Alumni Feature:

Jessica Greenwood

There was genetic counseling…and there was sports administration. No joke. Those were my two options coming out of undergrad. As a Biological Sciences major at North Carolina State University, I stumbled upon the field of genetic counseling through my mentor, Dr. Wendell McKenzie, who is notorious for being one of the field’s best recruiters. It was my “professional” option. My “what you’ve worked for” direction. And then there was the seemingly random, totally unrelated to my major, left field route of continuing my volunteer work with the Council on Athletics and getting a Masters in Sports Administration. I had already been offered a free ride at NC State to do so, and getting into a Master’s Program for Genetic Counseling is, as you know, hard. I applied to only four programs, thinking -- vainly and with way too much reliance on kismet -- that if I didn’t get in anywhere, it was a sign. Of course, the Universe approaches my life with much more care and humor than that, so I got in to my top two choices. Ummm…yeah…now what?

I’d like to say there was some extensive decision-making process or that I ultimately experienced a profound calling that led me to become a genetic counselor, but the reality is I caved. I loved sports, and a significant part of me wanted to follow in my grandfather’s footsteps to become a Division I Athletic Director. But, I had spent my entire academic career pursuing science. I was good at it. I generally liked it. And genetics genuinely fascinated me. It was like a math problem that actually made sense, not that advanced calculus crap, but basic arithmetic type math. Carrier + Carrier = 25% chance to be affected. Always. (Imagine my frustration when I learned about reduced penetrance!) So, I became a genetic counselor.

My graduation present was a job. An amazing job. But one I started two weeks after graduation because I was poor and scared that they would say no if I asked for more time. This job still lives in my “dream job” category because it allowed me to do a little bit of everything. I counseled prenatal patients two mornings a week, worked on building a national registry of patient recruitment sites for an anencephaly research initiative, and developed courses and taught in the University of South Carolina Genetic Counseling Master’s Program. I was mentored by people like Dr. Bob Best and Janice Edwards, who, like Nancy, are icons in the field of genetic counseling. They were patient with me, but they pushed me, and that is an ideal combination. Unfortunately, I was employed because of a large NIEHS-funded grant that suddenly and unexpectedly disappeared and after a few months it became clear that my job was likely to do the same.

At the time, I was in a long-term relationship and convinced myself that moving was not an option. There were no genetic counseling jobs available in my area, so I started applying with a liberal interpretation of my skill set. I finally landed a job as a Clinical Research Coordinator and quickly got promoted to Clinical Research Manager when it was determined the previous Manager had been stealing from the practice. As you might guess, I had no idea how to be a Clinical Research Coordinator, much less a Clinical Research Manager, but I was curious and learned quickly. I was also largely empathetic to the physical suffering of the patients with rheumatoid arthritis, osteoarthritis, and gout who participated in our research studies. These were not conditions that I learned about in school. Very little of what I did during that time had anything to do with core Mendelian genetics, but almost everything I did had a lot to do with genetic counseling. The 18 months at this job, where I cried in the parking lot in the morning trying to convince myself to walk in the door, taught me how to be a genetic counselor. It taught me how to leverage every one of the skills outlined in our core competencies and that the content of my counseling was not the crux of my counseling.

I eventually weaseled my way into a clinical position at one of the two local hospitals when they finally expanded their prenatal team. For the next five years, I worked various part-time schedules and at every one of the hospital’s main and satellite locations. I worked with patients who were the wives of NFL football players and patients who brought me squash from their farm. Those who couldn’t speak a lick of English, and those who spoke four languages fluently and switched into different languages during the session (true story). This diversity is what kept the job interesting. It’s also what allowed me to expand my counseling continuum. I had to flex to meet their needs, so I developed the ability to counsel a 16-year-old in leg and arm chains from the local jail followed immediately by the principal of an affluent high school. Because of the size of our hospital and its varied resources, I also had the opportunity to grow and stretch outside of traditional prenatal counseling. When Expanded Carrier Screening (ECS) came onboard, our reproductive endocrinology team asked if we would counsel preconception patients considering IVF about ECS. And when one of our MFM’s took it upon herself to train in laser therapy for Twin-Twin Transfusion syndrome and create a Fetal Care Center, there was an opportunity to join the team. One of my favorite books is called “What Would You Do With a Chance?” This job was all about chances, and I took every one that came along. It was one of these chances – setting up a Grand Rounds presentation on the latest technology, non-invasive prenatal testing (NIPT) – that led me to my next chance. Industry.

I became the Lead Medical Science Liaison at one of the “big four”, what we lovingly called the four competitors that duked it out from the beginning to become the leader in NIPT. I built a team of genetic counselors across the country, a team I lovingly refer to as “the Dream Team”, because they were, and we set off to educate some providers on why they needed to start drawing blood on everyone. We were trendsetters, pushing the envelope of the standard of care. We were defiant in our resolve to have NIPT become available to all women, regardless of age, because the data was solid and we believed our technology was sound. This start up environment was, well, insane. I worked all the time. I was on an airplane all the time. My phone became an extension of my hand. And I loved it! I will forever be grateful for this chance. It taught me to be bold, to think big, to carefully select who you go in to battle with, and to be resolute in your desire to work with and for exceptional people.

But, like all good dreams, this one came to a natural end. Our now not-so-small start-up was acquired by an oh-so-big biotech company and the “battle” had become less about the data and technology and more (or all) about cost. I was tired. I was also in love with a man who literally goes off to battle and whose country dictates where we live, so I said goodbye and took another chance for a job that paid more to travel less and allowed me to move with my soon-to-be husband. Smartly, though, I didn’t leave empty handed. During the year I worked for that big biotech, I used their generous continuing education stipend to complete a Certificate Program in Digital Health Communication through Tufts University. I knew how to talk to patients in person, and I knew how to present to providers over dinner, but I didn’t really know how to communicate with either via the internet or social media.

As luck would have it, that job that paid more to travel less wasn’t a great fit. In fact, it was another one where I did a lot of crying and a lot of convincing. To the point where my husband finally told me to quit. Quit?!? But what would I do? I wasn’t ready to go back to traveling, and not only was it unrealistic for me to look for a clinical position in our small military town, but while I missed patients, I did not miss direct patient care. I finally got over myself and asked for help. I called my mentor. I called other genetic counseling colleagues. I called my instructors from the Digital Health Communication certificate program. And I took another chance. One of those instructors happened to work for a company that was looking for a consultant to translate some in-person training for nurses to a web-based seminar series. The topic didn’t have anything to do with genetics, in fact, it was even more relevant. Medical Interviewing, essentially the basics of genetic counseling. I could do that. And so I became a consultant. Three months later, I quit that not-such-a-great-fit job and established my own business – JPHG Consulting (now JessG Consulting).

In the four years since, I have amassed a broad and varied body of work. I take contracts that interest me or where I think I, specifically, can help the company. Sometimes I take contracts because we could use the money or because my husband will be gone and I’ll have time on my hands, but I never take a contract out of desperation or obligation. It’s a luxury, I know, and a choice. I could make more, work more, do more. But I could also spend more time with my kid, not hate what I do or how I’m being asked to do it, and feel proud of who I’m working for and what I’m doing. Through my work, I’ve copy edited a book, managed social media for a podcast, written all of the copy for direct-to-consumer genetic testing reports, blogged about patients’ experiences with PGT, and been on the Dr. Phil show. The work has been interesting and, at times, challenging, and the flexibility has been invaluable.

And then 2020 happened. 2020 has been a landmark year for all of us. The COVID-19 pandemic has changed the way we practice, the way we play, the very foundation of who we are as people. For me, though, the pandemic has been the backdrop to the seismic shift in my own foundation. In February, my mother was diagnosed with metastatic cancer. She had a mass the size of a football in her abdomen, a hip socket that had almost disintegrated due to the cancer eating through it, brain mets in her temporal and parietal lobes, and polka dots all over her lungs. How we got there without recognition of these things is a story for another day, but the reality was she was going to die. Intense chemo was predicted to give her 6 months at best. She declined. Instead, she did five radiation treatments on her brain mets and hip. The intent was purely palliative.

My mother had had cancer before. Ten years prior, when I was still a young counselor, she had uterine cancer. I found out in the recovery room after her “routine hysterectomy” when a surgical oncologist greeted me to explain that her “lymph nodes were negative and margins were clearly differentiated.” Fortunately, that time the therapeutic hysterectomy was effective at treating the cancer. This time, the question of whether this was a recurrence or a second primary loomed large. I leveraged all of my cancer genetic counseling knowledge (limited to what I’d taken from NSGC meetings over the past 10 years and my cancer GC classmates) to lobby for genetic testing. Mom didn’t meet criteria. I didn’t care. After consulting with the genetic counselor at the world-renown institution where she was being treated, I ultimately talked her through submitting a saliva sample to Color via Zoom. I was with her when we found out she did not have a pathogenic variant in any of the genes tested. I cried for the first time. She asked me why I was upset. I laughed.

This experience reminded me of all of the patients who needed me when I was a clinical counselor. Not wanted me, because Lord knows they did not want to be in my office, but needed me. My mom needed a genetic counselor, and fortunately, her daughter was one.

My mother passed away on May 31st.

Over the summer, as I moved my family to a new base in a much bigger city (fortunately), and as I started to process my Mom’s illness and passing, consulting started to feel not enough. I did good work, necessary work, but I began to question whether I was doing meaningful work. Being the patient again, or more precisely, the patient’s daughter, had rudely and inconveniently reminded me of how awful that seat is, how painful, how terrifying, how lonely. What was I doing to help people like my Mom? And what was I doing to help people like me, her daughter? With the encouragement of a husband who has lived this journey with me, I once again called my mentor, called some genetic counseling colleagues, and took a chance by contacting the person who pioneered the field of advocacy for genetic diseases. I just wanted to pick her brain, to see if this might be a direction I should investigate. What started out as a mere exploration became a job offer. I am now proudly the Director of Exploration for the Genetic Alliance.

I am always grateful for the opportunity to tell my story, not because it’s extra-ordinary in any way, but because I learn something new from it each time I give voice to it. I hope that’s true of your story, wherever you are in your career journey. I hope you will ask for help when you get stuck from those you know will give it and from those you just wish would. I hope you will explore the full breadth and depth of your skills as a genetic counselor – reach, stretch, play, refine – and have confidence that you can learn on the fly even when you have no idea what you’re doing but need to make it look like you do. I hope you will have the opportunity to build or join your own dream team. Genetic counselors make excellent colleagues, choose them whenever you can. I hope you will listen to your husbands, or wives, or mothers, or anyone who loves you and believes no job is worth being miserable. I hope you will take chances every chance you get. Becoming a genetic counselor was a random, uninspired, safe choice for me, but being a genetic counselor has been everything but.