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In recognition of my retirement, Kathi and I set up a fund supporting Medical College of Wisconsin faculty, staff, and students who want to become Narrative Medicine champions. Our goal is that every patient will be listened to and cared for by physicians who take care of themselves.

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Bruce Campbell MD - Author

A Fullness of

Uncertain Significance:

Stories of Surgery, Clarity, and Grace


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  • Writer's pictureBruce Campbell MD

Updated: May 21

The Medical College of Wisconsin-Milwaukeee Campus Class of 2023 graduated on May 19, 2023. I have always found the transition from medical school to residency to be a fascinating inflection point. I wrote years ago that, although we refer to these ceremonies as "commencements," these near-graduates have commenced many times already.

This year's ceremony was particularly wonderful for me. My medical school classmate and friend, Julie Freischlag, MD, FACS, FRCSEd(Hon), DFSVS was the speaker and I helped hood her for her honorary degree. When I think of her career trajectory and accomplishments, it is hard to believe we started in the same place. Way to go, Julie!

I have attended many graduation ceremonies over the years, always wondering what I might say that would make a difference to the graduates, A few years ago, I wrote the speech that contains a distillation of some of the important lessons I have learned along the way. I am reprinting it below.

[Overly kind introduction...Very light applause...Papers shuffling...People looking at their phones...]

Ladies and Gentlemen, distinguished visitors, proud family members, parents, and graduates:

No matter how hard I try, I cannot remember a commencement address entitled, “Knowing and Doing” that Harriet Waltzer Sheridan, PhD delivered at my medical school graduation in 1980. She was a beloved, creative teacher at Brown University; her own struggles with cancer shaped her understanding of literature, the humanities, and medicine. Glowing biographies appear online and were recorded in the yellowed program my mother saved from that day. I know I heard her lecture; I only wish I could remember even one thing that she said. I’d bet it was wonderful.

Maybe my lack of recall is an unfortunate consequence of being in the presence of her genius on a day when my brain was already packed full. I don’t know. You students, of course, have the same predicament. Except the part about me being a genius.

The ceremonial events today might fade, but I guarantee you will remember encountering sheer joy after the recessional, out in the lobby where you will experience waves of emotion with your friends and family. I remember being overwhelmed, sharing tears and laughter with my wife, our families, and my classmates. That has stuck with me for all these years and I would bet that is what you will remember when you look back on today.

Advice given during commencement speeches has a very short half-life. At graduation, there are the obligatory word of congratulations, the plea to appreciate the journey, and platitudes about opportunities that stretch to the horizon. In the interest of time, let’s skip that part other than to say, “Congratulations! Smell the roses! and The sky’s the limit!” There. Done.

In the off-chance you remember any of this, I do not plan to provide answers to medicine’s burning questions. Rather than answers, I hope to equip you with questions. If you are still listening, you will hear three questions: one to ask every patient, one to ask yourself, and one that you should regularly review with a mentor.

First, a question to ask every patient:

Is there anything else you would like to talk about today?

In my practice, I have a cancer survivor who speaks agonizingly slowly. All. The. Time. Loooong, monotonous, convoluted questions. This has continued for years and our routine is unchanging. I complete the exam, check his labs, and pronounce him cancer-free. He is grateful, then has two more questions. Then another one. And another.

Years ago, not long after I began following him, a study appeared that evaluated communication between physicians and patients. The authors confirmed that doctors take control of encounters far too early, often denying patients the opportunity to bring up their own concerns. The doctors interrupted their patients after a mean of only 23 seconds.

The solution? Guess what? Office visits are no longer when the doctors repeatedly asked, “Is there anything else?” The patients felt heard.

Did the approach work with my patient? Well, sort of. But it forever changed the way I talk to patients in clinic and at the bedside. That’s a good thing.

Here’s a second question; this is the one you should ask yourself:

What else might it be?

This one comes from Jerome Groopman, a pediatric oncologist and New Yorker contributor. In his book, How Doctors Think, he recalls his own debilitating hand disorder. If he applied too much pressure to his right hand it became red and he developed excruciating pain in his wrist. He saw several Boston hand specialists over a number of years, each of whom came up with a different diagnosis. How could that happen?

Groopman compares most clinical decision-making to a branching tree; “yes-no” arrows point from box to box to box until the algorithm takes the clinician to a diagnosis. That approach works great much of the time.

Groopman points out, however, that cases that require “outside the box” thinking necessitate non-algorithmic thinking. The algorithm is actually a problem in those situations.

Here is what can happen. The physician starts heading down a path but it happens to be the wrong path. Each step is just a little incorrect but the small errors in logic add up. The physician, however, is more and more invested in the path with each step, eventually arriving at a certain – but incorrect – diagnosis. It becomes nearly impossible to shake the physician from his or her path even when there are clear signs that it is veering away from a correct answer.

So, what does he recommend? Repeatedly ask “What else might it be?” He found that this momentary pause forces the physician heading headlong down a rat hole to back up, reconnoiter, re-evaluate, and begin again. A correct diagnosis is, therefore, more likely. How much pain, expense, and suffering might you prevent over the course of your career by employing this tactic? Keep your mind open to other answers even when you are certain you are correct.

Here’s a third and final question; this is the one you should regularly review with a mentor:

How would you like to be remembered?

I recently spoke to a group of first year medical students and asked whether they viewed Medicine as a calling or a job. Happily, they all responded that they saw their careers as a calling – a special opportunity to help people and make a difference in the world. Then I asked them, “So, how many of you know doctors who apparently look at Medicine as a job?” The hands all went up again.

What turns the idealism of the first year medical student into the perfunctory job performance of the seasoned physician? There are studies demonstrating that with each stage of medical school and residency training, people become less and less empathic. In the interest of full disclosure, medical students with the lowest empathy scores are most likely to end up in surgical fields like mine.

There are minefields out there, my friends. We are not immune to depression and substance abuse. Coupled with knowledge of how to keep others alive, we apparently know a lot about how we might kill ourselves. About 400 US physicians take their own lives each year; that’s the equivalent of two entire classes at MCW.

We all know workaholics, right? Well, workaholism – for better or worse – is real and is the only addiction we celebrate. This addiction and its celebration are dangerous. We learn during our education about the importance of self-care but the hidden curriculum pushes us to work harder and harder. It drives a wedge between our idealism and our need to satisfy metrics and increase our work output.

Work is rewarding and good, of course, but so is the ability to shape the work we do. Finding ways to reflect, be creative, and nurture others – be it family, children, colleagues, or friends – brings joy and recovery. Like the runner who finds that she completes a race more effectively when she mixes running with walking, we need to take control of our lives and pace our work.

Back to the question: How would you like to be remembered? A group of interns was asked to write a speech that a colleague might deliver at a dinner honoring them at their retirement thirty-five years from now. You can imagine the responses. They did not hope to be remembered as the one who generated the greatest number of work-units or had the nicest collection of toys. They didn’t want to be celebrated for never being home. Instead, they hoped others would admire and remember them for their character and their idealism. They planned to reach their goal by listening to patients’ stories, being compassionate, and focusing on being present where they were most needed.

How do you keep focused on your goal? Find mentors who help you stay the course. Remind them of your goals and ask them how you will be remembered. Listen to those people.

So, my young colleagues, can you remember the three questions? Here they are again:

Is there anything else you would like to talk about today?

What else might it be?

How do you want to be remembered?

And, of course:


Smell the roses!


The sky’s the limit!

[People look up from their phones...Light applause...Ceremony continues...]

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What Readers are Saying About
A Fullness of Uncertain Significance

In this tender and candid collection of short essays, Dr.  Bruce Campbell illuminates how much medicine is truly  the sacred act of holding vigil with and for our patients.  Through his reflections, we get a glimpse of how surgeons  hone their instincts, grow through challenges, and cope with  disappointment as they navigate the uncertainty inherent in  medicine. Through his polished lens, the reader understands  how even in the pressurized world of surgery, heavy with the  responsibility of healing through a scalpel’s cuts, there are  moments of intimacy that are filled with grace. 


—Rana Awdish, MD, FCCP, FACP, author of In Shock: My  Journey from Death to Recovery and the Redemptive Power of Hope  

Dr. Bruce Campbell turns his scalpel on his own history  as a surgeon, probing the medical field past, present, and  future. His vibrant stories illuminate the fundamental human  underpinnings of medical science, bringing to light the glories,  tragedies, imperfections, and uncertainties we must all grapple  with. Eminently readable and richly satisfying.  


—Danielle Ofri, MD, PhD, Clinical Professor of Medicine  at New York University School of Medicine, Editor-in-Chief of  Bellevue Literary Review, and author of When We Do Harm: A  Doctor Confronts Medical Error 

Dr. Campbell’s reflections will resonate with those who treat  cancer patients as well as those who have had cancer themselves.  Medical students and residents will also be inspired by his life’s  journey as a surgeon and teacher, aspiring to their own joyful  and meaningful lives in medicine. 

—Julie Ann Freischlag, MD, FACS, FRCSEd(Hon), DFSVS,  CEO Wake Forest Baptist Health, CAO Atrium Health, Dean of  the Wake Forest School of Medicine, and 2021-2022 President of  the American College of Surgeons.  

In this rich collection of stories and essays, Dr. Campbell  reflects on his years of caring for patients and training young  doctors to follow in his footsteps. With compassion, humility,  and shimmering prose, he shares the joys, pains, and somber  responsibility of being a surgeon. 

—Gayle Woodson, MD, surgeon, educator, and award winning author of After Kilimanjaro and Leaving La Jolla  

Bruce Campbell is no average surgeon and no ordinary  writer. He takes the excellence of his medical trade and weaves  the challenges, exhilarations, and tough decisions of surgery  into beautiful prose. Here is one who clearly doesn’t reduce  patients to a diagnosis, but who sees them as whole persons  worth getting to know. The chapters in this book are like  windows into the humility and generosity of a man I’d like to  have as my personal physician. 

—Peter W. Marty, editor/publisher of The Christian Century 

With his willingness to delve beneath the surface, Bruce  Campbell has created a deftly interwoven series of lessons gleaned  from poignant moments of a fulfilling surgical career. In a warm,  compassionate, and honest voice, Dr. Campbell delivers to the  reader not just insights on medicine, but truths about humanity.  

—K. Jane Lee, MD, author of Catastrophic Rupture: A  Memoir of Healing 

Humorous and humble, serious and sublime, these lean essays  offer a glimpse behind the surgical drape to show what it’s like to  be a cancer surgeon over the course of a long, rewarding career.  From Campbell’s first invitation into the “inner sanctorum” of the  O.R. as a nurse’s aide while in college, through tender interactions  with patients, to his projections about the profession when he is  long gone, this smart, sensitive surgeon illustrates how doctors can  listen to, care for, and learn from their patients. He courageously  goes to the “hard places” as well as sharing those special moments  that make it all worthwhile. Early in the collection, Campbell  writes, “Besides being a surgeon, I am also a human being.” This  beautiful book is about both. 

—Kim Suhr, MFA, Director of  Red Oak Writing and author of Nothing to Lose   

In lucid and succinct vignettes, Dr. Campbell illuminates  the myriad of emotions and sensations that accompany a life in  surgery. These stories of persistence, camaraderie, shame, grief,  guilt, and regret 

vantage point of experience. These ideas serve as the springboard  to discuss unique, personal insights whose wisdom is of import to  anyone in the healing profession. With elegant and engaging prose,  Campbell beautifully expresses the honor it is to be a physician. 

—William Lydiatt, MD, Chief Medical Officer Nebraska  Methodist and Women’s Hospitals and Professor of Surgery,  Creighton University in Omaha, Nebraska 

“Over the years, I have made an uneasy truce with failure,”  says Campbell in the opening pages of his debut anthology, and  yet his stories are anything but. Captivating, heart-wrenching,  inspiring—he chooses his words as meticulously as he conducts  his surgeries. 

And it’s just like a surgeon to keep you up in the middle  of the night. “One more story,” you’ll tell yourself, but with  Campbell’s reflections, it’s hard to stop. There’s a familiar ease  with which he flourishes his pen; everything falls away, and it’s  almost as if you’re sitting across the table from him as he recalls.  You laugh when he laughs, you cry when he cries, and you wait as  he waits. His memoir of stories is sure to become a rite of passage  for future doctors and patients alike, enjoyable little tunes that all  hum together in a harmony of sound. 

Turning the last page of Campbell’s novel, I succumb to my own  “fullness of uncertain significance”—I have been charged to seek  meaning, to reflect, to sit in the silence of his reverberating truths.  

—Olivia Davies, MD, poet, writer, and dermatology resident at  Massachusetts General Hospital



The words “clarity” and “grace” take on heightened  significance in this honest yet lyrical set of essays by Bruce  Campbell. The immediacy and intensity of these stories  immediately swept me into the consulting room and OR. I felt  as if I were a privileged witness to an almost sacred encounter  between surgeon and patient. Subtle language lays bare a primal  relationship. It is impossible to read this book and not be  changed by the experience. 

—Carol Scott-Conner, MD, PhD, Professor Emeritus of  Surgery at University of Iowa Carver College of Medicine and  author of A Few Small Moments: Short Stories  

Dr. Bruce Campbell sets a new milestone for doctor-writers. As  an otolaryngologist and head and neck surgeon, he treats patients  with the most advanced and aggressive cancers imaginable. Internists  like me wonder how head and neck surgeons like him do it; this  book gives me the answer. Dr. Campbell brings luminous sight  to his work. His writerly gifts let him capture the delicate and the  solemn, the tragic and the everyday dimensions of illness. Not a  set of doctorly instructions (though instruct it does), A Fullness of  Uncertain Significance: Stories of Surgery, Clarity, & Grace lays open  the profound mysteries and truths and awe about this life of ours.  These stories will change lives. 

—Rita Charon, MD, PhD; Bernard Schoenberg Professor  of Social Medicine and Professor of Medicine; Chair of the  Department of Medical Humanities and Ethics; Executive Director  of Columbia Narrative Medicine, Columbia University, New York  City; Co-author, Principles and Practice of Narrative Medicine 



In this compelling, insightful, and beautifully written  compendium of stories, Bruce Campbell shares the lessons he  has learned, and continues to learn, throughout his medical  education and his years as a highly successful surgeon, faculty  member, and teacher. A Fullness of Uncertain Significance is  refreshingly honest and introspective, exploring not only many  of the desirable outcomes when he had been faced with a broad  array of professional challenges, some potentially life-and-death,  but also those outcomes that were less than he had hoped for.  Readers will appreciate the author’s willingness to reveal that,  “As a surgeon, I have made mistakes that have hurt people. This  should not surprise anyone since, besides being a surgeon, I also  am a human being.” Providers, teachers, and students of health  care in every field and at every level of service will benefit greatly  from what the author has accurately labeled “Stories of Surgery,  Clarity, & Grace.” This isn’t merely a book about one man’s life  as a surgeon. It is a book about the need for understanding and  compassion when dealing with others, especially those in distress. 

—Myles Hopper, PhD, JD, author of My Father’s Shadow 

In this collection of essays, Dr. Campbell pulls the reader into  his Milwaukee otolaryngology clinic, the operating room, and his  medical work in Kenya. He tells story after story with wonder,  humour, and affection. He looks back on his medical training and  fantasizes about medicine in the mid-twenty-first century. He lets us  in on his unique vantage point on humanity, and does so with such  humility and grace that his own humanity is never in question.  

—Martina Scholtens, MD, author of Your Heart is the Size of  Your Fist

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