When Brian Unwin took a much-needed vacation with his wife, Cyndy, to Ireland last September, little did he know the emotional and physical challenges that awaited him upon his return. Unwin, professor of internal and family and community medicine at the Virginia Tech Carilion School of Medicine and geriatric medicine specialist at Carilion Clinic, has treated many people over the years who were very sick, but when illness struck him, the doctor was forced to be the patient.

“I was scared,” he said. “There’s no other way to put it.”

Unwin will share lessons learned along his recent health journey and wisdom from 32 years practicing medicine when he gives the keynote address at the medical school's 11th annual commencement ceremony on May 4.

"I’m not going to get better without some help"

While on vacation, Unwin contracted COVID and was sick for about two weeks, but that turned out to be the least of his challenges. He then developed a bowel obstruction that persisted and kept getting worse.

“I was nauseated and very bloated,” he said. "They drained three liters of fluid from my stomach because it couldn’t empty. I thought, 'I'm not going to get better without some help.'”

He was sent to Johns Hopkins Medicine for a specialized surgery to treat tumors and other conditions in the pancreas, small intestine, and bile ducts.

“It was scary and life-changing. This was pancreatic cancer until proven otherwise,” he said.

Unwin spent 39 days in the hospital – 39 days of thinking he might have one of the most aggressive and deadliest cancers. But in the end, he did not have cancer and may have been experiencing a rare complication of COVID.

“I didn’t have an answer to the cancer question until the day I was discharged from the hospital,” he said.

“Dr. Unwin navigated this illness similarly to how he approaches his patients, their loved ones, and their caregivers – with love and thoughtfulness,” said Jon Sweet, the medical school's chair of internal medicine. “While humbly acknowledging fears and uncertainty, he dealt with this trial with true ‘Unwinian’ humor, grace, meaning, faith, and appreciation of others.”

Before the illness, Unwin was considering scaling back professionally. The illness made that decision for him, and he now practices medicine on a reduced schedule.

Embrace the negative

The first lesson Unwin will offer to graduates dates back to the 29 years he spent as a physician in the U.S. Army. “Embrace the negative” has a much more colorful Army vernacular, but the message is the same.

“The lesson is that life hands you things that are really bad sometimes, and all you can do is embrace it and do what you can to wrestle and overcome it. You’ve just got to do what you’ve got to do,” he said.

A second part to this lesson involves the mythological character Sisyphus, who was cursed to spend eternity rolling a boulder up a steep hill because he angered the gods and tried to cheat death.

“Sisyphus is a metaphor for the act of carrying our burdens, our narratives, ” Unwin said. “When we became doctors, we agreed to try to cheat death. Instead, we need to honor the patient’s burden – whatever that narrative is – and accept the fact that we’re not going to cheat death, but we can help the patient in their journey.”

The narrative speaks

Several years ago, Brian and Cyndy Unwin started a narrative medicine course, which has developed into an online creative journal for all of the school's students, residents, faculty, and staff to explore humanism in medicine. Brian Unwin encourages his students to write personal narratives as a way of handling the stress of being a doctor.

Unwin suggests he maintains his happiness as long as he reflects and shares.

He will ask the graduates, “How does your patient’s narrative intersect with your own? “Self-reflection will make the work much less hard.”

By sharing his own story of survival, Unwin hopes the graduating students will realize that while they may not know their final destination, they are well-equipped for the journey.

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