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Tim Cordes: 盲人获得医学博士
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发表时间:2009-05-04
更新时间:2009-05-04
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发信人: docrockville (docrockville), 信区: MedicalCareer
标 题: Tim Cordes: 盲人获得医学博士
发信站: BBS 未名空间站 (Mon May 4 10:57:59 2009)

URL: http://www.msnbc.msn.com/id/7318398/


Blind medical student earns M.D.
'Things are only impossible until they’re done'
The Associated Press
updated 8:24 p.m. ET, Tues., April 5, 2005

MADISON, Wis. - The young medical student was nervous as he slid the soft,
thin tube down into the patient’s windpipe. It was a delicate maneuver —
and he knew he had to get it right.

Tim Cordes leaned over the patient as his professor and a team of others
closely monitored his every step. Carefully, he positioned the tube, waiting
for the special signal that oxygen was flowing.

The anesthesia machine was set to emit musical tones to confirm the tube was
in the trachea and carbon dioxide was present. Soon, Cordes heard the
sounds. He double-checked with a stethoscope. All was OK. He had completed
the intubation.

Several times over two weeks, Cordes performed this difficult task at the
University of Wisconsin Hospital and Clinics. His professor, Dr. George
Arndt, marveled at his student’s skills.

“He was 100 percent,” the doctor says. “He did it better than the people
who could see.”

Tim Cordes is blind.

He has mastered much in his 28 years: Jujitsu. Biochemistry. Water-skiing.
Musical composition. Any one of these accomplishments would be impressive.
Together, they’re dazzling. And now, there’s more luster for his gold-
plated resume with a new title: Doctor.

Cordes has earned his M.D.

Many barriers to overcome
In a world where skeptics always seem to be saying, stop, this isn’t
something a blind person should be doing, it was one more barrier overcome.
There are only a handful of blind doctors in this country. But Cordes makes
it clear he could not have joined this elite club alone.

“I signed on with a bunch of real team players who decided that things are
only impossible until they’re done,” he says.

That’s modesty speaking. Cordes finished medical school at the University
of Wisconsin-Madison in the top sixth of his class (he received just one B),
earning honors, accolades and admirers along the way.

“He was confident, he was professional, he was respectful and he was a
great listener,” says Sandy Roof, a nurse practitioner who worked with
Cordes as part of a training program in a small-town clinic.

Without sight, Cordes had to learn how to identify clusters of spaghetti-
thin nerves and vessels in cadavers, study X-rays, read EKGs and patient
charts, examine slides showing slices of the brain, diagnose rashes — and
more.

He used a variety of special tools, including raised line drawings, a
computer that simultaneously reads into his earpiece whatever he types, a
visual describer, a portable printer that allowed him to write notes for
patient charts, and a device called an Optacon that has a small camera with
vibrating pins that help his fingers feel images.

“It was kind of whatever worked,” Cordes says. “Sometimes you can psych
yourself out and anticipate problems that don’t materialize. ... You can
sit there and plan for every contingency or you just go out and do things. .
.. That was the best way.”

That’s been his philosophy much of his life. Cordes was just 5 months old
when he was diagnosed with Leber’s disease. He wore glasses by age 2, and
gradually lost his sight. At age 16, when his peers were getting their car
keys, he took his first steps with a guide dog.

Still, blindness didn’t stop him.

He wrestled and earned a black belt in tae kwon do and jujitsu. An academic
whiz, he graduated as valedictorian at the University of Notre Dame as a
crowd of 10,000 gave him a standing ovation.


Cordes finished medical school in December but still is working on his Ph.D.
, studying the structure of a protein involved in a bacteria that causes
pneumonia and other infections.

Though he spends 10 to 12 hours a day in the lab, Cordes also carried the
Olympic torch when it made its way through Wisconsin in 2002 (he runs four
miles twice a week) and has managed to give a few motivational speeches and
accept an award or two.

He’s even found time to fall in love; he’s engaged to a medical school
student.

'You deal with what you're dealt'
But Tim Cordes doesn’t want to be cast as the noble hero of a Hallmark
special.

“I just think that you deal with what you’re dealt,” he says. “I’ve
just been trying to do the best with what I’ve got. I don’t think that’s
any different than anybody else.”

He also shuns suggestions his IQ leaves his peers in the dust.

“I just work hard and study,” he says. “If you’re not modest, you’re
probably overestimating yourself.”

Through the years, plenty of people have underestimated Cordes.

That was especially true when he applied for medical school and was rejected
by several universities, despite glowing references, two years of
antibiotics research and a 3.99 undergraduate average as a biochemistry
major.

Even when Wisconsin-Madison accepted him, Cordes says, he knew there was “
some healthy skepticism.” But, he adds, “the people I worked with were top
notch and really gave me a chance.”

The dean of the medical school, Dr. Philip Farrell, says the faculty
determined early on that Cordes would have “a successful experience. Once
you decide that, it’s only a question of options and choices.”

Farrell worried a bit how Cordes might fare in the hospital settings, but
says he needn’t have.

“We’ve learned from him as much as he’s learned from us ... one should
never assume that any student is going to have a barrier, an obstacle, that
they can’t overcome,” he says.

Sandy Roof, the nurse practitioner who worked with Cordes in a clinic in the
town of Waterloo, wondered about that.

“My first reaction was the same as others’: How can he possibly see and
treat patients?” she says. “I was skeptical, but within a short time I
realized he was very capable, very sensitive.”

She recalls watching him examine a patient with a rash, feel the area, ask
the appropriate questions — and come up with a correct diagnosis.

“He didn’t try and sell himself,” Roof adds. “He just did what needed to
be done.”

'What's the dog for?'
Cordes says he thinks people accepted him because most of his training was
in a teaching hospital, where he blended in with other medical students. One
patient apparently didn’t even realize the young man treating him was
blind.

Cordes grins as he recalls examining a 7-year-old while making the hospital
rounds with Vance, his German shepherd guide dog. The next day, he saw the
boy’s father, who said, “I think you did a great job. (But) when my son
got out, he asked me, ‘What’s the dog for?’"

With his sandy hair and choirboy’s face, Cordes became a familiar sight
with Vance at the university hospital. The two were so good at navigating
the maze of hallways that interns would sometimes ask Cordes for the
quickest route to a particular destination.

Some professors say Cordes compensates for his lack of sight with his other
senses — especially his incredible sense of touch. “He can pick up things
with his hands you and I wouldn’t pick up — like vibrations,” says Arndt,
the anesthesiology professor.

Cordes says some of his most valuable lessons came from doctors who believed
in showing rather than telling.

“You can describe what it feels like to put your hand on the aorta and feel
someone’s blood flowing through it,” he says, his face lighting up, “but
until you feel it, you really don’t get a sense of what that’s like.”


Dr. Yolanda Becker, assistant professor of surgery who performs transplants,
noticed that Cordes had a talent for finding veins. “I tell the students,
'You have to feel them ... you just can’t look.’ For Tim, that was not an
option.”

Becker soon became one more member of Tim Cordes’ fan club.

“He was a breath of fresh air,” she says. “He appreciated the fact people
took time with him to feel the pulse, feel the grafts, feel where the
kidneys are. ... He asked very good questions.”

Cordes’ training included observing surgery, helping treat psychiatric
patients at a veterans hospital and traveling beyond the hospital walls to
the rural corners of Wisconsin.

For six weeks, he experienced the front lines of medicine with Dr. Ben
Schmidt, accompanying him from house calls to the hospital, tending to
everything from heart trouble to chicken scratches.

Cars, camping and canoeing
They took time, too, to indulge Cordes’ passion for cars. Cordes, who reads
Road & Track and Car and Driver magazines faithfully, is a Porsche fan.
Knowing that, an internist in Schmidt’s clinic brought her husband’s
metallic gray Turbo 911 to work one day. Schmidt took the wheel, roaring
down the road with Cordes in the passenger seat — his keen hearing
detecting the sounds of the valves opening up.

Cordes also enjoys camping and canoeing with his fiancee, Blue-leaf Hannah (
her exotic first name comes from a character in “Centennial,” a James
Michener novel). They met when both interviewed for medical school.

“I was just mostly curious how he was going to do it,” she says. “I must
have asked him a million questions.”

“I figured she was just sizing up the competition,” he teases.

She was impressed. “He was smart and pretty modest,” she says.

“Handsome, too,” he adds.

“Yes, handsome,” she laughs.

They began dating and will marry this fall. It’s a match made for Mensa.
Hannah is now in medical school. She already has a Ph.D. in pharmacology —
her dissertation was on a human protein implicated in heart disease called
thrombospondin.

“Too long for a Scrabble game,” Cordes jokes.

The two have talked about starting a research lab together someday.

Looking back on medical school, Cordes says he savored the chance to help
deliver babies and observe surgery — things he’s probably not going to do
again. “I just made it a point to treasure them while I had them,” he says.

He once thought he’d become a researcher but is now considering psychiatry
and internal medicine. “The surprise for me was how much I liked dealing
with the human side,” he says. “It took a little work to get over. I’m
kind of a shy guy.”

Cordes plans to attend graduation ceremonies in May.

For now, he’s humble about his latest milestone.

“I might be the front man in the show but there were lot of people involved
,” he says. “Everybody was giving a good effort for me and I wanted to do
right by them.”



http://www.grow.uwcalscommunication.com/2008/02/19/science-through-a-blind-eye-by-michael-penn/


Tim Cordes can’t see the proteins he studies. But as a scientist, he’s
proven he has extraordinary vision.


A single piano key sounds into the darkened lab, mostly empty on this late
autumn evening. Tim Cordes adjusts the volume on his laptop computer and
types a short command. Another note, softer and higher.

“That’s a carbon atom,” he says. “A little bit away from us.”

A few more keystrokes, and a different tone sounds, this time an organ, high
and strong.

“Oxygen,” he notes. “You can tell it’s higher in the structure from the
pitch.”

With each click, Cordes is burrowing deeper inside the molecular structure
of a protein, one of the hundreds of thousands of proteins that carry out
the work of living cells. Like snowflakes, no two of these remarkable
molecules are quite alike. They’re formed by unique combinations of 20
different amino acids, which fold up on top of each other like a wad of
tangled spaghetti, and it’s these distinctive shapes that interest
researchers such as Cordes.

A 31-year-old medical resident, who last fall completed a Ph.D. in
biomolecular chemistry to go along with an M.D. he earned in 2004, he has
been studying proteins for eight years, probing their atomic makeup for
information that might help researchers design new drugs or combat genetic
diseases. Any one of the thousands of atoms inside that tight bundle might
be a clue about how the protein works—or, in the case of proteins that
cause infections and diseases, how to stop them from working.

But proteins are tiny and complex, too intricate to study with microscopes,
and so science has had to invent tools to analyze them. Most protein
researchers rely on computer graphics programs, which take data on the
positions of thousands of individual atoms inside a protein and create a
brightly colored, three-dimensional ball that scientists can rotate and
probe for interesting features. These programs typically give scientists the
power to see the invisible, seeking out places where drugs might bind or
proteins might interact. But the models don’t do much good for Tim Cordes,
for whom all of life is invisible. That’s because he is blind.

Early on in his research, Cordes tried using the graphics packages,
attempting to memorize coordinates and get a picture of certain regions of a
protein in his head. Two years ago, he had a better idea. A dabbling
musician who’s recently been teaching himself accordion, he began
experimenting with turning structure into sound, using audio tones to
represent the physical arrangement of atoms along a protein’s backbone.

Now, like a biochemical Bach, he conducts a symphony in which proteins play
their shapes to him, an alternative world where oxygen sounds like an organ
and carbon plays the piano.

“It’s pretty intuitive,” he says, demonstrating the software. “Every
visualization of a protein is just a mental abstraction anyway, so I fi
;gured, why not use sound?”

It seems likely that Tim Cordes would have stood out at UW-Madison if he had
20/20 vision. Even among graduate students, no collection of also-rans, his
résumé was uncommonly stoked with accomplishments. As an undergraduate at
the University of Notre Dame, he logged two years at a lab bench studying
antibiotics and ticked off a 3.99 grade point average while majoring in
biochemistry. (His only blemish: an A-minus in Spanish.) He wrote computer
programs, won awards as a wrestler and even earned a black belt in jujitsu.

That he did it all blind sometimes struck people as the least interesting of
his qualities.

“If I had to describe Tim, the fact that he’s blind would probably be
about the 10th or 12th thing I would list,” says Adam Hofer, who assisted
Cordes with his laboratory research while earning his degree in microbiology
. “He has so many other distinguishing characteristics and achievements.”

In a world that often treats people with disabilities as heroes or victims,
Cordes has spent much of his life trying to avoid being either. Diagnosed
with Leber’s disease, a rare degenerative condition of the retina, when he
was just five months old, he gradually lost his sight as a boy. By 16,
his world was darkness. Yet he embraced his passions with little regard for
the presumed boundaries of ability. Although he could not drive, he read
Road & Track in Braille and learned the mechanics of combustion engines. He
water-skied and went hiking in the wilderness. As a teenager, when he was
asked on a survey to evaluate the effect of blindness on his life, he
answered “minor inconvenience.”

“Every visualization of a protein is just a mental abstraction anyway, so I
figured, why not use sound?”

“I just tried to do the things that I wanted to do,” he says. “Everybody
has circumstances in their lives, and I think you just go forward and deal
with what you’re dealt.”

In graduate school, however, Cordes sought out a path where blindness seemed
anything but a minor inconvenience. He applied to the UW School of Medicine
and Public Health’s medical scientist training program, a brutally
demanding odyssey that involves completing both medical school and Ph.D.-
level academic research at the same time. As a medical student, Cordes faced
anatomy labs that required him to identify internal organs and blood
vessels—he did it by feel—and patient consultations on everything from
heart murmurs to skin rashes. He found a specialty in psychiatry and is now
a resident in the psychiatric unit of the William S. Middleton Memorial
Veterans Hospital in Madison.

For his Ph.D. research, Cordes wound up doing something no less visual in
nature: creating and analyzing molecular models of proteins. Inspired by his
experience studying antibiotics at Notre Dame, he wanted to explore the
biology of disease-causing microbes, which he thought might connect well
with his clinical training and open the door to a career in medical research
. That led him to Katrina Forest, a CALS professor of bacteriology who
studies pathogenic bacteria by isolating the proteins they use to interact
with host cells. Using a technique known as X-ray crystallography, Forest’s
graduate students grow large crystals of proteins and then bombard them
with X-rays to figure out their molecular structure, a first
step in designing new antibiotics or devising strategies for treating
infectious diseases.

When Forest met Cordes in 1998, she was new to the faculty and had hardly
worked with graduate students, much less a blind one. But she saw no reason
Cordes could not contribute to her team. For one thing, he was a computer
whiz who had written code since he was 10. Forest initially figured he
would dive into the mountain of data created by crystallography trials and
help resolve the structures of the bacterial proteins her lab was studying.
But when that task was completed, “ Tim’s project evolved in a different
way,” says Forest. “He ended up doing a lot of lab work, which I wouldn’t
have expected to be right up his alley.”

Mostly, it was. Cordes put Braille labels on bottles of reagents and
installed voice software on lab equipment, allowing him to grow and purify
proteins and test their functions. For them? At the protein level, we’re
all blind.

Cordes’ invention, like so many, was birthed from necessity. The standard
programs for studying protein structures “are sort of like playing video
games,” says Katrina Forest. “You get this graphical model on the screen
that you can spin around, and that helps you see it in three dimensions.”
But to make any sense of the interface, Cordes had to copy data into a
separate file and then try to extrapolate how atoms related to each
other in his head. “I couldn’t do a whole protein,” he says, “ but maybe
I could think about one active site.”

TimMol’s alternative concept is quite simple. It replaces the three spatial
dimensions with three different kinds of audio cues, so that atoms inside a
protein become like speakers in a surround-sound system. From a given point
inside a protein, a user can hear what other atoms are nearby, placing them
by the pitch and orientation of the sounds they make. A higher or lower
pitch indicates that the atom is above or below the user’s position. Louder
means closer, while softer means farther away. Atoms to the left play in
the left ear of the user’s headphones, and those to the right play in the
right. To help distinguish different kinds of atoms, Cordes assigned each a
musical instrument—piano for carbon, organ for oxygen. “I picked kind of a
cool, jazzy vibraphone for nitrogen,” he says, “ because nitrogen is
usually shown in blue in models.”

Partly for amusement, Cordes included a function that plays an entire
protein by tracing its backbone of amino acids, creating a meandering trail
of rising and falling notes. It sounds like some kind of minimalist sonata,
but the tune is deep with significance. “Usually, when I come to a
new protein, one of the first things I do is to play it atom by atom,
” Cordes says. “It helps you get an overall sense of what you’re looking
at, and you can get a feel for its shape and structure.”

Although he began building the model primarily to help him complete his
doctoral thesis—its invention is the topic of one chapter—Cordes is
enthusiastic about making it publicly available. A beta version is already
on the web, and he is waiting to hear from a top educational journal about
publishing his work.

“I think this can help shift that balance in science, where everything is
so visually loaded, so that more people who are not visually inclined can
get access to this kind of information,” he says.

But if he wanted an example of how visually loaded science can be, he need
only consider his own thesis experience. Late last year, when he went before
his committee to defend his work and polish off his doctorate, the
committee had a few final requests. One struck him as profoundly
ironic. While the reviewers widely praised Cordes’ scholarship and
methodology, they said his presentation needed brushing up. The group
suggested more graphics.

“That didn’t surprise me,” says Cordes. “It doesn’t help me any, making
these representations. But at the same time, it is the language of science
right now, and I have to speak that language, too.” In the end, it was only
a minor inconvenience.
--

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