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Karen Roos, MD, likes to say that she has “an arranged marriage” – arranged, that is, by T.R. Johns, the legendary Chair of Neurology at the University of Virginia (UVA), who chose both Dr. Roos and her soon-to-be-husband, Robert Pascuzzi, MD, for his neurology residency back in the late 1970s and early 1980s.

She remembers their first meeting down to the day. “I came to UVA for my internship in internal medicine and met Bob, who was two years ahead of me and already a neurology resident, on the 11th day I was there,” said Dr. Roos, now the John and Nancy Nelson Professor of Neurology at Indiana University (IU). “I literally remember the minute I met him. He was standing on top of a staircase. We started dating immediately, and he asked me to marry him on our second date, five days after we met.” They've now been married for almost 22 years.

Dr. Roos confesses that she probably had an unusual residency experience because of that fateful meeting. “My medical students are always telling me that they're dreading this and that about their residencies, and for me, residency was a wonderful time in my life. I don't know what it's like to go through residency not having just fallen in love,” she said.


Drs. Roos and Pascuzzi, who met while in neurology training, have been married for nearly 22 years.

In addition to the “romance factor,” she was grateful for the backup of a senior resident. Dr. Pascuzzi, now Professor and Interim Chair of Neurology at IU, doesn't think that his guidance offered her much more reassurance than any other junior resident, but Dr. Roos begs to differ.

“When you're just starting out, you're very anxious and there is a lot to learn. I'd talk to Bob about the patients I was taking care of and felt that I really had a very rapid learning experience, because I had the advantage of being able to run everything by a senior resident who was someone I really trusted,” she said.


Nine months into Dr. Roos' first year of residency, she and Dr. Pascuzzi were married in the Chapel in the Pines at the University of Virginia. It was a typical resident's wedding, with beepers going off throughout the ceremony. “John Fink, now one of the world's leading neurogeneticists, played the Wedding March,” Dr. Roos recalls. “He made me step in time to his playing. Only a neurologist would make the bride do that!”

The young couple didn't worry about competing with each other – but they did worry about finding positions in the same area. “The job market is pretty good for one neurologist, but for two? That was the biggest concern. How many places have openings for two people who do the same thing?” said Dr. Pascuzzi. As they were interviewing for positions, they both figured that the best they could hope for would be to find posts at different institutions in the same city.

As fate would have it, a faculty position opened up at Indiana – Dr. Pascuzzi's medical school alma mater – at just the right time. “It was really almost accidental,” said Dr. Pascuzzi. “Someone quit the faculty at the last minute, and the Chairman at IU, Dr. Mark Dyken, called us up and asked us to come out and take a look. He thought he could throw something together for a year or two for the second position.”

That was about 19 years ago. “My husband loves IU and he really wanted to come here,” said Dr. Roos. “I always say he tricked me because he said it'd be just a year or two, but I really love it. It's been a great place to work.”


Although their subspecialties differ – Dr. Roos, the author of Meningitis: 100 Maxims in Neurology, specializes in central nervous system infections, while Dr. Pascuzzi is a renowned specialist in neuromuscular diseases – both also teach basic clinical neurology and find it handy to be able to cover each other's patients. “It is really helpful from a scheduling standpoint, since one person can cover for the other on phone calls, night calls, weekend calls, and last-minute dilemmas,” said Dr. Pascuzzi. “And I think we understand very clearly all the aspects of the job, the positives, the pressures, the time constraints, and the stresses. It's pretty easy to empathize with what the other person is going through.”

The built-in backup – particularly useful when their two daughters, now 17 and 15, were small – isn't the only advantage, Dr. Roos said. “When you have these difficult patients that you worry about, and you can run them by someone you trust and respect as much as your spouse, it's very reassuring,” she explained.

Among the most popular professors at IU, Drs. Roos and Pascuzzi teach one of the country's largest medical school classes in neurology. “The medical students, I think, feel like they're all our children in a way,” Dr. Roos said. “Every year we do a seminar for them on marriage and children and medicine. Bob and I were very curious, when we were young, about how two people could stay happily married in the same career, so we're very interested in sharing our experiences with our students and talking to them about their problems and plans.”

Dr. Pascuzzi has twice been recognized with the Golden Apple Award by graduating classes of the School of Medicine, as well as a Faculty Teaching Award from the Trustees of Indiana University, and received the ANA's 2001 Neurology Teaching Award. Dr. Roos has been chosen Outstanding Professor in Clinical Medicine by three IU School of Medicine classes.


Aren't there any downsides to working so closely together, in the same institution and the same specialty? Probably just the same ones that all married couples in medicine experience, Dr. Pascuzzi said. “There is never enough time. You're both always busy. I think if you talk to other husband-and-wife physician couples, I'll bet that they'll all say that their problem is that medicine is very difficult right now, with all the rules and regulations and scheduling that's just getting worse, so it's not like there's a lot of down time. That's just the reality of medicine.”

Dr. Roos agrees. “I was talking to my daughters about this interview, and I said, ‘I have to come up with some negatives to talk about! What do you see as negative?’ Their main thing is that they feel that we work all the time,” she said. “It's true. I wrote my first book when the youngest was in kindergarten; she'd sit at the computer with me and I'd hold her dolls and teddy bears and work on my book. But everybody has to do something with their time, and this is what we like to do. Honestly, if I were married to Bob and I weren't in neurology, I wonder if I'd be lonely, because he works so hard. But that makes the shared specialty an advantage: we're there together all the time.”

In addition to their shared teaching responsibilities, Drs. Roos and Pascuzzi have worked on a number of articles together and co-edited Seminars in Neurology until Dr. Pascuzzi became the Acting Chair of the department at IU; now Dr. Roos edits the publication solo. “We complement each other in a lot of ways,” said Dr. Roos. “Bob has a lot of original thought, while I'm good at details and grammar and getting things in on time. He's the artistic side of the brain and I'm the detail-oriented side.”

Both agree that they didn't expect to marry another neurologist, but that once they'd met, there really was not any other choice. “We were embarking on a life that we didn't really have any role models for. We didn't really know anyone quite like us,” said Dr. Roos. “We worried that two neurologists would bore each other to death, but it has been just the opposite. We really enjoy sharing our career together and spending so much time working together. It's been a wonderful way to live our lives.”