[il-talk] Article on Dr. Tim Cordes

Wed Jun 15 21:31:29 UTC 2011

Here's a nice article about Tim Cordes, the blind MD who spoke at convention 
last summer.  It comes from On Wisconsin, the alumni magazine of the 
University of Wisconsin.

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 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."

. . .

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."

. . .

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.

Tags: Alumni, Health and medicine, Public service

Categories: Features, Issues, Summer 2011

3 Responses to "Seeing potential"
  1.. Jun 12, 2011

  What a great person to feature in this article. Am so glad that Tim Cordes 
became a physician. He's got all the makings of an outstanding physician.

  Glad also to see the author of the fine article is Susan Lampert Smith, a 
wonderful writer who used to write very insightful, helpful articles for the 
Wisconsin State Journal. Nice work again, Susan!

  I just shared this article with a friend who is blind, is a student at 
MATC and hopes to attend UW-Madison, majoring in social work. He was very 
interested in hearing about Tim Cordes. I believe this friend will be highly 
successful in his future career, too.

  Tim Cordes is a model for all of us. Thanks for highlighting his 
remarkable life!

  - Bill Breisch
  2.. Jun 13, 2011

  I am the retired nurse and visual describer referenced in the article on 
Dr. Cordes. I have worked with Tim since his 3rd year in medical school. It 
has been my great honor to have worked with Tim all these years. He is truly 
amazing. I have learned a lot of medicine from him. I've also learned what 
true compassion really is. Tim is my hero.

  - Liz Morrison
  3.. Jun 15, 2011

  I am one of several Puppy Raisers for Leader Dogs for the Blind, Chippewa 
Valley Group out of Eau Claire, Wisconsin.
  This article Seeing Potential was shared among our group of puppy raisers 
at our June meeting. We find this story to be very inspirational for our 
efforts in raising pups during their crucial first year of life by 
"socializing", going out in public places. Thank you, editors of On 
Wisconsin, for sharing this amazing story of Tim and the support and 
adaptations in his journey. I especially can relate to the presence dogs add 
to our social interactions as mentioned in this story.

  Kristi Anderson Sazama '78

  - Kristi Sazama, Puppy Raiser for Leader Dogs for the Blind
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Issue: Summer 2011
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