When you are a physician, and disability occurs post-training, you may have to pivot. Join us to hear the first-person account of Dr. Nichole Taylor and how she took her passion for medicine and her deep commitment to training learners, and crafted a unique position in medical education that has a powerful impact on shaping UME and GME perceptions of disability.
Dr. Nichole Taylor, Assistant Dean of Students Wake Forest School of Medicine
Episode 1, Transcript
Lisa Meeks: Introduction
Doctors with disabilities exist in small, but measurable numbers. How did they navigate their journey? What were the challenges? What are the benefits to patients and to their peers? What can we learn from their experiences? My name is Lisa Meeks and I am thrilled to bring you the Docs with Disabilities podcast.
Join me as I interview Docs, Nurses, Psychologists, OT’s, PT’s, Pharmacists, Dentists, and the list goes on. I’ll also be interviewing the researchers and policy makers that ensure medicine remains an equal opportunity profession.
Today we talk with Dr. Nichole Taylor about what happens when disability is acquired after training and how you can continue to contribute to medicine in a powerful way.
Lisa Meeks: I'm so excited, this is our first Docs with Disabilities interview, so we're learning together. I'm thrilled, and as you know, about a year and a half ago I asked if you would be my first interview.
I thought that, given your dual roles, you live in two worlds, you live in the UME world and the GME world, and the fact that your disability is a little bit more complicated maybe than others, that you were the perfect person to provide some really well-rounded perspective about what it means to be a doc with a disability, and what it means to work towards greater inclusion of individuals with disabilities in medicine. I'm going to ask you to introduce yourself, and then tell us about your story.
Nichole Taylor: My name is Nichole Taylor, and I am the assistant dean of student affairs at Wake Forest University. I also am the associate residency program director for anesthesiology at Wake Forest. My story was the typical normal story for most med students going through education, and four years of college, and four years of medical school. I did a year of general surgery internship at a pretty rough and tough county hospital, which taught me a lot, and then went on to do my three years of anesthesia residency. If that wasn't enough, I added another year of high-risk OB anesthesia, because I really loved ... I loved patients, and I was ... come from a family of teachers, and it just seemed right for me to land into a big academic center to do my fellowship training.
Nichole Taylor: In 2009, I was an attending. I was training residents, I was working with medical students, being in the OR with patients and taking a new learner who was very nervous about making a mistake which was kind of what I lived for, because I enjoyed showing them how to do things safely. I enjoyed watching them grow in that role to confidence. [music]
I remember my last case as an anesthesiologist working with Brian, one of my residents, and I started developing this really left-sided heaviness in my arm and leg. Wasn't really sure what it was, and as a typical doctor, didn't really seek a lot of medical attention. Thought it would go away on its own. Just needed another good nights' sleep.
That next morning, I woke up, and I was pretty much hemiplegic. It was really difficult to move my left arm and left leg, and so I went to the emergency room. [ambulance sounds] All of these things are going through my head. Like was this a stroke? Was this a brain tumor? What is going on? But something was definitely very serious. It was a different side of medicine than I was accustomed to. It was a different side of medicine than I was accustomed to. After a bunch of tests, an MRI and listening to some of the questions they were asking, I was pretty certain it was multiple sclerosis. Then I was admitted to the hospital. [music] [4:07]
Lisa Meeks: I can't even imagine what that experience had to have been like for you, Like the loss of control that has been described by so many physicians with disabilities when they are in the role of the patient is so starting to them. They see a different side of medicine that maybe isn't so wonderful. What were your experiences like interacting with other physicians and medical staff as a patient?
Nichole Taylor: I knew a lot of the people who were taking care of me, which was in itself a little odd too, but I remember the big teams coming in and even though I'm highly educated, I'm not a specialist in ophthalmology or optometry, or some of the other specialists that were coming in and I remember them using these really big words, which is embarrassing to say as an anesthesiologist, but we don't use those words and I was having a tough time just processing everything, really trying to get an understanding of what they were finding on the physical exams that was so interesting for them. I think I was in shock. It was definitely a lot of fear. How am I going to provide for my family? I had two small daughters three and five. My job, my career. A lot of concerns, and a lot of uncertainty, which isn't something I had encountered a lot of in my life.
Lisa Meeks: [5:36] You talk about the shock and the fear. Did you immediately think 'I can't be a physician'? How did you conceptualize your identity as a provider, a physician?
Nichole Taylor: That is a great question. It brings me to probably four days after I was discharged from the hospital when I was coming in to get my final diagnosis after the test had been run. I remember the neurologist sitting down and saying, "This definitely is multiple sclerosis. We're not really sure what type, so there's a few types, relapsing and remitting, where you'll have a setback, but then you may get closer back to what your normal was. And then there was a more progressive type where you would continue to have increased dysfunction and disability."
Being an anesthesiologist who's really used to giving a drug in the OR and seeing effect, so we're not the most patient people, I was like, "So when are we going to know which type we have?" He had said, "In about six months we'll have a better idea which type you have, and what your new normal function would be." I remember kind of joking, but kind of seriously saying, "Six months is a long time. Six seconds is usually what I see in medicine when I give a drug or an intervention. Six minutes is pushing it." He just stoically looked there and said, "We're going to have to wait six months." [music]
That's when I realized there's a big difference between different specialties, I was always hopeful I would get back into the OR. For the first two years, that was like the driving goal. I don't know if it's because you have these deficits, and for me it was the left-sided weakness in coordination with my hand, and some cognitive issues that I was seeing pretty serious speech therapy for at the time.
I had these significant deficits, but I think we're all fighters in medicine. We think if we work harder, or if we work stronger, if we work smarter, we can overcome a lot of the obstacles that are in our way. I started doing extensive physical therapy, occupational therapy, speech therapy, up to nine hours a week. Really pushing myself to get that coordination back, and that precision, because in our field you have to be predictable, reliable every single time. It's a very procedural-based field in anesthesia.
I'd go down to the sim lab where it was very safe. It was a good environment to continue to hone my skills. For two years, some days I would be able to slide a breathing tube in, or do a little procedure on the mannequin, and other days I wasn't able to do that. I think I realized over that time how unpredictable my disease is day to day, and what I can guarantee I could do safely for the patient. And that actually was a huge loss. But when I came to that realization where I think the term for me occurred was when I said, "Well, maybe getting back to the OR isn't the best thing for me, because relapsing or remitting MS means I'm going to have multiple setbacks, and I'm going to have to keep fighting this fight several times throughout my career, and each time starting over." For anyone, that would be like beating your head up against a brick wall. For me, I thought 'what can I contribute reliably and predictably in 25 years that will still give me the same satisfaction, and perspective and influence on the learners, med students, residents and other faculty members?' That's when the shift happened. [Music begins] Everything got better after that. Just acceptance is a process, and it's one that you visit multiple times.
Lisa Meeks: You clearly love medicine. Knowing what you do now, I know you're still involved in medicine. How did you switch to plan B?
Nichole Taylor: Yeah. For the first six months, I was on short-term disability. I was at home, which is really interesting, because I woke up routinely like I did every single day prepared to go to the OR, which anesthesia is pretty early. After six months, I had really great conversations with my leadership, specifically Dr. Tobin, who saw the value in what I was contributing before with the residents and the students, and in the residency program as a teacher. I think for Dr. Tobin, he saw that I could contribute significantly in a way that nobody else had in the department in administration on a daily basis. So he encouraged me to get involved in other little projects that he had to help him with certain policies, procedures that needed to be refined, starting a rotation for the residents in new things. It was able to help me see new ways that I could see my career. Then I also looked at listings through the school for other opportunities and mentorships. One really caught my eye, mentoring the medical students in their third and fourth year to apply to residency, which was perfect because I was doing recruitment already through the anesthesia residency program. Having the support of people to think outside the box, and not have a faculty member pulled clinically that can contribute significantly at an administration level really helped the entire department move forward.
Lisa Meeks: He leveraged all of these skills, and really facilitated this for you. You said you reached out, and in the third and fourth year you were really interested in mentoring anyway. You described your last resident, and it sounds like, for you, part of where you got your validation and feelings of success were really in the teaching moments. Mentoring is a nice natural expression of that. Talk to me about that, because you still do that.
Nichole Taylor: I still do that, yes.
Lisa Meeks: Talk to us about that. [11:52]
Nichole Taylor: Yeah. I think that when you have loss like I had with MS, there's nothing more fulfilling for me than to see students progress in their medical training, in their skillsets, packaging them up for a residency and walking with them every step of the way to help guide them. And some of the students that I think I'm the most proud of are the ones who have struggles, and adversity, adversity of all types. It may be disability. It may be life outside of medical school. It may be that they feel like they're impostors, and that they don't deserve to be there. I think that it's nice to be able to dialogue with a faculty member. I'm very open about my disability with the students. A lot of times I will speak in their orientation. I think it's important that they all know that we aren't these superhuman beings, and we struggle. But I think when you can be vulnerable, and you can show that we can be human beings I think it's good for them to know I'm stumbling now, but I have these role models who have shown me that they've overcome it too. And so I use a lot of my skills and my time and my experience to help guide them, and sometimes refocus them, or have them stop if it's a big decision they're making. A lot of times in the office I'll say, "Okay, we're going to pause because this is a decision that matters in 10 years." I think that it's my way of giving back to others to have a career that I loved and lost. [13:33]
Lisa Meeks: I would imagine that in those moments of pause that you described, that there's also an opportunity to talk to them about not ruminating about the decisions that don't matter 10 years from now, right? Helping them build resilience in that way, and being able to compartmentalize the energy and understand what is important. So often I think some of those types of accommodations, so physical space, modifications or bringing a designated interpreter, or a cart system into the ward or clinic is pretty straightforward. When we work with students who have psychological disabilities, or learning disabilities, or chronic health disabilities, things get a little bit more complicated. Not necessarily because it is more complicated, but the perception of the disability is that it's more complicated, regardless of fact. But why don't you talk a little bit about the unpredictability, and how you navigate that now, and how learners might be able to navigate that in when they're going into either UME or GME. How does someone with a chronic health disability navigate that space, and the unpredictability of their particular disability?
Nichole Taylor: [14:50] Multiple sclerosis is an autoimmune disease. I think that's important, because as with lots of autoimmune diseases, we do have more of an unpredictability component. The medications that can stop someone from MS or other diseases from having flares or relapses is different based on those diseases. I think what's particularly challenging with multiple sclerosis is it can be a physical disability, but I would want people to realize that MS is very different in everybody who has it. Being involved with the MS Society, I see a huge spectrum.
I think it's important with all disabilities to really engage the individual who's coming to you with that issue, and find out what exactly their needs are, because I have friends that have very little to know needs at all with their MS, and then I have other friends who are on the other side of that spectrum who would ... are very dependent, needing just the activities of daily living. I think it's real important to realize it's a spectrum, as with most autoimmune diseases. I think that a lot of it depends too on specialty that you're pursuing. So being more regimented seems to keep my multiple sclerosis just a little more at bay. That's tough to do in residency. I don't think that it's impossible, though.
But if I had decided to ... had pursued radiology ... or family medicine, I could be a fully functional physician in that field. So with all diseases, especially autoimmune diseases, it's going to be highly variable. For anesthesiology, it's a lot more intense. We're confined to space in the OR. I am the captain of the ship in a sense, in that if the resident, or maybe the nurse or mid-level provider couldn't do a procedure or an airway, that's a pretty extreme situation in which I would have to be the backup. And so, because I don't retain that ability to do that anymore, it's just not safe. But there's other specialties that I could've been fully functional in.
My favorite students are the undifferentiated. They have no idea what they want to do. A student who's coming with a disability where we would talk about what their limitations are. Of course, usually this would maybe done with a disability specialist, and not a student affairs person, just because I'm also in charge of other roles. But I think because I am so open about it, students do seek me out, but I also do often tag other people to assist. I think that it's about strengths. It's really not to me about disability. It's about what is a student going to do well. What do they enjoy? What are they passionate about? But there would be requirements of any specialty that would need to be taken into consideration.
[17:50] But I don't think that we should tell somebody from the gate that these things are off limits. I really with all my students do not tell them that they can't do something. A lot of times it's more academic performance, but I will say, "We can go down that road." I had a student who had an injury of their upper extremity, and they were not able to place a breathing tube and intubate somebody with their left hand. We were able to get a right-handed blade, which they could very successfully do.
[18:25] I'm not a big one to say no, but maybe on a black and white paper you'd say, "Oh, this person doesn't have mobility of their left hand," but there are very easy accommodations we could do. I would be very hesitant to tell a student they absolutely cannot do something because of this diagnosis. I think that it would be great in an ideal world if that student was brought to simulation lab, and we can really explore what their limitations are, and what they're comfortable at. Because I think in the end, I really don't feel a student will go down a road, and go and pick a specialty in which they could not be a full physician. But we have to be willing to have these conversations. We have to be willing to sit down and address what the concerns are.
Lisa Meeks: Because Not many people sit where you sit in UME and in GME. I'm interested in the transition from UME to GME. I've heard other people talk about how students in the traditional sense, so UME, have a lot of support systems, and have a lot of understanding, a lot of second chances, a lot of guidance. Then they transition to GME, where they are expected to operate autonomously almost with very little oversight. Someone could very quickly find themselves in a deficit type of situation if they don't have any true mentoring or guidance or support.
I think students are feeling out the space of GME, and trying to gain perspective. Some students do disclose and talk about it very openly. Others don't, and I don't begrudge them their fears, because I think it's a valid fear of not matching. But when they match, of course our formal advice to students is that at that point, you need to disclose disability-related needs and request accommodations in a formal manner. How do you, as someone involved in the GME space, advise students to navigate disclosure?
Nichole Taylor: [20:41] I think it's very interesting, because I feel like I wear lots of hats. When I'm dealing with complex situations, I really ... I put the hat on of assistant dean. I think about my students as they march up to transitioning to graduate medical education, and then I put my other hat on of being an associate residency program director, and taking that new intern into our program for four years. I definitely see that the undergraduate medical education has this huge support system for them. I think there's a clear pathway on how they can address needs like accommodation in several places. But when they do get to the graduate medical education portion, one of the biggest things is now they are also an employee, and so a lot of those types of accommodations fall in the human resource realm. For several, that may be the first time they've ever encountered it. I think that we definitely have people with disabilities in our residency programs. We may or may not know them.
I think that it would be helpful if we could be more open and vocal, and make this as part of their orientation. Just educating people just in general that all of these wonderful diversity initiatives, that disability is another form of diversity. We're going to be taking care of patients with disabilities. When they can see someone that looks like them, or has overcome something to be successful, it's inspiring to patients.
I think that there's one moment that I'm the most proud of about being a teacher. It's because I feel very passionate about the students. I had signed up to do this doctor/patients relations class, and it's a course that's offered one of the first few days of medical schools, just introducing the students into the hospital, instead of just into the classroom. I had signed up, and it was one of the things I really wanted to start doing now that I had more time and wasn't working clinically.
Unfortunately, I had a setback and was in the hospital getting IV steroids for five days, and so I wasn't going to be able to show up to meet the students for their first day and teach them. I was assigned another co-facilitator. I had called them and said, "Can we bring these students to my bedside?" Because I just couldn't pass up this opportunity to show them that we're not ... doctors aren't always what you think, and patients aren't always what you think either. He came and brought the students up. We didn't let them know that I was the co-facilitator. All they had to do that day was say hello, introduce themselves, say hello and ask just generally why I was there. The four students came in with Dr. Manthey and introduced themselves one by one. "Hi, I'm student doctor," and down the line. They asked my name. I gave my story that I have MS, and I was currently having a relapse, and I was having left-sided weakness, and I was being given IV steroids. At the end of that conversation, Dr. Manthey turned to the students and said to them, "This is your co-facilitator, Dr. Taylor, from anesthesia. She's going to be teaching this class the rest of this year with me."
It was so good in so many ways for the students as well, but also it helped me the next week when I was teaching them, because I was then going to teach them with a walker. I think often about instead of them meeting me in that patient space, meeting me walking in with this walker, maybe me not disclosing, having them wonder instead of them thinking about the case we're talking about. What's going on? We got through that part of the conversation. They knew exactly what was going on. The rest of the year as I had to sit down while they were interviewing patients, and I was critiquing their interview skills and their physical examination, I could sit on my walker and not feel that I was a distraction. It was the perfect introduction I think on so many things.
Lisa Meeks: People can't see us, but we're both here with our eyes welled up with tears. You think about the impact that that has on a first-year medical student. It could quite literally change their perception of people with disabilities, or patients completely, for the rest of their education. To see that the first patient that they're exposed to is a physician with a disability, who then turns around and teaches them, and there's so much value in what they're learning from you, has to really change their ideas. What a great story, thank you for sharing.
Thank you for joining us today for the docs with disabilities podcast, join us next time when we talk about medicine and mental health.
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