Indie Docs: The Podcast!

Our first podcast recording.

Joy has really been the catalyst behind getting this website site started. On a drive home from Minneapolis one day, she started talking about an idea for a blog that could serve as a resource for people interested in global healthcare. She had done a lot of research, figured out how to obtain the domain name, start the website, etc, but she couldn’t figure out what to call it.

She was so excited about the concept; honestly, I didn’t think one thing or the other about it. I liked the idea, but didn’t intend to get involved much. But because I could tell it was important to her, I participated in brainstorming names, trying to help her dig-in to what was driving this desire in her to make a website and blog. Eventually, we came to Indie Docs, combining the thought of indie music (the liberated, do-it-yourself attitude that has changed the music industry over the past few decades and resulted in many of our favorite bands and tunes), and, of course, the concept we are hoping to achieve of being free to pursue global health projects. Like I said though, I thought of this website as her passion project, not mine, or even ours.

Part of my–dare I say it–disinterest, stemmed from the fact that at this time I had commenced my final and toughest year of training as a chief resident. Combine that with the fact that we have a little girl, and at the time, another on the way (who is now here as of September 24th!), and trying to find a job, I didn’t have much mental energy for other things. But Joy’s enthusiasm is infectious and, within the seed of her idea, I started to see the many possibilities in it.

I’ve always been a big fan of talk radio, mostly NPR shows like This American Life, Fresh Air, and Radiolab; eventually I have found my way to podcasts, of course, and I devoured Serial, S-Town, Malcom Gladwell’s Revisionist HistoryMissing Richard Simmons, and many, many others. It’s such a populist art form and a brilliant way to tell stories, share ideas, and explore all the little nooks and crannies that exist in our world. I mean, 15 years ago, would anyone ever have produced a radio show about figuring out why Richard Simmons has disappeared from public life? Or spend a whole series on telling the life-story of an eccentric paranoid genius in Sh**town, Alabama?

Stories have always influenced the direction I think I want to take in life. When I was young and watched Karate Kid, I wanted to take karate. When I saw Top Gun, I wanted to be a pilot. I abandoned both pursuits eventually (made if further in karate than in becoming a pilot). Maybe growing up is choosing a story that inspires you, and sticking with it. It was the story of Paul Farmer as told by Tracy Kidder in Mountain Beyond Mountains that led me to become a doctor. It’s the stories we were both raised on of Jesus physically ministering to the poorest, least powerful, least cared-for that I think serve as the bedrock for why we want to work in global healthcare.

Truthfully, we are just now figuring out how to enact both of these sensibilities and, other than becoming doctors, we haven’t done that much in the way of caring for the poor other than a couple of short-term trips, relief efforts from afar, small amounts of charitable giving, etc. We’ve been trying to get through school and training, but now that we are finishing up with that part, we are starting to look at each other as we enter our mid-to-late thirties and say, If not now, when? And  beyond that, How do we start?

I don’t know how or when the idea of doing a podcast for the site came to my mind. There was no inciting event, or thunderbolt from the sky. I’ve always tried to learn the stories of people working in global neurosurgery. When I was a medical student, I went to the CURE hospital in Uganda, and learned about Dr. Ben Warf, who was the first neurosurgeon I came across that showed me neurosurgery was not only possible, but could thrive in an low-resource setting.  When I go to national neurosurgery meetings, they almost always have a session on international neurosurgery efforts, and I am amazed during the presentations by the intelligence and effort of people like Drs. Kee Park, Dilan Ellegala, and Michael Haglund who are changing the paradigm of global neurosurgery. My former senior resident, Will Copeland,  made the decision to go right out of residency to live and work in Kenya (with his wife and six kids!), and has shown me it’s really possible.  Joy and I think these stories, and stories of people like them, hold the key to figuring out how we are going to achieve our ambitions of joining the global health community.

And so the past few weeks, I’ve learned about microphones and pop-filters, Garage Band and Zencaster, how to use the Seriously Simple Podcasting app for Word Press (how to use Word Press at all really), how to register a podcast with Apple, make a logo, and on and on. I’ve also learned that I am as passionate about this as Joy is, that it is our project. We set out together to become physicians, and eventually a neurosurgeon and trauma surgeon, so we could gain skills we enjoy and that would be useful in global healthcare. Now we are setting out to discover how to employ them, and as part of that, finding, sharing, and learning the stories of people who are already doing just that in a variety of ways.

The podcast will include episodes in which Joy and I tell our story as it unfolds, interview others about their experiences, and reflect on how these interviews are shaping our thinking about what we are going to do next. We have several great interviews lined up already, starting with Sean Dupont, a general surgeon who Joy did residency with, who is just getting started working in Niger,  as well as Will Copeland and Kee Park, both of whom I mentioned above. We will talk about how they manage their lives and families, finances and careers, and what inspires them to do the work. Stay tuned!

~ Josh

 

 

Interested in humanitarian medicine? How to choose a specialty.

A Daunting Choice

The decision to select a specialty in medical school is one of the most exciting and intimidating moments in our careers. Many factors and external influences weigh in, even among students planning for more conventional career paths than us with global health ambitions. In the context of global medicine, won’t your specialty have different presentations of disease and treatments, as well as potential projects for research? Certainly, your case list as a plastic surgeon in the U.S. will look quite different than in a developing country. Some specialties have been involved in the public health realm for decades, like pediatrics and infectious disease, while others are recently emerging as population needs have been brought to light, like surgical oncology. So how do we commit to just one specialty?

How We Did It: The Path to Specialty Isn’t Always a Straight Line

As Josh and I entered medical school, we had many discussions about our big-picture goals and what specialty we should choose. We talked about the fields with big impact factors, thinking seriously about fields like obstetrics and infectious disease, as these areas seemed to have an obvious impact on large populations and seemed to be popular choices for others interested in humanitarian projects. Like many students in our class, we attended all of the interest groups for medical specialties, largely for the usual free lunch offered, and I genuinely could see myself doing a variety of things as 3rd year approached. Once into my clinical rotations, I mostly felt happy and immersed in whatever rotation I was on, with a few notable exceptions. I preferred the hospital to clinic settings, and preferred high acuity to chronic illnesses. I enjoyed working fast with high intensity.

Because I had amazing mentors in the field, I decided to pursue cardiac surgery. At the same time, my husband was strongly favoring neurosurgery; he talked often about how he worried that his specialty would not be useful in underserved areas. My perspective was that we should just choose the fields we were most passionate about, and make a way to provide the care where it didn’t already exist.

We had many conversations that seemed to go round and round about these topics. Nearly every car ride lasting longer than 15 minutes, this was the discussion. What should we become? Was that choice consistent with our hope to become humanitarian physicians?

Our 4th year, Josh did a sub-I month at a Cure Hospital in Uganda, working with the neurosurgery staff. This rotation helped solidify his confidence that there was plenty of potential for global neurosurgery projects.

We both matched into our dream program at Mayo in Rochester, MN. He in neurosurgery and me in general surgery with intentions to pursue cardiac. I went on a trip to Ukraine with an amazing organization called Novick Cardiac Alliance, and I saw first hand a successful project to elevate care in an underserved country. They had similar projects all around the world, and I loved hearing the accounts from the nurses, intensivists, and surgeons, about their different locations. This experience was formative. It showed me first hand that sophisticated, cutting edge, and resource-intense surgical care was possible anywhere. However, the irony of this trip was that the actual cardiac surgery that was happening was less interesting to me than the bombing of the Ukrainian city of Donetsk 50 miles away, with possible traumatic injuries that needed tending, and the illusion of cardiac surgery as the perfect fit for me began to crack.

In the cath lab in Kharkiv, Ukraine.

Within the year, I decided, definitively, to switch to Trauma and Surgical Critical Care as my specialty. It’s a perfect fit for me for many reasons, and is certainly one of those fields that has relevance in any setting around the world. Trauma is emerging as a hot topic of discussion for global surgery funding and improvement projects, as it is the leading cause of death and disability among young people. I do admit that this is one of many aspects that attracted me.

One detail I would like to mention, but not dwell on (I’ll save the long story for another post), is that I personally experienced a traumatic injury in a motor vehicle accident in high school, which was extremely formative for me. It undoubtedly changes my perspective when caring for my patients. However, I resisted going into the field of trauma surgery for a long time even though it weighed heavily on my mind. Having pondered this for a while, I think that I was rebelling a little bit against the idea of letting this negative experience steer my life in such a way. Ultimately, I think that the influence of this incident will enrich my passion for the field and help me to connect with my patients on a personal level.

Another attractive aspect about my field is that because it encompasses trauma care, surgical critical care, acute care general surgery, and elective general surgery, I can be quite flexible in how I work. Not to mention where I work. I can vary my schedule, and every week can be a little bit different depending on if I’m in the ICU, covering Trauma, or doing elective cases. Personally, I think that any job that was the same schedule, 9-5, week in and week out, would lead to burn-out for me. I like variety.

Josh has never waivered from his decision of neurosurgery, and he has had the benefit of observing one of his former chief residents, Will Copeland, MD, move his family to Kenya to work at Tenwek Hospital. Dr. Copeland is doing outstanding work there and is a great role model for Josh.

Observations

As I was discussing this post with Josh, he quickly surmised, “I think I know someone in every surgical subspecialty doing humanitarian work.” We are lucky to be in a place where our colleagues and friends have these shared ambitions and have launched into humanitarian careers around the world.

I’ve also benefited from many connections in social media, particularly Twitter, where countless organizations representing the full variety of medical specialties are represented. Online journal clubs are becoming more common, as are twitter-hosted journal club discussions (@MayoGlobalSurgJC for one example). To see the many excellent accounts I follow on twitter, see my list under my profile at @IndieDocs1.

Summary

In the end, I chose the specialty that suited my personality and interests, as did Josh. The simplest way I can describe my decision is that I chose what sounded like the most fun to me, and I’m very happy and confident with the choice. I took into consideration personal as well as professional goals. There is no doubt that we will both have abundant opportunities to serve patients and elevate local surgical care if we remain dedicated to that cause. Therefore, the answer to the topic, “How to choose a specialty,” is both simple and complex. Pay attention to the little thoughts and reflexes in your mind as you encounter diseases and treatments in each field, and be honest with yourself about what truly interests you. Allow your past experiences to form the type of doctor you are going to be. Be open minded about the possibilities of providing advanced-level medical and surgical care in low and middle income countries. Seek mentors and role models, but don’t choose a specialty solely because you like or are encouraged by your mentor. Pick what you can do all day every day, and also what will allow you to have a sustainable lifestyle and work schedule.  Don’t be afraid to change directions as you obtain new experiences and perspective. If you choose a specialty in which you can work passionately and sustainably, you will undoubtedly have a significant impact as you serve your community.

What weighs into your decision for pursuing a specialty?

Do you have any additional insight or suggestions for young trainees?

Please comment below!