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Welcome to the Why Urology podcast with Dr. Todd Brandt.

This podcast is my personal attempt to teach you about your genito-urinary tract, what can go wrong, and how your urologist may just become your superhero.

The name of the podcast comes from my ongoing need to answer the question that I get so often from patients, friends, and family, “Why Urology? Why did you choose to become a urologist?”

Aug 6, 2017

 This is episode number 33, the Work Hard, Have Fun How I Became Urologist episode. Recently I was speaking with my friend Rick, who had encouraged me to start this podcast. about how been it has been two months since I had put out a podcast episode. I was remarking about how I needed a spark to get me started again. I had been focusing on trying to line up interviews/co-hosts with my partners but my summer schedule and theirs have really not allowed any time to coordinate our efforts. I had stopped my personal writing schedule so I hadn’t produce any episodes on my own. Rick suggested that I do an episode that was more personal. How had I chosen to become a urologist? What was my path into the field? Did I know that I wanted to be a urologist when I went to medical school? Those are questions that I often get from patients and friends. My answer is usually that I wanted a specialty that combined both surgical and clinical responsibilities, a good income and reasonable lifestyle, and an interesting variety of medical concerns. This of course is the expedient answer, a sound bite, and one that is easy for most people to swallow. But couldn’t these requirements apply to many different specialties within medicine? How did I get interested in the field of urology over all of the other possibilities in medicine that are more lucrative, have a better lifestyle, or offered more variety?  Why choose the bladder over bones as an orthopedic surgeon or a radiologist, the prostate over pimples as a dermatologist, or the kidneys over cadavers as a pathologist? Why did I give my heart to urology and not fall in love with cardiology? Like all love stories the true story of how I met Urology usually takes too long to tell and its one that I am not proud to tell anyway so I don’t often tell it. But here we have the time. So here you go, Rick. This episode is my answer to the question "Why Urology?"  How I became a urologist. I have talked about being a physician since I was a kid. I was pretty good in science in school, didn’t shirk at the sight of blood, and the men I looked up to were the family physicians that I knew from our community. Medicine always seemed like a natural fit for a “nice, smart boy like me.” I am putting “nice, smart boy” in quotations here because that’s what most of the older ladies at church used to tell me I was right before they would pat me on the head and then going on and on about how thick my hair was. It’s hard as a kid to take yourself too seriously when your hair gets more compliments than your personality, but there I was, nice and smart, and a great head of hair to boot. What more do you need to become a doctor? As I grew older I never really lost the idea that I would go to medical school when I was going through high school and college, but I certainly questioned whether it would be a good path for me. To be honest, I wondered if I could enjoy the buttoned-down, serious profession of medicine. I was a good boy but, truth be told, I was also a goofy kid. I really can only remember having one hero when I was growing up. I wanted to be Johnny Carson. My secret dream as a kid was to deliver the best medicine, laughter.  One other thing, too. I had once told my father when I was in college that I was looking for a job where I didn't have to wear a tie. After getting over his disappointment that was the first of my list of job criteria and that his son might not be the over-achiever he had hoped for, he told me to consider his profession and become an orthodontist. He had a great life, make a good living, and, he pointed out, he had stopped wearing ties to work years before and nobody seemed to care. He was as busy as ever in his practice. Despite the promise of a no-tie-life my father couldn't convince me to go into dentistry. It really sounded kind of boring to me and I had no desire to walk a lifetime in my father’s shadow. But it was also around this time that my father, not at all a wordsmith, refined a simple refrain, a motto, that he would both continue to repeat to me and then to live out himself, and I always hear his voice when I say these words, “Work hard, have fun.” It was these words, a bit of excitement, a lot of trepidation and a pair of flip-flops that I took with me to medical school. I wondered where I would end up. Could a hard-working, reasonably smart, goofball like me ultimately find a place? I didn’t have to wait long to find the answer. When I was a first-year medical student, at a medical school party, a senior medical student came up to me, asked me my name, and said he and another senior had been watching the first-year medical students at the party to try to figure out what specialty they would choose.  "You are a wise-ass," he said with a wink, "you will become a urologist." I didn’t know at the time there was such a thing as a urologist. I went home that night and tried to figure out what a urologist was and why being a “wise-ass” would lead me to become a urologist. What I learned that night and in the following years of training and practice, was that urologists tend to be hard-working and passionate about their work, but also generally good-natured and fun people. It helps to have a sense of humor in our line of work. Urologists deal in an area of the body most people never want to talk about. Sure, there is a lot of poddy-humor and fart jokes that can break the ice, but having a frank discussion about sensitive issues requires mixing humor with intelligence and compassion. I suspect when that senior medical student called me a wise-ass I was more poddy-humor than compassionate, but I hope, at least, that I was being good-natured and fun. And I don’t want you to get the wrong impression about me. I was serious about my studies during those years, occasionally showing some academic promise. When I went to medical school most people actually expected me to follow the path I had chosen as an undergraduate as a Neuroscience major and become a neurologist or a neurosurgeon. Oddly enough, I actually disliked my Neurology rotations in medical school so ruling out those specialties was a no-brainer. (Yes, I went there. Sorry.) This reminds me of a funny story I like to tell about how I disappointed all of my family when I chose Urology. I laugh when I think about the time my grandmother asked me one day at the end of medical school what specialty I had chosen. Naturally she thought I had replied “Neurology.” “Oh,” my grandmother exclaimed proudly, “it must be exciting working on the brain!” “No grandma,” I said, “I am going to be a urologist.” “Oh,” she said disappointedly, “that’s too bad.” She never asked me about my work again. My grandmother articulated what most people think when you tell them you are a urologist. "What a terrible job.” That is usually followed by, “How can you stick your finger in you know where all day long?" When it comes to urology most people can't get past the digital rectal exam, reducing the entire urologic field down to a single component of our specialty, checking the prostate by placing one’s forefinger in the rectum to feel the prostate to check for enlargement or cancer.  While the prostate exam is a critical component of what we do, and, parenthetically, an art that is being lost at the primary care level, it is not ALL that we do as urologists.  That is, of course, what this podcast is all about.  But, coincidentally, it was the performance of a single digital rectal exam, or I should say the lack of the performance of a single digital rectal exam, that began my path into the field of urology. My story continues when I was a second-year medical student. In the second semester of our second year as medical students we took a physical exam course in preparation for our clinical years, the third and fourth year. There are legendary stories about medical students and residents practicing their skills on each other as they learn the physical exam. As a requirement for my class I was given a partner, a male partner, and we would practice some components of the exam on each other as we went through the course, checking each other’s knee reflexes on the knee or listening to each other's heart and lungs with our shiny new stethoscopes. But, of course, there are parts of the physical exam that were just not appropriate to practice on each other. And for those exams, the genital exams, proctored sessions with surrogate patients were arranged. The school would pay for people to come in and have a small number, usually 3-4, medical students perform the genital exam, a vaginal speculum exam in the female and the prostate digital rectal exam in the male. These were important sessions not to miss because there was not really another chance during the course to perform these exams for the first time. These sessions were scheduled at odd times, during the evenings usually, to accommodate the schedule of the proctors and the surrogate patients. It was the session for the male exam, specifically the male digital rectal exam, that would change the course of my life. And the story is most notable for my not being there. You see I missed the session with my small group. I didn’t show up. Just so the listener, one of whom is my mother, knows, this was very uncharacteristic of me as a medical student. I was not the brightest medical student, but I was a hard worker and a conscientious student so it was unlike me to miss something like this. I actually don't remember why I missed the proctored session. I think it was simply a clerical error on my part. Essentially, I think I got the date and time wrong. Remember these were days without cell phones or computers so wherever I was at the time, and I am going to my grave claiming I was in the library, I was not able to be contacted at the last minute to remind me to come to the session. And I didn’t. I remember finding out that I had missed the evening session the following day in class. My immediate reaction was that I was sorry I missed the session but I didn't think it would be a big deal or the mini-crisis it became to make it up. No problem, right? Go to the professor and get in on another session since they were being held on a regular basis. Well...Not so much. When I went to the professor who was in charge of the class I got zero sympathy. In fact, I got worse than that. He told me that I had missed a critical portion of the class. He would not allow me to get in on another session and that I would have to make arrangements on my own. Without satisfactory completion of a male exam, I was told, I was at risk, even though I was otherwise doing well in the class, of receiving a failing grade. It was explained to me further that if I failed his class I would not be allowed to go on to my third-year clinical rotations. I am pretty sure to this day he was bluffing, but I was not willing to take the chance. Naturally I questioned if there was another way, and objected to his dictatorial ways. He advised me to appeal my case to the Dean. I want to stop our story here and say that this episode was highly atypical for my medical school experience at Vanderbilt University. As I said I was a good, but not great, student and the Commodores (that's the mascot) were usually very accommodating to the needs of the student. As an example of this, during the same physical exam class, we had a lecture by a prominent Professor of Cardiology at the University. He came in to talk about listening to the heart, how characteristic sounds are made by the heart during different disease states. An experienced ear can hear an extra beat, a whoosh, or a high-pitched sound as muscles and valves become damaged or discordant. I remember this lecture specifically for the lo-tech way that he could illustrate the assorted dysrhythmias and heart murmurs. He would make the characteristic murmur sounds with his mouth in concert with tapping on the podium the various rhythms. I remember really engaging with that lecture and feeling that I had learned something. We had been given a cassette tape (remember those?) of the different rhythms recorded from actual patients to listen to, but I had found it difficult to learn from the tape. This was much more my style, strip the thing down to its bare essentials, and tap it out on the desk. My engagement in the lecture must have left a mark because several days later I was walking through the main floor of the hospital on my way to the medical school to study. This same cardiologist happened to be standing in the lobby waiting for an elevator as he was going to do his daily rounds on the wards. He shouted to me just before I left the building. “Aren’t you a second-year medical student?” I said that I was. “What are you doing right now,” he asked. I said I wasn’t doing much other than going to library. “I want you to come and round with me,” he said. Remember this is a Professor of Cardiology at a major university asking a second-year medical student to come to round with him. We first went to the doctor’s lounge where he grabbed me a white coat, a long white coat incidentally, not the yellowed and stained short white coats full of notecards and other paraphernalia that medical students are expected to wear on the wards that signals that they are medical students, but a real, long, angel-white doctors coat freshly laundered. I spent the next two hours being introduced to patients as Dr. Brandt and learning more about the heart that I had probably learned in two years of medical school. I don’t know where the residents and fellows were that day that would usually accompany this professor; that day it was just me. Remember I was no great shakes as a medical student, I am just giving you an example that was just more characteristic of my experience at Vanderbilt at the time. So, it was with some confidence for resolution that I quickly made my way to the dean's office to plea my case for the missing digital rectal exam.  And while I did receive a stern lecture about how physicians need to be responsible, reliable and on time, the dean quickly made a phone call to the Urology Department. Arrangements were made to have me spend some time in the Urology Clinic with the residents at the VA hospital associated with the University. The following day, at 1 pm sharp, dressed in a tie and a heavily starched short white coat I introduced myself to the chief resident at the VA. Even though all I needed was one rectal exam to complete my requirement I stuck around for the afternoon with the Urology residents, learning about the prostate, kidneys, and other genitourinary organs and the problems that can develop. It was basically a great time of intense learning with some very nice people who became role models over the next year or so as I thought about what field to pursue. Where my fellow classmates had done just one rectal exam, I did many. And I was introduced to the Urology in a way that I would not have otherwise, sparking an interest that did not fade. And the rest, they say, is history. From the first day, I guess you could say, I was in. After showing some interest in the field I continued to be encouraged by residents and professors to consider it as a specialty. When it came time to select my surgical electives, which sub-specialties of surgery to rotate through for the third year of school I chose Urology as one of the electives.  Of course, I enjoyed that experience as well and eventually chose to do a fourth-year rotation and, ultimately, applying for a residency position. I completed my residency at the University of Iowa in the year 2000 and I have been in practice now for 17 years. And I have been happy with my chosen field. From that first day forward I have been able to live out my father's advice to "Work hard, have fun." Each day I seek to be more wise than wise-ass. I’ve lost the flip-flops and my great hair long ago but I hope that I have kept the nice and smart parts as I put on my long white coat. And in case you are wondering Dad, yes, just like my hero Johnny Carson did, I reliably and responsibly put a tie on nearly every day when I go to work on time. And I tuck a joke into my front pocket as I leave home just in case I need on occasion to deliver the best medicine. For episode 33-How I became a urologist. I am Dr. Todd Brandt. That’s “Why Urology.” Work hard and have fun everybody. END