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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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Published on the website, Doximity - March 8, 2022

Illustration by April Brust



She was from my parents’ generation; he was from mine. Her childhood was dominated by the Great Depression, his by the Cold War. She was in her early 20s during World War II; he spent his early 20s in Vietnam. Her oral cavity cancer was likely related to radiation treatments for her teenage acne; his was, no doubt, from his smoking. Although they never met each other, they will forever be inextricably linked in my memory.


Let me share their stories:

She developed a small, superficial cancer under her tongue, which I removed with a limited procedure when she was in her late 70s. Ten years later, I excised another small cancer. Although she healed completely, the second operation affected her swallowing and articulation for a few weeks. The surgery made her, as she said, “feel old.” “It was,” she informed me many times, “the worst thing ever! I will never have another surgery!”

Her reaction was consistent with her personality. She carried herself like many of the adults of the Greatest Generation, and her clinic visits were always memorable. She was a bit combative, skeptical, sure of herself, and ready to share her opinions. She mentioned her husband and son, but always came to her appointments unaccompanied. She was shaken when her husband died three years after her second surgery but, as I recall, never spoke of him again.

I followed her for many years, checking her surgical scars and offering suggestions to help with her dry mouth symptoms. Then, in her early 90s, a new, large cancer blossomed in her throat. “This is much more dangerous,” I told her.

Without hesitation, she drew herself up and pronounced that she would have no further treatment. “Nothing! No surgery! And radiation probably got me into this mess,” she said. “Just let me go.” She permitted no discussion.

During her final months, she refused hospice consults, allowed no visitors, and left the house only for medical appointments. When the home health aide brought her for a visit, she let me know that, “You people don’t do much to help me.” Her son, she said, was attentive, but he traveled for work and wasn’t around much. She canceled her next appointment and I never saw her again.


***

My other patient’s story also begins with a small oral cavity cancer that I removed with a simple procedure. At the time, he was in his early 40s, yet several areas of his mouth were already red and thickened from smoking. He knew he should quit but never quite managed to do it. I kept a close eye on him, taking a sample of a new nodule or ulcer at almost every visit. Pre-cancers evolved into superficial cancers, and then into deeper cancers as things worsened. His tumors became more aggressive. About three years after his first visit, he underwent successful surgery, radiation, and chemotherapy. Things finally settled down.

I never met his family. His long-standing problems with narcotics and alcohol predated his cancer and were, he admitted, responsible for his estrangement from his ex-wife, his two children, and all his siblings. He never mentioned them. It didn’t seem as though he had any close friends. He always came alone.

Several years later, he developed a new, large cancer of the tongue. His treatment options were very limited, having already had radiation, chemotherapy, and surgery. In those days before immunotherapy and checkpoint inhibitors, we had little to offer other than supportive care.

Both the man, now in his late 50s, and the woman, now in her 90s, were patients of mine for over 15 years by the time their dangerous cancers appeared. With no treatment options, their conditions steadily worsened. The notifications from their home care agencies came in rapid succession. They died six days apart.


***

As I reviewed their charts, I confirmed I had never met any of their relatives or friends. Throughout my career, whenever one of my patients dies, I try to share with the family how honored I was to accompany their loved one on their journey. I don’t reach out every time but, whenever possible, I call one of the relatives. I send handwritten notes, realizing how touched I was when the doctor sent a card after my father died. I have gone to many visitations. Much as I was lifted by being allowed in the presence of grieving families when I was a student, I have learned the importance of intentionally reaching across the chasm between the family and the physician. Doing so helps everyone process their grief and profound sense of loss, including me.

For these two, however, I was unsure what to do. Although there were family members listed in their charts, it seemed odd that our lives had nearly touched over such extended periods of time, yet we had never met. Somehow, it did not feel right to address my own loss by making contact. Even a word of condolence seemed intrusive and, to be honest, selfish. Perhaps I was more aware of the disconnect because they died within a few days of each other. I still remember the emptiness. It felt as though I was watching from a distance as they walked through a door that never closed behind them.


As Longfellow wrote, “There is no grief like the grief that does not speak.” Since losing those two patients, ten years ago now, I have tried to connect whenever possible with the people that surround my patients. By understanding the collective narrative of their lives, I hope I will always be equipped to be present if, and when, the time to speak a word of comfort arrives.


 

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