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Bruce Campbell MD

A Fullness of

Uncertain Significance:

Stories of Surgery, Clarity, and Grace


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Updated: Feb 20

In this essay first published in the Transformational Times in 2020, Dr. Campbell reflects on how the self-care trajectory on which we place our students and residents will carry them beyond their careers …

A young physician and an old physician. Wait! It's the same guy!

Medicine differs from many other professions. Once a physician joins a practice, it is possible to become a perpetual-motion machine, working day-after-day, seeing patients and generating revenue. As long as the physician directly or indirectly generates enough cash flow to pay salaries, keep the lights on, and move the enterprise forward, the process can continue unabated. Theoretically, this hamster-on-a-wheel activity can continue for around 13,000 days. That’s thirty-five years. Then the hamster retires, and another is recruited to keep the wheel turning.

I don't usually view myself, our students, or our residents as hamsters, but there have been days when the thought crossed my mind. Still, what can medical educators do to prepare the next generation of physicians in ways that will enrich – rather than deaden – their lives and careers? And how do we help our trainees step back and begin to grasp the arc of their journeys from graduation to retirement?

Talking with trainees about their careers

A couple of years ago, I held a session on retirement with our otolaryngology residents. We read an article where the authors asked brand-new Johns Hopkins internal medicine interns to write down and then share what they thought a colleague would say about them at their retirement celebration many years down the road. I asked our residents to do the same. We also discussed which of their character strengths would be most noticeable in their careers (from the list at, what they think they will miss about their careers after they retire, and what aspects of retirement they are thinking about now.

Not surprisingly, the Hopkins medical interns in the article and our MCW otolaryngology residents all see the distance from where they are now to retirement as being an incredibly long time. The brand-new interns hoped that their colleagues would see that they had lived out their core values, been accomplished in their careers, and been good teammates. Among possible character traits, our residents hope that they would have been most admired for their dedication to teamwork and their humility. They anticipate that they will find their greatest personal satisfaction–and what they think they will miss the most–from being part of a team focused on helping others in times of great need. Like the interns in the study, our residents worried about retirement but, being so far off in the future, they could not imagine what it will feel like to get there.

Our otolaryngology residents did differ from the internal medicine interns. Although they know they will miss many things, they believed they will be able to replace professional relationships, the joy of helping others, and stimulating conversations with other post-retirement activities. As surgeons, though, they worried that they will have difficulty replacing the unique privilege of performing surgery. As one resident said, “I can’t imagine not operating again. That’s why we went into this.” Many agreed.

Our otolaryngology residents, who had been in training much longer than the brand-new interns in the Hopkins study, focused on how quickly time passes, even in training. “I am already realizing how much I will miss my fellow residents,” one of senior resident noted. “I’m sure my career will seem to pass by just as quickly.”

The challenges of helping students, residents, and faculty gain insight into themselves and others

There are data that strong relationships and lifelong self-care habits can yield benefits much later in life. MCW faculty members and the Kern Institute are building a portfolio of curricular and extracurricular opportunities that encourage resilience and insight. The challenge is to make these types of offerings available, appealing, and effective. Baking caring and self-care into the institutional culture and the curriculum creates opportunities for both transformation and scholarship.

But, let’s get real

Finding time for reflection, creativity, and long-range personal planning is difficult and, frankly, of low priority for busy students, residents, and faculty. Institutions can readily measure clinic slots, RVUs, grant funding, and fiscal margins, but we don’t (yet) have metrics that measure sustained empathy, strengthened character, prevented suicides, and successful prevention of burnout. If we cannot demonstrate that these habits can be nurtured, or if they aren’t seen as valuable, our interventions will have little impact and won’t be sustained.

Yet, raise your hand if you think that a graduate who is unprepared to thrive in practice will suffer needlessly over the coming decades.

Retirement isn’t for sissies

Over the years I have been at MCW, dozens of colleagues have retired. The end of a career rarely goes exactly as planned. Some have retired amid accolades for lives and careers well-spent while others have left baffled and reluctant, having no idea what they would be doing a week later. Some, after long and productive careers, were forced out after bitter disputes. Some packed up and left in disgrace. Some became ill or died before they had the opportunity to retire. Some, unfortunately, held on too long. Some left huge holes in the institution when they retired. Others barely caused a ripple.

Guiding our students and trainees toward rewarding careers and eventual retirements carries responsibility. We must do more than suggest they be financially responsible and keep track of their retirement account outlook. We have equally important responsibilities to help them develop well-rounded professional identities, “seize the day” mentalities, and careers as reflective, empathic, and mindful physicians. If they enter practice self-aware and focusing on character, caring, and practical wisdom, they should have a better chance of emerging into retirement possessing the same values.

Living each day

The act of living intentionally came to mind when I read a story in an interview with Duke University’s director of medical humanities, theologian, and pediatric oncologist, Raymond Barfield, MD:

“Think of each day as a gold coin that you are required to trade for something. You’ll never get that coin back, so whatever you trade it for had better be worth it. You also don’t know how many coins you have left to trade, and you don’t know what will happen when your bag is empty.”

My career shot past me like a rocket since I completed my fellowship and joined the MCW faculty 12,945 days ago. I now wish I had learned early on to treat each day like a gold coin.

As I look back on my clinical practice, there were too many “hamster on a wheel” days. Still, I am grateful for the moments when a colleague or mentor, some of whom have died, encouraged me to take advantage of the self-care and reflective skills I acquired along the way. It helped. A lot.

Here is hoping we all learn to pay it forward. Your retirement will be here before you know.

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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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