By Jody Manners
Dr. Cherylee Chang was born on Kauai, Hawaii and raised in Los Angeles from an early age. She graduated from Stanford University and completed medical school and her internship year at the University of California at San Diego. She returned to Stanford for her neurology residency. She returned to UCSD to complete an internal medicine residency before traveling to Charlottesville where she completed fellowships in internal medicine critical care and neurological critical care at the University of Virginia. She now serves as the Medical Director of the Neuroscience Institute and Neurocritical Care (NCC) at The Queen’s Medical Center and is a Clinical Professor in the Departments of Medicine and Surgery at the John A. Burns School of Medicine, University of Hawaii in Honolulu, Hawaii.
As the third president of the Neurocritical Care Society (NCS), she was also the first woman president, working in that role 2007-2009. She remains active within the society as a Fellow of NCS, member of the Quality Committee, ad hoc member of the Board of Directors and an ENLS instructor. She currently serves as a member of the American Board of Internal Medicine (ABIM) Critical Care Medicine Certification Examination Writing Committee and as a member of the Society of Critical Care Medicine Council in the Neuroscience Designated Seat.
She is also the mother of two grown children. After completing her degree in Public Health and East Asian Studies at the Johns Hopkins University and a Fulbright Scholarship in Nanjing, China, her daughter is completing a degree in Population Studies and Global Health at the Harvard T.H. Chan School of Public Health. Her son has started his second year at the David Geffen School of Medicine at the University of California, Los Angeles after receiving his bachelor’s degree in Bioengineering at Stanford University.
Please tell us about your path to neurocritical care. What brought you to the field?
Chang: A long, long time ago, during my internship in internal medicine at UCSD, my first month rotation was in the ICU, where on the first night of call, I stayed up all night helping to manage an intubated, severely edematous, septic, bleeding, postoperative patient with ARDS. That night, I helped to hang voluminous numbers of blood products, and manage the ventilator, vasopressors and other agents. That patient walked into the ICU months later to say thank you. I saw the amazingly gratifying and immediate impact that a person with a team can make for an individual and her family.
The following year during my neurology residency, I loved being able to medically manage my neurological patients by treating their hypertension, diabetes, infections and putting in intravenous catheters (even central lines as needed) in addition to treating their neurological condition. My neurology attending physicians literally thought I was nuts when they found me spinning and gram-staining urine and sputum to determine which antibiotics to order (this is the day before lab/CLIA regulations). Admittedly, I dreaded the neurology outpatient clinic where we could make diagnoses but only provide mostly supportive care. Instead, I enjoyed the sleuth work of a neurological consultation in the medical or surgical ICU. Reviewing the chart, examining the patient, trying to determine what was wrong with the patient was interesting. Even for the “not waking up” consult, the devil was often in the details of the amount or adverse effects of the medication that was given, the concomitant medications and interactions, and the concurrent renal or hepatic failure. I noted that for many neurologists, the nuances of ventilator changes and metabolic perturbations were not of interest. Conversely, I often encountered the hemiplegic patient in the medical or surgical ICU who had an undiagnosed hemorrhagic or ischemic stroke whose unilateral limb weakness was attributed to “being tired.”
I was hooked.
I soon found that this was a mostly unexplored, niche area of critical care medicine. When my residency director asked me what I wanted to do after residency, I shocked him when I told him I was returning to USCD to finish an internal medicine residency so I could be a neurologist practicing critical care. The only path for critical care certification was through the ABIM. At that time, the only active fellowships that I could find in neurocritical care were at the Johns Hopkins University under Dan Hanley, the University of Virginia with Tom Bleck, and at Columbia University with Matt Fink. Allan Ropper, editor of one of the only neurocritical care books published then, had recently moved from Massachusetts General Hospital to St. Elizabeth’s and his program was not active. I heard Cecil Borel had left Johns Hopkins to go to Duke, but I was not aware of a program there yet. My husband and I chose Virginia over Baltimore and we packed up our one-year-old daughter and our golden retriever and drove from San Diego to Charlottesville.
Can you describe your experience as the first female president of NCS? What do you consider your biggest accomplishments during your tenure?
Chang: Until it was pointed out, I never thought of myself as the first female president, only as the third president. NCS was an incredibly young society. As the founding and first president, Tom Bleck bore the birthing pains, and second president Mike Diringer did the nursing of the society and its knowledge-base by establishing its journal. I felt that my job was to help NCS walk by solidifying its foundations, to help create the rules to ground it and provide further structure to help it grow. Those on the Board at the time will remember long evening meetings ironing out the first set of Policies and Procedures. These policies help provide a way to codify and track the decisions we made as a young Board, and I think that was one of my biggest contributions to the society.
The other accomplishment during my tenure was the concurrent launching of the UCNS certification examination in 2007. Since the establishment of NCS in 2002, Jose Suarez and I were co-chairs of the certification committee of NCS, and I became the chair for the UCNS NCC examination writing committee in 2005. The ability to obtain certification was an important achievement for the profession of neurocritical care and for NCS that strategized and supported this endeavor.
Additionally, during this growth period, my goal was to help NCS become a multi-professional society. When looking around at a Board meeting, it was, frankly, all male physicians except for me. As president, I reached out to NCC nurses and advanced practice nurses and their societies to ask for their involvement. NCS has continued to reach even more professionals, including pharmacists. It is very satisfying to see the amazing contributions these leaders in NCC have made to NCS and to the profession.
What changes do you see as having the greatest impact on neurocritical care practice for women? Has the role of women in the field changed over time?
Chang: The changes are not just in NCC, but the overarching awareness of the need for diversity and inclusion at the workplace, in professional societies, and in educational and research institutions. The understanding, acceptance and valuing of the differences between individuals and being aware of the different needs of a person will continue to impact neurocritical care practice for women. It is gratifying to see that WINCC has programs and lectures that explore the differences in perception, negotiation style and other issues, for example, based on gender. I’m not sure if the role of women in the field has changed over time, but there are more women choosing NCC as a career. I am glad that others see the challenge and satisfaction of this very demanding field of medicine with many discoveries still to be elucidated.
What advice would you give to those considering a career in NCC? How do you maintain balance in your professional and personal life?
Chang: This field of neurocritical care is one that is hugely satisfying from the patient care, research and educational standpoint. It can also be taxing. Balancing sleepless nights with endless pages, getting children ready for and off to and from school, rounding, educating, performing administrative and research duties, and managing a household is an endless dance. This, in addition to making sure we do our own ongoing education to best manage our patients and build our career and then, it seems, last of all, managing one’s own wellness. In any career, it is important to put wellness first, so the other things can follow. We need to take time for ourselves. In addition to family life, we need also to deal with the emotional ups and downs of patients who live, who die. For me, my wellness has been in running, and now biking on my Peloton, cooking and traveling when I can. Set a wellness routine early in your career, and make this a habit that works for you.
Neurocritical care is typically a field of high-achiever, do-it-yourself type of personalities, yet it is OK to relinquish some things; learning how to delegate is an important skill. One high-ranking U.S. Army general who came to lecture at our hospital gave me advice to make sure to have people around you whom you can trust. When you trust someone, you are able to delegate with confidence. Finally, in considering a career in NCC, remember Mark Twain’s wise words: “Find a job you enjoy doing, and you will never have to work a day in your life.”