Episode 49: Rex Marco

This a two-part interview with Dr. Rex Marco, a musculoskeletal oncologist and reconstructive spine surgeon who is living with C3 quadriplegia. He is currently the chief medical ambassador for the Christopher and Dana Reeve Foundation, in addition to working as a clinician, investigator, and teacher at Houston Methodist Hospital. In these episodes, Dr. Marco recounts his inquiry, what he’s learned from practicing mindfulness, and how his time as a patient changed how he viewed his role as a doctor.

Transcript

PART 1

 

Lisa Meeks:

Doctors with disabilities exist in small but impactful numbers. How did they navigate their journey? What were the challenges? What are the benefits to patients and to their peers, and what can we learn from their experiences? My name is Lisa Meeks, and I am thrilled to bring you the Docs With Disabilities podcast.

 

Sofia Schlozman:

Welcome back to the Docs with Disabilities podcast. This is part one of a two-part interview with Dr. Rex Marco. Dr. Marco is a musculoskeletal oncologist and reconstructive spine surgeon who is living with C3 quadriplegia. He is currently the chief medical ambassador for the Christopher and Dana Reeve Foundation, in addition to working as a clinician, investigator, and teacher at Houston Methodist Hospital. When we spoke with Dr. Marco, we were incredibly moved by his story, and we want to make sure to accurately transmit his eloquence and wisdom in this episode. As a result, we've decided to structure this series in a way that centers on Dr. Marco's narrative with fewer questions and transitions than we typically utilize on our show. Before we jump in, we encourage you to make yourself a tea or coffee and settle into a comfortable spot. This episode begins with Dr. Marco's recollections of the day he acquired his disability.  

 

Rex Marco:

I felt like I was on top of the world, and I had just received a promotion to Vice Chairman of Orthopedic surgery. I had a wonderful practice in reconstructive spine surgery and musculoskeletal oncology. I had a wonderful life in terms of my family with a nice house and a nice car. I thought everything was great, and then tragedy hit me and my family. 

 

What I didn't realize was that there was a lot more going on in my life and my family's life. What I soon realized was that I have a lot of unrecognized stress, anxiety, and depression, and what I now know is I was probably burned out. Through that process, I also learned that the stress that I was experiencing was leading to hypertension, pre-diabetes, and insomnia as well. Through that experience, I learned about living in the moment through mindfulness. And soon, I also realized that mindfulness alone was not enough because I then entered a parent-driven recovery program and learned what true principle-based living is about. 

 

Through this recovery program, part of it included an exercise program where we would get out in nature and ride bicycles. On one of these ventures, I was riding with the other parents and teenagers, and on one of the trails, I decided to turn left instead of right because it looked like an easier path, and as I turned back up on that path. The next thing I knew was that the tire and my bicycle were not going up the path. And I heard a crack, and I wasn't sure if that crack was my helmet or my neck, or my skull. But I thought it was one of those, and in that moment, I started to breathe. I used my tools of recovery and mindfulness. And I started to breathe, and I took slow deep breaths and felt that peace and serenity that I learned my breath could give me. The title of this book called Radical Acceptance, which I hadn't read, but I'd heard about before, and I realized that it was important for me to radically accept whatever happened to me. I knew that it was a possibility that I broke my neck and that I could be paralyzed or severely injured. I didn't know if that was the case, and the next thing I did was to ask for the serenity to accept the things I cannot change and the courage to change the things I can, and the wisdom to know the difference. And soon thereafter, my friend came running towards me, and I heard the panic in his voice as he called my name, I asked him to touch my leg, and he told me that he was, and I asked him if I was moving my foot up and down, and he said that I wasn't. And in that moment, I knew that I was paralyzed. And I also asked him to see if my arm and hand were moving, and he told me that they weren't. Because I could not feel and I couldn't move, I knew that I had broken my neck and that I was quadriplegic, and in that moment, I knew that there was less than a 5% chance that I would walk again, and I may not ever go back to work or hold my unborn child.

 

 

Rex Marco:

I don't know why I didn't feel sad in that moment. I simply knew that I needed to get to the hospital as soon as I could so that I could have my spine decompressed as soon as possible if there was any compression on my spinal cord. I also had visions of trying to pull on my head so that I could reduce my own spine as I had heard stories of physicians doing this. I knew that since I couldn't move my arms that that was not a possibility. The only number that I could remember was my ex-wife's number, and I believe that's an important message. Since the advent and use of smartphones, very few of us know many numbers, but I believe it's important to memorize the phone numbers of people important in your life because I could only remember one number. Fortunately, she answered, and she had my PA's number and she called him, and thankfully he answered and he was able to get in touch with my friend and colleague Dr. Prasarn, who arranged to have everything ready for me when I got to the hospital.

 

The EMS team came, and the first thing they wanted to do is put a c collar on me and check my vitals, and put me on a backboard. My experience as a spine surgeon and orthopedic surgeon led me to also have traumatic thoughts of the patients I had taken care of who developed pressure sores from lying in one position. I was always taught to remove people from the backboard as soon as possible because when someone cannot feel and is lying on a backboard for a prolonged period of time, they can develop these pressure sores.

 

I had seen so many patients with quadriplegia have pressure sores, and part of what I did was to take care of patients who had developed severe pressure sores that were not healing. I performed around 50 hemipelvectomies to remove the pelvis bone and the lower extremity to help treat these pressure sores. So visions of all my patients that I had taken care of came through my head, and I knew that I needed to get off that backboard as soon as I could.

 

When I got to the emergency room, as soon as my CT scan was done, I asked them to remove me off the backboard, and miraculously within 2.5 hours of my accident, I was in the operating room getting my spine decompressed and reduced. The miracle about that was when I worked at that trauma center it was almost impossible to get a patient with a spinal cord injury into the operating room before 24 hours, but a paper that my friend and colleague, Dr. Fehlings, wrote studied the dramatic improvement that occurred when patients were decompressed within 24 hours of their injury. That pivotal paper led to my colleague and other colleagues at the trauma center to be able to work to get patients into the operating room sooner. 

 

When my operation was finished, I remember lying there in the ICU, and my surgeon told me that patients with my injury often benefit from a tracheostomy. When he said that, I knew that I could take a deep breath and find relaxation and peace like I'd always been able to do.

 

I tried to take a deep breath on my ventilator, and I didn't have any relief. My breath and my ability to breathe were gone.  

 

As many of you know, C3, 4 and 5 help keep the diaphragm alive. With my injury, C4 and 5 bilaterally were not working, so my diaphragm was not working, and my breath was gone, and I asked him to go ahead and arrange for a tracheostomy to be performed while I was in the ICU.

 

Sofia Schlozman:

In the next section, Dr. Marco describes the tools he used to process and accept what had happened to him.

 

Rex Marco:

I used a lot of tools that I had learned to help me with my minutes and hours and days, and I knew that there were stages of grieving that were important for me to go through to get to acceptance. Stages of denial and anger and bargaining and sadness or depression. Yet I also knew that there was no denying what was going on for me. Anger wasn't going to serve me, and yes, I had some bargaining that I was going to recover and walk and operate. I was going to do that by working as hard as I could.

 

I knew it was okay for me to feel sadness and I knew that sadness was one step closer to acceptance. I also knew that there was a plan. A plan for me to do something. I knew there was a reason for this injury, and one of the visions that I had was one of my childhood heroes named Christopher Reeve. He starred in the movie Superman when I was a young child. While he was riding his horse, he fell off and broke his neck, and became quadriplegic. I remembered him on stage at the Emmys, speaking on his ventilator to the world, and it was so inspirational to me. I knew that he had started a foundation to increase spinal cord injury awareness and find a cure for spinal cord injury through research. I knew that part of my plan was to increase spinal cord injury awareness and raise money for research to find a cure for spinal cord injury. I also hoped that I would be able to spread the message of mindfulness and mental health awareness. Most of my moments and days were spent living in that moment, not dwelling on the past or worrying about the future.

 

Being present in that moment with my ventilator breathing for me. With every in breath of the ventilator, I could try to smell. With the out-breath, I could taste. With the in-breath I could listen, and with the out-breath I could feel. Becoming present with my senses helped me stay in the present moment with the breath of my ventilator. There was a wonderful channel that played on the television called the healing channel. The healing channel played images of nature with instrumental music. I would watch this from the moment I awoke until it was over at Eleven P M. These images of nature I knew had helped patients live in the present moment and wean themselves off of strong narcotic medications. I knew that if I listened to the music and watched these images of nature that my brain would make substances like dopamine and serotonin, and GABA so that I would be able to live in the moment. Feel better. Have less anxiety. Have less sadness and try to combat this insomnia that I had in the ICU. Every night I would play the Surrender Guided Meditation by Jason Stevenson. 

 

Rex Marco: 

My nurses were kind enough to play that meditation throughout the night. I'm not sure how many nights or hours or minutes that I slept, but I knew that I listened to that meditation over and over again, and it really helped me through a difficult time. I also had a practice of loving-kindness, which in Bali is called metta. That loving-kindness practice allowed me to start my day and ask: May I be kind and compassionate. May I be humble and accepting. May I be honest and accountable. May I be forgiving and committed. May I love kindly and kindly love. 

 

This helped me start my day in a frame of mind where I was less likely to harm others with my thoughts and my actions. Although I couldn't move and I couldn't speak, there are definitely ways to communicate with my facial expressions. I could communicate with anger or frustration or fear and harm other people, or I could do my best to communicate with love and compassion.

 

I feel remiss in not mentioning another tool I used while I was in the ICU. I used a tool called the Panda Planner. Two weeks before my accident, I received my Panda Planner and every day before my accident and every day since my accident, I start my day with a short plan. That plan includes listing 3 things I'm grateful for, listing 3 things I'm excited for, listing my daily focus, saying my daily affirmation, and having an exercise plan. Every day since, by accident, I would list 3 things I'm grateful for and they've always been the same. I am grateful for life. I am grateful for my breath. I am grateful for my recovery.

 

The 3 things I listed that I'm excited for: I am excited to see my family and friends. I'm excited to see my caregivers and doctors.

 

My daily affirmation is I am always enough. I am enough. My daily focus is to do my best to be mindful and live in this moment. When I say that, I breathe in and smell, breathe out and taste, breathe in and listen, breathe out and feel. In the ICU, I had a daily exercise plan of getting out of my bed and into my chair. Now I have different exercise plans.

 

Working through the Panda planner every day also helps me start my day in a more nurturing mindset. 

 

Sofia Schlozman:

In the final section of this episode, Dr. Marco shares the importance of learning how to advocate for oneself and one's patients. Listen or read along, and he shares the technology and organizations that helped him advocate for himself and taught him how to better support his patients. 

 

Rex Marco:

I also learned how important it is to advocate for yourself and your patient. Like the time I knew that it was important for me to advocate for my friends to get me on the trail and on the way to the hospital. When it was important for me to advocate for my blood pressure to be treated or my ventilator to be fixed or to get off of the backboard. 

 

Other ways that I feel that we can advocate for our patients is to keep in mind some of the technology that we now have available and is not always available for your patients. I remember lying there in bed, wanting to be suctioned. Knowing that one of my patients with C4 quadriplegia had to have a spit fistula placed, which is a hole in the side of his neck. Saliva could empty out because he couldn't manage all the secretions, and I remember having a tremendous amount of saliva accumulate. Having visions of the need for a spit fistula and that feeling of drowning in my saliva. Not having a way to call for help lying there immobilized with no movement in my arms. Not being able to suction myself and not being able to call anybody because I didn't have a call button. There's a device that you can blow in and trigger a call to the front desk. I was so grateful that my rehabilitation center had this device because otherwise, I would just lie there drowning in my saliva, having images of the need for a spit fistula.

 

Thankfully voice control came out on my smartphone device, and my friend taught me how to use it. It's such a powerful tool. It's not SIRI. It's voice control, and you can control the smartphone by saying press 4 or press 3 or go to messages or open email. My other friend said you know they're these voice recognition systems like Alexa or home pods or Google makes a device as well, I think you could benefit from them, and he sent me one. My family and friends set it up in my room. I could call my nurses or call my friends or family, and it's such a powerful device and such a simple thing.

 

About a year after my discharge, another friend that I met who lives with quadriplegia told me about a sip and puff mouse that I can control with the use of my breath. Now I can use my computer and in some ways better than before my accident. So there are ways to advocate for yourself and your patients.

 

Another important advocacy organization that I've been fortunate enough to be a part of is the Christopher and Dana Reeve Foundation. Christopher Reeve wanted to find a cure for spinal cord injury and his wife Dana wanted to help improve the quality of life patients are experiencing, who are living with paralysis. Through that, they've been able to raise millions of dollars to fund research and, as importantly, obtain funding from the government to run the National Paralysis Resource center, which supports books, online information, blogs, and webcasts to help patients who are living with paralysis and their caregivers. They also have a peer mentor program that will pair you up with someone with your level of injury, age and gender. These resources are so helpful. 

 

When I'm in a bind and I need to learn more about my bowel program, my spasms, my pain, flying on an airplane, bathing, using a computer, thriving in life, I can reach out to the people that I've met through the National Paralysis Resource Center. There are also ways to get involved to give back to other patients living with paralysis and become a peer mentor yourself. Or if advocacy is something you want to do, they have a branch that helps advocate for patients living with spinal cord injury and paralysis at the national level in Washington DC and. throughout your community. 

 

Sofia Schlozman:

To our guest, Dr. Rex Marco, thank you so much for joining us on the podcast and sharing your story in this episode. We are so grateful for your insight and honesty. 

 

To our audience, thank you for joining us for this episode. We strongly encourage you to listen to part 2 of this interview, available now, where our conversation with Dr. Marco continues to consider how Dr. Marco's time as a patient informed his perspectives on medicine. 

 

This podcast is a production of the DocsWithDisabilities Initiative and is supported, in part, by the University of Michigan Medical Schools Department of Family Medicine M-Disability Initiative, the Stanford Medicine Alliance for Disability Inclusion and Equity and the Ford Foundation. The opinions on this podcast do not necessarily reflect those of the hosts, their respective institutions, or the funders. This podcast is released under Creative Commons Attribution Non-Commercial, Non-Derivative License. This episode was produced by Sofia Schlozman and Lisa Meeks, with support from our audio editor Jacob Feeman.

 

 

 

PART 2:

 

Lisa Meeks:

Doctors with disabilities exist in small but impactful numbers. How did they navigate their journey? What were the challenges? What are the benefits to patients and to their peers, and what can we learn from their experiences? My name is Lisa Meeks, and I am thrilled to bring you the Docs With Disabilities podcast.

 

Sofia Schlozman:

Welcome back to the Docs with Disabilities podcast. This is part two of a two-part interview with Dr. Rex Marco. If you have not yet listened to this first episode in this series, we strongly encourage you to listen before beginning this episode. In this episode, we continue our conversation with Dr. Marco to discuss how his time as a patient changed how he viewed his role as a doctor. Listen or read along as Dr. Marco begins by sharing the lessons he learned during his own hospital stay.  

 

Rex Marco:

As a patient, I learned so much about being a doctor, and one of the things that I learned was to praise my team. What I knew of myself as a surgeon was that I was "It." I was the main person that when someone came in with paralysis and a fractured neck, I was the one to fix it and get them on their way to recovery. Yet I didn't realize how much my nurses and therapists, and nurses assistants contribute to the recovery of my patients. I saw all of these people throughout the day, and I almost never saw my surgeon. I realized that I saw the person that cleaned my room so much more than I saw my surgeon. What I learned from that is that it's important to praise your team because they do so much for you. 

 

I also learned that as a surgeon, I would have a patient who is intubated, and in my head, I felt some happiness because, to me, that meant that I could get done seeing that person sooner and finish rounds quicker because I could tell them that I don't understand what you're saying, but when the tube is out I'll answer all your questions. I could move on. As a patient, I felt a lot of shame and guilt over the way I treated my patients before my accident in that situation. One moment came to mind, especially when I had a nurse who didn't know how to read lips. So for the whole shift, I couldn't communicate my needs or wants. She looked at me as if to throw up her hands and say I don't understand you. That feeling of hopelessness and helplessness in that situation, combined with the shame and guilt of knowing that I treated my patients the same way, taught me that it's important to bring a translator with you who can read lips for your patients who are intubated so that you can address their wants and needs.

 

[music transition]

 

Rex Marco:

I also learned that being a patient is terrifying, and maybe part of it was because of my own trauma that I experienced as a physician.

 

When my blood pressure would go up due to autonomic dysreflexia, it would go up to levels of 210/120. I would have severe throbbing headaches and have visions of having a stroke. I was terrified. A time when my ventilator was not working, and I was telling my respiratory therapist that my ventilator wasn't working and she couldn't read lips, so she had no idea what I was saying. That was terrifying waiting for her to get someone who could read lips and find a therapist who could fix my ventilator.

 

So many moments occurred like that, and I can only imagine that our patients are terrified in those moments. Understanding that they're terrified is something that I think will help you. Understanding that with fear, some patients go right to anger, and if they're angry, it doesn't mean that they're angry at you. It probably means that they're afraid of something. That brings me to the other important lesson that I learned has to do with the words empathy, sympathy, and compassion. I was looking at the keyboard one day, and I saw the escape key, and the escape key has 3 letters "ESC." I decided to use that acronym of the escape key to help me when I'm in a difficult situation in life or with my patients. In my mind, I can press the escape key and know that I could try to empathize and sympathize and have compassion for the other person. Empathy is the ability to feel and understand what someone else may be experiencing. In medical school, I learned that it is important to never say you're sorry to a patient. As a patient, I learned that it's okay to say I'm sorry you are experiencing this or I'm sorry this happened to you. That's what sympathy is. The ability to feel deep sadness or sorrow for what another may be experiencing.

 

If someone had an adverse childhood event or had a severe accident, or has a new diagnosis of cancer or diabetes or hypertension and they may be afraid or angry, or sad in that moment. It's okay to have and express sympathy for what they may be experiencing.

 

I learned that compassion is truly desiring that no one suffers, including myself. In those difficult moments with patients or in other interactions with people, I can press the escape key and have empathy and sympathy, and compassion.  

 

[music transition]

 

Rex Marco:

Through my recovery, I also learned that hope is an option. I felt sad as a patient because I knew as a surgeon, I never gave my patients hope. I felt that it may be false hope, so I didn't give them hope. I tried to be real and tell them what might happen rather than giving them hope. As a patient, I had so many of my friends who were living with quadriplegia or paraplegia come and visit me. One of my friends, Dr. Alford, is my patient and my friend. He's given me permission to speak about him. He would come and visit me, and I knew that he had returned to work as a physician and surgeon. When he would come to visit me, I had hope that I would return to the operating room. I knew that I would return to the operating room. 

 

My other friend, who was living with quadriplegia, would come and visit me. He would tell me how he was able to drive to work, and I knew that he ran the department of orthopedic surgery and neurosurgery and physical medicine and rehabilitation. I knew that someday I was going to return to work and drive my car there.  

 

My newfound friend, Toby, was living with quadriplegia, and through his injury, he went to school and became a lawyer and is a prominent lawyer in the Houston area. 

 

 All 3 of them gave me so much hope for the things that I could do living with my disability. 

 

Sofia Schlozman:

In the next section, Dr. Marco shares more about the financial implications of his disability. Listen or read along as he shares his insights on the importance of proper insurance. 

 

Rex Marco:

Another really important thing that I learned about was how important it is to have the proper insurance. Everyone has their financial limitations regarding insurance. One important thing I learned as a resident was when a financial advisor came to me and suggested that "now that you're graduating, you may want to consider getting more insurance." To me, that was a sales pitch. I just thought he wanted to make more money. The conversation stuck with me. He told me about this pyramid of what to think about doing with the money that you're going to eventually make after training. One thing he said was to make sure you have health insurance. Make sure that if you have loved ones, that you have life insurance. Make sure that you have disability insurance. My mistrust still didn't want to think about what he had to say, but something in me told me that it's important to have disability insurance, so I signed up for a disability plan when I was younger and healthier. A better candidate for a less expensive insurance plan. Terms like COLA, which stands for cost of living adjustment. Some of these plans have a cost of living adjustment; in the event that you do get paralyzed, your payments will be adjusted for the cost of living. Terms like own occupation or occupation-specific were new to me. Those plans cover your disability compensation even if you return to work at a different occupation, whereas plans that are not occupation-specific, no matter where you go back to work, your compensation will be decreased when you go back to work if you go back to work. I didn't completely understand this, and I was just happy that my institution offered disability insurance at a very low cost. What I didn't realize was that when we pay for our disability insurance with pre-tax dollars, the compensation that we receive if we are disabled is now taxed.

 

So if I make a hundred dollars or if I get compensated a hundred dollars now, I'm taxed at whatever rate I may be living at 20 to almost 50 percent of that compensation is taken because I accepted disability insurance paid for with pre-tax dollars. If I had chosen before my accident to pay for disability insurance with post-tax dollars, then any compensation I get after my disability would not be taxed, so that hundred dollars would be what I would get rather than $100 taxed at 20 to 50%.

 

I am also experiencing the difficulty of returning to work and not having a plan that is primarily occupation-specific. So even though I'm no longer a surgeon, the fact that when I go back to work, anything I receive, half of it is paid back to the insurance company, and my insurance compensation is diminished by that amount. So if I receive a hundred dollars from work, then I'm required to pay $50 of that back to the insurance company. If I had occupation-specific insurance, then they would say that I didn't return to my previous occupation as a surgeon. So if my institution gives me a hundred dollars, I keep that hundred dollars, plus I continue my disability compensation. If it is within your ability to obtain occupation-specific disability insurance paid for with post-tax dollars, then you may want to consider that if you can afford it. I know this is living in the past, but I wish I had chosen to purchase my own occupation disability insurance paid for with post-tax dollars. Having said that, the disability insurance plan that I have is really helping me now.

 

And another plan that helped me was accidental life and dismemberment. Technically I'm functionally dismembered in 4 extremities. A plan like that is relatively inexpensive, and if something happens, then the compensation for that can help you a lot. Another plan that I don't know why I signed up for it, and I didn't even remember that I signed up for it, was a long-term care plan. In retrospect, I remember sitting with my financial advisor and him saying do you want to sign up for long-term care. This was a few years before my accident, and I said okay. It didn't look too expensive, and it looked like I could afford it. Now that I am living with a disability, that long-term care policy is helping me a lot. So thinking about where you stand and how much you can afford in terms of insurance. It's critical to have health insurance. It's optimal to have whole life or term life insurance if you have beneficiaries. It's important to think about disability insurance, as well as long-term care insurance and accidental life and dismemberment insurance.

 

Lisa Meeks:

And those are incredibly important points, and I think that it's something that we don't talk about. People have competing priorities financially, especially right out of medical school. And no one ever thinks it's going to happen to them, right? that they're going to need to utilize this but setting yourself up so that in the event that something does happen and you become partially or fully disabled. You're able to not have financial burdens be one of the things that you have to tackle.

 

Sofia Schlozman:

In the next section, Dr. Marco describes what his own experience with disability taught him about the prevalence of ableism in his day-to-day life. 

 

Lisa Meeks:

I know we were both interested in talking about ableism, and in many ways, we've covered it indirectly so far. I wonder if you want to talk about it directly and how it comes out in medical education. What are you doing to actively combat it in your teaching and your supervision of students and residents? And why it's important that we change the narrative around disability.

 

Rex Marco:

My experience with ableism is that it was a new term for me. I had never thought about it. I didn't even know it existed. I didn't even know that I was participating in it. Looking back at how I would treat my patients who were living with a disability or illness. I feel sadness about not being able to have empathy or sympathy, or compassion for where they are. I feel that my medical school education was remiss in not addressing this. Not having some more education around what we can do as physicians to not dissociate and depersonalize and have more emotional intelligence rather than emotional ignorance. 

 

My experience with ableism started when I was discharged from the hospital, and I was in my apartment complex that we had found because I couldn't move back into my home being in a wheelchair. We were at the front office, and I was really happy, and I went to the manager and said how do you get up to the second floor, and which elevator should we use. She looked at me with disdain on her face and looked back down at her paperwork and pointed and said it's over there. I went over there and found the elevator, and it wasn't working. So I went back and let her know that the elevator was out of order. She looked at me with disdain and huffed, and walked 10 paces in front of me to an elevator that was working. That's not okay. 

 

I also had a caregiver who was putting me to bed. She looked at me and said, "why does she stay with you?" in reference to my partner. I asked her, "What do you mean?" She spread her arms over me and looked down, and said, "Well, look at you." That's not okay.

 

In the clinic, one of my patients was there, and she was excitedly saying that "Oh, a doctor that I'm seeing knows you and worked with you and has so many great things to say about you." I asked him, "did you hear about Dr. Marco" and he said, "no." She said, "well, he's um," and she paused, and she thought, and she said, "he's an invalid." I thought about how you spell that and affirmed to myself that I am enough and I am not invalid. It's important for me to teach people in medicine and people in this world that we may have a disability and we are people. We are people living with a disability. I am a person living with quadriplegia. I am not quadriplegic. I am not a diabetic. I am not hypertensive. I am a person living with quadriplegia.

 

Lisa Meeks:

Can I say that it is probably the honor of my lifetime to be able to sit in a space with people and listen to their stories? And every once in a while, I'll have a conversation that goes beyond the educational aim and the aim to provide mentoring. All of the reasons that we started the podcast. There'll be interviews both on the podcast and in my research that I think changed my life that I think are so profoundly impactful. And that makes me stop and take pause, and that truly will impact the next steps that I take with regard to my work or that will impact the way that I interact in the world or will change my mind about a subject, and I think today's interview is one of those. I know today's interview is one of those days. I personally plan to look into the resources you've shared about mindfulness to think about how we can create spaces and my teaching and then the work that I do to foster mindfulness in students. I think that this has been an incredibly powerful message really that I think has multiple components that will resonate with learners.

 

But also, I think that it will resonate with faculty and with leadership and medical education and in Health Professions education more broadly. 

 

Sofia Schlozman:

We end this interview with Dr. Marco’s advice for listeners with disabilities who are considering or pursuing a medical career. 

 

Lisa Meeks:

What advice would you give to the learner and the pathway to medicine that has a disability and is trying to decide whether to come into this profession or to the faculty member who will be teaching the learner? I think your interview is chock full of messages. But I want to give you the opportunity to answer that question, that kind of standardized final wrap-up question that we have about advice.

 

Rex Marco:

The one thing that came to mind was to consider reading or listening to the book called the 4 agreements by Don Miguel Ruiz. The 4 agreements, or the way I remember them, is Don't SPAZZ. Do your best. S is sarcasm. P is personal, and AZZ is assumptions. The 4 agreements are don't SPAZZ. Meaning don't use sarcasm. Use impeccable wording instead. Don't take things personally. Don't make assumptions, and do your best. The other things that came to mind are in life and in patient care. Consider pressing the escape key. Learn to feel your own emotions. For me, I needed to learn that it's okay for my patients to have fear and anger, and sadness, and it's okay for them to be in denial in that moment and bargain throughout, and it's okay for me to feel uneasy with that.

 

It's more nurturing to both me and the individual I'm speaking with to do my best to remember to press the escape key and empathize. Do my best to feel and understand what they may be experiencing. Sympathize and express sorrow or deep sadness for what they may be experiencing. Have compassion. Truly desire that neither they nor myself suffer.

 

One thing that really helped me was when I was watching a movie called Soul Surfer. That movie is about a young surfer who had her arm taken by a shark. It documented her recovery and her emotions, and her family's trials and tribulations. It was very impactful and inspirational for me when I watched the movie. In a part of the movie, one of the reporters asked her, "If you could go back to that day and not have gone surfing: Would you do it?" She said in the movie, "I wouldn't change what happened to me because then I wouldn't have this chance in front of all of you to embrace more people than I ever could have with 2 arms."

 

For me, I know that I cannot change what happened on that day, and I also know that I can ask for the serenity to accept the things that happened on that day and that if that day never happened, then I wouldn't have this opportunity to embrace all of you even if I had two functional arms.

 

Lisa Meeks:

I want to thank you so much for your time and your thoughtfulness. And your willingness to come and share this story and share the takeaways for medicine and for the learners and, I think, more broadly for all of us. It's a really special interview, and I feel really blessed that we can share this with our listeners.

 

Rex Marco:

Thank you for giving me this opportunity to share my experience and help those who are living with a disability and help those who may be teaching people who are living with a disability or taking care of patients with a disability or an illness. 

 

Sofia Schlozman:

To our guest, Rex Marco, thank you so much for joining us for this interview. I know that your thoughtfulness, openness, and honesty will have an enormous impact on our audience, and we are so grateful that you took the time to share your story in these episodes. 

 

To our audience, thank you for joining us. We hope you enjoyed this series, and we encourage you to subscribe to our podcast and tune in next time. We also want to let you know that we just launched a new mini-cast called Research and Resource Rounds, where we review research articles and critical commentaries about disability inclusions in health professions education in 15 minutes or less. We highly recommend you check it out. 

 

This podcast is a production of the DocsWithDisabilities Initiative and is supported, in part, by the University of Michigan Medical Schools Department of Family Medicine M-Disability Initiative, the Stanford Medicine Alliance for Disability Inclusion and Equity and the Ford Foundation. The opinions on this podcast do not necessarily reflect those of the hosts, their respective institutions, or the funders. This podcast is released under Creative Commons Attribution Non-Commercial, Non-Derivative License. This episode was produced by Sofia Schlozman and Lisa Meeks, with support from our audio editor Jacob Feeman.