December 3, 2019
Clifton Callaway came to Pittsburgh in 1993 to begin his medical residency and would go on to become a prominent researcher, physician, and leader in emergency care. However, before becoming a doctor, Callaway was a student majoring in psychology and working on an ambulance, an experience that led him to neuroscience and becoming an expert in brain injury.
Clifton Callaway, MD, PhD is Professor and Executive Vice-Chair of Emergency Medicine and the Ronald D. Stewart Endowed Chair of Emergency Medicine Research at the University of Pittsburgh. Callaway is also the Director of CTSI’s Pilot Funding Core.
Clif: I love emergency care because it's really the essence of medicine. “Oh, something is wrong with my body, I'm frightened right now. I'm not going to make an appointment or whatever I have to go find a doctor right now.” It's the moment we say “I need a doctor” and you know you go to the emergency and that's really what it's all about.
Mike: From CTSI, this is the Products of Pittsburgh. A show about the people in Pittsburgh – innovators, scientists, community leaders – and the remarkable stories behind how they came to be and the work they’ve produced. I’m Mike Flock. On the show today, we meet with Dr. Clifton Callaway, Professor and Executive Vice-Chair of Emergency Medicine at the University of Pittsburgh.
Mike: Clif came to Pittsburgh in 1993 to begin his medical residency and would go on to become a prominent researcher, physician, and leader in emergency care. However, before becoming a doctor, Clif was a student majoring in psychology and working on an ambulance as an emergency medicine technician. This experience led him to neuroscience and becoming an expert in brain injury. It was an even earlier experience though as a high school student in Atlanta that steered him to science in the first place …
Clif: I was certain I think before college that I was going to do some kind of science. So I envisioned being a scientist of some sort and was interested in a lot of different things – physics, some neuroscience. Those were things that fascinated me. I really didn't consider medicine as a career. I mean it was in the landscape but wasn't like there were doctors in the family or people who were pushing me that way. I was really thinking of a scientist profession.
Mike: Were there any earlier jobs that you had in high school or as a kid before going into college?
Clif: I remember one in particular. In Atlanta, they had a high school program at the CDC, the Centers for Disease Control. I got to spend a summer at the CDC. My work was very clerical, checking reports from hospitals and proofreading reports essentially about the infectious disease. But you got to go to all the conferences and so you got to go to the lunch seminars and hear these people talk who later I realize are very very famous people and you heard about whatever was the topic at the CDC at the time. That was right at the beginning of the uptick of the AIDS epidemic. So at the time AIDS was a new thing. I remember vividly now I actually went to a lunch seminar and the topic of the seminar is “What are we going to call this new disease.” So they had all the candidate names htlv3 and acquired immunodeficiency syndrome and different ones and obviously HIV and AIDS are the ones that stuck. But looking back now realizing that those were the guys who had to come up with like even the name. You really don't know that you're in the midst of history until later when you look back.
Mike. Sure. That's certainly unique for a high-school student to have that sort of exposure at that age.
Clif: Yea, it’s very cool. It’s something that I think the CDC does it reaches out into the Atlanta community and tries to get students. It’s competitive you apply and your science teacher, your principal has to write a recommendation but they take people from the local community and have students there so that they're exposed to science and get to see cool stuff. Obviously, influenced me even today.
Mike: So you went to Harvard. What did you major in?
Mike: Really, why psychology then?
Clif: It was actually a choice of different things I was interested in. I mentioned I was interested in neuroscience and in that time there weren't actually departments of neuroscience. There was subsets of psychology and biological psychology was one track. But I came to that second because I started out in physics and took a number of the physics courses and with them comes some math courses. Pretty quickly I think it only took two semesters before I was in a math course and I said I am doing the mechanics of this and I have no idea what I'm doing. So the math quickly exceeded my comfort level and I drifted more into the neuroscience track
Mike: And so from neuroscience you then decided to pursue a PhD and MD. Both. At the same time? How did that timeline work?
Clif: That is another formative experience. I was really targeting a science career still. I envisioned I would go to graduate school and probably do a PhD in neuroscience that was my intention. We had a number of roommates through college and one of my roommates said “I want to take a first aid course you know just kind of get up on stuff” and he was someone who thought he would be premed and would go into medicine that was his aspiration. He looked around and couldn't really find a just basic first aid course but he found an EMT course, an emergency medical technician course. He said, “Let’s take this one.” So it's out at some community hospital in Boston and we load up a couple of times a week can go and take this course at night you know for like 3 hours twice a week and accumulate over a number of weeks the hours and we become EMTs. And at the end he says, “Let's get a job” because we got these EMT licenses and there was a local ambulance company who provided the 911 service for Boston, for Cambridge actually, and we called them up and got jobs. They needed shifts covered and we decided to start working on the ambulance. We had a blast. And I became fascinated by emergency care and seeing emergencies, going to chaotic situations and making the chaos settle down, being able to manage anything that came in. It really truly is like one of the greatest jobs ever is to work on an ambulance.
Mike: Is there a certain personality type that is effective in those circumstances because you can imagine all of the chaos that is happening and having composure is certainly a skill whether it's learned or already innate?
Clif: Yea, it’s a skill or a trait. I think a lot of people who would get flustered or find the chaos unsettling. I think everyone who gravitate towards that enjoys going into situations and then taking control and putting order into a chaotic situation. I found it just tremendously gratifying and still do. I think it's one of the things I like about my job is coming to people who are in crisis and helping them through that, making them calm down. Deescalating a terrible situation. Now it's never good, you can't make like somebody's injury or illness or tragedy good, but you can make it less bad and you can help them navigate it with more composure. So being that person who deescalates things and makes it a bad situation better is really something I learned that I liked a lot as an EMT and convinced me to consider medical school as a career path in addition to my interest in science.
Mike: Emergency care plays a major role in health care. Research indicates that emergency rooms account for nearly half of the hospital-associated medical care delivered in the United States. Although working in the ER can be intense, and certainly stressful, it provides an opportunity to make a big difference right away. In 1987, Clif moved to San Diego to pursue a MD and PhD at the University of California. He focused on neuroscience and neurology, but also had interest in acute aspects of a whole range of other specialties, chemical processes, and ultimately… fixing problems. Between his MD and PhD, he was exposed to just about everything and for emergency medicine, that’s important.
Clif: I think people who wind up going into emergency medicine don't want to not study all the different aspects of different organs or different specialties that you're exposed to, you kind of like everything particularly the acute aspects of everything.
Mike: Is that because you just don't know sometimes the types of situations you might come across in emergency medicine? So just trying to be aware of all the different circumstances and conditions that might come your way?
Clif: Exactly. So emergency medicine is the other end of the ambulance ride and you have undifferentiated patients. So patients come in from whatever cause and their definition of whether it's an emergency might be an emergency because they just can't get hold of another doctor or they don't have access to another doctor but that still you know it can't wait till you got something that's wrong and it's not going to get better and they need help with it today. It's not divvied up by oh “I'm only going to bring my heart problem, I'm only going to bring my lung problem and I'm going to see a lung specialist.” You have to be prepared to receive undifferentiated complaints and again they're kind of in a crisis. They may not know what's wrong with them and you can deescalate that and go oh okay you know I know I've seen this before I know what’s behind this is a lung thing and here's what needs to be done about it and I'll do some of it and then we'll get you to a specialist who will do the rest and you know so forth and so on or here's the plan of care and now it's something that you can deal with as opposed to the great unknown.
Mike: Has emergency medicine changed since you arrived here in Pittsburgh as a resident to where it's at today?
Clif: Yea, that now is 26 years ago. The specific things we do are completely different. So take as an example stroke. At the time of my residency stroke was not a very acute problem it was just bad news. So if somebody came in with a stroke you would tell them the bad news and put them somewhere and hope that they got some recovery, but you didn't actually get to do a lot for them. Perhaps you gave them an aspirin. And you think now we have entire systems of care where we move people at great speed by helicopter from rural hospitals to places where they can have brain cath, have the clot removed, and huge interventions that make it so their stroke doesn't happen. We can actually take a stroke in progress and undo it and then they recover. It's day and night. So the actual things we do are dramatically different and 20 years is not a long time you know so to think that you've taken something that was just bad news and turned it into a time critical condition for which there's a whole system of care is dramatic. It's great to live through those kinds of transitions and other diseases have had similar kind of upticks. The basic human encounter is the same though. People have something going wrong with their body now it's sudden and frightening and they got to go somewhere. I love emergency care because it's really the essence of medicine. “Oh, something is wrong with my body, I'm frightened right now. I'm not going to make an appointment or whatever I have to go find a doctor right now.” It's the moment we say “I need a doctor” and you know you go to the emergency and that's really what it's all about.
Mike: In 2018, Clif received the Lifetime Achievement Award in Cardiac Resuscitation Science from the American Heart Association. He was also elected to the prestigious National Academy of Medicine, for his achievements in basic and clinical research to reduce brain injury after resuscitation from cardiac arrest. Clif and his colleagues have been making strides though not only in advancing the knowledge of resuscitation science but also translating the research to practice through the formation of the Post-Cardiac Arrest Service based at UPMC Presbyterian.
Clif: About 10 years ago I made a transition into clinical research and one of the things it was tremendously apparent to me studying cardiac arrest was that a lot of the things we were talking about in the laboratory or in our observations was that the care of somebody after cardiac arrest to have their recovery work and be successful required integration of multiple aspects of the hospital care, EMS care, and so forth and not everything could I guarantee would happen for every patient every time. Many times one aspect would be overlooked or just there wasn't good handoff from emergency to ICU or ICU to the floor so forth. In 2007 or 2008 I convinced a couple of my partners to just start showing up for patients with cardiac arrest and we would stay with them and help smooth out those transitions. Our excuse was temperature control. We would help with hypothermia treatment that was one of the new innovations but more and more we discovered that there were lots of things that we could help with to integrate the care of these patients and over the past decade it's grown into a clinical service where we receive patients and transfer from lots of other hospitals and concentrate them at Presbyterian Hospital. When we have patients there we have a service line that has multiple specialties contributing to. Some of us are taking call and just making sure that that system works for individual patients and now we’re touching base with those patients after they leave the hospital to help with their recovery. This to me is the implementation of all of the research I've done for all of those decades.
Mike: Putting it to practice
Clif: Put into practice.
Mike: Whether it be earlier on with your undergraduate degree or even today would you point to any particular role model or mentor?
Clif: This is one where I'm a little the heretic about mentors. I always thought that lip service to mentorship is lip service and that it was kind of a fad. It is actually correct that you get mentored but there was a big push in the late 1990s early 2000s to say oh you know you have to find a mentor. Nobody gets in advice from just one person. We are constantly learning from all the people around us and the older people have been around longer than the younger people and you sort of pick up more from their life experience than from other people's life experience, but people younger than you have had other experiences and might equally be your mentor. So I think it's a misnomer to say is there a mentor who guides you individually. I had great advisors who had roles in my training. My PhD advisor was a wonderful scientist who was very rigorous. His style was a little bit laissez faire. He would you would let you learn by trial-and-error and give you a generous ability to discover on your own what you need to do. That appealed to me. I had another adviser who I think is influential probably beyond what he expected when I was an undergraduate and what he did was teach me how to write. So the very first scientific paper I was involved with was my undergraduate research thesis and I wrote it and I gave it to my advisor and I thought that that was like how I got the credit and I was done. He said, “Good and you're going to do research again next semester right?” So next semester I found the same paper back on my table and I had lots of red ink from him that now we were going to write it some more and we wrote it for another semester and then we wrote it for the semester after that and he taught me that it matters if you say you know “or” or “but” or if you put the comma here or if the sentence has an active verb or passive verb and in science there's no loose words and it needs to be clear and you don't repeat yourself and all sorts of things that I now laugh when I hear myself repeating to my trainees or to other people when I critique their writing that those are actually skills I can trace back exactly to that multi semester writing project where he really cemented in me the importance of scientific writing. That's so critical because I pretty much make a living by doing scientific writing. So you know as you go through your career as a scientist more and more other people are doing with their hands the experiments that you're involved with and your job becomes analyzing the data, writing the data, writing the grant to get the next round of experiments going for the data, writing the presentations that go out and tell other people about the experiments. It really becomes writing is as the primary activity. I think that that advisor was really profoundly influential in any later success I had.
Mike: Effective scientific writing is an important skill and encompasses a whole range of forms in academia, such as grant applications, journal articles, books, book chapters, and even course curricula. Many of the words used in scientific language can also be quite technical and have origins in the Greek and Latin languages, such as in vivo and in vitro which are common Latin phrases used in science to describe experimental conditions. Clif’s early exposure to the Latin language provided him with the fundamental elements of scientific language. It also drew him to another area of interest: Roman history.
Mike: Do you have any hobbies outside of the work that you do here at University of Pittsburgh?
Clif: When I was in school in the course of school I took a lot of Latin. I could read Latin well and have been interested in Roman history as a consequence. So I continue to read that kind of history. When we travel, I try to find particular sites or excavations or things that are meaningful to me because I know something of the story behind it. My family makes fun of it they say you know there's another pile of old rocks that your dad likes here's another pile of rocks, I don't know what's different about that pile of rocks compared to the last pile of rocks but great I'm glad we walked five miles to come find it. That actually is quite important to me to try to make those connections and think about that period of history and its lessons that we might carry forward.
Mike: You mentioned being a dad. Do your kids have similar interests that you have?
Clif. Yea, I have twin daughters. They’re 25 years old now both are living in Boston and that's kind of cool. I got married when my wife and I were living in Boston. We didn't know what our kids would want to do. One of the things you always wonder about is how well to be attracted to medicine or not. They were not. So I think sometimes you see medicine up close and you go “Eh, no”. They were interested in different aspects. One of my daughters has her master’s in public health and she’s a data analysts. So she's become quite skilled in epidemiology and does large data analysis out of administrative datasets and is quite the statistical programmer. She’s got job interests that are great because they overlap a lot with my world and we can talk about a lot of things in her in her work that are very relevant to my own work
Mike: That's fun
Clif: My other daughter followed my wife’s footsteps a bit more and she's a school teacher. She teaches in Boston public schools in East Boston and is the science and technology teacher for elementary school there in East Boston, which is also just exceptionally cool because she's training the next generation of science and engineering folks and getting kids interested in that at an early formative stage. We get to share a lot of notes or if I see something I go you know this would be great for a 5th grader, here's a thing I came across at work that I know would resonate at that age know if we can we can pass it back and forth
Mike: One question that we always ask folks is that if there is one word you could select to describe yourself, what would that one word be?
Clif: I want to push for one to push for two words. At least how I would want people to think of me would be intellectually honest. I greatly value that I am an empiricist. That I want to get real observations and I will change my beliefs based on what I've seen and what the data show me. That’s something that I have wanted to model as a core value and hope that people remember that if I did work that it would not achieve a conclusion that was part of my agenda but would get to the right conclusion. So I actually accumulated a large portfolio of papers about things that don't help rats or things that kill rats or things that don't solve brain injury after cardiac arrest.
Mike: The null finding folder?
Clif: The null finding folder for which there is publication bias. I also discovered that’s an uphill push to get those papers published. Journals don't like those papers where you say something doesn't work but it doesn't work. So that's kind of one of my core values is if we test something and the answer is it doesn't work, we're putting it out there, it doesn't work. Now, it would be nice, I would love to be part of like the group that finds the thing that really works really well at least once, so I’m kind of hoping for that big score somewhere in my research career.
Mike: But to your point, it’s just as important to have the studies that keep everything in check.
Clif: Absolutely absolutely. You go down my list of publications you’re going to find a lot of that doesn't work, that doesn't work, that doesn't work. We tested this one really well on that one doesn't work.
Mike: So you’re keeping us honest
Mike: Clifton Callaway, MD, PhD - Professor and Executive Vice-Chair of Emergency Medicine and the Ronald D. Stewart Endowed Chair of Emergency Medicine Research at the University of Pittsburgh.
That’s our show. Thank you for listening to the Products of Pittsburgh. We’ll be returning in the New Year with some exciting new episodes. In the meantime, be sure to check out all our current episodes at ctsi.pitt.edu / podcast.
I’m Mike Flock along with Bee Schindler and Zach Ferguson, until next time on the Products of Pittsburgh.