[humanser] MEDICAL SCHOOL

[JD Townsend]

I am sharing an article I received.  It demonstrates what can be
accomplished with the right philosophy and determination.  Some of you
may have seen this already.
--


Seeing potential
Susan Lampert Smith
Photos by Jeff Miller


When the UW’s medical school gave Tim Cordes a chance, he exceeded
expectations,
teaching others that being blind needn’t destroy one’s dreams.
with guide dog
With guide dog Bella leading the way, Tim Cordes talks with physician
Michael Peterson,
left, and medical student Dhaval Desai, behind, as they do a morning
round of patient
consultations at UW Hospital.
A morning in the trenches of the Psychiatry Consultation Service at UW
Hospital is
like a visit to a MASH unit of the mind.
Medical students scurry out the door to evaluate hospitalized patients
who are suffering
from both psychiatric and medical illnesses, and then return with their
observations.
When medical student Tabatha Williams MDx’12 describes a patient who
attempted suicide
after her painkiller prescription was not renewed, Tim Cordes MD’04,
PhD’07 reacts
with concern. While the patient is insisting on going home, both student
and doctor
worry about another attempt.
“If nothing at home has changed, and she has no support, why would we
expect things
will be better?” asks Cordes, as he uses a computer voice program to
navigate Google.
He’s looking for a social worker or police officer in the woman’s
hometown, someone
who could ask a judge for an emergency hold and keep her hospitalized
for another
three days.
“Hi, this is Tim Cordes, I’m a physician at the University of
Wisconsin,” he says,
making the first of a string of phone calls before he finds someone
willing to help
on the legal side. That accomplished, Cordes explains to the students
that addiction
often is the end result of misguided attempts to come to terms with
emotional pain.
The goal, he says, is to get the patient to develop “a different
relationship with
[her] pain.”
He signals for his guide dog, Bella. Then dog, doctor, and students set
off through
the maze of hospital floors to see the patient.
• • •
“See the patient” is an inadequate phrase when applied to Cordes, who
has been blind
since boyhood. Yet colleagues insist that Cordes, who has an outpatient
caseload
of about one hundred and thirty patients and oversees psychiatry interns
at two hospitals,
has unique insight into the minds and bodies of his patients. Williams,
a third-year
medical student, says that Cordes is an adept listener who picks up
things from his
patients that others rely upon body language or other visual cues to
identify. For
instance, she recalls, he can realize that a medication is creating side
effects
based on the sound of a patient’s voice.
“His intuition is amazing,” Williams says. “I’m like, ‘Whoa! You picked
up on all
that, and you can’t even see the patient?’ ”
Dean Krahn MD’80, chief of psychiatry at the
William S. Middleton Memorial Veterans Hospital (VA)
, says that Cordes “does excellent physical exams.” Using just his sense
of touch,
Cordes has discovered potentially life-threatening blood clots that
others had missed.
But more important, Krahn says, is his ability to connect with his
patients. At the
VA, Cordes streamlined the process of getting a psychiatric consultation
so that
patients could be seen more quickly, and he is currently researching
better ways
to deliver addiction treatment to military veterans in rural areas of
Wisconsin.
This fall, he will begin a fellowship in addiction treatment at the
veterans hospital.
“Tim is a great role model for patients with addiction issues,” Krahn
says. “With
everything he has had to overcome in his life, it makes it more
difficult for patients
to tell him that they want to quit, that it is just too hard.”
• • •
dictating notes
As guide dog Bella patiently waits, Tim Cordes reviews patient records
and dictates
notes, working with Liz Morrison, a retired nurse and one of Cordes’s
visual describers.
Tim Cordes was just a toddler when his mom, Therese, heard from doctors
at the University
of Iowa that her son had a rare genetic condition called Leber’s
disease. He will
eventually lose all of his eyesight, and he will never drive a car or
pilot a plane,
they said. And they told her to think seriously about putting him in a
special school
for blind children.
“My mom cried all the way home,” Cordes told the Madison Civics Club,
“and then promptly
forgot everything the doctors told her.”
As Cordes gave his speech to an audience of about five hundred last
year, his mother
sat at a table up front, with his wife, Blue-leaf Cordes ’97, PhD’04,
MD’06, and
their two young sons, Peter, now four, and Paul, one.
Just one of Cordes’s many achievements would make most mothers glow. He
earned black
belts in jujitsu and tae kwon do, composed music, learned to water-ski,
and carried
the Olympic torch in 2002.
Cordes graduated as valedictorian of his Notre Dame class in 1998, after
earning
a degree in biochemistry and doing research on antibiotics. Then he
encountered another
group of people who told him he couldn’t achieve his next dream: going
to medical
school. Although he had a resume that would make anyone else a shoo-in,
eight medical
schools rejected him. Only the
Wisconsin School of Medicine and Public Health
  gave him a chance — and then only after some rather intense debate by
the admissions
committee.
When Cordes entered medical school in summer 1998, he was the third
blind medical
student in the United States. Not everyone was convinced he should be
there, including
a fellow student who sidled up to him during his first week and snidely
asked, “What
are
you doing here?”
But Cordes persisted, plunging his hands into cadavers to pull out and
feel the organs,
and earning kudos from surgeons and anesthesiologists alike. All praised
his intense
preparation, which allowed him to place a tube in a patient’s windpipe
correctly
the first time. In his third year, he won “student of the year” honors
from both
the obstetrics-gynecology and anesthesiology departments, meaning he was
the top
student out of one hundred and fifty in those rotations.
Wisconsin made a number of modifications for him. The school supplied an
Optacon,
a machine that converts visual images into raised lines, and a computer
that reads
notes at a frenetic clip of five hundred words a minute. The Iowa
Department for
the Blind, from Cordes’s home state, hired “visual describers,”
assistants who went
through the clinical rotations of medical school with him, describing
what they saw
and fulfilling duties such as guiding him into the operating room while
he held his
sterile hands aloft to avoid contamination. They also accompanied Cordes
through
his stints at rural and specialty clinics, including neurology and
family practice.
And when he was on twenty-four-hour call at the hospital, they slept
there, too.
Liz Morrison, one of the visual describers and a retired nurse, was
there the night
Cordes delivered his first baby. The delivery went fine, except that
Vance, Cordes’s
German shepherd service dog, wanted to be in on the action.
“Basically, Tim delivered the baby and I held back Vance,” says
Morrison, who still
works part time with Cordes, helping him fill out medical paperwork for
his patients.
But what Vance lacked as an obstetrical assistant, he more than made up
for during
Cordes’s psychiatry residency. Krahn, at the veterans hospital, recalls
that he initially
worried about Cordes’s vulnerability, because residents can encounter
seriously mentally
ill patients who can be unpredictable, and occasionally, violent. He
needn’t have
worried.
“Vance was the second-best observer in the room when it was Tim, Vance,
and me,”
says Krahn, who ranks Cordes first. He said the dog was “uncanny” at
being completely
alert to any unusual movements in a room, while looking like he was
totally at rest.
“I didn’t have to worry that anything or anybody would get past Vance,”
Krahn says.
“Vance seemed to know when the interview was coming to a close and would
stand, but
remain right at Tim’s side.”
But medical school, followed by residency, was hard on the old dog, who
wouldn’t
eat when he was at the hospital because he knew he was still on duty.
Vance retired
in summer 2010, and now lives with Cordes’s parents. His new dog, Bella,
a young
golden retriever-Labrador cross, has a decidedly different therapy
style. She bangs
her tail enthusiastically on the floor whenever people enter the room.
And when Cordes
gives her the hand signal, she rubs her head on his lap, giving him a
full body wiggle
of affection.
Cordes says that Bella likes everyone, which helps put patients at ease.
So far,
he has yet to encounter a patient who didn’t want to be treated by a
blind physician,
but he says he would be fine with a patient requesting another doctor,
saying simply,
“It’s about them getting the best care; it’s not about me.”
• • •
computer-translated charts
With earphones in place, Tim Cordes listens to computer-translated audio
of medical
charts as he and a medical team at UW Hospital discuss that day’s
caseload of patient
consultations.
Cordes is a classic Midwesterner, with a low-key style that seems at
odds with his
drive and accomplishments. So let the numbers tell the story: he was
selected for
one of 140 spots in the UW medical school from a pool of about 2,300
applicants.
The
MD/PhD program
  is even more selective, admitting just eight out of 200 applicants.
When Cordes
earned his PhD in biochemistry, he became one of 139 blind or visually
impaired scientists
or engineers in the United States earning doctorates, according to the
National Science
Foundation. Oh, and when he was working on his doctorate, he needed a
way to describe
complex molecules. Because he couldn’t see them, he wrote a computer
program that
uses sound — going up and down the scale, and getting louder and softer
— to explain
the branching arms of a lethal bacterial protein. His software,
Tonal Interface to Macromolecules
  — Tim Mol for short, is available to others who might need it. And his
doctoral
research helped scientists to better understand the virulence of
Pseudomonas aeruginosa
, a bacterium deadly to patients with cystic fibrosis.
If more students could get help that compensates for their disabilities,
they could
achieve what he has, Cordes believes. To share that idea, he addressed
the 2010 National
Federation of the Blind’s convention and contributed a chapter to an
Association
of American Medical Colleges guide to making medical schools more
accessible to students
with disabilities.
So far, no blind students have followed him at the UW’s School of
Medicine and Public
Health, but the school currently has two students with hearing
impairments: Josh
Reiher, who will be in his fourth year this fall, and Steven Tang, who
will be a
third-year student. To accommodate their needs, the school hired three
sign-language
interpreters who have backgrounds in health care.
Patrick McBride MD’80, the school’s dean of students, says that while it
is a major
— and expensive — undertaking to work with students with physical
challenges, he
thinks more medical schools should open their doors because these
students teach
their peers so many lessons.
“The legacy of Dr. Tim Cordes still has a profound impact on our school,
faculty,
and students,” McBride says. “Tim set an example for all of us that we
can overcome
significant challenges with determination, dedication, perseverance, and
the support
of others. Students and I still talk about what he taught us, especially
with his
incredible attitude and preparation for his work. Sometimes when I get
down or think
that something is too hard to do, I think of how Tim would respond and I
just get
to work.”
Because Cordes knew there were some specialties to which he could not
aspire, McBride
says he approached every opportunity — whether assisting with the birth
of a baby,
helping during surgery, or intubating a patient — with a “sense of
reverence and
wonder.”
Dan Albert, emeritus chair of ophthalmology and visual sciences at the
UW, is pleased
to see the shift in attitudes. He recalls serving on the admissions
committee at
Harvard Medical School twenty years ago, when, despite the impassioned
pleas by Albert
and other members of the committee, the school rejected a “dream
candidate” because
he was deaf. Today Albert serves as a mentor for one of the UW’s
hearing-impaired
medical students.
“Not only do these gifted disabled physicians benefit medicine,
sciences, and their
patients, but their classmates learn from them,” says Albert, who is
also a historian
of medicine. “[Classmates] gain empathy for people with disabilities,
and learn a
lesson in courage.”
• • •
Given his achievements, Cordes could have gone many directions with his
career. So
why pick addiction treatment, an area with low levels of success and
high levels
of frustration?
“I think addiction is a good model for understanding all kinds of
self-defeating
behavior,” he says. “To be a good general psychiatrist, you need to
understand addiction.”
And, Cordes adds, psychiatry needs to do better by people who have
addiction issues.
In many cases, he says, they are abusing substances because they have
untreated psychiatric
problems that need attention or because they are in physical pain.
“I think we automatically assume that pain equals suffering,” he says.
“But that
is not always the case. I would guess that Brett Favre was in pain
during his last
season of football, but was he suffering?”
Rather than always seeking to “bring the pain down” with narcotics,
psychiatrists
can help “bring the person up” so the pain is more tolerable, he says.
Back at the Psychiatry Consultation Service, Cordes is talking to
medical students
about having empathy for patients with addiction issues. One student
observes that
a patient is rejecting any psychiatric care, and seems interested only
in “drug seeking”
— obtaining another prescription for pain medicine. Cordes tells the
students that
convincing patients to seek solutions outside of drugs can be the best
medicine.
“People with substance-abuse issues always think that the solution to
their problem
is in the next pill,” he says. “Sometimes we have to help them take a
step back.
With time and support, they can learn to develop a different
relationship with their
pain.
“Remember,” he tells the students, “we’re in this business because we
care about
people.”
Cordes’s patients see that compassion — along with a gift of intellect —
in their
doctor, a young man who was told repeatedly that he should give up on
his dream.
“Fourteen years ago, when I was knocking on the doors of medical
schools, I heard
that all the time,” Cordes says. “One school opened that door, and that
was the University
of Wisconsin.”
Susan Lampert Smith ’82 is a senior media specialist for UW Health
Public Affairs.




JD Townsend LCSW
Helping the light dependent to see.
Daytona Beach, Earth, Sol System
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