Dr. Tim Cordes is a blind psychiatrist at the US Veteran’s Hospital in Madison, Wisconsin. He met his wife, Dr. Blue-leaf Cordes (who is originally from Lucknow, India), in 1998. They have two sons, aged eight and five. Tim is the only known blind person to have completed Medical school and a Ph.D. in the US. He earned his medical degree in 2004 and a doctorate in Biochemistry in 2007 at the University of Wisconsin, Madison. Born with a condition called Leber’s Congenital Amaurosis Tim’s vision declined over time during his childhood. His mother was emotionally supportive and his father was an engineer and problem-solver, which was a great combination for Tim. “Get the job done, Tim”, said his father as he encouraged him to find solutions to practical problems which he faced. Tim studied with sighted peers in private Catholic schools in Cedar Falls and Waterloo, Iowa and learned to read Braille. He has used the help of a service dog since he was sixteen. While he was studying Biochemistry in college Tim and his colleagues developed a software package called TIMMol which represents a protein molecule’s three-dimensional structure in the form of audible tones. His can-do attitude is what has helped Tim achieve success in his education and career.
My childhood was really nice. My visual impairment wasn’t a barrier. I could wash dishes, take out the garbage or trim around the house with hand clippers. I used a computer with magnification in school for a while and later with speech. My two older sisters would get the choice to help with dishes or read some of my assignments when I was younger. Eventually I got recorded audio books and textbooks in Braille. In high school I would partner with someone in Chemistry or Physics labs, do the experiments together and discuss our observations. I did the calculations and reports on a computer. Our general strategy then was to adapt what we could for me: like there are balances you could use without vision as they are labeled in Braille. I’ve had a lot of good high school teachers along the way. The Chemistry professor I worked for in college, Dr. Paul Helquist, was a great educator and teacher.
When I was around eleven years old I told my Mom that I wanted to join the school wrestling team. She was very nervous and anxious but she talked to two coaches who said, “There are even rules for blind wrestling and Tim’s welcome on the team”. I started wrestling from 5th to 7th grade and was pretty successful at it. It helped me gain physical confidence in a competitive space with sighted kids: if you know you can handle yourself in your space you are maybe willing to try other things.
I find moving around with a service dog in a busy environment is more efficient for me because I can move faster. My dog guides me around the hospital but won’t go into the operating room. She also wouldn’t go in where people are on contact precautions because their immune system is compromised, or you are worried that they have bacteria which are antibiotic-resistant.
I was about 20 years old when I was doing research in Organic Chemistry in college, which I liked. I got the idea to do Medicine as I wanted to do something more personal. I read David Hartman’s book called ‘White Coat, White Cane’. He is a blind psychiatrist who completed his medical studies around the late ‘70s. This gave me the idea that it was doable. After he came to know that I had read his book he reached out to me and we have communicated over the years.
Everybody but the University of Wisconsin! All the other places just said, “No, thanks.” My family was supportive of my plans.
I joined Medical school at the University of Wisconsin, Madison in 1998. The textbooks there were mostly on WORD files and I used a computer with speech for those. There were recorded books on cassette tapes provided by Recordings for the Blind and Dyslexic back then, which is now called Learning Ally. I scanned the textbooks with my desktop scanner for Literature and other subjects with simple texts. In Anatomy I identified things by touch. In the clinical setting we had it set up analogous to a laboratory reader in the lab where I would work with someone who would describe the color of a rash, for example, that I could appreciate. These individuals would also read hand-written charts when I was in the clinic. I also used two tools. One was an older device called the Optacon which isn’t made any more. I had to find one to use which is actually older than I am. It was developed in the ‘70s and it has a camera which can look at an image about the size of a postage stamp. The camera is connected to a set of vibrating pins that make a 12X12 array and that vibrates according to what the camera sees. You can slide the camera across an EKG or even a simple X-ray and know what was on them. I used it to directly interpret the data in Medical school. There still isn’t anything that can do what it does. The other tool we used was a special raised line paper called puffy paper. A lot of the diagrams and charts in Medical school would get transcribed to make the puffy paper versions. They do the same thing to represent what would be seen through a microscope in a tissue or histology class. There is a process by which you can laser print on the paper and run it through a machine that develops it.
I did my Ph.D. in Infectious Disease on how Bacteria Pseudomonas Aeruginosa causes disease. I came back to the clinic and realized that I wasn’t interested in Infectious Disease. It was on my third year of clinical rotation in Psychiatry that I really got hooked on it. I had some really interesting patients and got to see them improve in a relatively short period of time. In Medicine it’s about picking something you enjoy that you are going to do a million times and that’s what Psychiatry was to me. My specialty is Addictive Disorders in which I’ve been practicing for three years, working with people who are addicted to alcohol, cocaine and heroin. I mostly see out-patients but I also care for in-patients in the Psychiatry ward from time to time. I have several hundred patients, at least. I have a clinical appointment as the Director of a training program for Addiction Psychiatry at the University of Wisconsin. The program trains physicians who want to become Addiction Psychiatrists. It’s funny that the guy who could barely get his foot in the door is now training other physicians! I mainly supervise the residents there who are caring for patients when they are on call. They will call me in the middle of the night and ask what they should do.
I’m aware of one Osteopathic doctor (a DO), and maybe two others I’ve heard of. Around 2010 I helped review a chapter on visual impairment in a book by the Association of American Medical Colleges (AAMC) about ‘How to accommodate students with disabilities’. It was nice to see that they were thinking of giving guidance to the Medical schools on this.
It’s a good question. Electronic medical records (which include the patient’s charts, their recorded lab values, the last note that was written when they were in the clinic and their list of medicines) certainly can be accessible with speech but they aren’t always. Some of the existing systems are pretty complicated and not necessarily speech-friendly and I’ve been dealing with visually-impaired medical professionals who are trying to continue with them. That’s a challenge which needs to be addressed. I have speech software called Jaws which I run on my machine that lets me read the charts. I use an earphone when I am talking to a patient and look up their records at the same time.
Interpreting the images with Optacon worked but I think we could do better now with display computer technology. A multi-pin display that connects to a camera or iPhone would be really helpful. Another tool is Google Glass which can identify facial expressions in certain applications but none are available for visually impaired folks. So if I was in clinic with my patient I could imagine the Google Glass saying in my ear “Grimace”, “Frown”, “Smile”, which might help me track a patient’s emotions in a way that I haven’t had access to so far.
I’ve done more outreach to educators. I’ve spoken in Ireland, Sweden and a few spots in the States to let them know that higher level education in Science for the visually impaired is doable.
I’m far enough out now that I don’t know how applicable everything is but when I get a chance I give my input. I tell them to be clear about their disability early on because I think it is important that everybody knows what they are dealing with when they start. I tell them to get all the experience they can and build the best resume. Try to have an answer when people ask, “How are you going to do this?” The regular student doesn’t necessarily know how they are going to do things either. So I think that’s a false barrier. Medical school isn’t that different. Just use the techniques you’ve already used, and if you don’t have the techniques, get them. Make sure that you enjoy the Science and the learning. You’d better enjoy it as it lasts, every step along the way if you can. You have to be flexible. I was one rejection away from the University of Wisconsin and from my back up plan which was to go and be a radio DJ in Alaska! So my life would have unfolded on very different terms if that happened and I would hopefully do my best to keep moving! I think there are two kinds of barriers that people face. There are the technical barriers which are the real barriers and those aren’t necessarily that hard to handle. Then there are the barriers that exist because people are ignorant or because they don’t know or they don’t believe they can, and those are often harder to deal with. It’s harder overcoming the people who don’t think you can overcome the technical problems and those who don’t want to give you a chance. That’s where the challenge lies. You have to be willing to try different and new things and fail at some and keep trying to “get the job done”.