Episode 47: Dr. Eugene Alford

In this episode we are joined by Dr. Eugene Alford, an otolaryngologist and facial plastic surgeon practicing in Houston, Texas, for a conversation about becoming disabled while practicing medicine, the process of returning to work, life after acquiring a disability, and how he views the inclusion of disabled trainees in medicine.

Transcript

Dr. Lisa Meeks:

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 policymakers that ensure medicine remains an equal opportunity profession. 

Sofia Schlozman:

Hello and welcome back to the Docs with Disabilities podcast. In this episode, we are joined by Dr. Eugene Alford, an otolaryngologist and facial plastic surgeon practicing in Houston, Texas, for a conversation about the process of returning to work and daily life after acquiring a disability.  To begin this interview, Dr. Meeks asked Dr. Alford to share his perspectives about the day he acquired his disability.

Dr. Eugene Alford:

My story begins December 30th, 2007. It was a Sunday, and I was dressed and ready to go to church with my family, and I got this weird feeling of impending doom, and so decided to go to our weekend place in the country, which is where I go to relax, and I got on my tractor, and I started mowing, clearing brush, saw a dead tree, decided to push it over, as I had done a thousand times as a kid growing up on a working ranch.

 

And so my front end loader, I used it to push the middle of the tree away from me, unbeknownst to me, it had a Y at the top that had collected water, so the tree rotted, it broke in the middle, and the top of the tree fell back on me, and pinned me in the tractor with my chest on the steering wheel, my seat on the seat, and it curved my spine enough that I got a compression fracture at T4 and a neurologic vascular injury at T9.

 

I normally kept my cell phone on a holster in my belt, that day, I put my cell phone in my pocket. When the tree hit me, I reached for my cell phone, I went to the holster, and the holster was on the ground underneath the tractor where I couldn't reach it, my cell phone was in my pocket, I hit speed dial for my wife, she answered on the first ring, she tried to call 911, you can't call a different county from 911, so she called our down the road neighbors who the day before, had put a phone in their horse barn, had never had one before, they were loading their horses, heard the phone ring, answered it, called the local county 911, started driving to the farm.

 

Sheriff lives across the road from me, heard the call go out for the volunteer fire department, he said, "I know, that's doc's place," he walked across the road into the woods and just came upon me by happenstance, had his Sheriff's radio with him, called Life Flight. So I was at the trauma center within 45 minutes of my injury, I mean, it's not coincidence, it just wasn't my time. 

 

So made it to the trauma center, and then they transferred me to Methodist Hospital, where I've worked for 30 years, and that's where I had my surgery. 

Dr. Lisa Meeks:

What were your first thoughts?

Dr. Eugene Alford:

Wow, I knew immediately that I was paralyzed, and I really thought I was going to die, and I called my wife to tell her goodbye. When she answered, my thought was, "I need to say goodbye." 

 

Sofia Schlozman: 

The conversation now shifts to discuss how Dr. Alford’s injury impacted his career. Listen or read along as Dr. Alford discusses his attitudes about continuing to practice medicine as a surgeon with a disability.

Dr. Eugene Alford 

My first feeling was fear. I have this amazing fear of failure, but yet, my father gave me permission to fail back in 1978, it's a life changing moment that has stayed with me. I was a first-semester freshman at A&M, I got my midterm grade point average, and it was a 0.8, I was flunking everything except biology and PE. So I loaded all my stuff in the car, started driving home, intending to go to junior college and drop out. I didn't withdraw from school, I stopped in Madisonville, Texas, to get gas and saw a payphone, walked over and called my parents, and had a two hour conversation where my father said to me, "You've never been a quitter. You've never quit anything in your life, so you cannot quit now." Then he asked me a question, he said, "Have you done your best?"

 

He said, "If you've done your best and you've failed, it's okay, come home, you're not a quitter. But if you haven't done your best, then you're a quitter, and you can't come home." And then my mother said, "Hey, you need to go to the educational psychology department and get tested." So my father gave me permission to fail, which made life a lot easier, but he also gave me an admonition of what I had to do for the rest of my life, and then my mother gave me an idea, Okay, I have to develop an action plan. It's not going to happen if I don't do something. So it all worked out, I ended up going back to A&M, making a 3.0 for the semester, and then never made a B the rest of college. But that event has followed me the rest of my life. So I was in the ICU for two weeks and unconscious, but then I woke up and just this week of horrible fear of failure, asking myself lots of questions, how am I going to be a doctor? How am I going to be a husband? How am I going to be a parent? And then it just came back to me and said, well, you do your best, and you take an inventory of what your tools are. My brain still works, my hands still work, I don't operate with my feet and legs, so I still have the tools I need to practice medicine, I just got to figure out a new way to do it and figuring out the new way to do it involved a lot of rehab, a lot of learning how to use different muscles and maintaining strength and mobility. And it was 10 months before I went back to work, so I had this saying,"I was paralyzed by a tree, I'm not going to be paralyzed by fear," and I turned fear around to be a motivating factor, as opposed to a barrier to getting better. 

Dr. Lisa Meeks:

I love that. So you decide you're going to use the tools that you have, and you're going to decide how you can continue to practice medicine?

Dr. Eugene Alford:

Right.

Dr. Lisa Meeks:

Tell me about the reentry to work, what was your first day like? How did you navigate coming back? Were you having to talk to hospital professionals about re-credentialing? Were there questions about your ability?

Dr. Eugene Alford:

So the thing about reentering practice that my mentors always have taught me is, if you put the patient first, then everything's going to work out right. So I did have to go through a credentialing process, in fact I only encountered one situation that was vindictive by another physician. Three days after my injury, he wrote a letter to the State Board of Medical Examiners telling them I was no longer able to practice medicine and they should suspend my license.

My license was not suspended, but I did go through an investigation by the Texas State Board of Medical Examiners. I went through physical evaluation, a mental evaluation, was found safe to practice medicine, and went through the same process here with Methodist Hospital. It was extremely fair, they just said, "Okay, we're putting the patient first. Yes, you're still board-certified, but are you physically able to practice medicine from a stamina standpoint and from a mental standpoint?" and I passed that.

 

So the Texas State Board of Medical Examiners found that I was okay to practice medicine, I went through a similar, maybe a little more rigorous process with Methodist Hospital, they also found that I was capable of practicing medicine, so I was welcomed back to the medical staff with open arms. My colleagues welcomed me back and God, it was so uplifting um to find that people didn't hold it against me that I was different. 

 

[music]

Dr. Eugene Alford:

When I started off, it was really baby steps. The very first case I did was a friend of my youngest child who broke his nose, and I fixed his broken nose in the office one day, and just started small, and moved on from there and I've chosen to eliminate some parts of my practice. I don't do any airway stuff, just because in airways, there are emergencies that require life saving interventions in moments, and I just can't get there that fast. In 2007, I was the fifth busiest doctor in all of Methodist Hospital, having done 856 different surgical cases that year. My practice was completely filled for the next three months, I had had some notoriety for doing reconstructive surgery on a survivor of domestic violence who lost her face in a gunshot incident, that had put me on the Oprah Winfrey show, on the Larry King show, all this was before I was in a wheelchair, so there was a really good practice to come back to. But again, those nagging fears of, "Are patients going to accept me? Are doctors going to accept me?" And the great thing was, everybody accepted me, which was a surprise to me.

Dr. Lisa Meeks:

That's one of the number one questions I get from residency programs, is while we can accommodate someone, we can train them, what happens when they go out into practice? Are patients going to feel comfortable? And I have to tell you that I have never had a physician with a disability ever tell me that a patient was uncomfortable. What I have had is physicians with disabilities tell me that their patients feel a sense of comfort, they feel a sense of connection, they feel a sense of relief that their physician knows what it's like to be a patient. Does any of that ring true for you?

Dr. Eugene Alford:

Oh, absolutely. One of the most gratifying things that happened to me was the outreach that came to me from former patients after I was injured or current patients. So in 2007, there weren't many websites where patients can post on a website and allow people to interact with them. Methodist Hospital, while I was in the hospital, created one of those websites just so I could communicate with people. And in the first month, I had over 40,000 emails of encouragement from patients and people I didn't even know, and that was a huge encouragement, so unexpected. And the biblical aspects of your acts of kindness will be repaid a thousand times over proved to be true.

Dr. Lisa Meeks:

That must have been so heartwarming.

Dr. Eugene Alford:

Oh, it was heartwarming, it was encouraging, it let me know that there were other people out there rooting for me, it motivated me to work harder to meet their expectations or my own expectations.

Dr. Lisa Meeks:

So you have this practice that's full and thriving, tell me how your practice changed, and in what ways was it made better after coming back?

 

Dr. Eugene Alford:

All right, that's a complex story. I was part of a six man group of ENT doctors, I came back to work in October, and then in December, my partners told me that I was no longer financially viable and that I needed to find someplace else to work. That was the only time I ever felt abandoned, but I went out and borrowed money, started my own practice. I did a fellowship in head and neck surgical oncology as well as a fellowship in facial plastic surgery, and so I moved from doing mostly cancer and cancer reconstruction to doing more cosmetic surgery, and that turned out to be a really good thing you know,  I went from working 50 or 60 hours a week to working 30 hours a week, four days a week, and doing lots of functional and cosmetic rhinoplasty, facelifts, reconstruction of facial skin cancers, as opposed to reconstructing jaws and tongues. And it's not less important, it's just as important, and it's very rewarding. I miss doing the big cases, but I like where I am right now, certainly my family likes it better too.

 

Sofia Schlozman: 

As Dr. Alford describes, he acquired his disability at a time when he had already built a successful career as an ENT doctor. In the next section, Dr. Meeks asks Dr. Alford to share his thoughts on situations, unlike his own, in which learners enter their medical training as wheelchair users.

Dr. Lisa Meeks:

Your experience sounds like for the most part, it was really positive and that people were very welcoming and excited to have you back, but you had really had quite a reputation, and you had obviously produced for the hospital, you had produced for your practice, you were a phenomenal surgeon. And so you had this capital, right? This professional capital, if you will. 

It's so often, and I bet there are people who just don't even know still today, that there are physicians that are wheelchair users, they just don't know that, but we still see potential students that are wheelchair users, some with limited hand functioning, others without, they maintain full sensation in hand functioning, that because of really restrictive technical standards and because of stereotypes or assumptions about what's possible, still face a lot of bias when trying to apply to medical school, enter medical school, and there are some medical schools that are just doing a much better job than others.

And those are the ones everybody knows about, the Rushs', the UCSFs, Pitt, Northwestern, all of those schools, and of course, Michigan as well. But that's not the norm, and so when you have almost 200 medical schools between the MD, DOs, and you still have this resistance, a lot of times what I hear is, "Well, if someone was trained, and had full functioning, and then became disabled, it's different because they were already trained, versus training someone who is coming in with those functional limitations."

And so I wonder, as someone who is a physician that is a wheelchair user, what your thoughts are on admitting students that are wheelchair users, and what the differences might be an experience for someone going through this is as part of their education or training, and then versus someone who becomes disabled after being a licensed physician?

Dr. Eugene Alford:

So this is something I thought a lot about, because I recognized the difference between me and other people. I like the way you phrased it, I'd built up a lot of capital in the bank that allowed me to come back. So the best analogy I can give is, if we go back to 1990, when the Americans with Disability Act was created by George H.W. Bush, it was an instantaneous change in the law, but culturally, the change in the attitude of people in America and around the world did not change instantaneously, it's slowly evolved and changed such that disabled people, while they are still stereotyped by some, are not as stereotyped as we once were. We, as disabled people, are breaking down barriers that still exist and show that the Americans with Disability Act was a good thing.

 

The improvement in adaptive technology that allows disabled people to function is really important. Culturally, we have to recognize that disabled people most often can do more than the public thinks that they can do, disabled people also recognize their own limitations and are not going to put themselves in a position where they're going to cause harm,I was a keynote speaker at the National Neurosurgical Trauma meeting in Nashville, talking about the physician as a patient. And in a small group afterwards, I was asked by the chairman of a neurosurgical department, said, "We have a medical student who has a spinal cord injury, and is paralyzed, and in a wheelchair, and they want to be a neurosurgeon, should we accept them in the program?"

 

And so my response was, "Is that individual going to be able to care for a patient in the same way a non-disabled physician can? Are they going to place the patient in danger?” And then the other question is, “Are they going to be able to complete all of the aspects of a neurosurgical residency training program? That they will be a safe neurosurgeon and be able to sit for their board examination?" And so I don't know what that chairman ultimately chose, or if that student was accepted into neurosurgery, but I think that there are, without a doubt, places where a disabled person can successfully practice medicine. It may not be orthopedic surgery, I know I couldn't do that because I don't have the abdominal muscle strength to be able to manipulate a fracture. So if I were an orthopedic surgeon, I don't know that I would be back practicing medicine, maybe I would be doing something like hand surgery, I don't know. But there are places where disabled people can practice safely, and it's not just cognitive specialties where everything is just thinking, not doing, but there are non-cognitive specialties, surgery, where if your hands and brain work, and you've got the right accessory muscular tier that allows you to be stable and manipulate the instruments you need to practice safely, a disabled person can do it, but it just requires a cultural change and acceptance, mostly by other physicians, not by patients.

Dr. Lisa Meeks:

That is the absolute beauty right there, because truly, that is what I've experienced. And I have to say, I am loving every minute of this conversation. So at Michigan, the head of our neurosurgery department is a wheelchair user who performs surgery sitting, and it's just those types of stories and that understanding of the nuance, I think you captured the nuance so beautifully in that the answer to any question like that, any general question, is always a 100%, "It depends," and if the answer that is given by the institution is no, then it is grounded in assumption, and stereotype, and bias. If the answer is, "It depends, let's talk, let's do an evaluation of what's possible," then you're probably going to get that robust, interactive process that's required under the law.  So I appreciate how much of that nuance that you capture in your response to this group, and I bet on that day, I know on that day, that you changed attitudes, absolutely 100% changed some attitudes.

Dr. Eugene Alford:

 I made an analysis of my tools, and so one of the new tools I was given was a wheelchair, so how am I going to use this wheelchair? And I think that part of this new message or this new tool is to use my wheelchair as a platform from which I can speak about disability and what people can and cannot do from a wheelchair. 

People use the word inspirational, that I am inspirational, and I really don't like that word. I don't think that I'm inspirational, I prefer the word resilient. Resilience is the ability to overcome trauma, and recover, and come back to doing what you did before and so inspirational are the military guys that run across a battlefield, that fight for our democracy and are willing to sacrifice their lives, that's inspirational. I'm just resilient and work hard, and maybe I'm too mean to give in. So that's the message, is to be resilient, to overcome trauma and tragedy. I'm big on phrases, but the most insightful phrase I've ever learned that applies to me or to anyone else that goes through trauma is something called the Stockdale paradox. It was made famous in a book called Good to Great, about how to transform people and companies from good to great. So James Stockdale was the longest-serving POW in the Vietnam war, he was in the Hanoi Hilton for nine years, which is two years longer than the next longest-serving POW. When asked why he survived so long, he said, "Well, the other POWs were optimists, and they eventually died of a broken heart," and he amplified and he said, "So these POWs would all say, 'Oh, I'm going to get out by Easter.' And Easter would come and they didn't get out." And he goes, "I'll get out by July the fourth, and then July the fourth through come and they don't get out. And then they'd say, 'Oh, I'll get out by Christmas.” And they were disappointed so many times over and over that they eventually gave up and died of a broken heart. 

And he came up with the phrase that described the way he felt, he said, "Never give up the faith you will prevail while having the courage to face the brutal reality of the situation." And so faith is the belief in something for which there is no proof, so if you apply that to me, I didn't know of any facial plastic surgeons in a wheelchair, yet I believe that I could do that. And then to have the courage to face the brutal reality of that I'll never walk, but that doesn't mean I can't enjoy life, and through the use of adaptive technology and rehabilitation, return to a life that's enjoyable and pleasant, allows me to be a husband, a father, a surgeon, and a leader in the community, I just do it from wheelchair instead of standing up.

Dr. Lisa Meeks:

I love everything about what you've just shared, and I have a friend who's a physician, and he talks about that potential and possibility is an individual decision, people decide what they want to do, and if somebody wants to be a surgeon and they're a wheelchair user, that is possible, they just have to figure out, like you said earlier, what are the tools in their toolbox and how can they use those? But he also says that restrictions or the determination of what people are viewed to be possible to do is a societal one. So we put so many restrictions on people that the individuals would never put on themselves, and those possibilities, we need to open up people's eyes to what the possibilities are for individuals. 

 

Sofia Schlozman: 

We end this episode with advice from Dr. Alford for both fellow physicians and for students with disabilities seeking to pursue medical careers. 

Dr. Lisa Meeks:

One of the founding reasons for this podcast was to communicate to those that are in the pathway, and the whole pathway. So this could be pre-medical students, medical students, trainees, physicians, but also the people that are interacting with them, so all of the stakeholders that are involved in educating, and training, and employing physicians, to provide some advice for those people.

 

And I usually ask the person that's being interviewed if there's a specific stakeholder you'd like to speak to, whether you want to speak to students, or faculty, or other physicians, or all of the above, and to share with them some advice that you wish that you had known at any point in training, or you think it's important to know at any point in that experience, that you would want to share.

Dr. Eugene Alford:

There are two audiences, I guess I really want to speak to, and both of them involve accepting the culture change that the ADA legislates. I am so blessed by having colleagues that welcomed and accepted me, and hopefully, I've changed some attitudes with them about disability. But physicians need to understand that people that are disabled don't want to be accepted because they are disabled, they want to be accepted in spite of their disability. They want not equality, equality treats everybody the same and preserves the advantage that the physically intact have over the disabled person, what we really want is equity, which means we, as disabled people, want to be given the accommodations or the tools that we need to accomplish the job. We want to be held to the same standard as a non-disabled person, but the vast majority of disabled people recognize their own limitations and are not going to place a patient in jeopardy.

 

So give us a chance, give us the tools, give us the accommodations. We don't expect to be accepted because we're disabled, that's the most important thing. Disability doesn't make us special, it makes us different, which means we're going to do something in a different way and a different way is not wrong, as long as the outcome is the same. For disabled students that want to be a physician, most important, you have to be honest with yourself, make an analysis of your tools, recognize that the most important rule of medicine is first, do no harm. So figure out what you can and what you can't do, and don't ever put yourself in a position to harm a patient, and you can be a physician. So depending upon your disability, recognize it, accept it, you analyze your tools, you make a plan, you stick to that plan, and then you constantly improvise to make yourself better. Meaning, figure out a different way to use a tool, figure out a different way to use a wheelchair, how do you set your brakes on your wheelchair so you can examine a patient? For me, I use a Permobil C5 standing wheelchair to operate, and that works for me, but that may not work for everybody, and there are tons of standing wheelchairs which are tools out there for you to use, or you may need to do your surgery sitting as opposed to standing. But you’ve also, in order to be accepted as a disabled person, you've got to meet the standards that are fairly applied to everyone, which the ultimate result is, do no harm and make people better. 

Dr. Lisa Meeks:

I think that advice is straight on, and I believe that in giving this advice, you're speaking to not only the learner, the student, trainee, but also to the faculty and the administrators that are overseeing the training and making these decisions. You're speaking to admissions deans that are trying to decide whether to admit people, and everyone has to meet the competencies, as you so eloquently stated, and it is whether or not the attitudes of individuals allow for the idea or the possibility that these individuals are capable of doing this, or may be capable of doing it with some sort of accommodation. And not an accommodation that just removes all of the procedural or cognitive competencies, but an accommodation that, as you said, and again, you just said it so well, that has people getting to the same goal just differently, and different isn't bad. 

I love all of that, and I am sure we could talk for many more hours. I know without a doubt that your interview is going to impact a ton of people at the educational level, training, and employment, and for that, I am eternally grateful. And we were talking, before we started recording, about how we couldn't believe that we had not been introduced prior to this, and I do want to give a huge shout out to Dr. Ludwig for connecting us, I am forever grateful for that connection, and now we are in each other's circles and world, and I cannot wait to work with you more and hear more about your journey. But I just want to thank you for coming onto the show today and for sharing your story and your wisdom. There's a wisdom and a calmness about you that I just think is so centering and so reassuring, and I really appreciate that.

Dr. Eugene Alford:

Thanks, Dr. Meeks, I appreciate it very much. I'd be happy for us to work together, it's part of my new mission, is to advocate for the disabled and hopefully, change culture a little bit. I have to say, frankly, that on December the 29th, I had all those stereotypes about the disabled that I speak against, and now 15 years later, having lived it, and learned it, and know it, and understand it, those stereotypes, thankfully are gone.

Dr. Lisa Meeks:

I really appreciate you sharing that, I think it's important. And I think to some extent, we all still harbor some ableism, and we're all evolving, and we're all learning, and I know that sharing these stories is one really powerful mechanism of reducing those stereotypes. 

 

Sofia Schlozman:

On behalf of the entire Docs with Disabilities team, we would like to thank our guest, Dr. Alford, for his generosity in taking the time to do this interview and the openness with which he shared his own story with our listeners. We are so appreciative of the insights, wisdom, and perspectives that you shared with us today, and I know that this episode will be an incredibly meaningful one for so many of our listeners.

 

To our audience, thank you so much for listening to this episode. We encourage you to subscribe to our podcast, check out our previous interviews, and tune in next time.

 

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.