From medicine to fictional memoir: an author-psychiatrist explores opioids [PODCAST]

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Today, we are joined by James Champion, a psychiatrist and author of Adventures of an American Medical Student. With his extensive experience in mental health and addiction, James brings a unique perspective to our discussion, shedding light on the psychological dynamics at play and the challenges faced by medical professionals in such critical situations. Join us as we unravel the layers of this compelling story and delve into the broader implications of opioid addiction in our society.

James Champion is the pseudonym of a psychiatrist and author of Adventures of an American Medical Student.

He discusses the KevinMD article, “From overdose to ICU: a doctor’s battle for a young woman’s life.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at kevinmd.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we have James Champion. This is a pseudonym of a psychiatrist, and he’s the author of the book Adventures of an American Medical Student. James, welcome to the show.

James Champion: Thanks for having me, Kevin. It’s a pleasure and an honor to be on your show.

Kevin Pho: So we’ll talk about your book in a little bit. First off, just briefly share your story and journey.

James Champion: Yeah, so my story to medical school was meandering compared to a lot of people’s. I was what would be considered a non-traditional applicant, so I decided years after graduating college to apply to medical school. And so that was a meandering journey to get there.

And then when I started medical school, I thought I might choose primary care or orthopedic surgery or something like that. But along the way, I discovered in my second year that I really enjoyed lectures delivered to us by a practicing psychiatrist. He gave us two full days of lectures. And I found myself very interested in that, and I thought, “Well, maybe I want to become a psychiatrist.” So I just decided that I needed to do a clinical rotation. After I tried that, I enjoyed the rotation, so I ended up deciding to apply to psychiatry residencies. But, of course, you can’t just move it along and say, “I want to become a psychiatrist,” in medical school. You have to go through what I call a gauntlet of clinical rotations in a variety of different specialties to get there and apply.

And I thought that my experience in eastern Kentucky, where I attended medical school, was a unique and remarkable experience. A lot has been written about that region of the country for various reasons. And when I was in medical school, I also read a book called The House of God, which was written by Samuel Shem and based on his internship year, and he also decided to become a psychiatrist. I enjoyed the book, but I thought that maybe I could write a book like that that would have more specific case information in it. That was something that I kind of longed for in the book, more specifics about cases, though the book was entertaining and enlightening.

And it took me some years to finally get down to it and do that, but then, some years down the road, I decided to do that, and that was a daunting task too, years after being out of medical school. I had always wanted to write a book, and I thought that might be a good one to start with.

So I graduated medical school in 2010 and did a four-year psychiatry residency in Arizona, and then years later decided to write the book. Since psychiatry residency, I’ve been primarily practicing in community mental health. I supervise some psychiatry residents, teach some medical students who are periodically with me, and collaborate with nurse practitioners. I’ve been in community mental health for over 8 years now. November will make 9 years. And I was brave enough after I finished psychiatry residency to take a job with an Arizona state prison in Tucson, and I did that for a little more than a year. So that was a very interesting and challenging experience too.

Kevin Pho: So you mentioned Samuel Shem. He’s been on my show several times talking about The House of God, and I’m sure he’s an inspiration to a lot of physician authors that are out there. Your book is Adventures of an American Medical Student, and you mentioned that you wanted to incorporate more of your medical experience, case studies, into this book. Tell us what it’s about.

James Champion: So the book is based on my clinical years of medical school, because I thought that was what was most interesting and would make for good material for a book. It’s called a novel because it’s fiction, but it’s unique from most other medical fiction in that medical fiction is written to entertain, whereas I think my book is written to entertain but also has high educational value. And so I would describe it. It’s a novel in the sense that it’s fiction, but it doesn’t have an intricate plot or extensive character development. It is what I describe as a fictionalized memoir.

And I also encountered plenty of interesting cases, as you might imagine, after medical school. So I’ve drawn from cases I’ve seen over the years, not just in medical school, to try to make the book as interesting as possible with different cases.

Kevin Pho: So tell us about the case that you included in your KevinMD excerpt. I titled it “From overdose to ICU: a doctor’s battle for a young woman’s life.” This particular case should give an example of some of the content of the book. Tell us about the story.

James Champion: Yeah, so I thought that since this was my first book, and anyone who writes a book wants to grab someone at the beginning and get their attention, I decided to write an opioid overdose scene for the first chapter of the book. It’s a short chapter, but I thought that it would grab people’s attention. And I think it also draws attention to what we recognize as a national crisis now, but this was recognized as a crisis in Kentucky well before, I think, it got so much national attention. So it’s a really sad scene to start with, but I think it grabs attention.

And as the book goes on, there are plenty of scenes and cases that deal with addiction. As a psychiatrist, I would say half or more of the patients I see probably at least have a history of addiction. And the opioid crisis has been a big problem in Kentucky and nearby states for a long time.

Where I did most of my clinical training was also just about half an hour from the West Virginia border. And there was a notorious pill mill clinic just across the border in Williamson, West Virginia. They actually called that town Pilliamson, because it only had about 3,000 residents. [Remark removed by the editor.] Now, you can imagine the damage that that could do to people. And people came from hours away, of course, from other states, because you’d come and pay cash, and many of the patients weren’t even seen by a provider, and they’d get their opioid prescriptions.

So West Virginia has often had the highest opioid overdose rate in the country compared to other states. And right behind West Virginia are Kentucky, Tennessee, and Louisiana. I just looked at the most recent data before coming on your show to talk to you, and the 2021 data shows that these four states I mentioned all have the worst opioid overdose rates in the country.

Kevin Pho: Now, by writing about this and bringing attention to this through cases in your book, what do you hope to achieve? What are some of the goals that you want readers to come away with after reading, not only about your clinical experiences, but by shining a light on the opioid crisis in Kentucky, West Virginia, and Tennessee?

James Champion: Overall, as I said, I think this book has high educational value. It’s written as medical fiction, not just to entertain, but I think to educate. Some people who aren’t interested in medicine or mental health might find it kind of drudgery to get through, because it does have a lot of medical jargon. But I thought that that contributed to the authenticity and grit of the book.

But I think that it can serve, if we talk about target audience, I think that the wealth of cases in the book can serve to give pre-medical students an idea of what medical school is like. I think that it can help to prepare medical students in their first and second years for their clinical training. And I think physicians can find it a helpful review.

One of my friends from medical school, Dr. Rick Hilliard, who endorsed the book, trained in internal medicine and is now practicing emergency medicine. He said that he thinks the book basically covers 90 percent of the cases that a medical student could expect to see during their training. So I think there’s a wealth of clinical knowledge in there to be shared that could be helpful for medical and mental health professionals. It does have a greater focus on mental health and addiction as well, because that’s where my interests lie. And so I also think not just medical professionals, but those in the mental health field, could find it interesting as well.

Kevin Pho: Now, you mentioned that this book could be a nice primer, so medical students know what they’re going to get themselves into. Now, without getting into specific cases, what are some of the themes that you want medical students to know about, or know what to expect, as they progress through their medical education journey?

James Champion: Well, I think a major theme of the book is perseverance, because some people may seem to go through life without much adversity, or things just seem to be kind of easy for them, but in my experience, there were plenty of twists and turns along the road. But when that happens, how you choose to deal with it is what can make a difference. So if one person gets so frustrated that they just kind of give up, that person might become depressed and anxious. But if someone stays focused on the goals and looks for ways to move past the obstacles, then that person can have a very different outlook and outcome compared to the person who kind of gives up.

So I think my advice to people in the field and pursuing the field would be that when you fall off the horse, get back on it and keep riding. I think that kind of theme comes up repeatedly throughout the book. If you stay focused on your goals, then I think that can be a helpful way to deal with adversity and cope with it in a healthy manner.

Kevin Pho: Now, has writing the book changed how you interact with patients, or changed what you do professionally, giving you perhaps a new perspective on what you do in your professional life after writing the book?

James Champion: I think that the experience of writing it has made me a better-rounded physician, because I’ve been out of medical school for so long. In psychiatry residency, there were, of course, some other rotations besides psychiatry, like inpatient medicine, neurology, and other primary care specialties. I think that it has helped to refresh my knowledge about the rest of medicine, and everything advances so fast. There are always new medications coming out. It’s hard to keep up with it all.

But honestly, it was daunting to write the book years after being out of medical school as well. So I did a lot of research to do my best to make sure it would withstand the scrutiny of physicians from other specialties, and I was encouraged by several physician friends who read it and were willing to endorse the book, because I wasn’t like, “Hey, endorse the book for me.” I said, “Endorse it if you like it.” So I didn’t get any negative feedback from them about cases not being technically correct or anything like that. And even some patients who read the book and may have said, “This isn’t for me,” still commended it for the clinical cases.

Kevin Pho: So tell us about some of that research that you did, especially being out of medical school for a number of years, in areas outside of your specialty.

James Champion: Well, the internet is the library now. I’m 49 years old, and I can remember long enough back, when the internet was in its early days. You’d still go to a library and look at old-fashioned books, or get on a computer to do a search for various topics, but now the world’s libraries are at our fingertips. So I would do the research as I went along. For instance, if I was writing about a neurology case, a neurosurgery case, or some other specialty that I have distant knowledge of, then I would simply look up specific information that I thought would be relevant to making sure whatever case I was trying to write about would be plausible.

And I still had files saved from medical school, including notes and patient logs. The patient logs and any notes and documents I had about patients only had their age and their sex. So I was careful to also protect the anonymity of patients as well. And one of the reasons I chose to use a pseudonym to write the book is I just wanted to maintain anonymity, and I thought it would be good to have another layer between the patients and me, because I want to protect everyone’s privacy.

Kevin Pho: So overall, how has your experience of writing been? Do you envision sequels to this book? Do you envision writing more books along with what you do professionally?

James Champion: Yes, I do have in mind to write another book. I might write another book similar to this at some point, but aside from enjoying Samuel Shem’s The House of God, for instance, my other favorite physician author is the late Michael Crichton. My dream would be to write some kind of techno-thriller similar to his. I think that would be a big task to take on and require a lot more creativity, but I do have in mind that I’d maybe like to try something like that next.

Kevin Pho: Now, what kind of advice do you have for other physicians who are interested in writing a book, maybe tips to break into the industry, or tips to simply get published and flesh out their stories? So what kind of tips can you give to your fellow physician authors?

James Champion: I can say if you have an interest in it, then keep writing. It is daunting to get published. You get a lot of no’s before you get a yes; that’s pretty typical, especially if you’re completely new. I think it’s a lot harder to break in if you’re new. So for those who have aspirations to write and become published, just be realistic about how difficult it can be. But if you really have a passion for it, like I did, and I don’t think I would have finished it if I didn’t, it’s just something like, “If I’m going to do this, I need to do it.” Keep writing, because I wrote plenty before this.

I told you I took a non-traditional path before medical school. I was originally a pre-med major in college, but I changed my mind because I got interested in journalism and photojournalism, and I actually switched my major from biology to communication. And the meandering path included me working as a photojournalist, and I did some writing for newspapers as well after college. So I had experience with it years ago, and I’ve written off and on over the years, including some other creative writing.

So I think the more you write, the better you become at it. And also, lots of reading is important. And I expect most of your listeners are probably avid readers as well, because physicians and those in the medical and mental health fields have to read a lot, whether it’s patient notes or staying on top of medical knowledge and all that kind of stuff.

Kevin Pho: We’re talking to James Champion. That’s the pseudonym of a psychiatrist, and he’s the author of Adventures of an American Medical Student. James, as always, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

James Champion: OK, like I said earlier, my medical school experience involved plenty of twists, turns, and even some failures. So my advice for those who experience adversity is to do your best to move around the obstacles, and if you fall off the horse, get back on and keep riding.

Kevin Pho: James, thank you so much for sharing your story, perspective, and insight, and thanks again for coming on the show.

James Champion: Thanks for having me, Kevin. It was nice to talk to you.

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