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Bruce Campbell MD

A Fullness of

Uncertain Significance:

Stories of Surgery, Clarity, and Grace

BRUCE H CAMPBELL, MD FACS

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Below is my essay published on the website Doximity on July 17, 2022. I wrote this after an admired friend retired, hoping to share tips with students and residents to keep their sights on the end of their careers. I hope every healthcare worker can end their work lives with satisfaction and joy. The piece was meant to be lighthearted and celebratory.


As part of the essay, I wrote about an exercise I take students through where they recall a much younger time in their lives, reading a book with a protagonist who moved them profoundly. In class situations, I send them back to their middle school selves for that memory. For the essay, I created a short list of inspirational protagonists and initially included Anne Frank among the others. Her story has inspired me since I first visited her home in Amsterdam in 1968.


I extensively edited and rearranged my thoughts in the essay prior to submission. I focused primarily on fictional characters and novels. In the final draft, though, it appeared I was implying that The Diary of a Young Girl was a novel, and that Anne Frank was a fictional character. Nothing could be further from the truth. Anne Frank was a real person who perished in the Holocaust and her book is not fiction.


Readers immediately called me out in stark terms. I apologized and removed the reference to Anne Frank but, of course, the damage was done.


So, with the above in mind, I offer my slightly edited essay and my apology for my mistake.


-BHC





What Will Your Colleagues Say About You When You Retire?


A few months before COVID-19 swept the country, one of my surgical colleagues retired and his department arranged for a celebratory dinner, inviting people from the various eras of his life. There was an outpouring of response, and the large room was packed. Friends and co-workers gave speeches brimming with warmth, admiration, and love. Tributes were peppered with stories, inside jokes, and good-natured ribbing. There was laughter. There were more than a few tears.


My friend, without question, had a successful academic and clinical career. He had run a respected breast cancer program, built a busy, successful surgical practice, served as an associate dean, and was an advisor for a diverse group of students, residents, and junior faculty. People praised his academic and clinical achievements.


The evening’s focus, though, was not on his professional accomplishments. “He was the kindest doctor I ever worked with. All of his patients loved him!” said the nurse who worked alongside him for years. “He had strong opinions but was always a generous listener, no matter what. He made time for people,” said a friend from the community. “Everyone wanted to scrub with him or join him in clinic,” said a former resident. “When things looked most bleak, he comforted me,” said a patient.


At the end of the night, I thought to myself, “Everyone should finish their career this way. So why does this seem so incredibly unusual?” I don’t know the complete answer to that question, but I believe it has something to do with whether we stay true to our goals over the arc of our careers.


Medical students certainly start off in a good place. Many are drawn to medicine because they see it as a way of turning their idealism and altruism into a lifetime of service. More than once, I have asked a roomful of first-year medical students, “What motivates you to go into medicine?” and their responses are heartwarming. “I want to be a healer.” “I hope to accompany people through their difficult journeys.” “I pledge to concentrate my work on the forgotten and the underserved.” “I promise to be a great listener and take whatever time is needed to explain things to my patients.” “I will address social disparities, both here and abroad.” “I will bring healing and hope to all who suffer.” “I will give everyone my full attention.”


Yet, it won’t surprise anyone to discover that students evolve as they complete their residencies, graduate from fellowships, and go into practice.


Early in their clinical experiences, medical students explore how they might best separate their personal feelings from their “professional” responses to death and suffering. Their vicarious empathy — in other words, their innate ability to feel and respond to other people’s pain or suffering — drops during the first year of medical school and continues to decline throughout training. Students ask, “If I become emotionally attached to every patient, won’t my personal feelings overwhelm my ability to effectively practice medicine? I mean, if I break down while seeing the first patient of the morning, how will I get through the day? Surgeons can’t operate if they are crying, right?”


I tell them that it can be hard, but they should err toward caring and compassion. Empathy can be healing for both the patient and the physician, and our white coats are not designed to be used as shields.


Here is a thought exercise I share with them:


Recall the most engaging novel you read when you were young. It was likely a book you stayed up late for so you could read “just one more chapter.” You could not put down. How did you feel while you were reading? Did the world around you drop away? Did you celebrate when the protagonist was ecstatic? Did you become outraged when they were treated unfairly? Were you anxious when they were in peril, and did you find yourself choking up when all seemed lost? After you read the final page, did you wonder what happened next?


As soon as you finished reading, I would bet you found a friend and told them the story. You made the characters come alive for your friend and, if you were moved, you promised to be a different person or change the world. Despite the emotional rollercoaster, the opportunity to accompany the protagonist throughout their quest made you a better person, right?


So, next, I ask the students:


Now think about a challenging or depressing clinical encounter. What underlying narrative makes the encounter difficult? Why shouldn’t we throw ourselves into our patients’ stories with the same level of attention, representation, and affiliation we brought to "Harry Potter," "Little Women," "The Hobbit," or "Anne of Green Gables"? If we were willing to invest our emotional selves in the stories of fictional characters, why are we so hesitant to do the same for the people who are suffering and in peril right in front of us? Why do empathic relationships seem so dangerous when it comes to patient care?


There are ways to help stay on track. I run sessions with residents where I ask them to remember and refocus on their original motivations and goals. We imagine what colleagues 35 or 40 years from now will list as their most enduring qualities. Current residents see retirement as very far off, yet even they recognize that they have changed since starting their journeys. If their deeply held beliefs have transformed this much in the first decade of their careers, in how many more ways might they evolve in the future?


As they anticipate the end of their careers, my residents hope they will be admired for their compassion, generosity, teamwork, and humility instead of their RVU generation, income, or make of car. They dream that they will draw satisfaction from being part of effective, caring teams that provide quality care in times of great need. That, to me, sounds a lot like a first-year medical student's answer.


Physicians are human beings who have been blessed to possess a slightly enhanced knowledge of physiology, pharmacology, and related scientific fields. At some point in each of our lives, we felt called to care for those who are suffering. Like it or not, we also serve as role models for those who come behind us. Rather than showing our younger colleagues how best to build “professional moats” around our physician personas, perhaps we should tend to ourselves and build some bridges.


In Just Mercy, Bryan Stevenson writes, “we can embrace our humanness, which means embracing our broken natures and the compassion that remains our best hope for healing. Or we can deny our brokenness, forswear compassion and, as a result, deny our own humanity.”


On many of the 14,600 days of our career, things seem fine, and we keep plugging along. Yet, we remain broken and imperfect. Denying our brokenness hardens us in our personal and professional relationships. We owe it to others to rekindle what brought us into medicine in the first place. We will be better equipped to share what we learn with the people with whom we spend our days and with those who trust us to care. Returning to our ideological roots might reinvigorate our passion and joy. Retirement will come soon enough.




Illustration by Jennifer Bogartz



 

Upcoming Events

  • Narrative Surgery - A Conversation at Creighton University
    Fri, Apr 08
    Creighton University Medical Center
    Apr 08, 7:30 AM – 2:30 PM CDT
    Creighton University Medical Center, 2420 Cuming St, Omaha, NE 68131, USA
    An opportunity to discuss narrative medicine, reflection, and head & neck surgery
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  • Narrative Surgery - A Conversation at Johns Hopkins University
    Mar 14, 4:00 PM – 5:00 PM CDT
    ONLINE
    A conversation about narrative, the book, and retiring with grace.
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  • 2021 MCW Medical Humanities Lecture
    Nov 16, 2021, 12:00 AM – 1:00 PM
    TBD
    Dr. Campbell will give the 2021 annual MCW Medical Humanities Lecture at noon on Tuesday 11/16/2021.
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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