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Episode 97: PERSPECTIVES - Dr Tommy T. Thomas

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Dr. Tommy T. Thomas is a Neurointensivist and Associate Professor at Emory University and member of NCS’ Inclusion in Neurocritical Care Committee. We hear how he became the first man on the Woman in Neurocritical Care Committee as we discuss representation, advocacy, and allyship in neurocritical care.


  • Nicholas A. Morris, MD

    Assistant Professor and Fellowship Director
    Division of Neurocritical Care and Emergency Neurology
    Department of Neurology
    University of Maryland School of Medicine Medicine

  • Tommy Thomas, MD, PhD

    Neuroscience Critical Care
    Emory University

  1. Welcome everybody to the Neuro critical
  2. care podcast. This is the perspective
  3. series. I'm your host, Nick Morris
  4. from the University of Maryland, shock
  5. trauma hospital. And today I have the
  6. honor of interviewing Dr. Tommy T.
  7. Thomas.
  8. Dr. Thomas is neuro intensivist and
  9. associate professor at the Emory
  10. University School of Medicine. He
  11. completed an MD PhD from University of
  12. Alabama, Birmingham, followed by a
  13. medicine internship there. He then went
  14. on technology residency in neuro
  15. critical care fellowship at Partners in
  16. Boston. He has been at Emory University
  17. in Atlanta ever since. I've had a real
  18. pleasure of working with Tommy through
  19. the inclusion and neuro critical care
  20. committee at NCS. It's been really nice
  21. to get to meet him. I wanted to invite
  22. him on the podcast and talk a little bit
  23. about his perspectives on neuro critical
  24. care and some of the work that he's done
  25. through Inc. in the DEI space and how
  26. we can do better. So Tommy, welcome to
  27. the podcast. Thank you so much for
  28. having me right maybe for the listeners
  29. it would be helpful if you could start
  30. by tongue a little bit about your path
  31. into neurocritical care, which you got,
  32. we got you excited about it. How'd you
  33. find yourself here now many years later
  34. in Atlanta? Excellent. So well, my
  35. path was fairly direct. I mean, after,
  36. as I was finishing up residency, I
  37. started looking around for fellowships,
  38. started talking to people. And I was
  39. really torn between neurocritical care
  40. and believe it or not, neuro oncology
  41. And I liked the idea of kind of patients
  42. with advanced disease and illness and
  43. the opportunity to help those patients.
  44. And I talked a with number of people,
  45. including Galen Henderson. And I also
  46. talked to friends and family who kind of
  47. knew my personality. And one friend
  48. provided me with the most age advice,
  49. which one of them scares you more. And
  50. I was like, oh, definitely
  51. neurocritical care. Like it's a bit
  52. insane. It's kind of odd sometimes And
  53. she said, Well, you should do that one.
  54. And so here I am. Uh, but I always
  55. found the disease fast and the
  56. pathophysiology fascinating and the
  57. opportunity to really bring medicine
  58. back into my neurological practice and
  59. become an intensivist was exciting. And
  60. it's been even more rewarding than I
  61. imagined that it would be. Yeah,
  62. fantastic. I also thought about
  63. neuro-oncology. I think it makes a lot
  64. of sense to me, a lot of medicine in
  65. neuro-oncology, right? So I think
  66. there are some clear overlaps. We end
  67. up taking a terrible lot of tumor
  68. patients in the ICU, at least in the
  69. post-op setting. So that makes total
  70. sense to me. Can you take us back, I
  71. guess? So as you're a resident in
  72. neurology, you're looking around and
  73. trying to make the decision between
  74. neuro-oncology and neuro-critical care.
  75. And you mentioned Galen Henderson, and
  76. Galen Summond I worked with, and
  77. actually is on in committee with us, I
  78. just would.
  79. As you were looking into make this
  80. decision and you talked to Galen, what
  81. were you seeing in people like Galen
  82. that inspired you to go into
  83. neurocritical care? Was it just the
  84. content of the different specialties or
  85. was it the people involved as well that
  86. kind of drove you towards the decision?
  87. No, certainly the people and the
  88. personalities within neurocritical care
  89. that I found to be very similar to mine.
  90. Of course, there were differences, but
  91. they were all very similar to mine.
  92. There was an intensity, a desire for,
  93. a desire for kind of procedural
  94. knowledge, but there was also this kind
  95. of, I don't want to say go get her
  96. attitude, but there was definitely a I
  97. want to do something and see what
  98. happens pretty quickly after that. And
  99. the neurocritical care offers that
  100. feedback where a lot of other past don't,
  101. especially neuro oncology, where
  102. there's kind of a longer lag phase and
  103. and and kind of reaping the rewards of
  104. your interventions. Neuro oncology also
  105. fit into my research at the time, but
  106. there were also, I saw neurocritical
  107. care as kind of an unbeaten path. There
  108. was a lot of opportunities for a lot of
  109. different things and a lot of
  110. advancements within neurocritical care.
  111. And so that really guided me. And Galen
  112. always has a spirit that when he talked
  113. to me about kind of the professional
  114. life within neurocritical care, how he
  115. integrates it into his personal life,
  116. it really seems like the career for me
  117. at the time. Could you talk a little
  118. bit more about that? How do you think
  119. this is? I think something people
  120. struggle with a lot is how do you
  121. integrate the professional life of
  122. neurocritical care into a personal life?
  123. Well, at the time, Galen talked about
  124. it being kind of. on and off
  125. and it's not like the clinic patients
  126. where you're following them all of the
  127. time. There's an intensity to it, but
  128. there's a time for recovery that seems a
  129. bit greater than some of the other
  130. fields. However, the intensity is also
  131. a bit higher. But he talked about kind
  132. of integrating it and specifically from
  133. the standpoint of time because there was
  134. time to, there were larger blocks of
  135. time to do other things. And he also
  136. talked about the way that neurocritical
  137. care is done because it's a
  138. 247 field. There isn't really a start
  139. or a finish. It's just kind of when you
  140. start and when you finish. And so he
  141. really talked about the flexibility
  142. within within the field as to kind of
  143. how you how you did. things, how you
  144. treated patients, when you rounded,
  145. how you rounded, whether you rounded
  146. kind of a multitude of different times
  147. for short periods, one long period.
  148. And so you really talked about kind of
  149. molding the the career to fit my
  150. personality and my my interests both
  151. inside medicine and outside.
  152. Great. And it sounds like you have no
  153. regrets with the decision. What over
  154. the years have you found that you really
  155. liked most about the field? What's
  156. resonated with you? Has that changed
  157. over time or has it stayed steady? I
  158. think as the field has evolved the same
  159. types of things have generally kind of
  160. brought me joy and resonated with me the
  161. the opportunities to really kind of help
  162. people
  163. have have really significantly increased.
  164. I mean even if we look at things like
  165. thrombectomy for stroke and the advances
  166. and and that we've really been kind of
  167. able to see an evolution within
  168. neurology and critical care as to how we
  169. care for stroke patients, how we care
  170. for subarachnoid patients, and how
  171. those patient outcomes have improved.
  172. We've also seen changes in the way the
  173. work has done with regard
  174. to predictive analytics and bringing
  175. other types of things into the pursuit
  176. of neurocritical care. And so I think
  177. the field is advancing more rapidly than
  178. I could have anticipated. And I enjoy
  179. that. I enjoy that there's a novel
  180. aspect to it that keeps coming up and is
  181. reiterated over time. And is there
  182. anything in particular that you're
  183. finding really exciting right now, some
  184. area of the field that you think is
  185. really about to take off or explode? Oh,
  186. I think there's so many areas, I think.
  187. I think with regard to things like
  188. consciousness, John Klausen's work and
  189. Brian Edler's work on states of
  190. consciousness and kind of surveillance
  191. are really going to change things like
  192. brain death within the field. I think
  193. all of the neuro-interventional work and
  194. the recent kind of advances in who gets
  195. thrown back to me is who gets
  196. neuro-interventional care are really
  197. going to change not only kind of the
  198. patient pool that we take care of, but
  199. how we take care of them. And hopefully,
  200. we'll offer some advancements and
  201. improvements and outcomes from that.
  202. And so I'm excited to see kind of all of
  203. these new technologies coming in. We're
  204. still on the cusp of AI and getting
  205. predictive analytics in there. And I
  206. think rather than kind of taking over
  207. any roles, those analytics and AI will
  208. help us to do our jobs. better, faster,
  209. more efficiently, and kind of again
  210. integrate our lives both inside and
  211. outside of medicine more efficiently. I
  212. wouldn't that be nice.
  213. What are some of the frustrations you've
  214. had in the field? Some of the
  215. challenges you've faced? The
  216. frustrations that are numerous as well
  217. unfortunately, I think a lot of them,
  218. if I were to kind of do a root cause
  219. analysis of my frustrations with the
  220. field. Most of them start to stem with
  221. kind of the corporatization of medicine,
  222. as we have seen over time,
  223. while the numbers of intensivists and
  224. APPs
  225. and people around us hasn't really
  226. shifted significantly, the numbers of
  227. people within the corporate structure of
  228. medicine increased dramatically, the
  229. number of middle managers and the amount
  230. of effort it takes to get small changes
  231. implemented is really, really kind of
  232. frustrating. It really, really kind of
  233. stagnates change. And
  234. I think we as physicians, I think part
  235. of our personality is to accept things
  236. and to take part of our payment and the
  237. pride that we have done good work. And
  238. I think with the corporatization of
  239. medicine, we are going to have to kind
  240. of push things along and take a more
  241. kind of leadership role in both how
  242. things change and kind of being more
  243. actively involved in the evolution of
  244. medicine before it's kind of taken out
  245. of our hands and before we become kind
  246. of shop floor workers, which I don't
  247. particularly
  248. You know what I mean either. I joke
  249. with colleagues that here we have these
  250. kind of position tags that go on your ID.
  251. And I think as you walk down the hall in
  252. our hospital, it's like every third
  253. person says either manager or director.
  254. And I imagine like what that's like for
  255. someone who doesn't work in the hospital
  256. who's like, who are all these people
  257. managing? 'Cause it seems like the
  258. whole place is full of managers. Just
  259. speaking to this corporization
  260. This is a little bit off the cuff, but
  261. let's go there. So you mentioned floor
  262. shop workers. We don't want to be that.
  263. One thing that we've seen happening in
  264. residency and training programs recently
  265. is unionization. There's a reason why
  266. unions form among floor shop workers
  267. to protect their rights. I'm wondering
  268. as this generation of residents or
  269. fellows who are now unionizing kind of
  270. graduates to early faculty, whether
  271. there might be a push to see some
  272. immunization at the - position level or
  273. at least some way for us to band
  274. together to have more of a
  275. voice in corporate American medicine.
  276. And what are your thoughts on that? And
  277. is that something that we should be
  278. doing or? Well, I can't say should or
  279. shouldn't, but I can say that that I
  280. mean, we're we're we're both the part
  281. of ink and we're both talking about we
  282. both talk about representation a lot.
  283. And
  284. I think I think if we take this away
  285. from that that that lens of necessarily
  286. diversity for for a moment, I think if
  287. we if we look at at what happens in
  288. representation, then representation
  289. really kind of shows you what you can be,
  290. but it also gives you a voice. It also
  291. provides people it also provides some
  292. sense of protection. And frankly, I
  293. mean, we've been doing this in a in a
  294. similar fashion
  295. know some some small changes but but in
  296. a pretty similar fashion as as when when
  297. Osler was doing it and that's that's a
  298. long time to be doing things the the
  299. same way and um usually as as time goes
  300. along there there there becomes a little
  301. bit of of creep especially as you age
  302. within in the career and it becomes a
  303. little harder to see some of the
  304. eccentricities and and idiosyncrasies
  305. that that need to be corrected um and I
  306. think with with youth there comes a also
  307. a vitality for for change and an
  308. intolerance of of of things that seem
  309. unjust or injustices and so whether it
  310. be a union or just kind of louder louder
  311. voices um I do think that there is a a
  312. real need for for people to to speak up
  313. and to be heard and to make some noise
  314. and to make changes within the way
  315. medicine is practiced today.
  316. I completely agree. And maybe we can
  317. use this as a segue into talking about
  318. some of our work and ink together. I am
  319. struck by this quote. I read how to be
  320. an anti-racist, not too long ago by
  321. even Kendi. And he said something that
  322. I found very powerful, which is that in
  323. cityist forms of racism, people are
  324. often blind to because, but they hold a
  325. pivotal role in upholding racism. And
  326. people don't see it because these
  327. attitudes are often so deeply ingrained
  328. and it takes the ability to be deeply
  329. self-critical to examine and challenge
  330. these attitudes. I think there's a lot
  331. of corollaries to this in medicine. We
  332. have these deeply ingrained parts of our
  333. culture that we're often blind to. What
  334. are the insidious forms of not just
  335. racism but unjustness that are happening
  336. in the hospital that you see and who do
  337. we need to give a voice to? Well. I
  338. think
  339. we often tell ourselves a single story
  340. about
  341. existence, about people that we meet,
  342. about situations that we find ourselves
  343. in from an evolutionary standpoint.
  344. This is how we survive so long as a
  345. species.
  346. We make quick decisions and we stick by
  347. those decisions. But in doing so, we
  348. really kind of tell only one side of the
  349. story We only really, really kind of
  350. attend to one perspective. And in so
  351. doing, we miss out on all of the
  352. possible other multitudes of stories and
  353. perspectives and truths that can
  354. simultaneously exist. And when we talk
  355. about kind of the construct and
  356. construction of society today, it was
  357. really based on kind of injustice and
  358. injustice, it was really based on
  359. unpaid labor and building, building a
  360. foundation on the backs of that unpaid
  361. labor. Now, when we talk about kind of
  362. moving forward from that and making
  363. changes, if we don't take that into
  364. account, then it's hard to really kind
  365. of make changes because we're skipping
  366. over so many
  367. steps. And when we talk about kind of
  368. getting a seat at the table, we don't
  369. really look
  370. at one who made the table, who
  371. constructed this table, who was
  372. supposed to sit at this table, and why
  373. we would want to have a seat at the same
  374. table that has ignored and kind of
  375. maligned us for so many years. And so
  376. it really, in order to kind of build
  377. constructs and justice, we really have
  378. to kind of tear down some things. And
  379. I'm not sure that people are really
  380. ready to tear down things so much as
  381. they just wanna kind of make a general
  382. diversion. And I don't necessarily
  383. think that's enough to make substantial
  384. change. Certainly we'll make
  385. incremental and glacial change. But in
  386. order to make substantial change, there
  387. has to be some sort of reckoning about
  388. the past and how it has created the
  389. present in order to move forward.
  390. That's really powerful. Have you seen
  391. changes in your career that you would
  392. consider significant in this regard?
  393. Well, I think as time has gone along,
  394. I have become more comfortable in who I
  395. am and not having to necessarily
  396. demonstrate or prove I am in given
  397. settings and that's That's a
  398. double-edged sword because when I walk
  399. into a room, there's
  400. generally an air of lack of familiarity.
  401. Sure they know I'm a doctor, sure they
  402. know I'm black, but they don't
  403. necessarily know any other parts of my
  404. story. They don't necessarily know
  405. kind of how my foundation was built and
  406. what that means for me to be who I am
  407. now and walk into this space. And so as
  408. a kind of a hidden unicorn within the
  409. space, the assumption is that I'm the
  410. same as everyone else, I'm a horse.
  411. And it's not true and
  412. it skips a lot of steps and makes a lot
  413. of assumptions that if you look at those
  414. steps and assumptions, They really
  415. create kind of a different being than,
  416. than. anyone else and everyone there is
  417. an individual to their own degree with
  418. their own thoughts and beings. But they
  419. really don't look at my career path,
  420. kind of how that has gone, the things
  421. people have said to me, both good and
  422. bad, the little things. Like when we
  423. talk about representation and no, I
  424. don't see a lot of black doctors I don't
  425. see a lot of black men in the medical
  426. profession. But I do hear a lot about
  427. all of the diseases that
  428. disproportionately affect the black
  429. community and the Hispanic community and
  430. the list goes on and on. I do hear
  431. about inequities that aren't even
  432. corrected with socioeconomic status when
  433. we look at maternal mortality. These
  434. are the things that I hear with
  435. different ears because this is the
  436. community that I belong to. This is the
  437. community that I'm from. And so these
  438. things affect me more viscerally than
  439. they do on the surface. And that's not
  440. to say that someone can't understand
  441. them if they can't feel them, but
  442. they sometimes need to step outside of
  443. themselves in order to kind of make that
  444. happen and tear down the constructs that
  445. have been there and place there before.
  446. Got it. And so it strikes me as one
  447. solution to this, obviously there's no
  448. one solution to this problem, but one
  449. solution would be
  450. to
  451. increase the number of black men in
  452. neurocritical care, increase number of
  453. black women, increase the number of
  454. everything in neurocritical care. So we
  455. have a more diverse workforce that
  456. better represents the communities that
  457. we serve. really can interpret those
  458. patients and their illnesses through
  459. that lens.
  460. We just finished our, we have match day
  461. actually, it's coming up on Thursday,
  462. I believe. We just submitted our list.
  463. The group of applicants out there is not
  464. overly diverse. I think it's something
  465. we look at as a major deciding factor in
  466. our program is we'd like to diversify
  467. the trainees that come through our
  468. program. And yet, that's been a
  469. challenge for us because the applicant
  470. pool is not overly diverse. How do we,
  471. you hear always about the kind of
  472. growing the pipeline, or how do we do
  473. this in neurocritical care? And
  474. probably it has to go back before
  475. neurocritical care to neurology
  476. residency and even to just getting
  477. people into medicine to start with. But
  478. we put all of this in context with the
  479. recent court decisions on affirmative
  480. action. I'm seeing that, potentially
  481. things are gonna get worse and not
  482. better. What are your thoughts? Well,
  483. I think my thoughts really kind of go
  484. back. I mean, I have, I've posed this
  485. question to myself over and over again,
  486. and I don't, I don't necessarily have
  487. an answer. But I
  488. think a lot of it goes back to re kind
  489. of assessing those foundations upon
  490. which all of this is built Right now,
  491. what we're trying to do is we're trying
  492. to build diversity within a field that
  493. was frankly designed for
  494. kind of historically rich people,
  495. particularly rich white people. And if
  496. we suddenly shift our lens and say,
  497. well, we wanna make this diverse, well,
  498. is this the most socioeconomically
  499. uplifting for someone to think about,
  500. about joining? Is this the most
  501. supportive feel for someone to join and
  502. feel supported in who they are as an
  503. individual or is there kind of a cult of
  504. personality and a zeitgeist that exists
  505. within this field? You know, I
  506. think
  507. there is a comfort with bringing people
  508. into the field as it is, but there is
  509. not a comfort with changing the field to
  510. accommodate differences in personality,
  511. gender, race. I don't think the field
  512. is ready to make any type of shift
  513. towards that. And that shift is
  514. necessary and that shift doesn't mean
  515. that we accept subpar applicants, that
  516. shift doesn't mean that we don't have
  517. excellence
  518. changing both the people that are
  519. thinking and the different types of
  520. thought that are available within the
  521. field, it makes things better. I think
  522. there's
  523. always a desire within medicine,
  524. especially for consistency and
  525. maintenance. And I don't think, I
  526. think last year, I think last year,
  527. there was a question during one of the
  528. sessions So, and it was, so how do we
  529. encourage diversity and still maintain
  530. excellence? And I think - That's such a
  531. loaded question, right? I think that's
  532. a loaded and dangerous question because
  533. one, are we maintaining excellence or
  534. are we maintaining a status quo? And -
  535. And it seems to assume that if you add
  536. diversity, that excellence is in
  537. question, right? Exactly.
  538. So it makes a counterfactual argument
  539. that diversity somehow limits excellence.
  540. And I think that that is one of the
  541. things that's subversive, going back to
  542. that quote, that's one of the things
  543. that people don't know that they have in
  544. their minds. People that
  545. don't know that they carry this with
  546. them. However, I think this colors and
  547. jades the types of thoughts that people
  548. have about the table, bringing people
  549. to the table, encouraging, encouraging
  550. leadership that looks different, that
  551. acts different, that sounds different.
  552. And so I think when we ask about kind of
  553. how do we diversify medicine, I think
  554. we
  555. have to ask ourselves, well, well,
  556. who is this currently good for? And who
  557. can currently do
  558. this? in the way that it is right now.
  559. And is that the way that it should
  560. maintain? I mean, if you're a poor kid
  561. from rural Alabama, I mean, I was a
  562. poor kid from rural Alabama, is this
  563. the best choice to make? Or
  564. is the cost too great? Does it
  565. ultimately become a pure victory within
  566. your life? And so I don't know what the
  567. answer is, but I think there are lots
  568. of questions that we skip over in
  569. pursuit of the answer that we have to
  570. sit and uncomfortably address before we
  571. can kind of talk about solutions. Yeah,
  572. I remember there was a survey of
  573. recently matched neurology residents
  574. that came out several years ago. And it
  575. was basically asking there the reasons
  576. for going into neurology and why did
  577. they choose there? Why did, you know,
  578. what factored into that decision? What
  579. did not? And one of the things that was
  580. at the very bottom much known when into
  581. neurology, you know, for the financial
  582. perks, which is well informed thought,
  583. but it's also it's very privileged,
  584. right? And the discussion was sort of
  585. centered around, you know, how great
  586. that people go into neurology, mostly
  587. for this pure academic love of
  588. neuroscience and to understand sort of
  589. the essence of humanity. And yet, it
  590. just kept striking me as, wow, this is
  591. really a privileged space to look at
  592. this from. And, you know, I, I I'll
  593. admit, my story is I'm the son of two
  594. physicians, white male.
  595. I went in for the same reasons as that
  596. survey kind of highlighted. And yet,
  597. you know, I, I know people, some of
  598. the plenty of people that I went to med
  599. school with, who were loaded down with
  600. debt. And they were really making
  601. practical decisions in part in choosing
  602. their, their specialty. And I don't
  603. think that that's a bad thing Thank you.
  604. Right, I mean, at the end of the day,
  605. I mean, there is a quest for survival
  606. and thriving. And sure, medicine still
  607. has a law, it still
  608. garners a respect from certain members
  609. of the community. However, pay in
  610. passion and having a prestige career is
  611. a trap and it eliminates a certain pool
  612. of people who can't afford to live their
  613. lives that way,
  614. who can't afford to, who can't lift
  615. their families up out of poverty, who
  616. can't move themselves within the
  617. stratosphere of survival. And if we
  618. look around, if we look around at the
  619. socioeconomic of medicine, if we look
  620. around at who becomes doctors
  621. and why it's hard to compare because
  622. most of those people are from the top
  623. quartile, if not top 10 of
  624. not salaries, net worth. And if you
  625. try to make this offer as kind of an
  626. appealing career choice to someone from
  627. a lower socioeconomic, socioeconomic
  628. status, the amount of things that
  629. they'll have to sacrifice in terms of
  630. unpaid positions,
  631. kind of poorly paid positions, compared
  632. to their peers,
  633. it's hard to make the case that this is
  634. a viable option for them. And can we
  635. take this opportunity then to talk about,
  636. for those that do, we hear about the
  637. minority tax, right? This unfair
  638. burden of placing all of this hard work
  639. on those people that represent those
  640. groups that have made it through. And
  641. you know, how have you dealt with that
  642. in your career? Are you still, is it
  643. still a struggle continuously? And how
  644. would you advise young faculty to manage
  645. that? Oh, I mean, it's a continuous
  646. struggle.
  647. It's a privilege and an honor and a
  648. struggle yet and still. I feel like in
  649. all advocacy work, there becomes a bit
  650. of self-sacrifice. And part of that
  651. self-sacrifice aligns with this kind of
  652. black tax, minority tax.
  653. A lot of the times when you're sitting
  654. in a room and you're the only one,
  655. you're also the only one that has the
  656. potential to answer certain questions.
  657. And you're also the only one that people
  658. look to So you end up in a lot of things.
  659. that are steered around kind of who you
  660. are. You end up on a lot of committees
  661. because they need your voice and the
  662. career needs your voice.
  663. But
  664. it doesn't come with the prestige that
  665. there is no, their promotions aren't
  666. based on it It's not recognized as the
  667. time sink and effort and important
  668. effort that it is. And so it becomes
  669. more of a tax than it is an opportunity
  670. to help. And so that's a problem. I
  671. think it deserves and warrants more
  672. recognition and more understanding of it.
  673. And I think it is something that is so
  674. prevalent within all careers but
  675. especially within medicine because.
  676. because now as time has gone along for
  677. great reason, there is more attention
  678. to the problems, but there are not a
  679. lot of solutions. And I think more
  680. people are needed to be at this table,
  681. but they need recognition for coming to
  682. the table and offering what is kind of
  683. oftentimes trying in traumatic stories
  684. about kind of what has happened to them
  685. in their past and how they prevent this
  686. from happening in the future. As far as
  687. kind of the next generation, you really
  688. do have to look within yourself and say,
  689. can I afford this? Can my psyche afford
  690. this? Can my family afford this? Can
  691. my life afford this, this tax? Is this
  692. something I can do? And there's no
  693. right or wrong answer I think it comes
  694. down to a really a personal choice, But
  695. you have to know that this at times is
  696. going to be requested. And you also
  697. have to know that that that no is a
  698. power word. You have to be able to say
  699. no and no takes you no takes you a long
  700. way.
  701. Can you talk a little bit more about
  702. what you just said? You mentioned that
  703. the matter attacks, it plays a role on
  704. your psyche. And I think this is
  705. probably overlooked that maybe some
  706. well-meaning people think, oh, I'm
  707. giving you this great opportunity, this
  708. is probably something you're going to be
  709. really excited about, what is the kind
  710. of the cost to the psyche involved in
  711. doing this work? Well, I think it
  712. starts well
  713. before this starts to occur
  714. professionally I think it starts to
  715. occur with with the statements just in
  716. medical school about
  717. kind
  718. of the social determinants of medicine,
  719. which they're just starting to call it.
  720. But I think when you start to talk about
  721. kind of who's affected by these diseases
  722. and you just say things like, oh, it's
  723. disproportionately this or it's this.
  724. You don't even say disproportionately.
  725. You say black people are more affected
  726. by this disease. And that's it. You
  727. keep going. You don't talk about why.
  728. You don't talk about social determinants
  729. of health. You just say, oh, this is
  730. a black disease. This is a woman's
  731. disease. This is an ex disease. And I
  732. think that starts to build kind of
  733. within your core. And you don't know it.
  734. And I think that's part of what's under
  735. looks.
  736. throughout this whole experience is that
  737. part of what racism and social injustice
  738. does is it makes you look at your own
  739. group the same way that everyone else
  740. does. And so it starts to build within
  741. you. And then suddenly you're in a
  742. position and you already had this. You
  743. wrote, you leaped over all of these
  744. hurdles that have been created by who
  745. you are through no fault of your own.
  746. And then you get to a position and
  747. you're asked to do these things. You're
  748. asked to be on these committees. But
  749. these committees oftentimes don't have
  750. a power in
  751. the ethos of wherever they are in the
  752. structure of the organization they
  753. sometimes are a checkbox.
  754. they oftentimes don't offer an
  755. opportunity for advocacy. And they ask
  756. you to speak for an entire group,
  757. assuming kind of this group is a
  758. monolith. Whereas there are so
  759. many differences and unique
  760. eccentricities within the group that
  761. there's no possible way that you can
  762. speak for everyone. And they don't
  763. allow you to be an advocate. And what I
  764. mean by being an advocate is rather than
  765. speaking for someone, they don't allow
  766. you to bring other people there to speak
  767. for themselves. They don't allow you to
  768. dismantle the table that has been
  769. created. So it wears on you because not
  770. only are you doing this, it seems like
  771. you're on a treadmill. It seems like
  772. you're just kind of running in place and
  773. you're sweating and you're huffing and
  774. puffing but you aren't really going
  775. anywhere And so.
  776. You have to decide whether incremental
  777. glacial change is something that you
  778. find rewarding, is something that is
  779. not going to kind of eat away at your
  780. soul and your psyche and contribute to
  781. kind of your own breakdown and
  782. stress. We don't really kind of attend
  783. to that enough, kind of how we feel
  784. basically Yeah, and it strikes me as
  785. something you said in the beginning of
  786. the interview, which is one of the
  787. things you liked about neurocritical
  788. care is you like to make a change and
  789. then see the response in a fairly acute
  790. way, unlike neuro oncology. And that
  791. personality is the exact opposite of
  792. what you just described of this
  793. treadmill of hoping for glacial change
  794. trajectories. It's a real maybe
  795. challenge in our field that's somehow
  796. perhaps more challenging in our field
  797. than others. Oh, absolutely. I mean,
  798. we are not a field that's designed to
  799. tell our own stories and to talk about
  800. our own moral injury and burnout and
  801. kind of foster a compassion among each
  802. other. I mean, we do a lot about and
  803. talk a lot about kind of fostering
  804. compassion and healing of patients, but
  805. we don't look within our own career and
  806. kind of foster compassion and promote
  807. healing of each other within the career.
  808. And I think
  809. that is kind of
  810. a siloed manner of kind of ethical
  811. decision-making that is really
  812. problematic.
  813. How can we be good allies?
  814. I think we talked about this a few
  815. moments ago, but I think being good
  816. allies means rather than telling other
  817. people's stories only, I think you
  818. really have to pull those people to the
  819. table to tell their own stories.
  820. I look at, I think two people that were
  821. pivotal within the society for me, one
  822. above me, one below me, or not below
  823. and above, but one
  824. was there before and one came after,
  825. but Christina, you know, failing
  826. really kind of, kind of pulled me into
  827. wink, when, as kind of one of, as the
  828. only male member, and the only kind of
  829. black, I was a black guy, and she said,
  830. Hey, you should join this group. I
  831. joined, and I think that was
  832. instrumental in being able to kind of
  833. tell my story and other people to tell
  834. their story, and it evolved into ink I
  835. think Amy Eisen who. came after me,
  836. she was a few years junior to
  837. me, but I think she has spoken up for
  838. me and underserved people within the
  839. society and within leadership. And I
  840. think how to be an ally means really
  841. kind of bringing people to the table,
  842. to tell their stories, to telling
  843. different stories yourself and kind of
  844. fostering, kind of listening to those
  845. stories and understanding that there are
  846. so many multitudes of simultaneous
  847. truths and perspectives. And in a given
  848. moment, that kind of colored these
  849. lived experiences that need to be heard
  850. and ordered for there to be changed.
  851. And I think allyship really means kind
  852. of allowing people to stand on your back
  853. and speak for themselves.
  854. For people within NCS or beyond who want
  855. to start this journey into being a
  856. better ally, resources you recommend or
  857. ways to get started? Well, I think it
  858. starts, I think it really starts with
  859. listening. I recently have been
  860. involved in, and I think it's kind of a
  861. new thing, but it's called narrative
  862. medicine. It came out of Columbia. And
  863. it's really kind of the practice of
  864. mindfulness and kind of communicating
  865. and assessing all of these, these
  866. perspectives and truths that we're
  867. speaking about. And I think you really
  868. have to kind of start to learn to
  869. closely listen to the stories that
  870. people are telling you, and closely
  871. observing what's going on around you,
  872. and looking for different perspectives
  873. than your own, stepping outside of your
  874. own silo or spaceship or bubble. and
  875. really looking into to kind of others'
  876. lives and seeing what's missing.
  877. Certainly there are all types of
  878. resources that will tell you steps in
  879. the ally ship. But I really think that
  880. in order to kind of take those in, the
  881. first step is to really understand and
  882. learn how to listen and be mindful and
  883. to be introspective and step outside of
  884. yourself And I think without that, it's
  885. hard to subsequently take in all of
  886. these steps and become a true ally.
  887. Absolutely.
  888. Maybe we'll just wrap up now. There's a
  889. few questions we sort of ask everyone
  890. who comes on the podcast. There's kind
  891. of quick hits we call them. Okay. That
  892. was pretty deep and powerful and these
  893. are gonna seem perhaps out of place, I
  894. like it, I think we need a little
  895. levity. Yeah, we need to bring a
  896. little levity to the podcast. But this
  897. has been really fantastic, and I've
  898. learned a lot. What do you do outside
  899. of the ICU? What do you do for fun?
  900. What are your passions or hobbies?
  901. It's funny, the last time I answered
  902. this question, it was eating and
  903. drinking, but. Me too. But I would
  904. lie if I would say it's not that. I
  905. mean, when I travel, I travel to go to
  906. certain restaurants, and so I
  907. experienced culture through food, I
  908. like to call it peasant food sometimes,
  909. but it's not all kind of Michelin star.
  910. I really like to kind of experience kind
  911. of what people are eating, how they eat,
  912. how they gather together and commune.
  913. And so I think that's a big hobby.
  914. That's a big hobby, and I spend a lot
  915. of my time then pursue that and pursue
  916. kind of kind of. food in that
  917. experience. Cool. I mean, I just, it
  918. was in Minneapolis with a bunch of
  919. another neuro-intensivists. We went to
  920. this restaurant called Awanmi by the
  921. Sous Chef, and its whole deal is it
  922. highlights the food of indigenous people.
  923. Oh, yeah. They have no, like,
  924. post-colonial ingredients, so there's
  925. no dairy, right, because there's no
  926. cows. There's no beef. There's no pork.
  927. There's no chicken. There's no flour.
  928. There's no sugar cane. And it was wild.
  929. And it was delicious. We had a great
  930. time I think that's amazing. I also
  931. think that lots of people and most
  932. people show love through food. And so
  933. if you gain an understanding of kind of
  934. people's foods, then you really do get
  935. an understanding of kind of how they
  936. care for each other. So that's stuff.
  937. Yeah, it was really cool. There's the
  938. pride and enthusiasm from the staff was
  939. so infectious, it was like we all kind
  940. of walked out. It's just a huge smile
  941. on our faces because of
  942. that What other specialty would you like
  943. to attempt or would you would you You
  944. mentioned your oncology, but outside of
  945. neurology, maybe completely, but
  946. something you would like
  947. to try. So I think about kind of
  948. neuro-crewic care and neurology within
  949. the frame of kind of hardware software.
  950. And I think about kind of neurosurgeons
  951. as being kind of the expert hardware
  952. kind of technicians and then
  953. neurologists someplace in between and
  954. then psychiatrists to really deal with
  955. the software. I kind of like the
  956. software. And so if I were to do
  957. something else within medicine, it
  958. would probably be either psychiatry or
  959. anesthesiology because I find
  960. consciousness to be strange from an
  961. existential standpoint. And I don't
  962. think any of the work thus far, Emory
  963. Brown and lots of people are doing lots
  964. of different work on the nature of
  965. consciousness But I would - probably
  966. move out of medicine if I were really to
  967. do something else different. But within
  968. medicine, I think those two get the
  969. closest to consciousness and
  970. existentialism. And so that would
  971. probably be what I did. All right. And
  972. what's especially that you would not
  973. like to do? Oh, there's most
  974. of the best.
  975. I think this chose me more than I chose
  976. it I couldn't see doing most other
  977. things. Maybe cardiology, but I think
  978. of that heart as a lump of muscle,
  979. neurosurgery, but standing and looking
  980. in this tiny little surgical feel for
  981. hours seems less than a feeling. So
  982. most things I think I would sway away
  983. from. Yeah, yeah. I remember my first
  984. experience in the OR in neurosurgery as
  985. like a third year med student.
  986. heaven for 30 minutes and then about
  987. nine hours later. Right.
  988. Is there a sound or smell in the ice to
  989. you that you like?
  990. So this goes along with my alarm fatigue,
  991. but I love the cacophony of alarms.
  992. It's not it's not the same now as it as
  993. it used to be because because we have
  994. become more attuned to alarm fatigue,
  995. but walking in and hearing the the
  996. ventilator alarm, I used to just I just
  997. just loved that. I felt it made me feel
  998. like I was I was at home and hearing
  999. hearing everything kind of kind of go
  1000. off asynchronously.
  1001. I those were the sounds that I that I
  1002. really liked. Yeah, I'm I'm with you
  1003. on that. If I had a sound machine to
  1004. put myself to sleep, it would be
  1005. asynchronous ventilums. Exactly. And
  1006. is there a sound just from on the ICU
  1007. that you just hate? Oh, there's so
  1008. many, there's so many smells that like
  1009. the smell of the ICU is, is something
  1010. that I find terribly revolting. And,
  1011. you know, I'm almost ashamed to admit
  1012. it, but, but I just, sometimes the
  1013. smells are, are just a little bit, a
  1014. little bit too much. But, so any smell
  1015. within the ice.
  1016. And finally, what general advice would
  1017. you give it to a fellow about to
  1018. graduate?
  1019. Be yourself, make yourself, make your
  1020. own way within your career, say no, as
  1021. much as if not more than you say yes,
  1022. and really plot a path out that fits
  1023. within who you are and the life that you
  1024. want to lead.
  1025. All right. Well, would that be the
  1026. last word? Tommy Thomas, this has been
  1027. a real pleasure. This is, Probably the
  1028. the deepest and most impactful interview
  1029. we've we've done and maybe whoever will
  1030. do on the
  1031. But like that's what I really enjoyed it
  1032. and I think our listeners will too So
  1033. thanks so much for your time and I hope
  1034. to see you in sweaty Phoenix indeed
  1035. Indeed.