"David, I want to tell you my story." This is how I met Haley Diaz, who is a physician assistant/associate (PA) student about to graduate and looking for her first clinical job. Diaz struggles with postural orthostatic tachycardia syndrome (POTS).
The perception of the limiting effects of this trouble represented significant barriers for her during her education. It is notable that it was only the perception by others of what it was like to live with this disability that was the barrier, not the reality of how she lives and thrives despite an occasional bump in the road.
It made me think that I wish PA John Trimbath was here to talk with her. Trimbath was a giant in the PA profession who was respected and beloved. His career started as an experiment, and he went on to secure prescriptive rights for PAs in Ohio.
Trimbath started his PA life as an active mountain climber and skier, smart and adventurous. He suffered a freak accident falling off a mechanical bull that left him paralyzed from the chest down. For many of us, it may have represented the end of our clinical road, as we only saw the barriers. However, Trimbath saw the pathways around the barriers.
As I listened to Diaz's story, I recognized that she was telling me about barriers she encountered and how she found the pathways out of them. She described higher education physical technical standards as "ableist." Then she talked about how she became an expert in those technical standards and the rights of those who live with disabilities.
She described how others worry about her potential inability to participate in any surgical clinical experience, and how she met a surgeon with a disability whose only accommodation was that the table needed to be lowered.
Diaz talked about the incredible support she felt from the operative staff when she was open about her struggle and what she needed for accommodation. Then she described how POTS was never a factor in her lived experience during her surgical supervised clinical practice experience.
Empathy for Shared Struggles
Trimbath was a Vietnam-era Air Force veteran who was proud of his service and loved others who had similar experiences. Diaz described how she loved working in VA medical centers and how she aspired to serve veterans within a system that she felt understood her.
Both clinicians found meaning in their experiences, which made them better at serving others with similar vulnerabilities. This empathy could never be described as pity. Instead, both Trimbath and Diaz brought meaning to clinical practice born of shared experience caring for others.
Trimbath once practiced emergency medicine. His injury was not the end of his clinical story; instead, it was a pivot to another specialty. He recognized the massive gap between the needs of those who struggle with behavioral health and the access to the care they need.
So he retrained in psychiatry and served his community using technology that has become commonly accepted for learning and communication. Trimbath was an innovator in this respect. It also turns out he was a visionary because he was fully trained in psychiatry, telehealth, and providing access when the pandemic arrived and the demand for online behavioral health services skyrocketed.
Diaz and I met when she noticed I was wearing a badge at a conference that indicated my specialty in cardiology. She spoke of her desire to enter cardiology so that she could work with people who have experienced alarming symptoms and often go years without a diagnosis, and then how she struggled to find clinical answers for them to find relief.
I relayed my practice in cardiac electrophysiology and my experience helping people who struggle with POTS, which often leaves them tachycardic and hypotensive. We talked about how this can be a challenging diagnosis to make and a more difficult problem to overcome as patients discover what helps to mitigate their symptoms. We discussed how some clinicians back away from this challenge of working with patients who are frequently frustrated with the difficulties this disability poses to their lives.
Trimbath was uniquely suited to provide help and support for those struggling with the concept that sometimes personal barriers and troubles seem overwhelming. It is tempting to describe him as someone who had strength and power beyond the norm. However, I believe Trimbath would claim that everyone has resilience beyond what we imagine — that vulnerability becomes its own strength.
He would have had more insight and encouragement for Diaz than I had because of his lived experience.
Diaz's perspective into our biases deserves full exploration as we train the next generation of health professionals.
Trimbath died in November of an infection. I was shocked and saddened to hear of his passing, though it should not surprise an experienced clinician that someone who had significant physical obstacles also faced high risk. One would think my perception about a man who was paralyzed and traveled by wheelchair would be anchored in weakness and vulnerability. But my perception was rooted in his strength and ability. My perception of Diaz, despite her opening with her vulnerability, also hinges on her fire, passion, and potential to do great things.
Thanks to Haley Diaz for sharing her story and to John Trimbath's family, who gave me permission to write about him, plus PA Josanne Pagel, who helped me to stay true to her friend and colleague's legacy.
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Cite this: David J. Bunnell. PAs Defy Perceptions About Physical Disabilities - Medscape - Jun 13, 2022.