Joseph F. Clark, Ph.D.

Professor Sparks was excited.

“Good, we finally have a clear difference of opinion here.” He continued quickly. “Joe, you did not think that the conclusions were supported by the data. What data would you personally want to see to support those conclusions?”

I was on the spot and all alone on my opinion, but felt I needed to defend it.

“I think they need to do some experiments on live cells or tissue. All of their experiments were done with fixed cells, which are dead. If the conclusion was that a motion occurred that was like a muscle contraction, they did not show contraction. All they showed was differences in the cell shape before and after. They did a lot of manipulations after the cells were dead and during the fixing, so I feel that the results could be an artifact of their methods and not physiology of the cells.”

Nodding, he opened the question up to the class, “Who felt that the methods were solidly supporting the conclusions and why?”

He pointed to Ken and asked for his opinion. Ken pointed out that the differences seen between the groups of cells in the experiments were large ones and that for the differences to be so big the conclusion would have to be that the cells controlled blood flow. Several of my classmates agreed with Ken and eventually with further discussion were all nodding their assent, that it was a good paper.

Professor Sparks let that sink in and then reconciled the discussion for the class. “This paper is considered a seminal paper in physiology,” he said, meaning that my criticisms were wrong. “However,” he went on, “it is seminal because many scientists pointed out some of Joe’s criticisms as well as others and those experiments in living cells were eventually carried out. So both Ken and Joe are correct. It is a solid piece of physiology but it needed more work to verify the conclusions. Good job, everyone.” I think all of us in the class realized that a good opinion that has reasonable justification is a valid opinion. At the cutting edges of science there may not always be a right or wrong, but a difference of opinion and/or a consensus of opinions. Maybe we had been missing the point when my classmates and I agreed on one perspective and marched like lemmings into the class. After that day we no longer compared notes on our reading assignments and let differences of opinion be a catalyst for further discussion. It actually was a lot more fun if people disagreed and we could engage in friendly debate on the subject. As a group we were teaching each other to think as individuals and to respect differing opinions.

A lot of thought went into my Ph.D. project. I wanted to study vascular smooth muscle because there were so many diseases of the arteries that I could do research on. I wanted to learn about its function; contraction and relaxation, but I also its chemistry or the inner workings of the muscle. Because I had worked a lot on the nuclear magnetic resonance machine for my master’s, I decided that I would use that to study the chemical kinetics of at least one enzyme in the artery muscle. I would study pig arteries because pig arteries were very much like human arteries. I did not want to have to get human arteries at the hospital. Michigan State had a slaughterhouse on campus and the tissue from pigs killed for food was also available for research. There were also other slaughterhouses near campus that could be a source of research material as well.

The graduate students took classes together and in these classes we learned the theory of enzyme kinetics. There is a lot of math and many formulas to memorize in enzyme kinetics. The math was used to predict and explain how and why two chemicals interacted during a chemical reaction. We often learned how the equations were determined by scientists doing research, but all too often we learned very little as to how to use them. Sometimes we learned equations and wanted to use them. A colleague in my class named Tim Denerall fell in love with an equation. He described it as ”beautiful” and extolled its virtues for doing enzyme kinetics. The equation to describe the velocity and inhibition of reactions uses the formula[1]:

              Vmax_a [A]    + Vmax_b   [B]

V_t =                  Km_a                         Km_b. 

              1   + [A]   +   [B]   

                      Km_a       Km_b

The beauty of this equation, he said, was in its simplicity and utility, although that might not be evident to people who do not do enzyme kinetics, I have to admit I have personally never fallen in love with an equation, and sometimes I have to work hard to remember them because I tend to dislike them, but they can be useful for people doing biochemical studies in graduate school.

For my research I needed something that could be studied in vascular smooth muscle that would be able to fuse all my interests. I needed a subject that was important to chemistry and the physiology of arteries that would be testable in the nuclear magnetic instrument and that could eventually be of great help to people. After much thought and reading of the literature on the subject, I decided to study creatine and creatine kinase. Creatine is a molecule important to all muscles and the brain. It is important to athletes as a dietary supplement and the main function of creatine in the human body is to be acted on by creatine kinase, whereupon it makes and stores energy that is central to all muscle and brain work. I would study the arteries and determine how creatine and creatine kinase were used chemically in the muscle to aid muscle function.

I outlined my idea for the project to Dr. Dillon and he said yes. He actually said it sounded like a good idea. I was relieved and disappointed at the same time. I had read tons of books and papers on the subject and was prepared to justify my thinking with backup material in response to any questions or arguments he might have. But none of that was needed and I was now on the Ph.D. treadmill.

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[1] Taken from Page 113 of Enzyme Kinetics, Irwin H. Segel, © 1975; John Wiley and Sons Canada.

I was asked, or more precisely, ordered one semester, to do some lectures to the undergraduate physiology class on thermoregulation and thermogeneration in mammals. More simply stated, a series of lectures on how we keep warm. The senior lecturer for the class gave me some outline material and also the types of test questions that the students generally needed to answer. Giving me the old test questions to teach from is following an old adage that goes something like, “begin with the end in mind,” and the ending for the students attending the lectures was to pass the test. So with the test questions I could figure out what to focus on and at what level. It was extremely fortunate that Dr. Adams gave me those materials because I would have made the lectures much too difficult.

Even though I was only three or four years older than the students in the class, I had had so much science crammed into my head in those additional years that I had forgotten what it was like to be a 19- or 20-year-old in a college class. So I quickly skimmed through the text Dr. Adams was using, made sure to not use much math or calculus in my lecture, and skipped the sections on uncoupling mitochondrial oxidative phosphorylation to change membrane potential and capacitance – too complicated because there is no easy way to simplify that concept. I talked instead about how there was a transfer of heat from skin to air or water or clothes and how hair is an insulator. Animals have fur but humans need clothes and this keeps our heat in. I dramatized the concept of heat loss by talking about a hypothetical mouse and elephant who died at the exact same time in the forest. They both have a body temperature of 99°F, when they die. The mouse reaches air temperature in a few minutes, whereas the elephant’s body takes a couple of days to get there. This is because of the volume to surface area. The large volume of the elephant keeps in the heat, as the small volume of the mouse loses heat fast. So a mouse needs to work harder to keep warm. I gave a simple, but still correct lecture.

I worked really hard to try and give accurate information that would eventually answer those test questions, without getting too technical. I made handouts for the students but tried to lecture with animation and energy to keep their attention. Despite my best efforts often everyone in the audience looked bored and many were asleep – it was an 8:00 A.M. class. I gave my last lecture and as usual took time for questions and there were none. I handed out the requisite surveys for the students to fill out to tell me and the university how I was as a lecturer. According to University policy a student was asked to collect the surveys and hand them in to administration. I was not allowed to see who wrote what/ or who turned them in and who didn’t. I am happy to say that apathy is alive and well, in that there were almost no surveys turned in and the one that was said that I was too technical and did not give them what they needed for the test questions. I showed the survey result (yes, singular) to Dr. Dillon and he said that it was typical. He had talked to some students in the class and the verbal feedback was good, he assured me. He said that the written feedback was often lacking because the students just wanted to leave class at that point and not hang around any longer to fill out a survey.

Even without any substantive feedback on the lectures, I enjoyed them and hoped the students did too. I rarely enjoyed a lecture myself, but maybe disliked some less than others. So I guess I could hope that the students disliked my lectures less than others’ lectures.

We were in an advanced physiology class comprised of only the Ph.D. students. While we were all friends it was a highly competitive class because everyone in it was very intelligent. The tests were grueling and the class constantly involved group discussions. A typical assignment in preparation for a group discussion would have a faculty member assigning a paper or two for us to read and be ready to discuss. The papers would be on a particular subject and we often would do background reading to understand the methods and strengths of the authors writing the paper.

It was expected that the whole class would have read the papers and be ready to answer questions from the professor. One of the goals of these assignments was to teach us how to read papers objectively and critically. There is bad research in the published literature and it takes training to spot it. One particular paper was being discussed one day and I was the first person asked to give my impression of it. The paper was trying to explain how the kidney controlled blood flow to manipulate the production of urine. Part of the conclusion from the paper was that some cells in the kidney contracted like muscle cells to control urine flow. The cells were not proven to be muscle cells though but still contracted. I felt I had spotted a bad paper and criticized it thoroughly. I said that the conclusions made by the authors were not substantiated by the data they presented and gave reasons. Almost always the whole class would have compared notes on a paper and come up with a consensus. But for reasons I do not recall, for that paper I was unable to make the consensus discussion and went with my gut impression. I figured the rest of the class would have seen the same flaws I had seen. I was wrong. For the next several minutes every other person extolled the virtues of the paper that had been presented. I was the lone person with a “bad paper” vote.

In graduate school I was taking classes with some incredibly bright students. There were two people who were veterinarians studying for Ph.Ds. and an MD/Ph.D. student as well as regular Ph.D. students. All of them were superstars in their undergraduate programs or even in their first doctorate degree. I say all of “them” because I did not feel like a superstar. But the sad truth is that in a room full of students who were in the top ten percent of their class as undergraduates the average student was in the top 5% prior to graduate school. People who have never received anything less than an A in college will get Bs in graduate school. While I was in graduate school, with each new year after the first set of grades come out, there were always some tears and fear (of failure) from people receiving their first B. Often the more senior and seasoned students would say, if you got your first B ever; “get over it.” It is a different world in graduate school. There really was no grade inflation so each class had a bell shaped curve and there were people who were aces in college now struggling to get by in graduate school. That Ph.D. degree is neither free nor easy.

The class load in graduate school is lighter than in undergraduate with regard to the number of classes. But a lot more independent study and learning is needed and the whole class scheme in general much less structured. We were often not given specific reading assignments but told to understand what was in the assignment, we were however, advised to learn about a subject on our own. An assignment might be something like, “come to the next class ready to discuss the evidences for blood circulating throughout the body.”

This meant that we would have to find the texts and papers that reported research on this subject and be ready to discuss it in class. Students would come to class with references dating back to William Harvey’s experiments in the 1600s up to and including more modern indicator dilution methods which requires injections into the blood stream and measuring how the concentrations change over time. With 400 years of research, there were lots of evidences to be discussed. So from a reading assignment perspective one would have to choose a discussion option or two and stick with it. During the class it was important to be familiar with your evidence because if no one else came up with that perspective you would have to be and act as the expert in that subject. However, by the time such a class discussion was done, we would all be very familiar with several hundred years of research evidence in that subject area. Sometimes even the faculty members would acknowledge learning factoids that they would have otherwise not known.

In my current role as a college professor, I have embraced this teaching method on occasion and used it to my benefit. There was one particular subject, for instance/for example, that I felt I needed to update myself on and know better, so I had the class prepare a general discussion on research evidences related to that subject. I would also be studying for this class as the faculty in charge of the discussion, but I also wanted to learn what the students came up with. I was banking on the searching ability of the students to help maximize what I wanted to learn. I was not disappointed in that several students had references and research evidence I had not seen before and their efforts helped me get caught up on the subject matter very effectively. As many have said before, “the best way to learn a subject is to teach it.”

In much of my undergraduate education we took classes and learned essentially everything from published texts. Those texts were sometimes several years old. In fact most information in a textbook is ten years old even when the book is brand new. Thus what we learned in our undergraduate classes tended to be information that was 20 years old or more. But in graduate school that all changes drastically. We essentially stop learning from textbooks and get our lessons from team-taught classes where experts in the field teach the lectures. We learn research methods and the latest scientific thought from scientists who are actively publishing their data in trade journals. The reading assignments we might get were those journal articles ‑again because the texts were out of date. As a graduate student it was assumed, and pretty much demanded, that we know anything that was published in the textbooks as well as keeping up with the latest trends and technologies. Information in a textbook was a foundation at best and old news a lot of the time.

I was a lab assistant in a class on mammalian physiology. The lab was focused on renal physiology, that is: how the kidneys work. A student showed me a passage in the text about how the kidney reabsorbed compounds from the urine to go back into the blood. He said that the lecturer gave a different explanation than what was in the text. The lecturer said that there were sodium and chloride pumps but the text said only sodium pumps worked in the kidney and this discrepancy made the student confused. I told him that when the book was written it was correct, but that since it was ten years old that technology had changed and that the lecturer was correct. While I was accustomed to the rapidly changing nature of science, it was his first exposure to the idea of a written text being wrong and out of date. He seemed befuddled and unsure what to believe. I said to believe the live persons, me and the professor, and not the text.

For my Ph.D. research I had to know all the literature and publications that came before me and be reading all the new ones as they came out. To be truly successful in my work towards a Ph.D. I would need to stay on top of all the literature in my field. I felt a personal defeat if someone mentioned a new technology or publication to me, relevant to my work, without me having read about it first. I knew some senior faculty who said they did not keep up with the literature because they were too busy making the literature, and maybe someday I might feel that way. But as a Ph.D. student, reading everything related to my research was a job requirement.

 The more physiology I learned, the more I realized that I needed to learn a lot more physiology. I had a reasonable understanding of applied physiology between having worked on an ambulance to help pay for college and my experience as an athletic trainer, and my bachelor’s in chemistry gave me a solid foundation in science. But the integration of these disciplines was something that needed a lot of thought and work. Physiology is the synthesis of all the body’s processes from chemistry to behavior. Taking classes and learning about the details of the inner workings of the human body became very exciting. Now I was able to understand in great detail why an athlete’s ankle would swell after it had been twisted or broken, and what the colors of a bruise meant in that athlete’s ankle. I also learned why a person in shock sweats and has a fast heart rate. I knew the facts from my previous work and now I was learning the reasons behind those facts.

We were learning about the nose. Nose physiology may be boring or uninteresting and as the pun goes, it “smells.” but the nose does more than sense odors. We learned that the membranes in the nose humidify and warm air as it is coming in. When we inhale the dry outside air is humidified and warmed to body temperature. This particular lesson was taught in late February in Michigan; so believe me inhaled air is warmed by the human nose! Hairs in the nose also catch debris and prevent solid particles from reaching the lungs. When it is cold out, if we exhale from our mouths we see our breath, which is the water condensing as it hits the cold air after leaving our warm bodies. Every kid knows that you can see your breath better if you exhale out your mouth. This is because exhaling out your mouth allows more heat and humidity to be lost as opposed to exhaling from the nose.

When I learned the difference between the air coming in the nose and out the mouth it made perfect sense to me as an athletic trainer. We have taught athletes for years to inhale through the nose and exhale through the mouth when training. Now that training lesson had a physiological reason. The air coming in through the nose was better for the lungs and was better able to cool the body. But the fastest way to release heat in an exercising athlete is to exhale through the mouth. This was a great epiphany for me, linking my previous life as a trainer to my new life as a physiologist.

I also had an equally solid understanding of muscle physiology thanks to all the athletic training and exercise physiology I had learned previously. This was a tremendous help with advanced muscle physiology, which included learning a lot about heart muscle and smooth muscle. There are three main types of muscle in humans. Skeletal muscle is the bulging leg muscles we see on football players. Heart muscle is what makes the heart contract and pump blood. Smooth muscle is sometimes called involuntary muscle, because these are the muscles we do not consciously control. The muscles of the stomach, intestines, uterus, and arteries are all smooth muscle. They are called smooth muscle because under a microscope they look smooth, whereas skeletal muscle and heart muscle look striped. There are lots of diseases of smooth muscle, and opportunities for doing research that could help people whose smooth muscle is diseased.

Smooth muscle is very different from skeletal muscle. Skeletal muscle will grow and get thicker and stronger because of exercise and conditioning. That is why those football players have big arms and legs, from the muscles that have built up in size. But smooth muscle needs no exercise to get bigger and stronger. For example the uterus; the muscular part of the womb, gets bigger and stronger during pregnancy, but not by working harder. It gets bigger because of chemical signals from the mother and the baby. So, with chemical signaling being so important, my chemistry training was important too. Arteries and other smooth muscles grow a lot too if a person gains weight or grows. I kept thinking of the athletes who took steroids to enhance muscle growth. They would get big muscles, but only when training very hard. But the uterus will grow and get stronger because of estrogen stimulation during pregnancy. Interestingly estrogen is a steroid chemical, but not a steroid like the anabolic steroids that some athletes take.

As a graduate assistant in a Ph.D. program in physiology I had to take classes, start working on a research project and help teach. My research would be with Dr. Dillon and that project was being discussed. Dr. Dillon was somewhat of an old school advisor in that he said that I was to call him Dr. Dillon until I received my Ph.D., a tradition that is coming out of favor, but not unheard of in the field. My teaching was pretty much assigned to me and the classes were all requirements for the physiology graduate students.

After a lot of discussions and reading, I asked Dr. Dillon if I could be his graduate student to work on a Ph.D. in physiology, after my masters was done. He asked me if I knew what kind of research project I wanted to do, I said yes and gave a brief outline of a thesis. He smiled and said yes.

I would still need to officially apply to the Ph.D. program and take some standardized tests, but as long as those things went ok, I would have a graduate assistantship, be able to work towards a Ph.D. and enter a field where I would be helping people. I had previously thought about going to medical school to be a physician for that purpose, but by doing research I would ultimately be able to help a much greater number of people. The athletic training had allowed me to help people and I had wanted to do research in athletic training. But that didn’t work out. Doing medical research in vascular physiology might well be an even more meaningful and far-reaching way to aid others, people who were not poised between winning and losing a game or contest, but life and death.

All of this meant that after 4 years of college and more than a year in a Master’s program in biological sciences, I would be looking at another 4 years to get a Ph.D. Nonetheless, this career direction felt right. I would end up with a bunch of degrees—a bachelors, masters, athletic training certification and eventually a Ph.D. Then I would be Dr. Joseph F. Clark, EMT (retired), BA, MD, ATC, Ph.D. As my brother said, I would have more degrees than a thermometer.

My masters went well, the research was published and I got my master’s degree in Biological Sciences. Then I took the graduate record exam known as the GRE. The GRE is divided into a general and subject test sections. I would definitely take the general section but which subject test I should take was less than clear. Because my bachelor’s was in chemistry, taking the chemistry test would be logical. But because my master’s degree was technically in biological sciences, I was advised equally to take the biology subject test. Because I could not decide, I chose to take both, in two different sittings. After I had done this, several colleagues advised that doing so was a bad idea. But when I had a chance to talk to members of the admissions committee, they saw this as a way to demonstrate breadth of knowledge. They said that scoring well in both subject tests, as well as demonstrating improvement in the two general tests, would be seen as a positive. I guess it worked because I was admitted to the Ph.D. program in Physiology at Michigan State.

While I was leaving the sports medicine world, I did not sever all connections to the paramedical or allied medical fields. I maintained my EMT certification throughout my Ph.D. studies. I also maintained my Athletic Training Certification (ATC). With my EMT certification and ATC I spent some time working in the local emergency room for extra cash. There I met a couple of interesting people. One was John McRorie, a nurse in the emergency room who was also a graduate student in Physiology. The other was a nurse named Laura Foerster, who was a law student. Laura, John and I seemed to gravitate to each other because we worked in the emergency medical field to pay for advanced education. I worked on the ambulance and in the emergency room; John was a former medic in the military and studying physiology with me; and Laura was going to law school in Lansing. We all had an edgy outlook engendered by the grim realities of life and death we faced daily to pay for our studies. We all also aspired to maximize our potential via a graduate education. The three of us hit it off and we became good friends sharing stories, and commiserating about working on advanced degrees. John and I were going to be in some of the same classes, so it looked like we would be able to study together and have some similar perspectives based on our past experiences in the paramedical fields.

Laura and I both liked to cook, so we could do tag team cooking by working together to cook nice meals on occasion. We even went to John’s house (John’s wife was Susan and they had two cute little boys) and cooked for his family. It was a lot of fun going to someone else’s house to cook and make a mess there and then not have to clean it up. Susan insisted that she would clean up after us and Laura and I let her have her say in her own kitchen.

We formed sort of a regular lunch club to meet and talk about our individual hassles viewed through the mutual prism of having survived some of the seedier sides of life. On the lighter side, because we liked to cook, on one occasion we each made cheesecake and had a mini taste testing competition. Laura won with a traditional cheesecake with chocolate raspberry glaze, but John and I ate the most, so we all won.

The following week I did extremely well on my finals. I stayed in town and went looking for another job, because I would need it to earn the money to pay for graduate school. Also, as an out-of-state student, I needed to have a graduate assistantship at the university. Otherwise my tuition would be much higher next term. I had not yet registered for my athletic training classes next term and I pretty much decided that I was not going to pursue that option. I really wanted to do research, which was difficult with Clint giving me no opportunities to pursue that interest. I also still wanted to help people, so I needed to examine my career options. However, no job, full out-of-state tuition and possibly needing to change majors was not a good place to be.

Christmas break was stressful. I was very worried about how I was going to pay for classes next term and also about what classes to sign up for. Training classes were out. I liked the exercise physiology class I had taken, and already had one term of general physiology, so I decided to take the next level of general physiology in the graduate program. I also took some research classes and an advanced chemistry class. Paying for these classes was accomplished by applying for and getting a student loan, working in a local emergency room and draining what little savings I had. I was in a serious negative cash flow due to the out-of-state tuition and lack of a graduate assistant position.

By the end of the term I had found a new graduate assistant position and enrolled in the masters program in biophysics. Well, at least I thought I had. I ended up in the biological sciences program. When registering for different graduate programs at Michigan State, you check the box of the degree program you are in. I must have simply checked the wrong box and found myself in a different program than I had intended. After talking to some people, I discovered that I could change the program I was in, for a fee, and possibly be delayed in graduating, but also could graduate on time and with a master’s degree in biological sciences without changing a thing I was doing. My graduate assistantship was in Family Practice, studying cartilage from people who have arthritis. It would involve doing biophysical and chemical measurements of the cartilage using nuclear magnetic resonance, sometimes called magnetic resonance or NMR, and it required expertise in biophysics. I was doing and learning biophysics, not biological sciences. For example the advanced chemistry I was taking was physical chemistry. However, the people in family practice did not care one way or the other, and so I stayed with the biological sciences program.

I liked the nuclear magnetic resonance project on cartilage. The surgeons would obtain human cartilage from patients at the time of a knee replacement or amputation and give it to us. I would take measurements of the cartilage and the pathologists would look at the disease process that was visible in the cartilage samples. We eventually found that the structuring of water in the diseased cartilage was too tight, thus fluids could not flow in and out of the joint correctly. This is a biophysics problem because the physics of the water had changed as part of the disease. We were not sure if this was a cause or effect of the disease, but it was there in the diseased cartilage. This turned out to be a pretty successful research project with a clear result. With this knowledge, it might now be possible to find ways to improve water structuring in cartilage. I was on my way to helping people.

The director of the nuclear magnetic resonance facility I was using, Dr. Patrick Dillon, was also one of the professors teaching my advanced physiology course. Between having a class with him and working in the lab he ran, I got to know him pretty well. Dr. Dillon was an impressive individual. As a former rugby player he was tall and well built with just a touch of gray in his short black hair.

One day we got to talking about what I would do after finishing my masters and I said I wanted to help people by doing medical research like the stuff we were doing with the cartilage. Dr. Dillon said that his research was on vascular smooth muscle – arteries. After two terms in his classes I of course knew this.

“Did you know that about 43% of all deaths in America are in part due to arteries?” he said.

I was surprised by that statement and said so.

“It is quite true,” he assured me. “Heart attacks, strokes and a lot of kidney disease are the result of the fact that the arteries are not working correctly. Most diabetics who die from the disease die because the diabetes has damaged the arteries. Heart failure is often in part due to the arteries as well.”

I let that all sink in and I could see he was right. The largest single killer of Americans is the American’s arteries and veins. Our blood vessels are the key to our health. I knew this. As an athletic trainer I could get a good idea of the conditioning of an athlete by the vascularity in his or her arms and legs. The big bulging vessels on the arms of a weightlifter or the ankles of a runner always tell me they are fit and healthy. Big healthy vessels mean healthy people.

“Cardiovascular, cerebral vascular, peripheral vascular, pulmonary vascular and renal vascular diseases kill about 1.6 million Americans every year,” he said. “If you want to help people with your research, that is a field that needs research.”

I was hooked. I did some literature searches on Dr. Dillon’s work and on vascular diseases. I talked to Dr. Dillon regularly on the subject and found that my experience in muscle physiology helped me understand arteries too. Arteries are circular muscle formed into a tube. Dr. Dillon had made an important discovery as to how arteries function. He discovered that arteries are very economical when they are working. They can contract without getting too fatigued. This is achieved by what is called “latch bridges” in the artery’s muscle. If your arm muscle could do this, you could hang by your fingers on the edge of a cliff and your arms would not get tired. Arteries are working all the time to maintain blood pressure, so it is good that they do not get tired like arm muscles do. If we could figure out how diseases changed artery function, we might be able to help some of those 1.6 million Americans.

“OK, I’ll lock up the training room. I suggest you get someone here for when practice ends.” I said. Clint hung up on me before I could say any more.

Right then one of the wrestlers came in asking to have his wrist taped. I of course obliged him and told him I had just been fired. He was so focused on his practice I think it did not fully register. I taped his wrist and told him that was my last tape job.

He walked out and I followed shortly. I left the disinfectant rag on the exam table, locked the door and slid the key to the training room under it. As I was walking away from Athletic training I kept thinking that Clint and I over reacted, but I was not backing down. I needed to study and I guess Clint needed someone to cover the Special Olympics.

I went home and started studying one whole hour in advance of my previous plans. Studying is a way of life in college. Some people study in the library. When I tried to study in the library, I would meet too many people who wanted to chat, compare notes, or ask me questions about classes, so it all ended up being a huge distraction for me. So I studied at home at the desk in my bedroom. It was quiet there and generally had everything at hand I needed to cram information into my head for class.

My bedroom window faced the main street in front of the apartment complex. There was a major intersection of an access route to I-69 and a cross street there, with a stoplight at the intersection. The intersection was pretty dangerous, as evidenced by the broken glass always strewn about from the frequent accidents. On this particular Saturday afternoon I had the window open to let in the cool but fine Michigan air. The street noise streaming in the window formed a kind of background noise that was more a comfort rather than a distraction. The cars and trucks speeding by were just white noise for me.

It was white noise that is, until I heard screeching brakes, and an explosion of crunching metal followed a dull, thunder-like rumble. I sprang to the window and could see an eighteen-wheeled tractor trailer careening out of control into the median of the on ramp and into some deep brush. Worse yet, I saw a family sedan come to rest in the road after being t-boned by the truck.

As an EMT with experience on an ambulance I knew the damage to the car was likely to have caused injuries. I bolted out the door and ran to the scene, which was no more than 100 feet from the door of the apartment complex. It was eerily quiet as I came up to the car. Quiet is good because if the car was running it was more of a fire hazard. In the distance the truck driver was getting out of the cab, obviously dazed, but walking wounded; also a good thing. In the car were two young women. The driver seemed to be trying to communicate with her passenger. No other bystanders were at the scene yet, so I asked the driver if she was hurt or trapped.

“I don’t think so. Help Carol. She’s not moving.” She pleaded.

“I can see that.”

I stuck my face in the broken window and tried to speak to the injured woman. She looked to be a high school student, maybe the driver’s younger sister. Carol was breathing, seat belted, and bleeding from her head and shoulder. Her left arm was also probably broken. I could not assess her lower extremities; legs and feet. They were wedged under the dashboard and crumpled passenger door. The truck had broadsided the car right at the passenger side door. Fortunately, and miraculously, the truck had not run over the car or flipped it over, but pushed it out of the way like a snowplow clearing fresh snow.

The bleeding from her face was not severe, but I was concerned that she might have a head and/or neck injury. I also needed to check her airway and make sure she could breathe. I was able to climb into the back seat behind her just as the driver was being helped away from the car by someone else who arrived on scene—maybe the truck driver. I told Carol what I was doing even though she was not conscious or responding to anything I said. I informed her I was going to hold her head still and monitor her breathing and pulse. I could hear her breathe and feel her pulse as I cradled her head and neck in my hands. 

Blood from multiple small lacerations, caused by flying glass, oozed onto my hands, but I was glad that I could not feel any glass in her cuts. I continued to talk to Carol so that if she regained consciousness she would not be too frightened and would remain calm. It was important that movement of her head and neck be kept to a minimum, and my hands positioned on her head and neck from the back seat of the car formed a kind of splint for her head and spine. I knew that sometimes a patient can regain consciousness after an accident like this and become agitated, which may make her injuries worse. So I did everything I could do to prevent further injury to Carol.

I could hear the sirens of the police, fire, and ambulance speeding our way. I told Carol that help would soon be here.

To my surprise, she responded.

“Okay,” followed by a long pause.

“How are you feeling, Carol? Can you feel your hands and feet?” I asked.

“I … I think so. Yes.”

“Good.”

“Where’s Sally?” She asked with rising urgency.

Obviously Sally was the driver and it was a good sign that Carol was taking her surroundings into account.

“She is talking to some people outside the car,” I told her.

Carol didn’t say much more to me as the ambulance personnel arrived.

“What do we have here?” asked the first ambulance guy on scene.

“An approximately seventeen-year-old female victim of this MVA. Some L.O.C. for a minute or two, but now conscious and responding appropriately. I’ve been holding traction since coming on scene. She claims to be able to feel and move her extremities, though I’ve not witnessed movement of her feet. Arms are moving. Pulse is rapid and strong.”

“You’re not injured?” He asked.

“No sir. Joe Clark, EMT from New York and witness to the crash; just a bystander.”

“OK. Stay put.”

I nodded.

With great speed and efficiency the passenger door was removed, and the car seat moved enough to free Carol’s legs, which she confirmed she could move. A backboard was placed to support Carol’s head and neck and I was dismissed. Before leaving, I gave my name and info to the police and walked back to the apartment. I was greeted by some of my neighbors in the apartment complex, who asked me what had happened. I told them I saw the last half of the accident and had gone to see if anyone was injured.

“Obviously someone’s injured because the ambulance is there,” Kathy from the second floor said.

“Well, yes, but I got there before the ambulance.”

“Were there serious injuries?” Kathy’s husband Steve asked.

“Cuts from broken glass, broken left arm, and maybe a head or neck injury. I’m not really sure.”

“How close did you get to the car?” Kathy asked.

“I got in the car to help.” I said as I showed them the blood on my hands. I excused myself and went back to studying; after washing my hands. I had finals to worry about and tried to not think about Sally and Carol.

We were learning how to relieve back and neck tension by back and neck cracking along with muscle stretching. Because I had a solid anatomy background from dissecting Clare, all the lessons made tons of sense to me. The muscle stretching would focus on loosening the longest and strongest muscles to increase range of motion and strength. The back cracking would stretch the ligaments and joints of the back to cause the typical “crack” that helps loosen the joint. Doing these things would relieve tissue tension and improve circulation to the region. In many joints the cartilage is thick and lacks blood vessels, so they do not get blood flow to deliver nutrients or remove cell toxins. Cracking and stretching increases the circulation in the cartilage and lubricates the joints as well. So most of the athletes welcomed this treatment. All these things seemed natural for me to learn and do; I picked up the techniques quickly. That is all but one. We learned how to crack necks, but I had kind of a mental block when it came to cracking necks. I learned how to do it, and from a technical standpoint, I could do it quite well. It made me intensely nervous, however, because I had seen my cousin’s diving accident when he broke his neck. I was one of two witnesses to Tom’s accident, which occurred when he was 18 and I was 15. He dove into the water at a lake and came up with mud caked in his hair and flailing his arms. We held his head above water as we waited for help from the shore. Anyway, feeling the joints of a person’s neck crack in my hands gave me a very disconcerting feeling, so I tried to avoid it.

Doing the stretching and back cracking was gratifying because you could see the relief on the athletes’ faces immediately. On the rare occasion where I had to crack someone’s neck, I really do not recall the relief of the athletes, because I was too focused on my own emotions and my personal angst. 

Because of my previous training and experience, I was assigned to work the men’s wrestling team and it was in a separate training room in another building. This was a hard job, with a lot of responsibility. I was working there on a Friday before finals. Finals started on Monday and I had taken more research classes than the other trainers, so my course and exam load was pretty high. Nonetheless I was doing fine with the studies. I had all weekend to study and felt that my management of work, classes and studying was going quite well. I was not getting enough time or training to do research, however. Because I was a certified trainer and an EMT, I kept getting assigned to cover sporting events as a first aid and training staff in case of injuries. There was so little time for academics and to do the research I was interested in. I was hopeful that some opportunities would present themselves eventually, especially as others of the GA trainers gained experience.

The training room was very busy because the wrestlers were getting ready for the yearly Christmas tournament and there was a lot of stress, and adrenaline and testosterone flowing to keep the athletes sharp. Because it was relatively early in the season, the patient care that was needed was mostly to keep the team healthy and to help them make weight, which is important for wrestling. Wrestlers compete in specific weight classes and they often will need to lose weight to participate in their weight class. So a kind of perfect storm of intense exercise, low calorie intake and a sweaty germ-breeding environment surrounds the wrestlers in the winter season. This is ideal for leading to infections, colds and miscellaneous other ailments for the wrestlers. Keeping them healthy becomes just as important as treating injuries.

I became intimately involved with the health and hygiene of the wrestlers. I was teaching and preaching hand washing and personal grooming endlessly. Wrestlers need to keep their finger and toenails clipped and their hair trimmed. Some of the wrestlers needed to be reminded to shave regularly and appropriately with clean and sharp razors or electric shavers to prevent facial cuts that could get infected. This type of almost paternal care brings the trainer and the team close together.

The practice was supposed to end at 6:00 P.M. this day, and I planned to be out of the training room as soon as the athletes were cleaned up. Even though it was 5:20, I was not clockwatching until 6:00 and I was not in with the wrestlers during practice. I was cleaning the training room with disinfectant. Training rooms, gyms, locker rooms and anywhere you have sweaty bodies is a breeding ground for bacteria and infections. So multiple times every week these places all need to be thoroughly cleaned and disinfected. I was wiping down an exam table that had the traditional forest green vinyl top when the phone on the cinderblock wall rang. It was my boss, Clint Thompson. Clint was a great trainer but a horrendous manager, with poor people skills and notoriously bad planning. Without preamble he informed me that I was to work all day Saturday and Sunday to cover the Special Olympics that were being held locally. I was being assigned this duty the weekend before finals and at the very last minute.

 “But finals start on Monday,” I said.

“The special Olympics are over by then. You’ll make the finals,” he responded.

“That’s not the point. I need to study this weekend.”

“Bring books,” was his terse reply.

“I simply cannot work this weekend.”

“If you do not work this weekend, you do not have a job.”

“I guess I don’t have a job then.”

“You’re fired.”

 I studied for and passed the Certification exam for the National Athletic Trainers’ Association and became a certified athletic trainer the summer before starting graduate school at Michigan State University. I left for Michigan State to join the training staff who were going to work with the football players at the start of camp for the Michigan State University football team.

When I arrived at Michigan State University I got a roommate named Tim Roe. Tim was from Montana and was starting in the athletic training program as a graduate assistant. He was tall, well built and an affable guy. I could tell we would get along great. When he was unpacking his stuff I noticed his winter gear. I knew that Michigan was going to be a cold place to live, but based on the gear Tim had packed it looked like he was ready for life in the arctic. He had a full-length parka with water resistant outer shell, a thick lamb’s wool-lined fleece and heavy hood. He also had rubber boots that looked like moon boots on steroids. They felt about ten pounds each, well worn, and with big treads. I had boots and what I considered winter coats that Tim commented looked more like spring wear. Well I guess if I needed to buy warmer clothes I was in the right place, but it made me wonder how severe the winters would be.

Tim said that Lansing, Michigan, was on the same latitude as his parents’ place back home in Montana and that they regularly got two-foot snows in one night and dozens of feet of snow each year. All their cars had winter packs in the trunk, including a “trouble shovel” to help dig you out of trouble. I had a first aid kit in my trunk. Well, I guess I needed to adapt to my environment and it looked like that would be a cold one.

Later that day I also noticed that several of the cars in the parking lot of the apartment complex had extension cords coming from the front grill. I instantly realized that these were for heaters to heat the engine block to help start the car on below-zero degree mornings. While the weather was warm those first few weeks in August in Michigan, I started to notice all the snow preparations in the community. In town, the restaurants and buildings had grilles in front of their doors to trap falling snow from the shoes of patrons. All the fire hydrants and road signs had bars sticking up from them to show snowplow drivers their location – under the impending snow. There were many little reminders around that shouted to me that this was a region used to experiencing a lot of cold and snow.

The training staff arrived several days before the players and we had to get briefed and familiar with the process before the players arrived. I was accustomed to the training system and football camp at Susquehanna University, but Michigan State University was a big ten team and their system was enormous. They had twice as many players try out for the team than they could field and a huge coaching staff including trainee coaches. I also learned when I arrived, that I was the only certified GA in the program, the only GA who was an EMT and the only GA who was not from an athletic training undergraduate program. There was a lot to learn because people were going to be depending upon me as if I knew something when I really felt more like a wide-eyed kid seeing the big city lights for the first time.

All the new guys also had to learn and perform the Michigan State University fight song at a dinner. This indoctrination was initiated by a senior member of staff announcing whose turn it was to stand on the dinner table, avoiding dishes, and sing the fight song, solo and a cappella. I memorized it, sang it, and did not sing it well, but my first test at Michigan State University was technically an oral exam and I passed.

We new athletic trainers were all issued our Michigan State University greens. The recommended attire for the sports med staff was green and white—shorts, shirts, socks, hats, jackets, sweats—everything was green and/or white. We were also all evaluated on common procedures like fitting helmets and mouth guards, taping ankles and general first aid. I could tape an ankle as well as any of the other jock stappers and some people were impressed that I could tape an ankle and without ever letting go of the tape. Many people would put the tape down to do certain steps. I, however, never let go of the tape. I got in that habit while working on the ambulance because if you put tape down in a moving ambulance it would roll away. So you pick it up, use it, and don’t put it down until you put it away. At Michigan State University we would have taping contests for fast ankle taping. I rarely engaged in those, but could match the speed of most of the other staff members, and that was largely because I kept hold of the tape all the time.

Many people wonder why taping ankles is so prevalent in the Athletic Training community. The reason is simple. The two weakest joints of the human body are the knees and ankles. Not only are these joints among our weakest, but the motions of most competitive contact sports put them under greater stress than ordinary walking or running would. The ankle is actually more complicated than the knee because it has more bones, tendons and ligaments than the knee, so it is a joint that suffers wear and tear injuries in essentially all sports. Taping the ankle provides a little support for the tendons and ligaments and security for the bones. The result is that the athlete feels more stable on his or her feet and the risk of a twisted ankle is lessened.

Athletic trainers spend a lot of time with the athletes before and after practice. We will monitor the game and some of the practices, but generally during practice we do maintenance and upkeep duties in the training room. This includes thoroughly cleaning surfaces such as training tables prone to harboring bacteria, and stocking supplies. One day there were a group of us doing this type of routine stuff and I noticed one woman was sharpening scissors. I had learned to sharpen knives at the deli and she was sharpening them just like a knife by running the sharpening steel on both sides of the scissors. A simple understanding of physics says that scissors cut with a shearing action—the two edges of the scissors force the surfaces of the material apart; where a knife cuts by slicing through the material. Scissors need two square surfaces to match up along each other. What she was doing was actually making the scissors duller. I tried to explain what she was doing wrong. She advised me that she sharpened knives and scissors like this all the time. Based on the tone of her voice, I knew I was not going to pursue the issue. I simply resolved to bring my own scissors and sharpen them myself.

We also met the team physicians. I talked to them and Clint about research opportunities and it appeared that several of the physicians had active research programs. I also received instruction in how to deal with acute injuries that required medical attention. All the teams and trainers carried first aid kits designed to manage sports injuries and the phone numbers of physicians, campus security, and the ambulance. Relatively common medical emergencies that athletic trainers come across are heat exhaustion, heat prostration or heatstroke. True heatstroke is a medical emergency that can quickly kill a young, healthy adult. In the USA one or two athletes die from heatstroke annually. Typically it is an out of shape football player in full gear training in the summer, doing two or three practices in one day.

Heatstroke occurs when the human body is no longer able to cool itself. A person who has sweated all they can and stops sweating cannot maintain the body at 98.7 °F. The body temperature starts to rise and the brain cannot work too well, so the person gets uncoordinated and confused. Unfortunately this confusion may make the person not realize how sick they have become. If a person’s body temperature reaches 107 degrees, brain damage can start and can be fatal. Trainers are taught to watch for players who are not drinking enough water, who may look dry from not sweating or who are stumbling unnecessarily. If spotted early, just rest and water can prevent any further difficulties. However, if a person goes down because of heatstroke the treatment is easy – if witnessed or found early, but it must be given quickly. The treatment is the three S’s—Strip, Sip and Spray. Strip the person to their underwear, spray them with a hose using cool water and let them sip water, but not too much. Generally this was a two or three-person job: one person to strip the athlete, one person to start dowsing with water and another to call for help. Sipping would be done as long as the athlete was conscious and coherent. Usually both the athlete and trainer were getting soaked with the hose during this episode and if the equipment was not coming off easily we were to cut off jerseys, pads or anything that could slow the cooling process.

So the sick joke that was always added to the Strip, Sip and Spray treatment was to ask the question, “What do you do if the three S’s don’t work?” Pray. So you strip, sip, spray and pray because the next step is to begin CPR. All the training staff was trained in CPR and Clint told the group that he had once had to give CPR. He recounted the story of a fan at a sports event who had a heart attack near the field and Clint did CPR as someone else did mouth-to-mouth before the ambulance came. He went on to say that the person died and he felt bad because he broke the guy’s ribs and was originally concerned that the CPR was not done correctly. I chuckled to myself because I knew that CPR almost always breaks ribs. Clint went on to say that he was assured that the broken ribs did not kill the victim, but emphasized that all the staff was required to stay current with their CPR training.

I drove my Ford Econoline 150 to the Canadian border from the New York side and entered Canada late one evening. My intention was to drive through the night to get to Michigan. I liked to drive at night because there was less traffic. I was pretty good at staying awake all night based on my experience on the ambulance and my familiarity with the over-the-counter stimulants containing caffeine, which helped on such long drives. I’d used the stay-awake pharmaceuticals during my Omaha trip and had them at the ready for this one. At the border a female border agent stopped me to do the normal security measures. I told her I was just passing through Canada and would be driving on to Michigan. She nodded and asked me to pull over and park. That surprised me because the cars in front of me all drove off, but of course I did what she asked.

A short time later the same woman came up to my van and announced that she was going to inspect my vehicle. I shrugged and handed her my keys and she indicated she didn’t want them by turning to open the door to the back of the van. She went through my bags, first aid kit and tool kit as I stood outside. Next she headed for the front seat and went through the glove box. I couldn’t see what she was doing and after a few minutes she hurried past me with something in her hand.

A more senior-looking male colleague and the female inspector came out to see me. I could tell he was more senior because he had a lot more accoutrements on his uniform.

He informed me that I had drugs and drug paraphernalia that would not be allowed into Canada and that they were going to do a complete, detailed search of the car and a strip search.

After the shock of hearing “strip search” wore off and as they kept on talking, it became clear to me that the female border guard felt that the hemostats hanging from the rear view mirror were drug paraphernalia used to smoke marijuana and the over-the-counter stay-awake pills were illegal in Canada. I was going to be there a while.

I was invited into the border security offices and led to a windowless room with a bunch of chairs and told to strip in front of three other male officers. I took off all my clothes and each article was visually inspected and rummaged through in great detail. They also told me that several people would be doing the same thing to the contents of my car. I tried to explain the story of the hemostats that needed to be returned to the Anatomy lab and that when working long hours and driving a lot of nights the caffeine pills were common over-the-counter remedies often used in the States. They were not listening. They were pulling out the lint from my pants pockets.

Once completely naked, I was told to hold my hands above my head and turn around three times. As I did this, one of the guys was pulling on the sole of my sneakers trying to see if something was hidden in them. Almost in unison the three fellows then stood, told me to get dressed, and meet them at the front desk. I got dressed and found one of the guys at the desk filling out some paperwork. I asked what I should do now and he informed me in a stern, authoritative voice that we would know when the inspection of the car was done.

I kept thinking that the last time I was in a police station like this the cops and I were having a good time talking about transvestite muggers. This, however, was much more serious. They thought I was some kind of druggie or drug runner. I knew they would not find anything, but I did not know how serious the “paraphernalia” was that they found. Would I go to jail or be sent back to the US? It seemed almost sure I was not going to be let into the country.

Eventually the female border guard came in and she looked upset, which worried me. What could she have found that made her so upset?

“We did not find anything!” she said and walked away.

“You’re not allowed to bring paraphernalia or these drugs into the country,” said the remaining border guard. “However, there are no charges for having these on your person and you are free to go.” They confiscated my “drug paraphernalia,” which was not for illicit purposes.

As I left, I realized that the Anatomy lab was never going to see those hemostats again. After all of this, however, I did not need any caffeine to stay awake. I was too afraid that someone would conclude that I was some kind of felon and re-arrest me. I was so thrilled to cross back into the USA and did not feel the miles and hours of exhausted driving that followed as I made my way to Michigan State University.

I had been strip searched and my car practically taken apart because of about 10 caffeine pills and a medical instrument that I used as a medical instrument, but others had assumed to be drug paraphernalia. The suit and tie I had brought along for my interview were taken out, rummaged through, and put back into my suitcase crumpled into a ball. I didn’t discover this until I got to the hotel and unpacked. I went to my Michigan State University job interview in a wrinkled and disheveled set of clothes because of a strange misunderstanding. I eventually figured out that the female border guard looked upset because she had assumed she would discover some serious offense like massive quantities of drugs, but did not. It must have disappointed her that I was a law-abiding citizen. She likely saw the hemostats when she sat in the front seat during the inspection and assumed them to be paraphernalia. When it came right down to it, those hemostats were there because I had planned to be a good citizen and return them to the anatomy lab. If I had decided to keep them and add them to my first aid kit (the only use I would have for them), I would not have been inspected.

Despite this inauspicious beginning, my visit to Michigan State went very well. You can be sure that when I drove back home, I took the all-USA route. Spring at Michigan State University was very pretty with lots of green and a picturesque river, called the Red Cedar River, flowing though the middle of campus. There were hundred-plus year old buildings and a nice mixture of newer construction. The sports facilities were extensive and everyone seemed to be on top of their game.

I met Clint Thompson, who would be my boss, and he was a diminutive guy with tons of experience. He was very focused on helping the athlete and the team to be able to achieve their potential, which resonated with me. He liked my ambulance and EMT training and my strong science background; including the Anatomy class. He encouraged me to complete the requirements to become a certified athletic trainer but assured me that being certified was not a job requirement. He could help me get certified as a trainer. He outlined the scholarship I would get and what would be expected over the 2 years of the MS program in Athletic training. This would include being given the opportunity to do research in athletic training and take classes on proper research methods. I said that sounded good and asked him to put it in writing and I would get back to him. I liked what I was seeing.

Even though I knew no one in East Lansing, Michigan, and had no ties to the university, I drove home feeling that it was a place I could fit in. And I told myself I could even tolerate living for two years in an icebox.

Less than a week later I got a letter of offer from Clint and the details of the offer were far better than any other offer I had. I committed to Michigan State University to start as a GA in athletic training the following fall.