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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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By Bruce Campbell, MD


Published September 19, 2022 on Doximity. This was the sixth and final essay I wrote as a 2021-2022 Doximity Op-Med Fellow.


View the original post here.





It is the 1990s and I am running the head and neck cancer clinic. I open the door, step inside, and greet my new patient, a casually dressed woman in her early 40s.

“Good morning!” I say. After we cover the basics, I ask, “Tell me your story.”

She relates to me that she bit her tongue several weeks ago. Her dentist sent her to see me after the sore spot persisted and was getting larger. She grimaces. “This just isn’t getting any better. It bleeds sometimes.”

After gathering the rest of her information, I grab a headlight and put on some gloves. “Let’s take a look,” I say. Sure enough, there is an angry looking mass on the side of her tongue where it rests against a tooth. I am concerned. She is a smoker, and she has a persistent tongue ulcer. It looks like cancer. “Can I get a biopsy while you’re here today?”

“Sure,” she says.

I ask her to sign the consent form, then step out to gather my supplies. While I am gone, she slips off and hangs up her jacket. When I come back into the room, she is wearing a brightly emblazoned T-shirt with the logo of a tobacco company. It reads: NEWPORT! Alive with Pleasure!

How ironic! I think. Who goes to the cancer surgeon’s office wearing an advertisement for cigarettes?

It makes me wonder: How do people decide what to wear to an appointment?

Somehow, we get up each day and get dressed, although what we choose to wear has evolved over the decades. As a Boomer, I remember my mother having me put on my “nice” clothes to go out to the store or to see the pediatrician. Mom wore a dress to have coffee with friends. Dad always went to work and church in a coat and tie. My parents got dressed in "good clothes" to pick someone up at the airport or the train station. Even though standards have slowly relaxed, everyone must still put at least a little thought into what they wear.

In my office, I have had patients arrive wearing tailored suits accessorized with pocket squares. People coming straight from work might have steel-toed work boots, motor oil-impregnated shirts, paint-splattered pants, carpenter’s suspenders, or lanyards with corporate ID badges. Couples might appear in coordinated Harley-Davidson leathers or full-on Green Bay Packers regalia. Older women might show up in embroidered sweatshirts decorated with chickadees or reading “World’s Greatest Grandma.” More than a few have had orange jumpsuits, leg irons, and handcuffs. Clothes provide context and give me clues about my patients’ lives.

For years, I saw a restaurateur who owned a wonderful dining establishment a few blocks from the hospital. Radiation therapy had affected his sense of taste. Since he always arrived in a chef coat with a meat thermometer in the breast pocket, I never failed to ask about how the treatment was affecting his work. He taught me how slowly radiation effects can resolve. Another man, who struggled mightily against his cancer and its treatment, came to every visit dressed in his security guard uniform, despite having lost his job when the company shut down and merged with another firm. Even as his old clothes became frayed, he never failed to tell a story about working on an armored vehicle or protecting a local business. He sat up straight as he talked.

What I wear is important, as well. I hope my clothes convey that I respect my patients enough to show up a little cleaner, a tad better pressed, and a bit more organized than I need to be. Though many employees must wear scrubs back and forth to work, I personally avoid wearing them outside the hospital because I don’t want patients and visitors to think a surgeon might wear the same clothes from home directly into the OR. My clothes tell people a bit about me.

Our professional lives are full of vanishingly brief encounters. Office visits are packed with the competing responsibilities of discernment, planning, and documentation. As Miuccia Prada said, "What you wear is how you present yourself to the world, especially today, when human contacts are so quick. Fashion is instant language." I believe how we observe others and how we ourselves are observed is part of the dialogue. What we wear shares our stories.

So, when I notice my patient is wearing the Newport logo, it opens the door to a conversation. “Well, that’s an interesting shirt!” I say. “Where did you get it?”

“Oh, I sent in enough coupons and they mailed it to me. I have a few of these.”


“Well, I hope we can get you to stop both collecting coupons and smoking.”

The biopsy goes well, and we schedule her follow-up. I sense she sees no irony in appearing in a cancer surgeon’s office in a shirt she earned by smoking. Maybe she does, though, since through the two years I care for her through multiple surgical procedures, radiation, salvage chemotherapy and, finally hospice, she never wears it again.

Image by GoodStudio / Shutterstock

 
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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