Cosette Burian, PA-C, MMS, was first acquainted with the devastating effects of neuromuscular diseases as a child, when she saw her father develop progressive fatigue and muscle atrophy that refused to respond to treatment. Now, as our first physician assistant in our neuromuscular division, she’s helping patients with similar and other conditions. In this week’s “Spotlight” interview, Burian talks to us about how she was inspired to help patients with neuromuscular conditions, how the tight-knit community in her field made the switch from her native Chicago to Durham easier, and her time traveling, exploring the outdoors and practicing her Spanish when she’s not at work.
What are your current responsibilities within the Neurology Department? What does a typical day for you look like?
As the only PA in the neuromuscular division, I see return patients of the attending neuromuscular physicians. I see any diagnosis my attendings would see, at the physician request, and communicate with the physicians closely in the care of our shared patients. I hold these return patient clinics every day of the week. My clinic visits include patient care or measures associated with any academic endeavors that my physicians may be involved in, and I can be involved in research, improvement projects, and knowledge sharing in the field. I also have dedicated procedure slots to do skin punch biopsies to aid in the diagnosis of small fiber neuropathy, which is a service for which patients can be referred to our center from practices internal and external to Duke.
How and when did you first get interested in neurology? What do you enjoy the most about working with patients with neuromuscular disease?
I have been in neurology for my entire career as a PA, since 2016. Originally, I became acquainted with the neuromuscular field as a child through a personal connection to someone with neuromuscular disease. I enjoy the biologic complexity of neuromuscular disease, and the severity of the conditions that we treat, which presents opportunity for us to make a great difference in patients’ lives through treatment. Since I started in practice, the new treatments available for previously untreatable neuromuscular conditions has made the field particularly rewarding.
Can you tell me more about that personal connection and how it introduced you to the patient side of neuromuscular disease?
My dad started having progressive fatigue, weakness and muscle atrophy when he was in his mid-thirties. Despite evaluation at multiple renown academic medical centers, his condition does not respond to any treatments. He has now had the condition for nearly thirty years and is essentially paraplegic in a power wheelchair.
Growing up with a parent facing significant, progressive disability, my dream was to someday cure conditions like my father’s. As I grew older, I realized that bench lab work was not my niche—I found more enjoyment in patient interaction! Understanding how rare many neuromuscular disorders are, I figured that my childhood aspiration to work in neuromuscular medicine was kind of like “wanting to be an astronaut”---probably not going to happen. I became a PA with a passion for academic medicine (in multiple “dorky” fields!). As fate would have it, however unlikely, I have been working as a PA in academic neuromuscular centers since!
Watching a neuromuscular patient’s experience through my father helps me understand my patients’ struggles on a more intimate level, as well as helps them brainstorm solutions. It has been very rewarding to work with neuromuscular patients and on advancing the field in honor of my father. My dad is a …“congenially noncompliant” patient---I know he is proud of me, and on the other hand he probably wishes I did not understand as much about his condition as I do !!
You worked at Northwestern Memorial Hospital before coming to Duke. What was your role there, and how does it compare to here?
I went to PA school at Northwestern University. I was interviewed to be hired as Northwestern’s neuromuscular PA during my neurology rotation at the institution, which led to my previous position as the PA at Northwestern Neuromuscular. I have been blessed with a very easy transition in starting my position in neuromuscular here at Duke, as my clinical responsibilities are very similar between institutions. The academic neuromuscular field is very tight-knit, so that I had been familiar with the amazing faculty and projects here at Duke from national conferences I had participated in while at Northwestern. Many of my wonderful attending physicians at Northwestern had also shared training with my equally exceptional attendings here at Duke, so the skills and style of practice I was trained to perform are the same as well. Each program has slightly different academic focuses, so it is rewarding to be able to apply my past experience to patient care here at Duke, as I similarly gain new experience here to add to my repertoire.
What’s the biggest change coming from Chicago to the triangle? What do you miss most about living there?
There are LOTS of huge difference between life in the triangle and Chicago. My dog, husband and newly growing family previously lived for years in the heart of downtown Chicago, on the lake and river. It was wonderful to live in such a large downtown in that period of our lives. We will always keep our great memories from there, but we do not miss any of it. The nature, warm weather, decreased crime, lower cost of living and friendly pace of life here in the triangle are perfect for my family’s next stages and long-term future.
What other passions or hobbies do you have outside of the Department?
I love nature and my favorite way to spend my free time is outdoors. Outside of work, you can find me gardening, swimming, traveling, or running with my birding dog through the public hunting grounds here. My husband and I also enjoy creating artwork and speaking Spanish, our shared second language, together.