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MICHAEL S. SMITH, MD: NEUROLOGIST, ASTRONOMER, AND OUTDOORSMAN

Antoline, Dawn

Careers Plus: Up Close and Personal With

Neurologists often wear many hats, but Michael S. Smith, MD, has enough chapeaux to open a haberdashery – and a woodsman's cap would be on the shelf. After years of private neurology practice, he took a six-month hiatus to volunteer for the US Forest Service – canoeing up rivers, chopping down dead trees, and cleaning up campsites. That trip was a turning point away from an unhappy life as a practicing neurologist to a position as Medical Director of St. Mary's Hospital, and eventually to his current career amalgam of patient safety initiatives, consulting, freelance writing, teaching statistics, and amateur astronomy. “Once you make a change, it is not hard to make other changes,” he explained.

Dr. Smith's road to neurology was paved by naval service, which he pursued as a reservist while earning his MD at the University of Colorado Medical School in Denver, and as Medical Officer on the USS St. Louis after his 1975 internship. “When I was a shipboard naval medical officer, I was going to be an internist, but thought, I am so far behind on internal medicine being out in the middle of the Pacific Ocean that I am never going to be able to catch up. I had always liked neurology, so I decided to do a neurology residency at the University of Arizona in Tucson,” he said.

Now he spends his time fighting for patient safety legislation as a “thorn in the side of a lot of the medical community in Arizona.” Until recently, he wrote an astronomy column for the Arizona Daily Star, and in between long canoe trips in the northern wilderness, he has skipped multiple time zones in rapid succession to watch solar eclipses. Last year, he received the AAN Award for Creative Expression of Human Values in Neurology for an essay in Neurology about how his relationship with his father evolved during his mother's fatal battle with dementia. He recently shared a few details from his winding journey as physician, writer, and amateur astronomer with Neurology Today.

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TELL US ABOUT YOUR ESSAY THAT WON THE AAN CREATIVE EXPRESSION AWARD

I wrote it for the Nisus column in Neurology, and I had no idea the Creative Expression Award even existed. I realized that my experience of the changing relationship with my father was interesting to write about because my mother had a rapidly progressive dementia, and I thought this would be interesting to neurologists. Then David Goldblatt, who is a superb editor, said, ‘This is all right, but you really need to write more about the relationship with your father.’ He worked on it with me. When the essay appeared in print, I thought, ‘That is exactly what I wanted to say; there is nothing I would say differently.’

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WHAT WAS THE ESSAY ABOUT?

It started when my dad called me from Oregon, where my parents spent their summers, and asked me to come up. My mom had broken her hip, and my dad kept telling me she was fine, but she wasn't. I brought them back to Arizona and after a short hospitalization we put my mom in a hospice, where she died within two weeks of the initial call.

I knew this time would come, but I wasn't sure when it would happen and what it would be like. My relationship with my father took on a new paradigm, not his father-son paradigm or my adult-adult paradigm, but adult son to failing, depressed parent. His memory was failing, his hearing was bad, and he would go on and on about my mom and the medical errors leading up to her death. I became very frustrated with him.

Figure. D

Figure. D

About eight months after mom's death, I invited him to watch a lunar eclipse with me in a local park. We set the telescope up and after the eclipse started, two women came up and asked why these eclipses happen. I was going to answer, being the amateur astronomer, but dad barged in and explained it better than I could have. Suddenly I realized that he was there, intact, and could do things that I had been too short with him to appreciate. When I thought back on that night, I realized how important it was, and decided to write the essay.

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DID YOUR DAD INSPIRE YOUR INTEREST IN ASTRONOMY?

My dad was an educator. He taught science and was a school principal, a superintendent of schools, and an assistant dean. My brother is a neurochemist and more curious than I am. But my dad brought us both up to question why things are the way they are and to try and figure it out. I was always really curious about the world, not just astronomy.

Actually, I've liked astronomy since I was a kid. I got away from it for a while, and then got back to it in the early 80s because someone pointed out a couple of stars, and I didn't know what they were. I thought, this is crazy, I was a kid who used to teach the planets to third-graders when I was in fourth grade, why don't I know astronomy any more? I set out to learn it again. I do a lot of looking up when I am outside.

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HOW DID YOU GET STARTED WRITING AN ASTRONOMY COLUMN FOR THE ARIZONA DAILY STAR?

In 1984 I wrote the newspaper and asked if they would be interested in an astronomy column. True to form, they didn't write back, so I called them. They said, ‘Let's see what you have.’ I sent a paragraph, a two-page article, and something much longer. Much to my surprise, they wrote me back and said, ‘We have been looking for something below the PhD level, and you can do it.’ Unfortunately, this August they said that they had to save money and were going to do it internally, and that was that. I think I got some people interested in astronomy, but I probably learned more than the readers.

The same week that I lost my column, a radio station called me. Now I do a one-minute weekly spot on astronomy that plays about four times a day on radio. I am now talking about the stars. It is nice to still be out there in the community.

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SO THAT PASSION FOR ASTRONOMY HAS INSPIRED YOUR ECLIPSE-CHASING JOURNEYS?

Yes. We saw the first one in Baja, which was close, lasted about six and one-half minutes, and was splendid. About two years later, we saw a PBS special on it and my wife, who isn't really interested in amateur astronomy, said, ‘Hey, do you want to go to Bolivia for the next one?’ Then we started going to other places: India, Siberia, Aruba, Zambia, and Antarctica. We have had three trips where we were clouded out and didn't see anything. The most memorable was Siberia, where we went 16 time zones throughout the world and got good weather at the last minute. They are all beautiful, all different, and unless you have seen a total eclipse, it is hard to describe it. The partials are really nothing like it.

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I UNDERSTAND THAT YOU ALSO TOOK TIME OFF TO BECOME A FOREST RANGER. WHAT PROMPTED THAT?

I wasn't happy in private practice, but it took me a long time to admit this, and even longer to do something about it. I was working harder that I wanted to, I was chronically tired, I hated being on call, I was always in a hurry, and I never seemed to be able to do for patients what they wanted.

I decided to take six months off and go up to the Boundary Waters. I wrote the Forest Service and asked about their volunteer service. They had a position called a wilderness ranger; I have never worked so hard in my life. We would go into the woods for eight days in a canoe and clean campsites, dig latrines, fell dead trees that might be a hazard to tents, and rehabilitate campsites, all with hand tools. We would be out in the rain, filthy, and I absolutely loved it. I spent 100 days in the woods that summer. It was a very special time in my life.

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HOW DID THE EXPERIENCE CHANGE YOU?

When I came back and was in the practice mode again, I didn't like it, and when the Medical Director job at St. Mary's Hospital opened up, I took it. At that stage I was still doing consults, but I was doing mostly administrative work. As time passed, little by little I was doing more administrative work and fewer consults.

I also learned that if you don't like something, change it. You really do have a choice, although you may lose something in the process. I can never go back to the influence, money, and power that I had as a Medical Director, but on the other hand, I don't regret having made the changes I did.

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WHY DO YOU WRITE?

It is how I express myself. I have written about a run-in with a bear, canoe tripping, when I got sued, when my mother had a major medical error. I got into creative nonfiction, which is basically telling true stories in a way that evokes imagery that people find interesting. I have had four articles in Medical Economics, and I write a column for the medical society monthly newsletter on anything in medicine that interests me: the error reporting system, tort reform, statistics, how to do a survey, whatever strikes my imagination.

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AAN CREATIVE EXPRESSION AWARD WINNER

The AAN Award for Creative Expression of Human Values in Neurology is given in recognition of a poem, short story, or work of creative nonfiction that artistically expresses human values in the practice of neurology. The competition is open to AAN members, and is judged by published authors of creative writing who are either physicians or persons with a chronic neurologic disorder.

Dr. Smith's award-winning essay, “Personal History: A Wise Owl,” is available in Neurology's archives (2003;61(9):1311–1313).

This year's Creative Expression Award submission deadline has been extended to Friday, December 31st, giving aspiring physician writers a few additional weeks to submit their work to the competition. For submission guidelines or other information, visit: http://aan.com/professionals/awards/award/awa_cre_exp.cfm.

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DR. SMITH'S PICKS FOR ASTRONOMY ONLINE

©2004 American Academy of Neurology