Dr. Chris Cashman, MD/PhD in Neuroscience | Neuromuscular Fellow at Mass General Brigham

In this episode, we discuss what led Chris to the field of neuroscience and his experience in the dual MD/PhD program at Johns Hopkins, his advice for seeking out hands-on experiences to help refine and solidify your career aspirations, and his take on the importance of establishing a support system and taking a pendulum approach to finding work/life balance.

Hosted by Brooklyn Arroyo

To connect with Chris and to learn more about his story, visit his page on the PHutures #100AlumniVoices Project website.

Transcript

Brooklyn Arroyo

Hello, I'm co-host Brooklyn Arroyo and this is 100 Alumni Voices podcast, stories that inspire, where we explore the personal and professional journeys of a diverse group of 100 doctoral alumni from Johns Hopkins University. Today we're joined by Chris Cashman, PhD and MD in Neuroscience. Welcome to The Phutures Podcast and I I'm really excited to be able to work with you today because I am pre-Med and one of my majors is neuroscience, so I'm really intrigued by your study.

Chris Cashman

That's great.

Brooklyn Arroyo

And and would just like to know what led you to to going down this path of medicine and studying neuroscience specifically.

Chris Cashman

Yeah, you know, so thanks for having me on. It's been fun and it sounds like a great project. And thank you for all the work you guys are doing. So, I ended up pursuing both degrees and I'm currently just wrapping up so my my clinical training returning to the lab, but I I think as with many people in science in particular and and in neuroscience perhaps as well, I think my initial interest was sparked very, very early. And a lot of us have sort of personal connections to these, these stories that drive us right. And, you know, in my family, there was history of dementia, for example, and other sort of neurologic disease. So, I was exposed to some of those disorders when I was very little and I'm talking about, like, elementary school, just with the fact like, oh, you know, Grandma and Grandpa you know are are sick in a certain way. And I think that was one of the things that prompted an interest in the brain, and then more generally, the nervous system. You know, the the brain, I, I, I still find this fascinating. You know, if you think of all the organs in the body, it's the one that gives us memories and our emotions and our personality and kind of makes us who we are. You know, there's there's a reason why, among many ones, but a brain transplant, for example, would be very problematic. And it just seems so interesting to me that something so organic, you know, it's just a bunch of cells together can give rise to something so surreal and human, if you will. And and that kind of prompted my that my research interests, I think. In in high school and whatnot, I would read kind of general books about neurology and Oliver Sacks and all these people. And and at the end of high school, I sort of shadowed a neurosurgeon. And I was interested, it was doctor Michelle Cleo. He was at University of Washington at the time. That's where I grew up. But he was just, I think, the seeing the the substrate was even more exciting. And then by the time I got to undergraduate, I was, I knew I liked neuroscience a lot. I'd I'd sort of wanted a little bit about medicine at that point, but I was actually more interested of the on the research side initially. There were no physicians in my family, for example, but there were some basic scientists, some chemists, and some physicists way back. But I so I ended up actually pursuing a degree in biochemistry. I was at Bowden College, so it's a small undergraduate institution. And they have a they do have a neuroscience degree there, I think at least early on in my undergraduate career, I sort of wanted to keep a lot of avenues open and biochem, I was interested in chemistry as well, so biochemistry seemed like a a great way to go, especially because being such a small institution there's a lot of overlap. So, I did some basic kind of research projects that were joint biochemistry and neuroscience. I started on that my sophomore year and kind of continued it. And really, really enjoyed it a lot. By the time I and I pursued, like, sort of a more formal sort of end of end of undergraduate career research project in that realm as well. And then ended up going into really liking the research side and beginning to wonder about the application kind of going back to my initial interest, kind of how can we apply these or what's the impact on on potentially families and patients? My basic research was in sort of signaling within the gastric nervous system or stomatic acid nervous system of of crustaceans, which was fascinating and I really enjoyed it and I learned a lot. But it also did prompt me to wonder, oh, I wonder how this could be used, you know the implications of this and the applicability. So, I actually took some time off after “off” after undergraduate. I took two years. Continuing my first year at Bowden as an in a research position, and then the second year I knew I really liked research a lot and I knew I really liked neuroscience a lot and I wanted to make sure I didn't just like the research, because of the neuroscience. So, I decided to do some research in something else. I did some cancer biology. At that point I was in Tyler Jackson's lab at MIT, wanted to kind of try Boston and really enjoyed it. And then I was I at that site at that time also to actually pursue an MD PhD. I was starting to volunteer at MGH as a when I was a technician in Boston and and really enjoyed that side of it as well. And the things that patients teach us and can teach us not only about neurology and neuroscience but about that life and humility. And then and then, yeah, I was very fortunate to be accepted into the dual degree program at Hopkins and that kind of really brought me brought me to, I think, where I am today and I'm sure we can talk about that in more detail later on. But it was very, very fortunate there.

Brooklyn Arroyo

And it's definitely something that we should talk about. And I'm sure that the audience is interested in and and just briefly to to open up the subject. What was it like for you experiencing the dual degree of both the the research focus of getting a PhD but also the the focus of medicine within your MD and and achieving both of those at the same time?

Chris Cashman

Yeah, I think so, you know to take a a step back on the way the dual degree program works in general, but and and Hopkins as well, although Hopkins is a wonderful program, partly because it's quite flexible, so you can kind of find ways to to to pursue what what interests you while also making sure you get the proper training. So, the way I did it is the kind of the more common pathway where I had two years of medical school sort of the preclinical years. And then I had my did my PhD in about four years, and then I finished the last two years of medical school. During the summers between sort of the first couple years of medical school, you do some of your graduate rotations in the labs. So, I think I I really enjoyed it I think for two reasons and and I'll I have kind of a anecdote at the end, but the I think they're I think it's so critical for both of those worlds to inform each other. And I think in some ways we almost think of it as a dichotomy. But I think it's kind of a false dichotomy and they really are intertwined. And at Hopkins, it's even physically so, which is great, where you know the labs and the hospital are just across the street from each other. The I think the what I really enjoyed about the basic science is I'm I'm someone that really has in order to really understand something, I sort of have to go back to basic principles. I mean, so I'm I'm for example, I'm a neuromuscular fellow right now, which means I do a lot of electrophysiology and I and use that to help with diagnosis. And I think sometimes going back to the fact, oh, this is, you know, remembering all these are the dynamics of these channels. This is how this may work. That's why we see this abnormality in electrophysiology in this type of disorder, for example. And I just I find out I can retain things better that way. So, I find that really helpful. But I think it also helps direct it goes the other way. That is the patients can help direct the research. My research has has been in like nerve regeneration and regrowth and and I have my future projects are sort of in diabetic neuropathies and and I think what has humbled me there is that not only the number of patients that have these disorders, but the fact that most of the time is sort of symptomatic treatment. And I know there's a huge area of research in terms of understanding how we can actually try to treat the disorders rather than just the symptoms. And I think you know they're in clinical medicine, too, you know, neuropathies are exceedingly common, and I think for that reason are sort of oftentimes at least the more kind of common ones thought to not be that exciting. But I think the implication to me of of how many patients you could impact and and what and what those common processes tell us about the mechanisms, for example, of, of of disorders I think is what I find really exciting. So, I think they help seeing patients and the impact they have help inform the questions I asked in some ways. But I think you know it's it's really fun. They they do have you think different ways. You know, there's some things I find like medical school for example, the exams are mostly multiple choice whereas in Graduate School the exams are mostly essay based. I think that sort of describes a little bit on how the brain has to think through things differently in medicine. It's a lot of pattern recognition, a lot of kind of facts and review. That's of course independent of kind of the art of medicine. Whereas in I think basic training it's interesting to learn how to think and how do we know what we know and that sometimes I think is helpful thinking for clinical medicine too. When you know like, well, we, you know, we have know these trials or the classic example you know we don't have you have a negative test by antibody panel but you in fact we only know about these antibodies. So, there may be other ones we don't know about, for example. I think my favorite days and now and and including in and when I was at Hopkins too are ones where I got to do both. I remember as a medical student, I finished up my surgery rotation, so I'd taken like what we call the shelf exam. I took that in the morning and then I went and gave a poster presentation at a conference that afternoon that happened to be in Baltimore that was on my research and it was such a intellectually dynamic and fun day. I really enjoyed it and it's one of those areas where it's a lot of work to do and it is a long road, but I certainly can't really imagine doing anything else. I think I'm kind of at that point.

Brooklyn Arroyo

Definitely. So, within your work and your experience, you talked about how they sort of amplified one another and they they helped, whether it was speaking to patients, helping your research or your research being able to allow you to view patients with a more open mind and more diverse area of questions you're coming from, and so what was your hope for the sort of work that you did after your PhD and and how did you want to take that dual degree and implement it into sort of the “real-world”?

Chris Cashman

Yeah, yeah, no, it's a good question. So, I think, you know, it's a very important question because there’re always stressors pulling you in both directions or pushing you in both directions, depending on what it is, and I think even when I was interviewing for the dual degree program, I I was saying what I still think is true. And and I feel like the the goal for me as a physician scientist at least is one thing that I think is common to all physicians and to all scientists, and that's of course to help people and some of that is through the application of knowledge and and some of it is through the discovery of knowledge. And I think what's exciting about the physician scientists’ kind of dual degree in particular is, is the goal of being able to help facilitate if not completely drive really taking something from basic science, understanding and development into clinical practice and treatment. You know they’re, for example, taking something a discovery about some signaling abnormality in the lab to drug development to clinical trial to hopefully help people. Medicine is so complicated that some of that can be the good part of a career, but at the same time it's I think it's also really helpful to be that person that can kind of speak both languages and to try to bring both the worlds together. Not everywhere is like Hopkins, where it's quite as across the street as I mentioned, and sometimes it's a, you know, it's it's not a a deliberate separation, it's just a natural one that can occur. And trying to help people with slightly different areas of interest and expertise find that overlap and to try to help drive and motivate additional questions and development of of of research questions and development of potentially therapeutics or under at least understanding. And I think I think that's been my goal. I'm still, you know, in the scheme of things, pretty early in my career, but that's what I'm hoping to do, and certainly what I've seen modeled, which is really really great. I was fortunate I did my PhD in Doctor Ahmet Hoke’s lab. He's in the neuromuscular division in the neurology department and neuroscience, and he's a dual degree as well MD/PhD. And he's been a tremendous resource for me both there and afterwards. And now my current research mentor, so I’m at Harvard now, is Craig Blackstone also MD/PhD, who trained at Hopkins actually. And just having some of their guidance and leadership on how how to maximize your your ability to do things as a as a MD/PhD has been nice because there are challenges, but there are also certain opportunities that come with that responsibility, I think.

Brooklyn Arroyo

So, stepping back a little bit, I I'm personally interested in, you mentioned briefly how you were able to work with a neuroscientist before even really entering this field and just be able to have a shadowing opportunity with them. And so, what advice would you have for getting opportunities like that and really putting your foot in the door of of this field?

Chris Cashman

I think, yeah, I think you know one thing I would say is I encourage people, no matter what, when time, whenever time and interest develops to try to try to pursue it. So, I was fortunate that I had some of this interest in the brain nervous system fairly early, at least back then I thought it was early, which was like high school. And I remember just wondering we had a parent come in and and went into my biology class I remember and just talk about the brain. This parent was a was the neurosurgeon that ended up shadowing later on. Now that required a lot of things that I was fortunate, one, that there was a parent at the school who was a neurosurgeon, one that that parent was available and interested in talking and and then another thing is they had the opportunity the school was interested in bringing them in to try to stoke those and and and promote those interests in the students. So that is opportunity is both kind of offered and sometimes grasped for or taken, if you will. But that one, yeah, I ended up speaking with my science teacher, who then connected me with that parent. But then in, yeah, in college, I think it's, you know, can be overwhelming on the opportunities in a way. And sometimes there's so many opportunities it's hard to find one, if you will. There's, I guess, a sea trying to find the right person to talk to. And I think sometimes. And and there may be opportunities don't realize, you know, reaching other of course some formal pathways. I think there are ways you know for different classes for example that may have connections with different labs. But even like talking to other graduates like graduate students, something that you may know or, you know, some of the other other professors, for example, can often kind of link you in or health professions advising for example. I remember we had a number of undergraduates, especially in the summer, working in the lab over on the medical campus, which was always enjoyable. At the same time, like I a lot of my early interest and developments really on the basic science side. So, I came to the realization of medicine kind of late in some ways compared to some of my peers, that was, you know, kind of toward the end of college. And that was one of the motivations on taking a couple of years to make sure I really wanted to do clinical work as well. And, but it wasn't too late, you know. You know, I was able to then start to get more looked into volunteering at hospitals, which I know like I've been recommended to do before, even just to get the experience of talking to patients, seeing patients. My role there was on patient transport. Sort of usually out of the hospital on discharge, I would go to the room, take the patients down to their family or the ride anyway. And it was interesting because there were patients who were feeling great and really happy with their experience and there were other patients who were upset for other one reason or another, the families the same way. So, it was kind of eye opening but also very humbling. But I did that, you know, after after undergrad even. So, I think you would find take an opportunity when you can. If it's something you're really interested in, I think it never hurts to ask. The worst thing that's going to happen if someone says no or. Can't right now. But many times, like well, maybe this person may do it, or they'll send the e-mail. Sort of a larger group of people being like anyone have availability to help this person, for example. I think, yeah.

Brooklyn Arroyo

Yeah, and I.

Chris Cashman

It’s tough, but you have to kind of go for it sometimes, but also sometimes things are brought forward, which is nice.

Brooklyn Arroyo

Yeah. And and I think that you bring up a good point of the worst that they could say is no, so sometimes it just takes a leap of faith and asking everyone if they're willing to to help you with an opportunity. And so, this sort of leads of my next question leads my next question of were there any big surprises that you faced in the work that you were studying, in the work that you were doing, and just in your career path and your trajectory throughout your academic experiences? Were there any major surprises that the past you would not necessarily have foreseen?

Chris Cashman

Yeah, I think I think a couple of things. And I think one of them is related to the last question about the opportunities and I think, and this was sort of hard when I was very fortunate, you know, I was to to go to my undergraduate and then to go to Hopkins and everything else. And I had a lot of opportunities. And I think at the same time, because of that, I think it was, it's good to keep in mind though it's, it's easier to think if you're coming from, you know, a a place like Hopkins or from a small liberal school like I did, Bowden, which were all wonderful experiences for me, it's good to keep in mind that there are a lot of other people out there who are who are also super well trained and have had wonderful experiences other places too, and it doesn't necessarily have to be, you know, small schools or or big-name schools for example. And I remember it was I was I was warned about this would be the case from my older brother actually, that you know when you're applying for jobs. This was coming coming, you know, coming out of undergraduate, that there are a lot of other people applying for jobs, and it's important to keep in mind that there's nothing wrong if you don't hear back from a place you're interested in. They don't think that you're a bad person. For example, they may just have the spot filled. They may be looking for something slightly different and it's obviously easier intellectually to understand that. But it's always a little like I, you know, I have all this great training. Like I did really well academically. Like why aren't I hearing back from these places? But then, you know, you go for an interview and there'll be four other four dozen other people there. So, I think, you know, humility is important and also appreciating there are a lot of very, very capable people out there. So, you know, if you do reach out to someone to have an opportunity and you don't hear back. You don't hear anything. It's it's nothing personal typically, you know, then you can just try someone else you know and not hold any grudges or anything like that's important for everyone. So that was kind of one of the early surprises. I think in my PhD training, I can't remember who told me this, but I think it was really good advice that you know a PhD, there are two things I guess. We all know how important a mentor is, and I was really fortunate to get an amazing one. We we're still kind of on a texting basis today. But the, you know, a a mentor it's almost like being married in a way, in that you go through thick and thin together. And I think that's really true. So, you have to be able to be honest and frank with each other, even if it's like this is not your best work kind of thing. But the other the other part of it is that I wish I could, but the PhD is sort of like baseball. So, in baseball, right? If you think of a hitting percentage, you know, one out of 3 is really good, right? Because that means you know, typically you'll get a, you'll get a hit before you strike out. Well, a PhD is like that in that one out of three ideas if you're doing if one out of three ideas works or is good, that's doing pretty well. So, the corollary of that is 2/3 of the time things aren't going to work or it's that idea that doesn't quite pan out. And that's and that's and that's generous, I think. I think since it's higher than that. So, and that was one of the realizations I had like 1) research is it can be really exciting and very fun, but it can be very hard and require a lot of patience because just because you work really hard at something doesn't necessarily mean it's going to work, and I think that's different than other areas even in training and clinical training. If you work really hard as a resident, typically you're going to you're still going to finish, right? And you could do well. Whereas in a PhD, you can have a great project and work really hard at it, and it can may not work out. You know, there are ways to try to protect against that, the key one being try to have multiple projects going and and try to work on them all as much as possible. See what one does stick. So that was the one. And then I think the one that looking back if I could tell like my my high school and middle school self about self about it, I think was one that is a is a fortunate lesson, I think for me, maybe not lesson, but affirmation maybe. And it's that I you know, I've been very fortunate to always have, like, a really loving and supportive family and you know, you I remember watching medical shows when I was little, whether they were real ones or kind of fake ones, but just about how all-consuming that kind of training can be. And of course, you hear the same thing with like scientists too. And I think earlier in my career, you know I was concerned would be difficult to like, have a have a, have a family at least in training that somehow, I would be hard to have the time to do either of to the way I want to and obviously there are challenges. But I was fortunately, I met my wife in undergrad and she also went to Hopkins and we got married while we were down there. And you know, now, now we're up here and we have a son. And so, we had my our son when halfway through my intern year. And then of course, I meant all the way through residency ss well, but the I met I was talking to another of my Co-residents and I was talking to him. This was before my son was born, but we were knew he was coming any minute. I was like, oh, how, how have you done? And this was one of the senior residents. He was very capable, well respected, super. And he had a couple of kids and we used to talk about that a little bit and he was telling me, well, you know, it used to be, I would. And so, he had the same thought I did. It used to be, I wondered how I could do this with a family in terms of the hours, and I was. But then he was like, but now I just I wonder how I could do without a family. And I think that was a nice way to think about things, for me anyway, in terms of like the support and the different identities that they lend you. You can have a crummy day and come back and you know your your kids are not going to care really. And they’re just going to be typically happy to see you, and even if they're not. If they're sad and upset, just that a different role is kind of nice sometimes. Obviously, there are days where it’s exhausting. You know, I acknowledge my wife has been amazing, you know, on the days where I've been on long calls and overnights and these kind of things. But but it is I think, trying to imagine being at this point now without without that kind of whole little family network and support group both my wife and my son, and then my, my, my parents and everything else, and her parents, I would be and brothers would be, would be hard, I think. I think it certainly does take a village to get through a lot of these kind of more rigorous trainings, you know, whether it's a PhD, an MD or both. Or undergraduate, for that matter, right? Undergraduate can be hard too, so trying to find those pillars of support I think is really helpful because things get tough. They always do, but they often get better too, and it's helpful to be able to have someone to kind of fall on to if you need.

Brooklyn Arroyo

And I think that it’s a really important, important thing that you highlight because medicine specifically is really daunting for a lot of people. I think that even for me, it's something that I've always been passionate about pursuing. But there's that thought in the back of my mind and other pre-meds of, will you be able to have that much of your time consumed by this work and will you be able to give yourself 110% to the things that you're studying? And and to your point of how could you not have a support system while you're also doing this is really it's important and I I found it inspiring because we're often told that we have to just only put our time and energy into being pre-Med and studying that and we wouldn't really have time for anything else. And in reality, we can still be a whole person and and be great doctors as well, so.

Chris Cashman

Yeah, I think so. But I had an attending doctor one time. She had a couple of kids and this is when I was was one for residents and oh no, this is no, this was actually in medical school, actually. And this was doctor Christmas. And she told me one time, like work life balance obviously it's important to think about and she was an advocate for that. But she's also, well, people should understand it's a pendulum. It's not really a balance, you know, sometimes swing one more than one way or another. So, it's good to be gentle with yourself with that, but and to set expectations that way, but. But you know it’s having that that support is is so, so important as well, so yeah.

Brooklyn Arroyo

So, our grand finale, in a sense of each episode, is a big question for you. And and that is what inspires you right now?

Chris Cashman

Yeah, I think it would I think there are probably 2 main things and it goes back to kind of the very beginning in some ways. And that's like family, right. And what we were just talking about. So, I think my definitely like my son is a huge inspiration for me and I think he represents a lot for me as well. And I think both on the emotional and on the intellectual level. I think, you know emotionally, when you have younger family, whether it's younger siblings, cousins, or children, you're so immediately emotionally invested in the future, right? You want a better future for them. There are a lot of a lot of craziness going on right now as we can all and, but and to be fair, there's been a lot of craziness in other eras as well. But we all want to have a better future for our children or our younger family or younger friends. And I think to me that means trying to bring leave the world somewhat in a better place than when I came in. A large part of it may be him, you know. But I think at the at the same time, it's also what are the things that we can do that will have, you know, a lasting impact on the future, and I think science is a wonderful way and I think medicine too. Obviously, science you find new knowledge or develop new knowledge that lives on right and can lead to who knows what, may may lead to something that can help many people. Perhaps those younger family members. And then in medicine too, you know, if you're you're helping someone at the immediate an immediate era, you know. And the immediate immediacy, I guess would be that you're helping them. You know, they, they they feel better, they get better, maybe perhaps they don't die. But at the same time, you know your some patients do pass, but you're also still in many ways helping family, who knows what impact of that people. I mean, so one of my favorite one of I was also like a film studies minor in undergraduate and the movie It's a Wonderful Life. Many people are familiar with. The whole premise of that film is what would the world be like if I hadn't been there? And I think the take away is you don't know, you don't know many people you touch or you impact throughout your life and what downstream consequences that can have. So, who knows if I treat a patient this way, you know what that implication of that person now being treated is going to be? And I think, yeah, that the practical side is, you know, I'd like there to be more knowledge and for my son and his generation in terms of their health and their future. I was recently told that his generation is expected to have something like 80% of the children live over 100, which is amazing to me. And that's the sort of the advancement of of science and health. But that also means that for at least neurology and neuroscience, you know, there's going to be more potential risk of developing things like dementia or neuropathies in my case. And I think trying to find ways to help help that help those people, even those people we don't know, is a huge inspiration for me.

Brooklyn Arroyo

Definitely, yeah. The the unknown of tomorrow and where we could progress and how we can do better is definitely inspiring and I've really appreciated being able to speak with you today and and have found you inspiring. So, thank you for coming onto the PHutures Podcast again and speaking with us.

Chris Cashman

Thank you. It's very kind of you and it's it's always enjoyable to to to, to chat about Hopkins and training and and just to see students too.