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Women in Neurocritical Care: An Interview with Diana Greene-Chandos, MD

By Currents Editor posted 04-16-2019 14:13

  

By Jody Manners, MD 

Diana-Greene-Chandos.jpgDiana Greene-Chandos, MD, was born in Canton, Ohio, but grew up in Scottsdale, Arizona. She began her medical training at the University of Arizona College of Medicine in 1992, taking a year off in the middle of medical school for a research fellowship funded by the Howard Hughes Institute, during which time she worked in a neurosurgical research laboratory at the University of Washington studying neuronal plasticity. After medical school, she completed a neurology residency at Washington University in St. Louis in 2001, and did a neurocritical care fellowship at The Johns Hopkins Hospital, where she was the first woman with a child to enter the fellowship.

She is currently at The Ohio State University Wexner Medical Center and James Cancer Center, where she was the founding medical director of the neurocritical care unit and developed a thriving fellowship program at OSU. She is also the current chair for the Women in Neurocritical Care section (WINCC), working to champion causes relevant to all women within the field of neurocritical care. 

Please describe how you came to the field of neurocritical care. What inspired you to become a neurointensivist?

I came to neurocritical care in a variety of ways, but two really stuck with me. During my research fellowship in the middle of medical school, I met a young neurology resident, Dr. Bill Coplin, who was planning to practice critical care after residency and educated me about this emerging field. At the time, I had a passion for neurosurgery. In fact, I went into medical school certain that I would be some kind of surgeon but hoped it would be neurosurgery. Unfortunately, during a sub-internship, I discovered that I didn’t love the operating room, except for the first hour or so.

Plus, becoming a mother was very important to me. And, truly, being a student member in the Women in Neurosurgery group, I could not find any women who were mothers to show me that it could be done. The two issues combined turned me away from neurosurgery. 

Thankfully, my neurosurgical mentor suggested a career in a developing field, neurocritical care. So, my path quickly changed. I loved the neuro-ICU at Barrow’s and Washington University as a student and resident. The acute care and procedural nature of neurocritical care appealed to me. But what sold it was combining the extensive and carefully detailed efforts taken for the purposes of preserving the brain, while also getting to be a source of strength and comfort for families in heart-wrenching times. 

What are you most proud to have accomplished so far?

I am really proud of the OSUWMC NCCU team, unit and fellowship program. It was started from scratch. The first person that I hired to help move the vision was Susan Yeager, ACNP. I don’t have a sister, so she really is my chosen big sister. We persevered together to prove this was a program that would succeed. Each and every aspect of the unit and program grew at lightning speed. The unit is 24 beds and has the best numbers in our institution for morbidity and mortality index as compared to the illness severity index. When I walk through the unit and see this multi-layered team now of 10-plus people rounding and caring for people in the way I imagined, my heart swells. It will be hard to say goodbye when I leave to go to New Mexico, but it has been handed to extraordinarily capable people who will grow it more and make it better.   

And, of course, I’m proud of the great kids I have — four in total (two of my own and two stepchildren from Dr. Michel Torbey). 

What unexpected challenges have you overcome during your training and career? What strategies do you find effective when confronting such obstacles?

I had my son in residency before there were any work hour restrictions. I had everything planned with two years of stockpiled vacation time for maternity leave, so that I would graduate on time. Preeclampsia and other postpartum complications had different plans. It was the first time that I wasn’t “on time.” That was truly a sign of how my new life as a mom in a male-dominated arena would be. 

I was no longer going to be ahead of the pack (and sometimes, not even running at the same pace). Letting go of that was hard, but it had to be done. I could wallow in pity that many of my male colleagues had babies, too, that year and didn’t have this happen to them — or I could get moving. I got moving. 

For neurocritical care, I did take the train off the tracks for a while. I never really healed from that traumatic childbirth and went straight into my chief year, and then straight into my fellowship. I thought for a good 2.5 years that I couldn’t do critical care and certainly wanted another child without having to risk my life. So, I did outpatient neurology private practice for some time. If you ever want to be sure that you are meant to be a neurointensivist, step away and do some general clinic for a while—it will show you quickly. 

Thankfully, I had an easy pregnancy and delivery the second time and gave birth to a healthy girl. So, the diversion in my plan was worth it. 

Finally, when creating ICU programs, there are people who will not have your best interests at heart. It comes in different ways and surprised me a bit as the concern in private practice was mostly monetary, not ego and power positioning as in the arena of academic medicine.

Someone important to me gave me some advice that has stuck. She said when you are upset about something to “put in your notebook.” First work through it own your own to decide how best to handle it. Even if I chose to put it aside and not respond, I would have a memory to prevent it from happening again in the future. This allows me to continue moving forward, working toward my ideal vision. I haven’t been perfect at following that advice, but in my best moments, I have. 

How have you balanced raising a family and your career?

There is one word important for balance: help. Get help in those years when the kids are little — get lots of it and do not skimp on it. When you find someone who is amazing with your kids or your home, treat them like family and pay them the best that you can. You may not reach your financial goals when you do that, but you’ll have your sanity, which makes you a better parent, spouse and physician.

Now with the kids barely needing me except for entirely unplanned spurts, I’m glad I gave into that. It is a short period in life in reality. It gave me time to not have to worry about the little stuff when I got home and to be physically present at most events for them. 

When my childcare was sick and the backup childcare was sick, and there was no one else who could help, my kids came along with me. It is just what had to be done. When I was in residency, Dr. Bill Landau once pushed my six-month-old son around the clinic while I was seeing patients.       

What kind of advice would you offer to women facing competing interests (eg, their spouse’s career or role as a caregiver)?

Dr. Torbey and I are probably a case study in this. We both are neurointensivists, but on a day-to-day basis, what we love in the field and our goals are entirely different. 

His stroke and telestroke came under a division in Neurology with neurocritical care academically that he ultimately led as division chief (I was in the Neurosurgery department). We tagged teamed everything: call, recruiting telestroke sites, wooing donors, picking up kids, being at home in time to relieve the nanny, etc. 

With time, it became more complex. His division became larger, and he had to travel often for his leadership roles in NCS. During that time, the majority of childcare came back to me, and I took a step back with all that I was doing at work. Plus, I found that I prefer educating and growing young doctors over number-crunching administrative meetings. When we were offered our positions at UNM, we knew we had something good that would benefit us both. I think it is a constant give and take. 

And, really celebrating one another’s successes, because we truly know what goes into them. But, when I finally transition fully to New Mexico, we will have a completely empty nest. And who knows what that means for me. It will be another chapter. 

Reflecting back, is there anything you would change? What lessons have you learned?

There is plenty I would change. First, I would stop the development of EMR (but that won’t happen). Seriously, it is absolutely no joke when people say to you that you blink and your children are grown. For all parents, listen to that. I did run at a fast pace in my early years before and after kids, I would get knocked down before I listened to my body. I wished I hadn’t done that to myself or had my kids see me do that. We don’t have to be martyrs in this field. We can say, “I’m tired.” 

Also, some people think that there is only one line or path to success in this field. Or that you have to choose academics or private practice straight from fellowship, and it is impossible to switch. That isn’t the case.  I’m living proof. You might be an older assistant professor, but so what? 

What would you like for others to know about the role of WINCC? Is this section open to anyone within NCS, and how can they join?

WINCC has shown significant growth recently. We are energized and want to bring to women the issues most important to them in this field. Our initiatives for the next two years are based on a needs assessment that was taken at the beginning of my tenure as chair. Deepa Malaiyandi, MD, is the chair-elect, and she and I have put together an incredible leadership team of women who are pulling things together so quickly. They do need volunteers to bring their goals and visions to realization. 

There are five sub-sections that anyone with an interest can join. They are focused on the following:

  1. Families Sub-Section (Elissa Fory, MD, and Katherine Hogdin, MD): Bringing childcare (onsite, ideally) and family friendly activities to the annual meetings, so that parents of children can come to the meeting if they do not have childcare.
  2. Mentorship Sub-Section (Christa O’Hana S. Nobleza, MD): There is so much going here! There is a NCC women’s speaker list being created; a partnership with the fellow/resident section in mentoring pairs; partnership with WNG and AAN; and even more outside-of the-box pairings like “Moms who are medical directors” and “My nest is empty and now what can I do in NCC?” Finally, ongoing work to assist women in research, leadership, promotion, tenure processes, etc.
  3. MINCCs for WINCC (Katherine Hodgin, MD): See below
  4. Membership/Media (Kimberly Levasseur-Franklin, PharmD): We are looking to engage all women from all professional areas of NCC. We want to organize our website and use social media to discuss WINCC member success stories.
  5. Research (led by Holly Hinson, MD): This will focus on being a resource for women, while collaborating with the research committee on ongoing trials and projects. It will also aim to look at diseases in neurocritical care that predominantly affect women and any gender discrepancies for professionals in neurocritical care. 

One of WINCC's current undertakings is to explore offerings for child care at the annual meeting. Can you share some preliminary details of the proposal and discuss how WINCC is working to further this possibility?

This work has been made a possibility by the Families Sub-Section led by Elissa Fory and Katherine Hodgin. Ideally, we would have options for both on-site child care and hotel-/resort-based child care that the member can link to on their own. The on-site child care would take a room or two at the conference center and be set up like a day care. We would use a credible, highly-rated child care company that vets and background checks caregivers, and provides necessary equipment for the room. Parents would then sign up for a day’s worth of care when they register for the meeting. If it looks like there is a need, we will quickly figure out all of the details and get the message out to members. 

Women face unique challenges throughout healthcare, regardless of occupation or specialty, and spanning across stages in a career. How can men within NCS support the mission of WINCC?

While I think many of us would like to think we can create our own success as women in isolation, often times, we do need to the support of our male colleagues just as much as our female colleagues, especially since the power is still shifted toward men. 

There was a recent “Time’s Up” video calling out the problems that all women in medicine (nurses, NPs, pharmacists, physicians) face made by men and featuring many of medicine’s male leaders in the United States. Attitudes and support are changing. Women are slowly being asked less and less to act like men or lead like men and instead to be who they are as a woman. 

There is still so much work to do. MINCCs for WINCCs was created for any man who is passionate about supporting women in neurocritical care. These are men who have witnessed the discrepancies and want to help level the playing field. If you are man interested in being a part of this, we want to involve you and need your input. Please email myself or Katherine Hodgin.

#NCSRoundup

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