How I Wrote This: “Deciding on My Dimples” for the New England Journal of Medicine
In case you haven’t heard the news, a Perspective I wrote about shared decision making during awake craniotomy (brain surgery) was published a few weeks ago in the New England Journal of Medicine (NEJM). I am over the moon excited.
NEJM is recognized as one of the most influential medical journals in the world with an academic impact factor of 91.24 (nerdy academics know what this mean). Getting published in NEJM at least once is consider to be a major career accomplishment.
Check it out!
Acknowledgements
From concept to publication, it took eight months for this Perspective to be published in the journal. One thing missing is an acknowledgements section. If the journal allowed it, I had planned to thank the following individuals.
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The first thank you goes to one of my mentors, Dr. Tom Delbanco at Beth Israel Deaconess Medical Center and the Harvard Medical School.
I Facetimed with Tom and his wife, Jill, a few days after surgery in May 2022 and recapped to them about my incredible experience in the operating room (OR).
Tom said, “That’s a paper.” Meaning, the experience I recounted to him should be written up and submitted to a medical journal.
I laughed in the moment, but over the following days the idea grew in my mind, especially after sharing my experience with a few friends and colleagues who called to wish me well.
Two weeks after surgery I posted a blog to this website to share with friends how I was doing. However, a blog post to an audience of my friends did not capture the larger learning moment I hoped to share with a wider audience of the medical community (clinicians, researchers, health administrators, etc.).
I knew that if I spent more time thinking and describing the kinds of decisions I made in partnership with my neurosurgeon during surgery, and the nuances behind how my decisions were made, perhaps a wider audience could learn from our shared experiences… and now that was a paper.
A few weeks later on a call with Tom, I told him I was writing about my awake surgery and was thinking about where to submit. (Read this blog post to better understand the nuances involved with deciding where to submit an academic publication.)
When Tom learned about the narrative, he said it had the potential to be accepted by a high tier journal because it was:
1. A novel perspective—he had never heard of someone writing about their own brain surgery for a journal, usually it is a doctor writing about their patients; and
2.) I am pretty good at writing from a first person perspective. Fifteen years of blogging were finally paying off!
Tom asked how many words I had written. When I told him I was at 2,000 he told me to get it to 1,200. I died a little inside, but knew he was right. He was asking me to aim high.
I asked, “So should I be writing for the Annals of Internal Medicine, or JAMA?” Two other high impact journals.
He said, “I think you should be writing with NEJM in mind, and if they pass on it—which you need to be prepared for—then send it to JAMA.” So that’s what I did.
By version 9 I finally shared the manuscript with Tom to get his eyes on it. I was still at 1,400 words and I needed to cut at least 200 words. Tom, famous for his Socratic method, made me think intentionally about each word I used and whether it was necessary for the overall narrative.
What I eventually submitted to NEJM was version 15 at 1,213 words.
But who is counting?
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The second, however equally important and crucial thank you, goes to Dr. Shawn Hervey-Jumper, my neurosurgeon… and fellow protagonist in “Deciding on My Dimples.”
The first time I met Dr. Hervey-Jumper he shook my hand and introduced himself to me as Shawn. As a person who might become his patient in a few days, I saw this introduction as a specific choice on his part.
Since surgery #1 (we’ve been through two together), I think of him as Shawn, even though when I talk about him to the medical team at UCSF I refer to him as “Dr. Hervey-Jumper” out of massive respect.
That all said, here’s some backstory I couldn’t fit into the final perspective published in NEJM:
After our first surgery together, Shawn recognized the unique situation we were in—him having a patient who is also a researcher of patient engagement, specifically for malignant gliomas.
Between November 2021-April 2022, Shawn and I exchanged more than a dozen emails discussing a possible collaboration, although we didn’t know what it would be. However undefined, Shawn’s suggestion that we might “work on something together” was the spark I needed to recover from my surgery in Oct. 2021.
Looking back at my blog from that time, it’s clear I was struggling with my new normal. I wrote:
“… the deficits I now face challenge the very perceptions I have of my cognitive capacity. The number of therapy activities in which I am engaged (e.g., physical, occupational, speech) highlight I am not the same person I was a few weeks ago. I suffer from scattered thoughts, and stumble over words and limbs that may never be what they once were.”
By spring 2022, I was feeling more like myself again. I had been taking copious “field notes” about my recovery and was this close to proposing a possible research collaboration by mid-April. (Read about what I was thinking here.)
But right as I finally let myself think of Shawn as a potential colleague it was clear he was back in the “doctor zone.” A scan showed I was facing a recurrence and would require surgery again.
However morning of surgery in May 2022, things felt somewhat different and I wondered who I was going to perceive him to be: Shawn the surgeon, or Shawn the open-minded collaborator?
Interestingly, I saw him as both in the pre-op area. As he pulled up scans taken the day prior, he talked me through his planned surgical approach. I asked questions. He had answers. I confessed I was scared and he held my hand.
I recognize my Perspective in NEJM is as an unreliable narrator. but my POV, no time passed between the moment we were talking about surgical approaches, to when the two of us were working through surgery together.
The narrative about what happened during surgery can be read in “Deciding on My Dimples.”
I was anxious for six weeks after submitting my Perspective for review in NEJM. I honestly thought the editors were going to reject the paper within a few days. But when days became a few weeks, colleagues (especially Tom) told me that the fact that I hadn’t received a response was a clue that it was receiving a serious review.
On Sept. 19 I received the preliminary acceptance from the journal. I couldn’t believe it. My hands started shaking. I took a screenshot of the email and texted it to Shawn. He responded with confetti emojis.
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I want to thank three friends for commenting on an early draft of the manuscript: Erika Dimmler, Jennifer Laam, and Jared Rubenstein, MD.
