NDD: Guest Intro, Jaime Shoup, MD

Ethan Intro Monologue: In this segment, Jaime and I talk about his professional background, and then we transition into a little bit about his personal background.

Ethan: Today, joining us for our discussion, we have Jaime Schoup, a child neurologist in his 5^th and final year of training at the University of Louisville. I have known Dr. Shoup since the beginning of medical school. We both went to Louisville together, hung out quite a bit, studied quite a bit, didn't study quite a bit, but I've always respected Jaime. He is a very curious, compassionate [1:00], objective, down to earth, intelligent, and open-minded so I wanted to have him on the podcast because I know we can have good discussions and disagreements and appreciate the nuance that is a reoccurring theme with my guests. Dr. Shoup, why don't you tell us a little bit about your professional journey?

Jaime: Really it started when I was growing up. My mom was a special education teacher and just seeing the different neurodevelopmental conditions in her classroom and wondering what was going on, it seemed like an incomplete picture. And, she tried her best to provide teaching to these kids, but it always seemed like there was something missing. So I wanted to figure out ways of helping. I went to University of Kentucky for chemical engineering with a thought that I would go into biomedical engineering, but [02:00] ended up not wanting to just be doing equations all day and wanted to interact with people. So, decided to go to medical school. The 1^st year in medical school, shadowed Dr. Vinay Puri, an excellent child neurologist at Louisville, and fell in love with the field, and it's been a passion of mine ever since.

Ethan: Did you always know that you wanted to do neuro?

Jaime: I always knew that the brain was something I wanted to go into, yeah. It was complex, plenty of fodder for thinking for the rest of my life.

Ethan: At what point did you make the decision to not go into engineering? Was there any pivotal moment, or what happened?

Jaime: It was actually within the 1^st semester of engineering. I did my first engineering class and was like, ‘Nah, I can't do this for my whole life.’ Luckily, the prerequisites for medical school overlapped, so I just figured, hey, I'll [3:00] continue with this. If it doesn't work out, I can always do chemical engineering and do biomedical, but luckily it did.

Ethan: What about in high school? Did you have any other career aspirations?

Jaime: Actually for a couple years I wanted to be an astrophysicist, went thru a brief period where I wanted to be a chef, but realized I'd have to cook for other people instead of myself, and figured that sucks. So, decided on engineering after that. The first thing I wanted to be was a big cat veterinarian. I thought Cheetos were really cool, going out to the Serengeti and picking up big cats and healing them would be a really cool job. But, it turns out I'm allergic to cats. That did not work out in my future.

Ethan: Obviously, you didn't have enough cat exposure at a young age.

Jaime: That's what it was. That's exactly what it was.

Ethan: Tell us a little bit about where you're at and then what are your plans moving forward?

Jaime: I'm gonna be doing an epilepsy fellowship at University of [4:00] Louisville as well, and then I've signed on to join Norton Children's at UofL, at the Autism Center, where I'll be doing research, some epilepsy, as well as treating kids with autism.

Ethan: If you could go out tomorrow and do anything that you wanted to do, your ideal job, what would that look like? No restrictions at all.

Jaime: It would be to be an autism doctor and have a large component of research, have a laboratory where I can do experiments on benchtop research as well as translational, so that we can push the envelope in that regard 'cause there's such a pressing need with that population.

Ethan: Absolutely. So what causes autism?

Jaime: That's why I gotta do the research.

Ethan: Jaime and I have had a lot of conversations about potential causes of autism. There has been a lot of [5:00] media publicity over the last 20, 30 years on whether or not vaccines contribute or if some of these other environmental toxins are what, “causes autism.” And, I think the general consensus that we have come to, it's a similar theme to a lot of causes of different complex disorders, it is very multifactorial, likely a combination of genetic conditions, environmental factors, as well as cultural and societal factors. We were just talking about whether or not the lack or the decrease in interpersonal communication or social interaction, whether that be through learned behavior, a more psychological perspective, or just the lack of transmission of different internal components. You know, when you interact with anybody, you [6:00] exchange information of some sort genetically, virally, bacteria. There are so many different exchanges that take place in everyday conversations that we don't think about. And Jaime, you kinda said that you feel like, as a society, we've demonized germs.

Jaime: I do. While germs cause disease in a certain regard, bacteria play an immensely important role in just normal human functioning. We have 10x as many bacterial and fungal cells as we do human cells. Our gut is lined with thousands and thousands and thousands of them. Our skin is covered in them. We're reliant on these bacteria and fungi to create barriers for us and to be part of our immune system. So how babies come into this world and learn how to [7:00] cope with that kind of microbial environment is essential to how our bodies learn to cope with the environment going forward. Higher rates of autoimmune conditions and higher rates of hypersensitivities that go with kind of a sterile environment, potentially point to disordered immune system learning that I think also affects our neural development.

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Ethan: Jaime, tell us a little bit about your personal journey in life. What do your parents do? What was your family life like?

Jaime: My mom is a special education teacher, and that's where I, you know, learned to interact with kids who have neurodevelopmental conditions and people who just think differently, have different brain processing capabilities. And it gave me a big appreciation for the differences amongst people and how to care for them in a [8:00] compassionate way and try to optimize their life, 'cause if we can help all of the people around us, our society thrives much better.

Ethan: Yeah, what else?

Jaime: I have a family, 3 beautiful, healthy kids and my wife, Taya, who I met in medical school. I've been able to watch my kids grow and develop and get more of an appreciation of that aspect of life, while simultaneously treating kids has been, I think, immensely formative for me.

Ethan: Do you ever get caught up in seeing your patients in the light of your children and maybe have a little bit more emotional attachment?

Jaime: That's always the struggle. Certain rotations during residency were more challenging for that reason. Pediatric ICU is some of the hardest cases that I've seen and it's hard to go [9:00] home after seeing parents in shambles 'cause their kid is critically ill, and then seeing your own kid and thinking, ‘Hey, that can easily happen and you just hold them a little tighter that night.’

Ethan: Yeah, the mind is able to produce a lot of ‘what ifs.’ After that shooting at the bank in Louisville a couple of months ago, I went to the coffee shop with my not-quite 1-year old. I went inside and I put him on the table 8 feet from where I order my coffee, and as I put him on the table and walked up, immediately I had this wave of thought about what if somebody walked into here right now and started shooting? It's crazy what our minds are capable of and also the influence of all of this information that we're exposed to. How many thoughts did you have about the [10:00] submarine?

Jaime: Yeah, a lot of thoughts. It's a complex subject. I wouldn't wish that on anybody, but there were some questionable decisions made to forgo certain regulations and use like what, a PlayStation remote, to try to navigate that thing. Maybe that could have been handled better.

Ethan: But the point is, how many thoughts did you have about that and how many of those thoughts were you trying to have? Did you just keep getting bombarded by your mind or your subconscious, ‘Hey, what about this problem that's out there that doesn't have any impact on your survival or anybody that you know or care about really?’

Jaime: Yeah, I'll be honest, I thought about it, but it almost seems so far removed from myself that I didn't delve too much into it. I deal with so many other people's problems on a day-to-day basis that I think sometimes I don't [11:00] pay attention to the news as much as maybe I should, cause it's stressful. The world's stressful and we're in this kind of connected system where you can see the ills of the world more than you can see the good in it. And I think that leads to somewhat of a hyper-amygdalated state. It leads to further inability to feel socially connected.

Ethan: The hyper-amygdalated state, I like that. The amygdala is your fear and anxiety center of your brain, logs all of those experiences that you have. 100 years ago, we could even 1,000 years ago, your amygdala would mostly respond to things that you have directly witnessed, but now, I can pull open my phone, and I can watch a series of 100 straight short clips of people having near-death experiences. And what that does to my amygdala is, I don't have to directly experience it [12:00] firsthand, I can experience things secondhand and have the realization and recognition, due to consciousness. It makes it to where we can imagine so many possibilities, and that can be good; that can lead to innovative ideas and innovative thoughts and potential to do great things. But, it can also lead to a state of paralyzation because you're constantly thinking about not only everything that can hurt you, but also all of those things that you thought about doing, that would be a good idea, that would be pro-survival, that you didn't do. And then you feel guilty about it.

Jaime: And it also leads to a desensitization. The more that you get exposed to a fear-provoking response or super-pleasurable response, the more you become desensitized to it over time. I think that plays a role in maybe what we are [13:00] motivated to do when we hear about a fear-provoking response

Ethan: Did you grow up with any siblings?

Jaime: I have 2 sisters. One who's 1.5 years younger, and then one who's 10 years younger.

Ethan: What do they do?

Jaime: My 1.5-year younger sister, Jasmine, Jazzy, is an elementary school teacher. And then my 10-year younger sister, Angelique, or Angel, right now is nannying.

Ethan: What about your dad?

Jaime: My dad is an interesting guy. He worked in a mattress factory for about 5, 6 years and then decided that he wanted to go back to college when he was in his 40s, for horse track management. There were 2 programs in the country, one was in Tucson, Arizona, the other was in Louisville, Kentucky. We had family in Tucson, so we moved to Tucson. He got his degree and then we moved to Kentucky so that he could get into the horse track industry, worked [14:00] there for a couple years and then decided he didn't want to do it anymore, so now he's just taking care of the family.

Ethan: What are your hobbies now? What do you like to do outside of medicine?

Jaime: I enjoy drawing, painting, writing poetry, cooking, gardening, hanging out with my kids, that takes up the vast majority of my time.

Ethan: Oh man. Do you ever find yourself at work just thinking about getting home and just like seeing, I mean, it is so fucking special.

Jaime: It is.

Ethan: For your kid’s face to light up when you walk in, and I know that's not gonna happen forever and I wanna hold onto it for dear life.

Jaime: It is. It's very special. There's an innocence to just their expression. It's like they're not trying to get anything out of you when they're just saying, you know, ‘I love you, dad. Hey, come here, see this, look at what I'm doing.’ [15:00] And it's, ‘Ah, this is special. This is what life's about.’

Ethan: What do you and Taya like to do?

Jaime: We, man, take care of kids. That's most of what we do.

Ethan: It goes from like a marriage to a team.

Jaime: Yeah, exactly. You're like two coaches… Sleep when we can. In shifts. No, we liked going to concerts and seeing live music. I think seeing live music is an experience that, it's hard to replicate otherwise, and I miss that, so I can't wait to get back to being able to do that.

Ethan: Any type of art, whether that be movies or forms of entertainment or picture art, Nobody is telling you how to feel about it. People may tell you certain things about it, but how you experience those things is not dictated by anybody else.

Jaime: Absolutely. That's actually one of my favorite parts of drawing. I tend to have more of an abstract type [16:00] of style because I want the viewer to interpret it their own way, which I think is a unique expression of itself. You go into the projections of somebody's mind different depending on the person. And I think that speaks to, you know, a collective consciousness that is meaningful… And I think telling…