Learning the Hard Way

The international renown of Johns Hopkins Medical School isn?t always a good thing. Its proximity to Washington, DC is another problem. Together, they produce a stream of foreign doctors intent on seeing Washington and then Hopkins, an hour away in Baltimore. The problem for a Hopkins scientist like me is what to do with the visitors once they are here. Often, their English skills are weak. Usually, they are only interested in checking off a line on their itinerary. Their most frequent, and my favorite, response to the question ?What is your research interest?? is ?Johns Hopkins is the finest hospital in North America.? Unless they are from Mexico, in which case they say ?in America.? So, if you?re a busy head of lab, you really don?t have time, and if you are a good head of lab, you don?t burden your trainees with entertainment duty. I prided myself in becoming very good at avoiding these interactions.

One day I received an email from a friend in otolaryngology. She said that there was a visitor from China who was interested in my lab and wanted to spend a day with me. I figured that this was a code for ?I?m really busy, and I?m really tired of this physician.? I demurred, I was too busy, and in fact, I didn?t answer her email. My friend simply subverted my ruse by giving my email address to Dr. Peng Ding, M.D., Ph.D. from Shanghai.

Dr. Ding began to email me every day. She emailed her CV, which had a few publications in Chinese, outside my area of expertise. I delayed. I avoided. She started calling, and one day left a phone message saying that she was called ?Cee Ling? and really wanted to meet me. Finally, after a week, I figured I was being rude, and assigned one of my post-docs, Nicolai, to help me do a dog-and-pony show for Cee Ling at the end of the week.

Nicolai and I debated what project to discuss with her. We had just finished working on how parts of the long thin muscles in your neck can do different things at the same time. They can because there are many muscle fibers that make up each muscle, and many small nerves going to different fibers. What we used to think of as a single muscle was working like a group of many small muscles. It was really interesting stuff, and might just catch the attention of a foreign doctor.

But, we had also just written a grant we were really excited about. I had done a lot of work on the motor nerves that activate muscles during swallowing. Now we wanted to study how information from the sensory nerves inside your throat affects the function of the muscles when you swallow. Swallowing is supposed to be a reflex. This meant that, once a swallow has started, the sensation signals to the brain should not influence the motor signals to the muscles. We were going to examine the relationships between sensation and muscle function in animals by taking away the sensation with an anesthetic.

There are two particular nerves we were interested in, called the laryngeal nerves, branches of a large nerve coming directly from the brain stem. These nerves convey sensory signals from the larynx, or voice box, to the brain. One, the superior laryngeal nerve comes down from the top of the neck, and the other, the recurrent laryngeal nerve travels down into the chest near the heart and ?recurs? that is, travels back up to the larynx from below. Other people?s work suggested that these two nerves have an effect on swallowing. We wanted to measure exactly what that effect is.

Dr. Ding arrived 10 minutes early, and was very excited to be in the lab. I felt bad about delaying to see her. I realized that she didn?t call herself Cee Ling, but Ceiling, because she was a very tall Chinese woman. She listened very politely to the muscle fibers story, and asked some surprisingly good questions. She looked at all our equipment and computer programs, and asked more good questions. But I couldn?t figure out why she was so interested in my work. All she was doing was confirming my hypothesis that she needed to show people back in China that she had met some American researchers.

Then I asked my standard question about what research was she interested in. As she began talking, my eyes got big. She said that she wanted to study the problems that patients have with swallowing when their laryngeal sensory nerves get damaged in surgeries. Nicolai looked at me and I looked at him. Ceiling went on. She said that she thought there was an important link between the loss of sensory information from these nerves that gave problems for the muscles in the neck and what made swallowing problems.

You could have picked Nicolai and me off the floor. Ceiling said that she thought I might be interested in this problem, because I had worked on the muscles before. I started laughing. Nicolai started telling Ceiling about the grant we just wrote. It was her turn to look surprised and amazed and very happy. She said ?I have two more weeks in America, and I will stop doing everything else, if I can come and work in your lab.?

Ceiling, Nicolai and I had a great time in those two weeks. We did two brand new preliminary experiments and got incredible results. Ceiling went back to China, Nicolai got a job at Brown University, and I needed a new post-doc.

Ceiling has been working in my lab for two years now. The clinical implications of my work are much stronger for her input. Our results are much more interesting. But the most important change is in my attitude towards those foreign visitors. 99 out of 100 may think that Johns Hopkins is a great hospital. But the 100th will change your research.

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