine that’s been such a fascinating thing to me: We are completely encased in stories constantly, and it’s just a matter of finding the time to pick through and find the ones that are most inspirational to us. That’s been the journey that I’ve been on through a 45-year career in medicine, living the dream, really, and gathering stories along the way.

Kevin Pho: As you reflect on your decades-long career in otolaryngology, what would you say are some of the biggest changes over those decades?

Bruce Campbell: Well, that’s wonderful. My practice is almost entirely cancer, or head and neck surgery, but as I’ve watched within the specialty, our ability to make a diagnosis has so incredibly changed with the advent of imaging. When I started, we just basically had head CTs, and that was about it for digital imaging. The advent of MRIs and PET scans and all of the functional scanning has been really amazing. In my world of head and neck surgery, the ability to do reconstruction with microvascular techniques has really been a game changer, and now there’s the advent of robotics and endoscopic procedures. So just being able to do very precise surgical procedures in ways that we really couldn’t do back in the ’70s.

And there’s been a huge paradigm shift in how cancer is treated. When I was in training, we were doing a laryngectomy about once a week, and we don’t do laryngectomies very often anymore except in salvage situations, because of the advent of much-improved radiation treatment. So the image-guided treatments, as well as the combinations of much-improved chemotherapy and targeted therapies, have been a game changer for our patients in survival and quality of life. It’s been a lot of fun to watch that happen, because I have the perspective of seeing how some of our patients just suffered so terribly, even if they were cured, years ago. The quality-of-life side effects were so awful, but now we can really do a much better job with managing the cancers as well as helping patients survive and thrive afterwards.

Kevin Pho: And again, from your perspective as an otolaryngologist, what would you say are some of the remaining challenges, or some of the biggest challenges, facing your field?

Bruce Campbell: In the cancer world, the problem with all cancer trials is that the interval from the initial idea to the final results from a big phase 3 randomized clinical trial can be seven to 10 years. In the meantime, there’s been so much progress in the molecular biology as well as just the management of cancer, and so few patients are entered on trials that we really don’t optimize our ability to care for these patients or provide the best, most cost-effective, and most effective treatments. So I would love to see ways that we get more patients involved in trials, as well as find better ways to use the treatments that we have to help people.

I think the technology will continue to expand. Technology tends to find a use even if it’s not always the best way to do things, and I think finding better ways to focus expensive and difficult-to-learn technology on patient care is going to be relevant. My son is actually an otolaryngology graduate who is currently doing a fellowship, and his practice will be quite different 40 years from now than my practice was 40 years ago. So it’s fun to watch that transition time.

Kevin Pho: All right, so let’s transition to your excerpt and book. Once again, your book is titled A Fullness of Uncertain Significance: Stories of Surgery, Clarity, and Grace, and there’s an excerpt from that book on KevinMD titled “Mom’s new pacemaker: a story.” Now, Bruce, for those of you who get a chance to read your excerpt, can you just walk my audience through it and share the story of why you decided to write that particular one?

Bruce Campbell: In writing in medicine, some writing is very difficult and trying and stressful, and some of it’s just a lot of fun. This was a piece that was actually a personal experience. Several years ago, my mother was in a hospital a couple of hours away from where I was living at the time, and she needed a pacemaker. So I went down to be with her as she had the experience. She stayed overnight, and the next morning the cardiologist’s nurse practitioner came in to give us a demonstration of how she would take care of the incision and the things to watch out for, and handed us a brochure that said all the different things that she needed to watch out for.

It’s a very practical experience, but basically, when you have a pacemaker, they tell you, “Don’t use a stun gun. Don’t use a jackhammer. Avoid high-voltage equipment. Be careful around high-powered motors.” And my mom was 90 years old at the time, quite frail but lively, and we really had quite a conversation. I stressed to her that I did not want to find out that she had become a lumberjack or a police officer, because it was just too dangerous at the time because of the potential damage to her pacemaker. We carried that through, and she really lived a much better quality of life because of the pacemaker in her final years, but we actually had lots of fun talking about the things that were on that list that she needed to avoid.

Kevin Pho: So as a physician yourself, going with your mom, tell me a little about that experience.

Bruce Campbell: Well, I have to say that the one thing I remember most about that was that the cardiologist actually never came in to speak to us after she had her procedure done. That is something that I have talked to my own residents and students about. There is nothing as important: After you’ve done a procedure, after you bill somebody, after you’re going to collect money from their insurance company to do something to them, you must make that personal connection. That’s just one of those experiences that stuck with me.

We certainly got lovely care from the nurse practitioner, but the woman, the cardiologist who actually put the pacemaker in, never touched base with us afterwards. That procedure was done in the hospital where I’d spent years working as an orderly and as a volunteer. I knew the people there, and it just felt a little disrespectful not to have that moment with the cardiologist. But that said, everything went fine, and she did just great.

Kevin Pho: Your book is a collection of many of these stories, and you’ve contributed so many stories on KevinMD for the past many years. So how do you go about collecting, remembering, and deciding which stories to include in your book?

Bruce Campbell: As a writer, and I don’t really view myself much as a writer, more as a physician who just happens to be around stories, I tend to write about things that just really grab my attention for the moment and make me sort of stop and go, “What just happened there?” Those are the things that I’ll jot down a note here, or maybe I’ll put something in my journal or put it on a note card and stick it in my pocket, and I may go back and write about it later on.

I’ve been fortunate to have places to share my stories. I was able to have a blog on the hospital’s website, you’ve been kind to share some of my stories over the years, and I’ve got my own website now. I feel that having the chance to write the stories out and share them has been a gift and a joy to me, and people have been very nice and responsive to the writing.

So when a story catches me, I’ll go home and begin writing about it, and I never really know what direction the story is going to take once I start writing and editing. But then I get to the end of it, I whittle it down to its bones, and then I’ll put it out and just see where it goes. I’ve got two or three hundred of those things that have happened over the years. I was fortunate enough to have the opportunity to compile about 60 of them into this book collection, and that’s where we are now, the ones that probably caught my attention the most. There are others, and one of these days maybe they’ll see the light of day as well. But it’s just been a great joy to have this as a way to reflect and to remember and to celebrate and validate some of the experiences I’ve had over the years as a physician.

Kevin Pho: Are there any common themes that run through the stories that you included in your book?

Bruce Campbell: No. Maybe what an idiot I can be. I mean, in medicine we’ve been told that there’s a hierarchy, and the physicians are at the pinnacle of that, and everyone else is trying to do us damage and harm. And I found that I learned so much from my patients. I learn from the nursing staff, and I learn from my students. There’s always a moment where I can get more insight into my own weaknesses and feelings.

I actually wrote out a complete story about a terrible mistake that I made several years ago, and I contacted the family, which to me is very healing personally. They were not interested in having me share that story, but I did reflect on it, and one of the essays in the book is a bit of a reflection on that experience. So we are not perfect, and those things that cause us moral injury are real, but writing about them has actually been helpful to me, and I think it’s also helpful to others.

Kevin Pho: Did you have a background in writing prior to writing all those blog posts? Because I’m sure a lot of physicians do want to share their stories but may not be able to articulate them on the computer or on paper.

Bruce Campbell: No, I really didn’t. I liked writing when I was in high school, but I was a biology and chemistry major in college, and the only creative writing you do between graduating college and graduating medical school is two personal statements. Those were opportunities for me to do a little writing. The writing came just sort of accidentally over the years, so I guess I did the book partly just to show that anybody can do this, and I would encourage other physicians to take this on as well.

I mean, I always start writing, and I never know where an essay is going to end up, and I always learn something in the process, and that to me has been healing. So I guess I would encourage people to give it a go, because I’m not a great writer, but I love it. And if you find that you enjoy it as much as I’ve enjoyed it, you’ll probably have a book at the end of your experience as well.

Kevin Pho: We’re talking to Bruce Campbell. He’s an otolaryngologist and the author of the book A Fullness of Uncertain Significance: Stories of Surgery, Clarity, and Grace. Now, for those clinicians and medical students who read your book, what would you say are some of the biggest lessons that your book can share?

Bruce Campbell: Well, I hope what they take away is that medicine is a hierarchy in the sense that there has to be a leader of a team, but the teams are multidisciplinary, and I’ve tried to point that out at any opportunity I had. I’ve learned so much from others along the way, and I’ve also learned that narrative is a critical piece of every patient encounter. We are taught to go in and nail down a history of present illness and the chief complaint and those kinds of things, but stories emerge. If the first question you ask when you see a patient is “Tell me your story,” you get a much different response than if the first question you ask is “Which ear hurts?”

So I try and help students understand that it’s gathering the story that tells us more about the patient within the context of his or her illness and suffering, and then our job is actually to accompany that patient. We pay attention to their suffering. We learn to represent that suffering, either in a progress note or in an ability to tell the story back to the patient, so they know that we understand what they’re going through. And then we affiliate with the patient, and we are charged with making their suffering disappear as we accompany them.

Those are the things I know. The precepts of narrative medicine are the things that can drive a clinical practice or a training program in a way that will help students and residents become better physicians who are more compassionate and caring.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Bruce Campbell: Oh, gosh. First of all, everyone should send an essay to Kevin, because I think you will be amazed at the responses you will get from people who read it. It’s a wonderful community, and I’ve been pleased to be part of it. It doesn’t have to be writing. It can be anything creative. It’s so healing for physicians, and those that I’ve worked with who have had the opportunity to write or paint or do sculpture or poetry or any sort of the creative arts, or even just take time out to read a solid piece of literary fiction, all of those things can be healing and make us better physicians, because we learn to listen to ourselves as well as we learn to listen to our patients.

Kevin Pho: Bruce, thank you so much for sharing your time and insight, and thanks again for being on the show.

Bruce Campbell: Thank you so much, Kevin. It’s a great honor. Thanks.

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