Oh, the Places You’ll Go

You may have been wondering what to do after medical school–or perhaps you haven’t had the time to even think about it. In any case, the possibilities are endless. Let these five physicians’ tales inspire you to explore your unique career opportunities. Your future awaits you.

The New Physician, September 2001

So there he was. The Jerk, in person.

Alice Brandfonbrener had no idea when she decided to go to medical school that she would one day wind up here, rustled from her office at Northwestern University in the comfy northern suburbs and called down to Chicago’s Van Buren “L” station, to treat a case of ordinary bronchitis. Of course, this case didn’t belong to just any ordinary throat. It was Steve Martin’s, and he was filming “Planes, Trains and Automobiles,” and if she didn’t get down there right away, well … ladies and gentlemen, I bid you to consider the cinematic disaster that might have unfolded. Did you laugh at “Planes, Trains … ”? Yes? Go tell Alice: “Thank you.”

The truth is, though, that the comedian’s cough was far less interesting than what comprises the rest of Brandfonbrener’s world as a physician in performing arts medicine. No, the Columbia University medical school graduate and Northwestern University professor doesn’t serenade her patients in the examination room; in fact, she’s not very musical at all. But what she does do is ensure that actors, musicians, vocalists, dancers and the like can perform their jobs without injury.

To the untrained, it might seem like a medical catering service for prima donnas with hangnails on their pinkies. But Brandfonbrener’s expertise–which she began to develop when she became the first staff doctor for the Aspen Music Festival in 1983–is widely sought after and highly technical. She learned, she says, “to combine traditional medicine techniques with knowledge of the instruments [the musicians] were playing, the way they were being taught, the way they were trained.”

And voila–a specialization was born. One that, despite managed care’s song and dance, is thriving among performers because it’s the only medicine that understands the real demands of their professions.

“We can speak their lingo,” says Brandfonbrener, who founded the Performing Arts Medicine Association. “We can ask about the medical symptoms they have, the aches and pains, in artistic terms. We can talk to them about what they can do–and avoid doing–in terms of their talents.”

Piano players, for instance, suffer from too much finger motion. They frequently don’t know how to use the full weight of their arms on the keys, and particularly in a classical musician who practices for hours, the physical effects can be devastating.

“We’ll see a lot of students right before exams or juries, because those are the times when they’re practicing the most and at the same time dealing with a lot of the emotional tension that goes along with it,” she says.

Many of the injuries she treats come as a result of poor teaching methods or just plain inhumane training hours. She spends a great deal of time educating performers and their instructors about healthy practicing.

And the field, she says, is growing, despite those within the industry who still believe her patients are “just neurotic musicians who were making it all up. This is life to these performers; their talents are what drive them.”

Brandfonbrener has seen her share of unusual medical requests, though. This is, after all, the world of the artist. She has been consulted by actresses doing nude scenes about the best type of hair removal; treated a Romeo for repeatedly jamming his thumb into a sword prop; and given advice on mastering the tipped stage–which is “a nice visual effect for the audience, but terrible for actors, who have to use different shoes without support, and they’re walking with one leg higher than the other.”

Brandfonbrener says she wouldn’t trade her job for any other. Every day bucks routine; she never knows what sort of problem she’ll be solving, whether she’s treating a performer or helping Northwestern’s music medicine discipline, which she oversees, to grow. It’s all worth it–even if Steve Martin didn’t say anything funny at that “L” station.

“Performers are [in] the most intense field of anyone I know. Many of them come in [saying] how they think it’s all over. And helping them solve these problems and [getting] them back to performing is wonderful. Being there to see them perform is even better.” !

Like many a hiker, Jay Johannigman carries all of his supplies on his back. But few backpackers hear strains of “Hail to the Chief,” or are surrounded by men in black suits with small coiled cords attached to their ears. Few ordinary backpackers are like Johannigman, responsible for the health of the leader of the free world.

Johannigman grew up in Ohio, went to Kenyon College (where he served as a volunteer fireman) and was accepted to medical school at Case Western Reserve University. One problem: no money. So he made a decision that significantly changed his career–he joined the Air Force’s Medical Health Professions Scholarship Program.

That meant he owed the Air Force four years after completing medical school. But don’t pity Johannigman, who still moonlights with the Air Force Reserves in Cincinnati, where he teaches and practices trauma medicine at the University of Cincinnati College of Medicine. While stationed in San Antonio, he traveled to Desert Storm in the Persian Gulf and to other military theaters in Bosnia and Kosovo, caring for soldiers and evaluating how the military transports and treats critically ill patients. What he and other military docs discovered was how inefficient those operations were. And they did something revolutionary about it.

“We developed small, portable, lightweight teams of five people who can carry all the equipment necessary for an operating room in their backpacks and set it up in 30 minutes,” Johannigman says. “Whenever the president or vice president travels to remote areas, the White House now requests us to go.”

Air Force One does have some operating room capabilities, and the president has a personal physician. But the surgeon general of the Air Force thought an expanded medical presence–one that was quicker and more specialized–was necessary for travel to such areas as Vietnam, where Johannigman went during former President Clinton’s historic trip there.

“The medical team met about a day-and-a-half before the president arrived in Hanoi, where we met with the Secret Service and toured the city. But once the president hit the ground, we never left the hotel. Two members of the crew were always inside the room where we had set [up] operating services. Three days later, we packed it all up and headed to Saigon.”

The crews carry equipment that allows them to do 10 intra-abdominal operations and 20 other general surgical procedures, such as to treat wounds to arms and legs. They have enough supplies to last 48 to 72 hours.

But don’t confuse this setup with what you may have seen in “M*A*S*H,” which featured clunky surgical facilities that would take four days to move. Johannigman’s teams are better able to respond to today’s quickly moving battles thanks to the small, lightweight medical equipment that has emerged over the past six years. And the backpacking physicians aren’t limited to presidential forays; they have also traveled to Oklahoma City to aid the Murrah Federal Building bombing victims and assisted in other tragedies, both civilian and military.

For Johannigman, who says he felt “neutral, at best” toward the armed forces before medical school, the experiences he’s had as a military doctor have given him a new respect for U.S. soldiers.

“It’s helped me understand who’s in the military, why we have a military and what it’s all about. It’s changed my perspective,” he says. “I wholly encourage students coming out of college to [do what I did]. I just don’t know many doctors who can say they’ve worked in places like Santiago, Geneva, Kosovo … . I’ve got the best of all worlds–one week I’m traveling as the flight surgeon to an F-16 wing; the next, I’m back in the hospital at Cincinnati, teaching students and taking care of patients.

“I’ve gotten a lot more out of it than [what] the military had to pay me for medical school.” !Peter Lurie has been on the same journey since his teens when his wealthy family was leaving its town in South Africa, and he boarded a bus. The first five rows, it was clearly marked, were reserved for white passengers only. The next 10 or 12 were for blacks. Lurie sat down in the seventh row–”I made a choice to do that, just to make a point”–and rode along to the next stop. A white woman climbed aboard and, paying attention not to signs but to the young man sitting in the seventh row, took his queue and then took a seat in front of him. They rode like this for a few miles before the woman noticed the seating sign.

“Wait a minute,” she said, turning around to Lurie, “are we sitting in the wrong section?”

“Well, it doesn’t really matter,” he told her.

It was a small gesture, but the kind that has nonetheless guided Lurie throughout his life–from childhood in South Africa to a medical education in the United States and in his current position as deputy director of Public Citizen’s Health Research Group.

“The impacting part about growing up in South Africa was that you were completely assaulted by those forces daily,” Lurie says. “You can’t grow up there and not want to help people. You realize pretty early that things are awry.”

Whether he realized it or not, Lurie’s experiences had set him upon a path that would make him question realities around him, and then work to alter them for the better. After moving with his family to New York when he was 17 (his father feared the transition away from apartheid would be a dangerous one in their homeland), Lurie attended Cornell University and then the Albert Einstein School of Medicine, intending to become a family practitioner. But while he was there, he began to have doubts about his future profession and dearly wanted to be more of an activist.

“It had been two quite dreadful years, really, in terms of academics for me,” Lurie says. “It was very obvious to me that I was being made to learn great details through memorization that I would never use. When I left medical school [after the second year], it was not with a definite commitment to return.”

Instead, Lurie spent a year as an intern at Public Citizen’s health operation. It was in his first month on the job, however, while sitting in a research library, combing through the “incredibly arcane details of neural carcinogenic medicine,” that he decided he would go back to medical school and finish his studies. Public Citizen was going to use the research Lurie was conducting in a lawsuit against the U.S. Food and Drug Administration regarding the use of blue dye #2, which had caused cancer in rodents. His work in the research library made Lurie realize the value of medical school: he was turning what he had considered to be abstract and unimportant into something relevant.

“But that’s not a defense of how they taught us,” he cautions. “What [medical school] should have been teaching us is how to learn, not what to learn. Students believe they need to spring full-life physicians from their residencies. But they can’t be complete–they haven’t read tomorrow’s medical journal yet. There’s always something new to be learned. It’s the method of learning, not the knowing, that’s important.”

Lurie did a residency in family practice in California–loved it–and spent a great deal of time breaking new ground in AIDS research. There was very little, in fact, that Lurie wasn’t doing, including teaching. But he found academia to be overly simplistic in its conclusions, unwilling to embrace the complexity of human existence, and less than collegial. After a “very ugly” period in Ann Arbor, Michigan, when his activism received cold stares from colleagues who felt his work would compromise their research dollars, Lurie decided to return to Public Citizen, where he finally feels he’s found a home, a place to continue the journey he began in South Africa.

“Everybody should be asking themselves if what they are doing is enough,” he says. “The fundamental notion in medicine is that you should be making an impact on individual lives and in the collective people. Not everyone is cut out to do what I do. It takes a drive. But you should be able to answer [this] question: Where can I make the biggest difference in the world?

“I was a really good clinician,” he says. “But I’m a far better activist.” !

Her first moment of service came when she was still but a child herself–at least in the world of medicine.

She was in her second year of medical school at George Washington University in Washington, D.C. And one afternoon in 1968, just months after Martin Luther King Jr.’s death, it was a lonely 16-year-old girl who desperately needed Donna Christian-Christensen and found her outside a medical van in the nation’s capital.

“That summer there was the Resurrection City and the Poverty March on Washington, and I went to volunteer at it,” Christian-Christensen recalls. “A girl came up and needed attention, wanted to see a female–and here I was, this second-year medical student, the only female around to help her. It turned out she had a chancre. She had come up by herself, without any family, from Mississippi or Alabama.

“One minute she was hysterical, the next uncooperative and argumentative, and the next, thankful to have someone around to help her.”

The experience convinced Christian-Christensen that she wanted to specialize in adolescent care; but it’s not a stretch to say the range of emotions that young girl experienced can represent the range of people Christian-Christensen now meets with daily as the delegate to the U.S. Congress from the Virgin Islands, her native land.

Her decision to be a doctor occurred as spontaneously as her decision to specialize in adolescent care. One night, while pursuing a degree in medical technology at St. Mary’s College in Indiana, Christian-Christensen picked up a booklet about the National Association for the Advancement of Colored People for a friend and started flipping through it. It discussed the need for more physicians of color, and by the last page Christian-Christensen had changed her mind about that career in medical technology. People needed her.

The congresswoman says she always wanted to have a profession that was dedicated to helping other people, and, by one fortuitous stroke after another, she’s done just that. In fact, it was good fortune that handed her a family practice of her own in the Virgin Islands after she completed her residency in San Francisco. She was working in the emergency room in St. Croix when “one day, I was asked to fill in for a physician at his family practice. He was planning to be gone two weeks–but he never came back.”

The daughter of a federal judge, Christian-Christensen was no stranger to the ins and outs of politics, and there was never a time in her medical career when she wasn’t involved with community issues as well. But in the early 1980s, she entered the political ring with greater visibility when she helped organize a local campaign for a federal judge. She soon became a leader in the Democratic Party, attending the national convention for the territory. In 1994, when the then Virgin Islands delegate to Congress retired, she mounted what became an unsuccessful first bid for public office.

“Leaving medicine was a big issue in the campaign,” she says. “I had a large practice–a large geriatric population, as well. And my opponent campaigned against me by saying, ÔWe need good geriatric doctors here.’ I wouldn’t say that was the reason I lost, but it did play a role.”

She hadn’t planned to run again in 1996, but she knew she should give it another go when her elderly patients particularly showed great support.

“ÔYou’ve served us for 20 years,’ they told me, Ôand it’s time you served others,’” she recalls.

And so she has–and then some. As the only woman physician in the U.S. Congress, Christian-Christensen has become one of the most trusted voices on health-care issues on Capitol Hill–despite the fact that she has no vote in legislation as a representative of a territory. She serves as chair of the Congressional Black Caucus Health Braintrust and has successfully worked to increase funding to communities of color to fight AIDS. But her proudest accomplishment, she says, was helping to secure the creation of the National Center on Minority Health and Health Disparities at the National Institutes of Health.

She says politics, like medicine, is about solving people’s problems. But the difference is that, while she treasures the time she spent in practice, now she’s working where health policy can be changed and not just complained about.

“Where a person lives, what their economic conditions are, their mental strains–all of these things are a part of health,” she says. “As a doctor, you can often feel powerless to not be able to change the circumstances under which people live. But I can impact them as a member of Congress. People still become doctors because they want to serve humanity. This is a way to serve humanity.”

The scene is Madam’s Organ, a rambunctious little hole-in-the-wall of a night spot in Washington, D.C.’s Adams Morgan neighborhood that boasts a long mirror behind the bar and some less-than-reserved bartenders. It is a hangout for the city’s singles scene, and on certain nights, its corner stage is also home to one Andrea Pennington, M.D.

Being a doctor is a part of her life that Pennington just sort of picked up along the way and can’t really rid herself of, like a puppy that followed her home. Her mom was an internist, and Pennington pretty much figured on that path from the time she was 4 years old. It’s just that all this other stuff kept getting in the way.

Like singing jazz and funk at Madam’s Organ. Or acting in New York. Or modeling here and there. “In college, I was also doing all these drama [and] theater productions and performing; but I still had a burning desire to learn more about the human body,” she says. “So I decided on medical school. I was just too fascinated with science. I figured I’d do community theater on the side–which I did. But back then, I believed that a play only had a two-hour impact on someone’s life, and I knew as a doctor I could fulfill the desire to make a lasting impact on someone’s life.

“I took the safe route [with medicine],” she says. “I mean, who wants to be in New York waiting tables? I knew I had the intelligence and the savvy to become a doctor and be a good doctor.

“But nowadays, I do see that going to a movie or seeing a live performance can change your mood, alter your outlook, for more than just a few hours. And I’ve come to just know that my place is on the stage.”

She’s taken a circuitous route to that knowledge. After medical school, Pennington did an internship in pediatrics at Georgetown University Medical Center, and she left after that year, when the hospital began to deal with “serious financial and organizational problems.” She moved to Atlanta to work as editor-in-chief and animation art director at an Internet company that produced educational guides for health. That led to her current full-time job as medical director and spokeswoman for the Discovery Health Channel in Washington, D.C.

“It was really a no-brainer. At Georgia State, I had been general manager for the student television station. I had the medical degree and knowledge. I was working at an Internet company. I’d been a performer, and I loved D.C. It just all made sense.”

Now, when she’s not reviewing content for Discovery’s Web page and television channel, appearing on-air in promos and developing business for the company, Pennington is rediscovering her inner ham. She’s actively pursuing a performing career in movies and television and will appear in a PBS documentary series on parenting, airing this fall–playing herself as a pediatrician. Oh, and she still finds time to see patients on Saturdays and a couple of days a month at free clinics in town, plus lend a hand to UNICEF and other charitable causes.

“When fellow performers find out I’m a doctor, they’re pretty surprised,” Pennington says. “And they think it’s cool. But on the other hand, I have doctor friends who think it’s amazing that I sing and perform on the side, too. Each group thinks that the other side of your life is more interesting.

“To me, that’s reason to be engaged in both sides. I’m interested in getting at that other 90 percent of our brain matter scientists say we don’t use. If it’s there, it’s got to have a use, and I want to find it.”

Ultimately, Pennington hopes to earn enough cash through performing to found a charter school for underprivileged youth at which science will be a cornerstone–because she knows that the stage is vain, but medicine is infinite. It’ll be around for her entire life, but the bright lights won’t.

“Close your eyes and think of the one thing you do in life that you feel totally caught up in, that you lose all sense of time to, and do it–happily. “You ought to be able to explore life,” she says. “That’s what you came here for.”

 Copyright 2001 American Medical Student Association