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Perhaps the most unusual and challenging teaching assignment of which we are aware is the one that Dr. Tim Cordes is preparing for. The following article originally appeared in The Capital Times of Madison, Wisconsin, June 2, 2010. Dr. Cordes was a 1998 winner of an American Council of the Blind scholarship.
TODD FINKELMEYER
It’s not uncommon for co-workers to stumble upon Tim Cordes sitting in the dark.
“I couldn’t function in the dark, but he 'sees,'" says Dr. Nancy Barklage, who recalls entering a room prior to a UW Health staff meeting, turning on the lights and finding Cordes quietly working on his laptop while waiting for others to arrive. “I’ve experienced this a number of times now and it still kind of puts you into his reality.”
Cordes is blind.
As an infant, he was diagnosed with Leber’s disease, a rare degenerative condition of the retina that gradually steals one’s sight. Cordes still remembers one of the first times he heard someone trying to explain how his impending blindness would affect his life. “Your son can be president of the United States, but he’s never going to fly a plane or drive a car,” an ophthalmologist explained to his parents when Cordes was about 7.
“And as a young boy who liked planes and cars, that was one of my first indications that things wouldn’t necessarily go smoothly,” says Cordes. “That made me sad.”
He never did fly a plane or drive a car. In fact, when most of his friends in Cedar Falls, Iowa, were learning to drive, a 16-year-old Cordes got his first guide dog, a German shepherd named Electra.
But Cordes didn’t shrink from life. He’s now a 34-year-old trailblazing physician who is wrapping up the third year of a four-year residency program with UW-Madison’s department of psychiatry.
“He has overcome challenges that most of us have just never been faced with,” says Barklage, an associate professor of psychiatry who has supervised Cordes’ work at UW Health’s Psychiatric Institute and Clinic the past three years.
Cordes has been reticent to share his story, not wanting to become a poster boy for overcoming visual disabilities. But he’s slowly becoming more at ease telling his inspirational tale. Earlier this spring, the husband and father of two young boys wowed 450 members of the Madison Civics Club with a speech at Monona Terrace titled, “How I See Possibilities.” In July, he’ll give a similar talk in Dallas at the National Federation of the Blind’s annual convention. And he contributed a chapter for a book to be published later this summer by the Association of American Medical Colleges that is designed to guide medical schools in accommodating students with disabilities. Cordes’ chapter deals with the use of service animals.
“Thirteen years ago, I was knocking on a lot of closed doors,” Cordes says of his struggles to have medical schools seriously consider him as a candidate for admittance. “So the fact a book is coming out describing the issues people with disabilities face and ways to accommodate them, I think is tremendous progress.”
Cordes was valedictorian of his class at the University of Notre Dame in 1998, posting a 3.99 GPA while earning an undergraduate degree in biochemistry and conducting research on antibiotics. He then was accepted into the UW School of Medicine and Public Health’s medical scientist training program, completing the notoriously challenging sequence that requires a student to finish both medical school and a Ph.D.-level research program.
Over the years, Cordes also earned black belts in jujitsu and tae kwon do, carried the Olympic torch during its cross-country journey to the Salt Lake City Games in 2002, and developed computer software that uses a number of musical instruments, varying tones and left-right speakers to allow those with vision problems to conceptualize and study protein structures.
Despite these made-for-the-big-screen qualities to his life, Cordes remains leery of being put on a pedestal: “I look forward to a world where people with disabilities do what they can and what they want, and it’s not exciting or it’s not different.”
Dr. Brad Schwartz still remembers the paperwork Cordes forwarded to the UW Medical School when applying to the medical scientist training program. While most attempting to head down this path are high achievers, Schwartz says Cordes stood out from the pack due to his Medical College Admission Test scores, 3.99 GPA in a demanding major and his interesting research on antibiotics. It was a reference letter from a Notre Dame researcher, however, that floored Schwartz, who was director of the program in the spring of 1998.
“It’s just this incredible, glowing letter,” says Schwartz, now the dean of the University of Illinois-Urbana’s College of Medicine. “And then you get to the last line, and it says, ‘This is all the more remarkable because Tim is blind.’ We’re all thinking, 'Oh my God!'"
Schwartz says his admissions review committee agreed Cordes was a "one-in-a-million" candidate and assumed "every program in the country would be fighting to get him because he was so remarkable."
But that wasn’t the case. In fact, Cordes applied to eight schools, but no one else showed interest. During one med school exit interview, doctors and researchers at a rival Big Ten Conference institution made it clear to Cordes, who has only a limited amount of light perception, that there was no way a blind student could complete the school’s required coursework and rotations to earn a medical degree.
Cordes doesn’t appear bitter about these rejections, but his mother, Therese Cordes, acknowledges it was a difficult time for her son. “To have someone tell Tim he’s not good enough, despite all he accomplished, was very, very tough on him,” she says.
Even at UW-Madison, those close to the situation say some top medical school administrators were adamantly opposed to admitting Cordes. Concerns centered on two factors: the cost to make all the necessary accommodations for a blind student; and the fear that the Association of American Medical Colleges might frown on a school admitting a student who couldn’t see.
In the end, Schwartz stood his ground against the naysayers and Cordes was ultimately one of 143 students earning a slot in med school out of 2,300 who applied. Although no official records are kept and there are various scales to measure the extent of vision loss, published reports in 1998 indicated Cordes was only the second blind person ever admitted to a U.S. medical school. The first was David Hartman, a 1976 Temple grad and psychiatrist in Virginia whom Cordes considers a role model.
Some members of the Medical School were guarded about Cordes’ chances of success at first, says Schwartz. “But I can tell you, each year that he went along he won over more and more people,” he says. In the years to come, Cordes would learn the lessons and complete the tasks asked of every other doctor-in-training.
In the classroom, he used books on tape and in Braille to learn the fundamentals. He also relied heavily on a computer that could read downloaded texts and e-mails at a blistering 500 words per minute — something Cordes can easily understand but would sound like gibberish to someone accustomed to normal-paced speech. The university also provided him with a machine — “It looks a little like an Easy-Bake oven,” says Cordes — that makes raised-line drawings so he could interpret images using his sense of touch.
In the lab, he helped dissect a human cadaver and used his fingers to identify the various nerves, muscles and organs. “I was the guy who reached into the chest and pulled out the lungs,” says Cordes. When it came to hospital rotations, he helped deliver babies (earning Student of the Year honors in the obstetrics and gynecology rotation), observed surgery — “I felt blood flowing through an aorta” — and intubated patients during an anesthesiology rotation.
The school also hired “visual describers” to tag along with Cordes and his seeing-eye dog to help Cordes read paper charts or act as his eyes during a physical exam. In 2004, he earned the title of medical doctor.
His Ph.D. work centered on biomolecular chemistry and the makeup of proteins, a field that relies heavily on colorful, computer-generated models of complex molecular structures. Out of necessity, Cordes wrote a computer program that replicates the 3-D images using a range of audio tones and surround-sound speakers, allowing him to “visualize” the proteins in his head. In 2007 he earned his Ph.D.
Although Cordes isn’t one to puff out his chest and say “I told you so,” he is proud of the fact he never allowed others to squash his dreams. “Choosing to ignore what other people say, when they say it can’t be done, is a powerful tool,” says Cordes.
When Cordes started his medical school journey more than a decade ago, he had no desire to work directly with patients. Research was his passion, and the medical scientist training program is designed to develop people who can bridge the gap between basic research and clinical work.
“I think it was just intellectual curiosity,” Cordes said of the research-first focus.
But while working his way through the various rotations during his third year of medical school, Cordes started to zero in on a specialty and re-think his career options. He knew he couldn’t be a radiologist but thought any other area was up for grabs. A four-week psychiatry rotation at the William S. Middleton Memorial Veterans Hospital stood out.
“I was lucky and had a really great psychiatrist running the ward I was on,” Cordes says of Dr. Tony Braus. “Some of the patients we saw there really got better in a relatively short time, and we could see some improvements in people.”
While he enjoyed interacting with the patients, Cordes also saw the potential to conduct groundbreaking research in the study and treatment of mental disorders. “There is just a lot we don’t know,” he says. “In other places of medicine, some of the more fundamental questions have been asked and answered, but in psychiatry we are just starting to ask them.”
So after earning his M.D. and Ph.D., Cordes in 2007 entered a four-year, psychiatry research track residency program, which allows him to spend time working with patients and conducting research. Although he notes there has been no single “ah-ha” moment, Cordes says it’s becoming clear his desire to work as a clinician and teacher of future doctors is stronger than his drive to focus solely on research.
Cordes’ typical week currently consists of two-and-a-half days at the Veterans Hospital, where he helps supervise the medical interns in an inpatient psychiatry unit, and one full day of outpatient care at a UW Health clinic in University Research Park, where he oversees more than 100 patients. He also spends a half-day attending lectures and gets one full day for research. His research mainly consists of mining data and searching for interesting patterns using the Midlife Development in the United States survey, which examines the lives of people ages 30 to 70 in such areas as physical health, psychological well-being and factors that might lead to mental illness.
At the Veterans Hospital, he also worked on a clinical trial systematically rating symptoms in patients with post-traumatic stress disorder.
While he has a proven track record as a researcher, Cordes is also earning kudos as a clinician.
“In psychiatry, part of what we do is getting to know patients, establishing a rapport and trying to understand what’s going on with them so we can help them out,” says Art Walaszek, the residency training director for UW-Madison’s department of psychiatry. “And Tim just has an incredible, natural ability to put people at ease and communicate and listen to them. I don’t know exactly how he does it, but he just has this awareness of what’s going on with the patient.”
Body language and expressions often convey information to therapists, but Cordes is able to pick up on these cues despite his sight limitations. He says he’s “gotten good at listening to people — not just what they’re saying but hearing how their body moves or what direction they’re talking in.”
Colleagues say they can’t recall an instance in which a patient did not want to be seen by Cordes because he is blind. In fact, says Braus, Cordes’ disability seemingly allows him to more easily connect with patients.
“It’s almost like Tim has more credibility with some patients,” says Braus, who today works at the VA’s outpatient clinic. “Tim knows what it means to recover from something or to be able to compensate or overcome a problem. People at some level seem to relate to that.”
It’s not easy keeping pace with Cordes — even if you can see.
With sprinkles just starting to fall one dreary spring morning, Cordes and Vance — his loyal guide dog for the past nine years — walk briskly from the bus stop to his office.
The ride from near his home on Madison’s East Side to UW Health’s Psychiatric Institute and Clinic, which is across town in University Research Park, takes about 40 minutes — not bad considering Cordes has to transfer buses on the UW-Madison campus. The jaunt from the final stop to the clinic takes about five minutes at a quick pace. Somehow, Cordes narrowly misses several potholes on the driveway leading to his office. Those who have watched Cordes for years insist he has some sort of internal radar.
“He has this like, Zen, where he can walk through the living room and not step on all my son’s trains,” says his wife, Blue-leaf, a native of India and a 1994 Madison East grad who met Cordes while interviewing for the M.D.-Ph.D. program, which she also completed. “I don’t know how he does it without falling and hurting himself.”
Before long, Cordes is heading up a set of stairs leading to a back entrance of the clinic. He scans his security badge to gain entry to the facility; it’s just past 7 a.m.
Using his sharp memory and displaying complete trust in Vance, Cordes quickly moves down a hall to his office, drops off his jacket and backpack, and heads back down a hallway to separate locked rooms that house medical records and the mail. He intuitively slides his hand over the keypad security system, and quickly taps out the code. Inside, Braille labels allow him to promptly grab the correct patient records and mail.
Back in his office, he sets the papers neatly on his desk before flipping open his laptop and scanning through e-mails using screen-reading software that ticks off the messages in quick order. Like clockwork, Jeanne Harris, one of Cordes’ visual describers, arrives in the office at 7:10 a.m. to read over any faxed-in requests for prescription refills or hand-written notes, charts or surveys Cordes can’t read himself. (For many printed materials, he can take a picture of a document with his smart phone, and a program will read it to him.)
Ten minutes later, the paperwork is cleared, Vance is resting on the floor in the office, and Cordes is preparing for a day of numbers-crunching research on his computer.
It’s easy to be impressed by how efficiently Cordes operates, but he wishes others would view it as ordinary. “Just like you, I have a job to do and I figured out how to do it,” he explains. “To me, it’s gratifying how profoundly routine this all seems at times.”
Even those closest to Cordes — the ones who have never doubted his potential — confess it’s difficult to view this all as merely routine.
Therese Cordes still has vivid memories from three decades ago when she put a 2-year-old Tim in the car and drove him to meet with the University of Iowa’s highly regarded pediatric ophthalmologists. The experts there gave her little hope, rattling off a list of things her only son would never be able to do.
“I cried all the way home,” says Therese, “and then decided to forget everything they told me.”
Tim Cordes credits his mother for being a rock of emotional support over the years, while his father, an engineer, was pragmatically supportive — the problem-solver and the one who helped Tim get up to speed with many of the technological gizmos he relies on.
It also didn’t hurt that Cordes was being pushed by two older, successful sisters, both of whom were valedictorians of their high school class (Tim finished as runner-up during his senior year) before also moving on to Notre Dame.
Earlier this spring, Therese Cordes was in tears again after her son got a standing ovation following his riveting speech to the Madison Civics Club. “He’s inspirational,” said the proud mother.
What, exactly, the future holds for Cordes isn’t clear. After he completes the four-year residency program in July of 2011, he’s considering additional training so he can help people with drug addiction problems. Another option is to land a position working with military veterans suffering from post-traumatic stress disorder and severe brain injuries, work Cordes enjoys and finds rewarding.
No matter what direction Cordes ultimately decides to push his career, he has no intention of becoming part of what he calls "today’s risk-averse society."
"I went to a playground with my son and I found out what passes for a teeter-totter these days," he explained during his civics club speech. "It’s a U-shaped, spring-loaded contraption that assures nobody gets too high off the ground or nobody comes down too hard."
Cordes adds proudly: "I learned to swing on monkey bars — which I could not see well — over asphalt. I learned that if you fall it hurts, so you try not to fall. But it’s still worth swinging."
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