Brendan Riordan, MS, PA-C is an Assistant Teaching Professor on the faculty of MEDEX Spokane. He joined his MEDEX Spokane colleagues in January 2021 and he hasn’t looked back. A second-generation PA, Brendan’s path to teaching includes stops working in pre-hospital and transport medicine in New York City, graduating from the PA program at Hofstra University in New York, completing a post-graduate training program in Critical Care Medicine at Emory Healthcare in Atlanta and working there in Cardiothoracic Surgical ICU, giving up on the humidity and crossing the country to the Pacific Northwest, continuing his clinical work as an intensivist in the Cardiothoracic Surgical ICU at the University of Washington Medical Center in Seattle, guest lecturing for MEDEX and finally getting the nod to join MEDEX fulltime.
MEDEX Magazine: Let’s start from the beginning, shall we?
Brendan Riordan: Okay. So I was born and raised in New York. I’m the youngest of four boys. My dad is PA, in fact. I think he was part of the 2nd or 3rd graduating class of PAs out of Stony Brook University on Long Island. He graduated in 1974. So I’ve known the PA profession since birth. He started in emergency medicine, then he transitioned into pediatric cardiothoracic surgery, and then into adult cardiothoracic surgery, and then eventually to adult cardiac surgery critical care, which is ultimately where I ended up starting my career. I used to go to the hospital with him all the time. From the beginning, for as long as I can remember, it’s all I wanted to do.
MM: Healthcare was it for you.
Brendan: Yes. My dad used to run the Advanced Trauma Life Support [ATLS] course for New York City, and I used to roleplay as a patient. I would get all moulaged up and pretend to be a kid who got hit by a car. I knew my lines so well that I could tell what kind of job the physician had done.
MM: That’s so interesting. And what a great way to make good use of ‘adolescent who knows everything’ energy, too!
Brendan: Yeah, exactly. There was a fair bit of precociousness in this young adolescent who was telling the doctors how to do medicine! In retrospect, I don’t think 10-year-old kids should know what a Battle sign is!
MM: As you look back on it, do you really think that you were aware of being on this path even then?
Brendan: Yes I do. I accrued thousands of hours volunteering in the hospital from the time I was 13. Then I majored in biology in college, pre-med. But at the end of four years of biology, I felt like I did not want to be in a classroom anymore. All of my classmates were taking the MCAT and applying to medical school, and thought, “I can’t imagine doing this for another four years.”
MM: And where were you in school at this point?
Brendan: Catholic University in Washington, DC.
MM: Oh, okay.
Brendan: I decided to do some volunteer work instead. I moved to a small village in Zambia called Mpanshya, and found a hospital there that was willing to put me up and let me just, you know, be there.
MM: You had no professional title at that point?
Brendan: No, and no real formal training in anything, really. I lived at St. Luke’s Mission Hospital for eight months. I volunteered in the lab, collecting blood samples from kids, running HIV tests, tuberculosis samples, malaria slides, all that. I worked in the dispensary, too, giving out medications.
It was a small village, very remotely populated. But not everyone could get to our village. Nobody had vehicles or anything. So everything was ambulatory. Once a week we would go out to one of something like five clinics around the region. We would do a general medical clinic, we would do an antiretroviral clinic, we would do an under-5 clinic. People from the local villages would bring their kids there. We would arrive with a little scale that we would hang from one of the thatched roofs to weigh the kids, then manually mark them on a growth chart to make sure that they were meeting their standards. And we would give the families nutritional packs that they could use to supplement their food intake.
MM: Sounds like a potentially life-changing experience.
Brendan: It really was. And the thing was, I wasn’t affiliated with any organization. Through a complex network of friends and colleagues I would up finding this tiny hospital in the middle of nowhere that would let me experience a life so different from my own. I did a letter-writing fundraising campaign and got enough money to buy airfare, eight months’ worth of living expenses, and a metric ton of vaccinations in my arm. I didn’t have any particular things that I was required to do, you know? I was there to experience as much of it as possible. I was living right there at the hospital in the village with the people, eating the same food that they were, just trying to embrace the whole of it. I wanted to see what pure medicine looked like,? Not what we see in hospitals here, with all the bureaucracy and insurance and forms.
It was really quite inspiring. It shook me to my core about what I wanted to do with my life. At that point I was like, “Well, maybe I should go to medical school.” But I was having a hard time deciding between becoming a PA or a physician. I came back home and started working in EMS as a volunteer, a volunteer firefighter and an EMT. I got an advanced certification as a Critical Care EMT which allowed me to start learning more complex medicine.
MM: Were you back in DC? Or up in New York?
Brendan: This was back in New York, out on Long Island. And I loved it. I loved the adrenaline. I loved being able to pop into a crisis and try to make it better. I didn’t get into PA school the first time around because I had applied to a couple of programs pretty much on the last day of the cycle and all the seats were already full. So then I applied to a local school, Hofstra University, and was accepted..
MM: And what year was that?
Brendan: I started there in September of 2011. And at that point, I was working in EMS for a large hospital called North Shore-LIJ It’s now called Northwell Health. It’s one of the biggest hospital organizations in the world now. It services all of Long Island, New York City, and parts of Connecticut.
MM: That’s a lot of people!
Brendan: Then I started working in the New York City 911 system in Queens. And that was, well, quite an experience, as you can imagine. I got into PA school and continued to work, but I switched over to dispatching. I worked in emergency communications and learned how to take 911 calls. It’s almost like being an air traffic controller, but for the ambulances covering this huge catchment area.
MM: Sounds like very demanding work. And what about school?
Brendan: Don’t tell my current students, but I kept working during didactic year. I would go to school Monday through Friday, then do 12-hour overnight shifts on Friday and Saturday, then sleep Sunday and do it all over again. It’s a system I would recommend to absolutely no one. But while I was in school, I absolutely fell in love with the heart, loved everything having to do with the heart. I aced all my cardiology exams. I was successful academically across the board, but there was just something special about cardiac stuff.
MM: That’s interesting. And a bit poetic, really, “something special about the heart.” And did that remain the case for you? Is the heart still your thing?
Brendan: Oh yeah. As I was finishing up school, I had done my elective in surgical critical care and really loved it. I asked my dad, “Should I do critical care or emergency medicine?” He said, “Do critical care because that is the hardest thing that you can do. And if you can do that, you can do anything.” So, I applied for and got into a post-grad program at Emory Healthcare down in Atlanta.
It was a wonderful experience. One-on-one attention. I got to rotate through every subspecialty of critical care for a year. I spent three months in neuro ICUs. I spent a month in the heart failure ICU, one in cardiac surgery ICU. Got to do anesthesia and go to the OR and do intubations. Got to rotate with infectious disease, which was pretty special because Atlanta has one of the highest prevalences of HIV in the country. And the hospital that I was working at specifically had a HIV clinic.
Some of the ID attendings that I worked with became quite famous that year because that’s the year when Ebola hit, in 2014. I was still at Emory when the first Ebola patient arrived there. I knew some of the nurses who were assigned to the communicable disease unit.
Brendan: I also met some of the patients who had Ebola. One of them was a physician who had been working in Africa.
MM: That’s interesting, these sort of connecting circles being drawn around your life and your training and your experiences in Africa.
Brendan: Yes, yes exactly.
MM: So going to Emory sounds like it really paid off for you. And then what?
Brendan: Well, I was at a sort of crossroads at the end of my residency. There were a lot of openings I was well qualified for and a number of directions I could have gone. But I was still really thinking only about the heart, so I had two opportunities. One was to work in the heart failure ICU, which had a great team. It was a day shift, but they didn’t really do critical care. The other option was for me to work in the cardiac surgery ICU. That was on nights, so I’d be by myself and make more money. Ultimately, I decided that I wanted to take care of the sickest patients in the hospital, which was by far in the CTICU. I was going to take care of ECMO, and heart transplants, LVADs, all these highly complex and fascinating patient pathologies. And I just soaked it all up.
I did that for a year. But after that, I found that I couldn’t live in Georgia anymore. It just wasn’t for me. I was working nights. The weather was so humid and brutal during the summer. It just wasn’t my scene. So I started looking all around the country for where I could go next and continue to do this same sort of clinical stuff. I landed myself in Seattle. Like Atlanta, I moved here without knowing much about it.
MM: Yeah, it sounds like someone who puts a random pin in the map and then goes there.
Brendan: Yes, that does seem to be the way that I do things! And that’s the same way I ultimately ended up here in Spokane! But first I stayed in Seattle for five years. I worked in the cardiac surgery ICU there.
Brendan: At University of Washington Medical Center — Montlake. And it was during that time that I managed to cross paths with MEDEX folks, and then started guest lecturing for MEDEX classes, which was a really positive experience.
MM: What years are these?
Brendan: That would’ve been 2017, 2018, around then.
MM: And what topics were you covering in your lectures?
Brendan: Cardiac stuff and shock, stuff within the emergency medicine course. And that’s where I met [former MEDEX faculty member] D.J. Smith. D.J. was my first contact with MEDEX, and he’s the one who really got me set up. And then Ky Haverkamp [another former MEDEX faculty member] took over from D.J. when he left.
I wanted to come back to lecture the following year, but then everything went topsy-turvy with COVID, and I couldn’t do any of the lectures anymore. But people told me that I was a gifted teacher, that I really was passionate about my topics. They were like, “You gotta teach.”
I wanted to do it. But I was just trying to find the right time to depart from clinical medicine. Originally, I was going to split my time in half, continue my clinical job half-time and then teach for MEDEX half-time. But then one day D.J. was like, “Do you have any interest in Spokane? Because they need somebody in Spokane, like, yesterday.” I’d never been to Spokane! I knew nothing about it!
MM: Another pin in the map!
Brendan: Yes, standard procedure for me. But I did a little research. I looked closely at the cost of living because I realized I was never going to be able to afford to buy a house in Seattle, or have a job that I wouldn’t have to, you know, basically work my tail off to afford living there. And so I accepted the job offer at MEDEX Spokane and began fulltime here January of 2021. I bought a house sight unseen! Never even been in Spokane before, but purchased the house online.
MM: And how have things been panning out here?
Brendan: It’s great. I couldn’t be happier.
MM: What are the things that you like about it?
Brendan: I’ve sort of been a victim of what I do for a living in the sense that I’ve needed to be in a city because that’s where the big academic tertiary and coronary cardiac surgery programs are gonna be. And so that’s meant living just outside of New York City and then in Washington DC for college, and then Atlanta, and then Seattle. Now I was like, okay, I can settle down in Spokane. It’s cheaper here, it’s quieter here. I live about 30 minutes north of the city. I’m practically on the last street of suburbia, a very quiet street. Once you go north of me, there’s nothing except an open field. I have a family of deer that visit me every night. I keep them and a menagerie of wild birds well fed.
MM: So that’s all good, yes?
Brendan: Oh yeah. It’s so quiet. There’s no street traffic, there’s no sirens, there’s nothing but nature.
MM: Nice. And how’s working with MEDEX?
Brendan: I really love it. You know, sometimes Spokane doesn’t have the best reputation, especially coming from the perspective of Seattle. You know what I mean? “It’s on the other side of the state, it’s basically an extension of Idaho, it’s not diverse, it’s predominantly red politically, not progressive,” all of that. People here were like “Why on earth do you wanna come to Spokane?” But you know, I said to myself, “What better way for me to actually put into action the things that I believe in? Go and advocate, go and create a safe space for members of society that are often rejected in this part of the country. Try to make things better.”
MM: And that’s really part of the MEDEX mission, isn’t it? It seems that what you are describing is embedded in the long-term mission of supporting and improving and expanding access in rural medicine. It comes with the territory, so to speak.
Brendan: Exactly. And honestly, I am so impressed with the students here.
MM: Tell us more.
Branden: Well, you know, lots of programs claim to be primary-care-focused, and rural-focused, but then most of their students graduate and go into specialties like orthopedic surgery! I was actually pretty skeptical when I learned that MEDEX requires a four-month family medicine rotation at one site. I was thinking, “Oh, aren’t the students getting robbed of other clinical experiences?” But honestly, I am astonished by how many of my students come back from these rotations and go, “This is what I want to do for a living.” And they are. They’re taking jobs in primary care.
And now I’m interviewing applicants who are coming from these rural places. I read their applications and they’re saying, “We didn’t have a healthcare provider where I grew up.” You know? And things like, “The first time I ever felt acknowledged was by a PA.” So, these people, these students, they’re graduating from this program and actually living out the MEDEX mission.
When you look at the societal factors that have led people to wind up in one place or position or situation – and I preach this all the time about minoritized people and people from underfunded cities – when you come out here and you look closely, you quickly see that a lot of this is about rural poverty. Many of these people really haven’t been given a leg up on anything. You start to see the lack of access to healthcare in rural communities. And well, it’s turned this suburban boy into someone who notices and appreciates that rural hardship. I come in here from Seattle and people are like, “Oh, here’s this lefty blue liberal,” you know? And I’m like, well yes, I certainly have opinions on things that might not line up exactly with my students and other faculty members, but I’m also able to bring my own perspective that they’ve never experienced.
I went on a recruiting trip recently out to Montana in the Fall. I spent five days driving around central Montana, meeting people from these rural communities, listening to the issues that are facing them, and I’m saying to myself, “I need these students in my classroom.” I think past me had a limited definition and understanding of diversity, and now I recognize how important that our classroom is diverse in as many forms as possible – including geographically.
We are struggling with getting applicants from Wyoming, this giant underpopulated place with a severe lack of providers. And so, we went down to a career conference in Laramie, and we were telling people about the PA career path and hopefully giving them an alternative to thinking that they could only go to medical school, right?
Brendan: I really want my classroom to have everyone in it. Just like I want my students to come from Seattle, I want them to come from Wyoming and Montana, too. And I want them to come from tribal communities in the area. I want them all to be here in the same physical space so that we can learn from each other and hear out our different perspectives.
MM: It sounds like you are speaking of a renewed faith in the potential of this work, and that you’ve found your place here, your professional place.
Brendan: I’m thinking of one student I have right now whose family immigrated from Mexico and now live in Washington up near the Canadian border. I remember interviewing him, and his telling me that there are no Spanish-speaking providers in his home community, even though it has a significant Hispanic population. His goal is not to stay here and work in Spokane, but to get this degree and take this knowledge back home. And that’s exactly what I’m talking about: the Spokane campus serving as a hub where people can become qualified and capable PAs and take it back to where it is needed.
What I find truly remarkable too is how many people apply only to this program and even only to this campus. They’re like, “I’m applying to the MEDEX Spokane specifically. I’m not interested in going to any other MEDEX campuses, and I’m not applying to any other programs.” And this is usually because they have been in contact with or have been taken care of by a MEDEX Spokane grad, you know? They like the focus on rural healthcare. They want to stay in this area. They want to go back to their home community.
MM: Is your father still a practicing PA?
Brendan: He’s not. He retired a couple years ago.
MM: What is his take on what you’re doing, and on what you just told us?
Brendan: Well basically every time I talk to my dad now, he starts crying, because he’s so proud of what I’ve become.
MM: Nice. He didn’t go down the education route as you have.
Brendan: No. He and I, we are so similar in so many ways, but we are definitely different too. He spent 40 years practicing clinically. He just wanted to put his nose to the grindstone and be the best for his patients and teach anyone he could find. He wasn’t interested in the formality or the administrative side of things.
MM: It’s not hard to understand that approach, really.
Brendan: No, it’s not. But I think that in some ways he sees me as the antithesis of that. He sees in me and my work some things that may have gone unfulfilled from his perspective, things that I’m able to do.
MM: The old yin and yang. What a nice feeling that must be, for you and for him.
Brendan: You know, he came to my office recently and I found some words of encouragement he had written on my whiteboard. He can be a bit terse, especially when it comes to emotion, so it just says “Good Luck” – but that translates roughly to “I can’t quite put into words how proud I am of you.”
MM: Brendan, thank you for taking the time to help us get to know you and your work for MEDEX a little better. Is there anything else to add before we stop for today?
Brendan: Well, I guess I want to say that it is very important to me to make sure that my students know that they can be themselves here, with me and in this setting. This plaque behind me says “This is a safe space to be who you are.” It is designed to be a message to the LGBTQIA+ community, but I hope anyone who sees it feels that they can be themselves here.
Right next to it is a lighthouse, which is an extraordinarily important symbol for me. It’s my sign of stability in rough seas. I talk very openly about my own mental health struggles with my students, and I think they really appreciate that. It makes them feel that that they can speak openly and safely. I hope to be a beacon to all those out on the stormy seas of life who are looking for safe harbor.
MM: Super important stuff, Brendan. They’re lucky to have you on board.