By Hoyt Smith
In many ways, 39-year-old Jeff Lawler is indistinguishable from his classmates. He attends class, works in the anatomy lab, practices osteopathic manipulative therapy with a partner and spends numerous hours studying in the library. Like all medical students, he faces numerous challenges which will put all his abilities to the test in coming years. For Jeff, however, there are additional obstacles to overcome.
At age 24, Jeff was diagnosed with Retinitis Pigmentosa, a degenerative disease of the retina. Within 10 years he lost all vision and became severely depressed, even questioning the worthiness of his life. At about the same time, Jeff's mother was diagnosed with breast cancer. Watching her live and cope with the disease - from which she eventually died - ultimately helped the Denver native to overcome his depression and feelings of unworthiness.
"Losing my mom was more difficult than losing my sight," Jeff says. "I watched her battle [the cancer] and she didn't give up. So I decided, neither would I."
As a teenager Jeff had contemplated going to medical school, but no one in his family had ever gone to college. Academically and financially, it just didn't seem like a realistic option. "It took my blindness for me to focus and realize that I had the qualities that would allow me to be a physician," he says. "If I hadn't become blind, I know I wouldn't be here today. I would never be on my way to becoming a doctor."
Shortly before his mother passed away in December 1993, Jeff enrolled in the Colorado School for the Blind. It was a revitalizing experience. He met his future wife, Sandy, "a tiny, 100-pound woman" whom Jeff describes as "my rock." The Center's director, Diane McGeorge, also challenged him to build a new life by turning his disability into an advantage.
A year later Jeff enrolled as a full-time student at the University of Colorado at Denver. As a blind undergraduate student, he earned straight As and ascended to the top of his class. In the summer he took an accelerated course in organic chemistry and received an A+, the highest grade in the class. It was then that Jeff seriously considered his lifelong dream of becoming a doctor.
In 1998 Jeff took the Medical College Aptitude Test (MCAT) and applied to eight medical schools. He was confident. "Medical school is very competitive," Jeff explains. "My MCAT scores were not super high, yet high enough. I knew I could be a good doctor - not just get through medical school, but be an outstanding physician."
Lawler was invited to interview at four schools, but WesternU's College of Osteopathic Medicine of the Pacific (COMP) was the only one to offer him a seat. Following his first semester, he has already made a profound impression upon his fellow students and faculty. Recently he scored As on his histology and gross anatomy exams.
"I think Jeff has been an outstanding medical student up to this point. He is probably the hardest working medical student I've ever seen," says Dr. James Jones, who is a professor of Jeff's at WesternU.
"I think Jeff is very motivated. He's a gifted and determined individual," says Dr. David Redding, who instructs Jeff in osteopathic manipulative treatment - a key component of osteopathic medicine, which is also known as "hands on medicine." "His blindness has allowed Jeff to excel in certain areas, and touch is one of them," Redding adds. "He is palpating with a greater intensity than others are perhaps able to. He may actually have an advantage there."
Jeff is among four students with physical disabilities to attend WesternU since the CDIHP's founding. "Students gain an incredible amount of knowledge and experience directly from their peers," says Brenda Premo, director of WesternU's Center for Disability Issues and the Health Professions. "Bringing qualified students with disabilities into our academic programs sends a clear message to their colleagues that these are able and capable people. It shatters stereotypes and misperceptions from the first day of class."
How will the faculty teach and test disabled health professions students? What are the essential technical standards required for becoming a physician? These are key questions that will need to be answered if WesternU is to enroll more disabled students in the years to come.
"We have to determine fair methods of evaluation without making wholesale exceptions to the curriculum," says Dr. Jones. "Accommodation for disabilities cannot equate to complete elimination of the requirements that others are expected to meet. We are also re-evaluating the basic physical criteria needed to become a complete physician. Should all of our graduates be able to intubate [insert a breathing tube into a patient's trachea]? Should they be able to read an X-ray or an EKG? These are important questions."
Premo recognizes that the educational process, particularly clinical rotations, will present substantial challenges for Jeff and other students with disabilities. "We will have to seek out clinical instructors who are willing to expand their experiences and their expectations," she says. "Preliminary discussions (regarding Jeff) already reveal four or five possible rotations sites with preceptors who are willing to try. It's a matter of desire more than anything else. I won't accept the use of the word 'can't.' Blindness is not the barrier obstructing Jeff's future. It is the fears and anxieties of the people around him that threaten to impede his success."
Is a blind person capable of graduating from medical school and practicing medicine? Jeff isn't the first blind medical student in the U.S. According to Premo, there are a dozen blind physicians that she knows of who are in practice across the nation. In fact, there are numerous examples, both historically and current, of blind physicians who have overcome visual disabilities to achieve their professional goals. (see accompanying article).
In addition to historical precedence, one has to consider the broad scope of medicine and weigh the opportunities for blind physicians on a specialty-by-specialty basis.
"Skeptics frequently ask, 'How can a blind person look into a microscope or read an EKG?' says Stanley Wainapel MD, a blind physician who is clinical director of the Montefiore Medical Center's department of Rehabilitation Medicine in New York. "My immediate answer is this: how often does a cardiologist look into a microscope? How frequently does a pathologist read an EKG?
Dr. Wainapel and Brenda Premo both argue that, in most circumstances, physicians can and often do rely upon others to gather and present relevant data. If necessary, however, there are options available for blind physicians to gain firsthand access to medical information. For example, Dr. Wainapel notes, the technology already exists to convert data from EKGs into vibratory signals that can be directly interpreted by blind physicians. While it is essential that such information be acquired accurately, he adds, It isn't necessary that it be acquired visually in order for the physician to render an effective diagnosis and prescription.
"We have to ask ourselves in ADA (Americans with Disability Act) parlance, what are the essential functions of the job," says Julie Madorsky, MD, clinical professor of physical medicine and rehabilitation at WesternU and Chair of the CDIHP Advisory Board. "This is a complex and difficult question for physicians, considering that medical students are expected to be omnipotential."
Dr. Madorsky defines "omnipotential" as the capacity to succeed in every field of medicine or surgery, be it clinical, academic, administrative or research. "Of course the reality is that none of us is omnipotential," she says. "Regardless of the presence or absence of physical disability, all medical school graduates eventually make career choices that align their professional activities with their special talents, interests, aptitudes, strengths and weaknesses. The essential functions of a physician are health maintenance, diagnosis and delineation of treatment of disease and disability. And these are all, first and foremost, cognitive tasks."
Preliminary indications reveal that Jeff has gained the acceptance of his classmates and faculty, and that his presence in medical school has been an education for them as much as it has been for him. Furthermore, attempts to accommodate Jeff may ultimately prove beneficial to all students, according to George Charney, DO, WesternU's executive vice president of academic affairs/chief academic officer.
"The majority of funding for Jeff's accommodations come from pre-existing programs and scholarships," says Dr. Charney. "Other services, provided through CDIHP for our 31 students with disabilities equate to less than $7 per semester for each student. I consider that an excellent investment. What we learn by diversifying our presentation of information, materials and ideas to disabled students will help us to communicate more effectively to non-disabled students."
Does Jeff feel the pressure of being a trailblazer for other disabled health professions students?
"I have anxieties, just like any other medical student," he admits. "But I don't have fear. I'm aware that there will be many obstacles ahead to work through, but I am confident in my abilities, and I have a lot of faith in the people who are supporting me, most of all my wife, Sandy."