Think Like a Toxicologist

Finding clarity under pressure

I help oversee a poison-control team in a safety-net hospital in downtown Minneapolis that manages 60,000 calls each year across Minnesota, North Dakota and South Dakota. I’m responsible for quality assurance, staff training and clinical guideline development, ensuring our advice is accurate, evidence-based and compassionate. But at my core, I’m a clinician who loves solving toxicology puzzles — the kind that turn confusion into clarity, and sometimes even save a life.

This mindset helped our team unravel one of the most haunting and tragic cases of my career: a thallium-poisoning homicide.

I sat for the Diplomate of the American Board of Applied Toxicology (DABAT) exam, the highest certification for a pharmacist in the field of toxicology. Only about 150 people in the country have ever passed it. The test is legendary: two days, 10 hours, covering everything from antidote pharmacokinetics to rare heavy-metal poisonings. To prepare, I spent a year studying “Goldfrank’s Toxicologic Emergencies,” a 2,000-page tome.

On exam day, the first session was six hours. Around hour five, my brain hit a wall. I’d memorized everything from cyanide to colchicine, but the details started to blur. Then I heard my own inner coaching voice — the same one I use with trainees — say: “You don’t have to know it all. You just have to think like a toxicologist.” So, I wrote what I knew, outlined my reasoning and explained how I’d verify it. That mindset of clarity under pressure was the key to finishing.

A few months earlier, this mindset helped our team unravel one of the most haunting and tragic cases of my career: a thallium-poisoning homicide. Thallium, a toxic heavy metal once used in rat poison, has long been banned because of its high toxicity and potential for misuse. A patient’s unexplained hair loss became the clue that led to testing, an FBI investigation and the identification of the poison. It reminded me that our work can uncover truth and even lead to justice being served. In this situation, it meant trusting my instincts and following a line 
of reasoning that initially 
seemed improbable.

When I passed my exam and was now what we call an “ABAT,” it marked not just a professional milestone, but a direction for the future of my work. My next goal is to expand our inpatient toxicology service at Hennepin County Medical Center. My hope is that the same steady, evidence-based guidance we provide over the phone can one day support patients at the bedside, because in toxicology, the right response in a crucial moment is everything.