And Death Shall Have No Dominion

“Though lovers be lost, love shall not;

And death shall have no dominion.”

Dylan Thomas, 1933

The Pasatiempo magazine comes every Friday with the local newspaper’s end of the week edition—the New Mexican’s “Weekly Magazine of Arts, Entertainment and Culture.”  Needless to say, with two yearling giant sized puppies hell bent on destroying my house, I don’t get out much.  But I do like to browse the magazine.  What caught my attention today was not the local events profiled inside, but rather the advertisement on the back cover:  “An Open Letter to the Citizens of New Mexico.”  The full page ad detailed a place called Orion’s Peace Camp and Learning Center.  As it turns out, Orion Strong was a boy who attended the Peace Camp in 2005 as a seven year old.  In 2013, at his eighth grade graduation, Orion received an award presented to the student who best exemplified the concept of selfless service and for his commitment to being drug and alcohol free.  On November 10th, 2014, the ad stated that “Orion earned his angel wings after a 17 month battle with leukemia. Before he transitioned, Orion asked those who want to honor and remember him to do something to uplift the community.”  Earned his angel wings?  Transitioned?  Why can’t we just say “He died.”?   Because, as the poet Rilke said, “Der Tod ist gross.”   Death is huge.  And when it happens to a child, it is unthinkable and unmentionable.

Tuesday, October 25th would have been my nephew’s 21st birthday.  He died on August 30th while away at college, about to begin his junior year.   He was articulate, intelligent, handsome and beloved by his classmates.  To celebrate his birthday, his friends and peers gathered at a harvested wheat field near the college in eastern Washington state.  In the photographs, the wheat chaff is yellowed and lifeless against the ground and there is a roiling gray sky.  There is a storm coming—one can feel it.  His friends hold balloons, each emblazoned with a message for their lost friend. The barometric pressure rises, creating an intense feeling of suffocation. And then the balloons are gone, risen to the ether while his friends remain behind to grieve.  There is a strange light in the horizon.  It is dusk, but it seems like dawn.  And death shall have no dominion.

I am sure that two years later, Orion Strong’s family is still grieving.  And I am certain that we will be grieving the death of my nephew in every year to come as summer gives way to fall, as the leaves turn blazing colors and the nights grow cold.  There is no making lemonade out of lemons when it comes to the death of a child, a brother, a grandchild, a nephew.  We each have to do what we can—my sister will establish a scholarship in her son’s name at his college; I will go back to work to fight cancer and I will make a donation to Orion’s Peace Camp.  And I hope that my nephew’s friends and classmates will remember him and seek help if they are struggling, and lend a hand to their peers that need guidance, and that each and every one of us will resolve to be a little kinder and a little more understanding.  Death is real; death is huge, death is not a euphemism.  But let us all strive so that in the end, no matter how or when it comes: “Death shall have no dominion.”

Reason to Believe

“Still I look to find a reason to believe.”  Tim Hardin

The events of the last few days—no, the last few months—have been horrendous.  From the attacks in Paris and Brussels to the slaughter in Orlando and the bombing of Baghdad, it seems that every time we turn on the TV, or open up a newspaper, we are assaulted with more violence, more bloodshed, more hatred and more death.  At a time when we as scientists are on the brink of a new era in technology—a visit to Mars, cars without drivers, a “moonshot” to cure cancer—we as the human race seem to be backsliding into a new and darker Dark Age.  For me, the dregs of misery came when I read the transcript of Diamond Reynold’s video of the shooting death of her fiancé Philando Castile in front of her four year old daughter, on the front page of the New York Times right alongside of the story of five Dallas policeman being shot and killed in cold blood.   I could not watch the videos of either event.

Today at work one of my physicists gave me a gift.  He is Romanian and recently returned to the land of his birth.  He brought me back a photograph of the monastery at Voronet, in the form of a refrigerator magnet.  He said that in Romania, there has been a rebirth of spiritualism and faith.  The photograph is beautiful, and I later learned that this monastery is also called the Sistine Chapel of the East.  From Wikipedia, legend tells us that the monastery was built by Stephen the Great, who in a moment of crisis in his battle against the Ottoman Turks, came to Daniel the Hermit in his skete and asked for advice.  Daniel told him not to surrender the battle, but that if he won, he must build a monastery dedicated to St. George.  Stephen the Great won the battle and in 1488, dedicated the monastery with these words:

I, Voivode Stephen, by the Grace of God Ruler of Moldavia, son of Bogdan, have started to have the monastery of Voroneț built to the glory of the holy and well-known St George, the great and victorious martyr, in 6996 in May on 26, on one day of Monday, after the Pentecost and I had it finished the same year, in September, 1488.

In these best of times, these worst of times, we all need to find a reason to believe.  I believe that ALL lives matter—black lives, white lives, police lives, Syrian lives, children’s lives—all of us need to relinquish the fear and hatred that has taken over our lives and our human decency.  Like St. George, we need to reaffirm our faith, whether it be in God, or in love, or in kindness, or in our fellow human beings.   We need to do it now.   We have met our nemesis and he is us. Time is short and we have a dragon to slay.

The Disconnect

On Tuesday I did what I said I would never do.  Three years ago, as I was buying an iPhone 5, the Verizon guy was intent on selling me a $70 case called “Lifeproof,” which was guaranteed to be exactly what it sounds like—you can drop it on concrete from five feet up, a horse can step on it, no harm done, and most importantly it is waterproof.  I looked at the salesman and said, “I’m not an idiot, I wouldn’t put the phone in water!”  He smiled knowingly and said, “Women drop their phones into the toilet ALL the time.  They wear tight jeans and put the phone in their back pocket and forget about it and when they stand up, it pops right into the toilet.”  I said, “I don’t wear tight jeans and I don’t take my phone to the bathroom, so THAT will never happen–but a horse stepping on the phone is a distinct possibility!”   Thirty minutes later I walked out with my new iPhone and a $70 case.

I was so very pleased with my Lifeproof case that last summer, when Verizon informed me that I was “due for an upgrade,” I hurried into the nearest Verizon store and got my new iPhone 6, a trimmer sexier model which required—you guessed it—a new $70 Lifeproof case.  As someone who now drives her fourth Chevy Suburban, product loyalty is a big thing with me.  If I like something, the only way to pry me away from it is to give me a new one, same model, perhaps with an upgrade or two.  The last Suburban is fifteen years old and going strong at 250,000 miles.  The upgraded new one cannot hold two 700 size dog crates the way the old one can, which in my opinion is a major design flaw.  This prompted a two hour phone call to a Chevy customer service rep in India, to no avail.  No such problems with the iPhone 6 or my new Lifeproof case.  They function perfectly—no glitches.

So on Tuesday I loaded up the Suburban and headed north to Pagosa Springs, CO, a beautiful town in the Rockies which boasts some of the best trail riding around.  I was going to meet some girlfriends for a 4 day ride.  When I got to my cabin, I put my cell phone in the back pocket of my jeans while I unloaded the car.  And promptly forgot about it.  So imagine my surprise, sometime later, when I noticed a strange blue light emanating from the—well, you guessed it—the toilet.  As I fished it out, the screen gave a last little flutter of activity and then, suddenly and irredeemably, went black.  Lifeproof, as it turns out, is only waterproof if one closes the charging port, which one did not.  Twenty four hours and one bag of white rice later, I ordered my new phone.

If I was going to be disconnected, I only wish there had been a little more excitement—my horse sailed over a rocky cliff, the phone went flying into the air, and landed in the West Fork River but we survived the tumble a la “The Man From Snowy River.”  Next time, that’ll be my story and I’ll be sticking to it!

On The Road Again

On the road again
Goin’ places that I’ve never been
Seein’ things that I may never see again,
And I can’t wait to get on the road again.  Willie Nelson

 

If someone had told me even ten years ago that I would retire young and become an itinerant radiation oncologist I would have thought he had lost his mind.  As the career medical director of community based cancer centers, I was used to running the show.  And as the saying goes, I ran a “tight ship.”  Consultations were performed and documented in a timely fashion, day of the request if the situation was urgent, or within a few days if not.  The patients were given time to think about their treatment, but simulations could be done the same day as the consultation, or as soon as the patient agreed to treatment, and the new start times were never more than a week away. Patients were seen every week, or more frequently if needed.  I had the best team of radiation therapists, physicists, nurses and front office people that anyone could ever ask for.  But in early 2014, I like to say I retired.  But the truth is, I quit.

Articles about physician burnout are legion, and I have avoided adding to that literature in this blog. The truth of the matter is that we, as radiation oncologists, are a very privileged group.  We are privy to the most intimate details of our patients’ lives; we practice in a highly technical and ever changing environment which challenges us to be constant and consistent learners; our hours are regular and we are very well paid as a medical specialty.  And most importantly, we cure cancer.  What could be better?  But after thirty years in the field, I was tired.  2013 was a terrible year for me—in December of 2012 I lost a close friend, Catherine, and then my little dog Jack, and then in January my mother, and shortly after that my work partner Dr. William Spanos, the best colleague and friend a physician could ever hope for.  And in between, some very beloved patients who I had followed and treated for years.  I was done.

But a calling is a calling, and somehow, between the enchanted mountains of New Mexico and the healing hours spent on horseback and with my dogs, and the otherworldly sunsets and the pleasures of growing a vegetable garden, I needed to get back to doing what I do best—helping cancer patients.  So here I am, a “locum tenens” radiation oncologist, working for an agency, going where I am needed, for a few days, or a few weeks at a time.  On Sunday night I “saddled up” the old Suburban and headed to Las Cruces, NM to provide a little relief to the solo practitioner stationed there.

Today I saw an elderly woman who had just been diagnosed with locally advanced and metastatic lung cancer.  Despite the effects of her disease—weight loss, shortness of breath and pain—I could see that she had been and still is a beautiful woman.  I can’t cure her—no one can.  But I could promise her that I could make her breathing a little easier, and relieve the painful metastases in her lumbar spine. As I sat with the patient and her husband, I knew with certainty that I no longer had to be “in charge” or command my own practice.  I knew that I could help her.  And I knew, beyond question, that I had begun to love my profession again. For that I am very grateful.

I Want to Live With Chip and Joanna

I’ve always been a fan of home improvement television shows.  Back in Boston, watching Bob Vila’s This Old House was an obsession, considering that there were few homes in the Boston area that WEREN’T “this old house.”  In 1980, we bought our first home—an 1860’s post and beam Victorian, complete with porch and pillars.   It was a wreck.   Bob taught me to sand the old hardwood floors to a polished sheen, to install an insulated window to protect against the frigid winds of winter, to update a kitchen from the days when no one had cabinets, and to make the most of a stone and earth cellar.  He was my idol, a man who could actually fix things (quite unlike my new husband) and take the tired bones of a once handsome Victorian and make a warm inviting space for a young family.

These days, there is a whole cable television network dedicated to the proposition that behind every dilapidated homestead there is a diamond in the rough, only waiting to be polished to highly marketable perfection.  I happened upon the Property Brothers one day while I was having my teeth cleaned at the dentist.  Nearly horizontal in the chair with a headset kindly provided to distract me, and trying to ignore the scraping and picking, I fell madly in love with Jonathan and Drew Scott. These twin Canadian brothers first disavow prospective homeowners of any delusions they might have about affording the house of their dreams, and then proceed to transform a cheap wreck with the right square footage into that very house.  Nothing less than miraculous, in my humble opinion.

From the Property Brothers, I graduated to Flip or Flop.  Tarek and Christina El Moussa are real estate agents who fell upon hard times during the 2008 recession.  So they decided that instead of selling real estate, they would buy foreclosed and other distressed properties, fix them up and resell them.  I’m no television critic, but a few seasons of Christina shrieking when the bargain house turns out to have (gasp!) cockroaches, and the renovated house has (gasp!) a subway tile backsplash and dark wood cabinets—well, I guess I’m easily bored.  Although I have to admit, when a viewer who happened to be a nurse diagnosed Tarek’s thyroid cancer from her home screen—yes, I was impressed.  I watch reruns just to see if I could have picked it up myself.

But when I happened upon “Fixer Upper”, I knew I had hit pay dirt.  Chip and Joanna Gaines, a lovely couple from Waco, Texas are the real deal.  Together they find houses that are sorely in need of TLC. Their typical clients are young, on limited budgets and are full of dreams.  These two make dreams come true and they do it with compassion, empathy, minimal fanfare and great taste and impeccable style. And they do this, of all places, in Waco, Texas.

But all this is not why I want to live with Chip and Joanna.  The real reason is that these two are the parents I never had.  Their home, Magnolia Farm, is where I would have given my eye teeth to grow up.  They have lots of kids.  And horses and cows.  And goats and chickens and kittens too.  Joanna knows how to jump rope and she can do cartwheels.  Chip knows how to make every construction project a playground and he is the consummate clown, juggling eggs to the delight of their children, even when one smashes on the floor.  Their farmhouse has just the right amount of shabby chic appeal, light and bright and cluttered with the best things—crayons, coloring books, and a stray hair barrette.  They are indeed the real deal.  They are Chip and Joanna.

Since I am doing locum tenens work, and since I have always kept my Texas license, I am going to request an assignment in Waco.  And I am going to go see Chip and Joanna. I want to see firsthand the magic that puts the heart where the home is.  Isn’t that what we all want—a place where deep and true love becomes manifest in the visible tangible everyday life?  Come with me.   It’s never too late.

Gone With The Wind

I have forgot much, Cynara! gone with the wind,
Flung roses, roses riotously with the throng,
Dancing, to put thy pale, lost lilies out of mind,
But I was desolate and sick of an old passion,
Yea, all the time, because the dance was long:
I have been faithful to thee, Cynara! in my fashion.

Ernest Dowson

Having no artistic talent whatsoever myself, nonetheless I am fascinated by art, and especially by artists themselves.  My father has been both an artist and an avid collector since the ship he served on as a Navy dentist docked in Sicily, and the local artists were allowed to come aboard to sell their wares.  He still has paintings he bought in 1945 hanging on his walls.  As a teenager in Depression era Chicago, he took classes on Saturdays at the Chicago Art Institute and wanted to become a portrait artist when he grew up.   His father, my grandfather, told him to get real and learn a trade.  He chose dentistry, and only later, after going to medical school, discovered that as a plastic surgeon, he could both be a portrait artist and earn a living.

Many of my artist friends do not take commissions.  When asked why, they say that it is often very difficult, if not impossible, to reconcile their own interpretation of a subject with that of the person commissioning the work.  Fortunately for me however, some do, and I have been the appreciative beneficiary of portrait work by artists such as Stephanie Snell, Paul Doyle and Marilyn Terry.  What do these artists paint?  They paint my dogs of course.  My children and I would never be able to focus and sit still for our own portraits to be painted and besides, despite this age of “selfies”, we are far too self conscious.

A few years ago, a young man’s wife developed breast cancer at age 25.  He is a well-known video artist known as Daarken and he and his wife needed money to meet their medical expenses.  An on-line fund raising auction was conceived, with the theme stated as “Beautiful Grim.”  Beautiful, because despite his young wife’s diagnosis and treatment, she was and always will be beautiful– yet for some young women with breast cancer, the prognosis can be grim indeed.  His friends and fellow artists rallied to the cause, and many contributed original works to the auction.  I am a friend of Daarken’s sister, and I followed the auction with interest.  In particular there was one painting that I kept coming back to, that no one was bidding on.  It was a portrait of an African American woman, beautiful and naked, except for her long stockings which were peppermint striped, red and white. Her hair was a tangled wild mass of curls against her beautiful skin. When no one else bid, the portrait was mine.

Over the years I have become very friendly with the artist and his wife, who shall be unnamed because of the personal nature of this anecdote.   They visited our home this past summer, and we commissioned a work of art.  The assignment was intentionally vague—“just paint something you see in New Mexico that inspires you.”  A few weeks ago the painting arrived, a full 4’ X 4’ landscape entitled “Sombrillo Vista.”  It is as beautiful as I had hoped, and emblematic of the New Mexico I have come to love.

When I called to offer my sincere gratitude, the artist’s wife said, “You know, just after he finished your painting he received another commission—a most unusual one!  A man called and said he wanted a portrait painted of his ex-wife. He is still in love with her and wants an oil painting to remember her by.”  Apparently he had sent a few snapshots of his ex along with his request.  Always a romantic at heart, this struck me as both somewhat insane, but also a true romantic gesture.   I said, “Send me a phone pic of the work in progress.  I want to see the woman who inspired this act of unrequited love.”  She did.  The woman was indeed beautiful, and playful, and mysterious all at the same time.  I said, “Well if the ex-husband doesn’t like the portrait, let me know because I will buy it.”

Shortly after our conversation, a photo of the unfinished work was sent to the hopeful ex-husband.  He liked it a lot, but he felt that it was not quite there yet.  He had some advice for the artist– he said, “Just think—complex and Mona Lisa eyes with a dash of mischief and you’ll nail it!”  I laughed and said, “Now that should be simple.  You know, just be Leonardo da Vinci.” The finished portrait was unveiled to the good patron last week who promptly proclaimed, “It gave me goosebumps!”   The man likely needs a good therapist instead of a portrait of his ex.   But let us be clear:  he has been faithful to her, in his fashion.  And my artist friend, well—clearly, he NAILED it!

My Night At the Opera

“Was that a high C or vitamin D?”  Groucho Marx as Otis P. Driftwood

Okay, I admit it.  I am a Philistine when it comes to opera.  I can’t help it.  I grew up in Houston, Texas when the acquisition of central air conditioning was a cultural zenith.  Houston, back then anyway, didn’t have opera.  It had swamp coolers and mosquitos.  It wasn’t until I got to college, and had a boyfriend from New York City, that I was invited to go to an opera—a real and very famous opera, “La Boheme”– in a famous place, The Metropolitan Opera House.   My boyfriend was well versed in the genre but neglected to give me one important piece of information—the fact that the opera would be sung in Italian.  For three hours I watched fabulously costumed singers with enormous voices waft slowly around the stage, living their Bohemian lives, building towards the climactic scene when Mimi, stricken with tuberculosis, gives her final aria, and final cough (complete with fake blood) and dies right there on stage.  I was premed and into medical realism.  She was far too fat to die of consumption and I said so.  End of boyfriend and operatic opportunity.

Fast forward forty plus years, and here I am in Santa Fe, New Mexico which boasts of having one of the finest opera houses, and opera seasons in the world.  My husband had never been to an opera, and so when he noticed an ad in our local paper for tickets forty per cent off for newcomers to New Mexico and the opera, he said, “Let’s go!”  We chose a night—last night—and an opera, “Rigoletto”, dressed up and headed out to what is surely one of the most beautiful outdoor venues in the Southwest.  We settled into our $150 per ticket Row Y seats just as the overture was starting.  After I snapped a quick phone shot of the opera house from inside, what looked like a teleprompter on the back of the seat in front of me warned me to turn off my phone, and I was thrilled to see that by pressing a button, I could read the libretto in English.  The only thing missing was the forgotten set of antique opera glasses I bought years ago on Ebay—you know—just in case I ever needed them.

Thirty minutes into the first act, Rigoletto comes home, and is fussed over by his daughter Gilda who undresses him, and helps him into a limp white garment that resembles a bib while both are singing loudly in perfect harmony.  Just as Gilda hit her high note, I heard a single muffled cough from the woman behind me, and suddenly there was a sensation of wetness on the outer aspect of my left ankle. Momentarily distracted, I glanced down my leg, thinking, “I hope that isn’t blood she coughed up,” but it was dark and the music was loud and the air was dry and caught up in the passion of the song, I quickly forgot about it.  That is, until the curtain went down and the lights went on, and the woman sitting to my left said, “Are you alright?”

I said, “Thank you but of course I’m alright—that was the lady behind me who was coughing.” Undeterred, she looked at my silk clad pants leg, and my purse sitting on the ground beside it and with a quick motion, gestured to the now empty seat and floor behind me, which was covered in vomit that had been slowly dripping down the concrete stadium wall to engulf my purse and my left shoe.  Abruptly standing, I announced to my husband that “we have to go NOW!” and once in the lobby, holding my purse delicately in front of me as exhibit A, I barreled past thirty or forty well dressed women waiting in line for the bathroom, shouting, “I don’t have to use the toilet—someone threw up on me and I need that sink RIGHT THIS MINUTE.”  The line in front of me parted like the Red Sea.

Now I am a doctor with three kids, and trust me, that was not the first time I have had a close encounter with throw up.  But winding my way back to the lobby to find hubby, I realized that I was not going back to my expensive seat at the sold out performance.  In fact, I probably was not going back to the opera at all, ever.  My husband who generally adores music was relieved.  He said, “I have discovered tonight that I really don’t like opera.”  Like I said—I am a Philistine.  You can have your Boheme and your Puccini and your high soprano operatic notes amidst shouts of “Bravo!  Brava!  Bravissimo!”   But for me—just give me the down dirty raw and emotional Broadway production of “Rent.” Without side effects.  Sorry, opera fans!

Live Long and Prosper

I was sitting at lunch with a friend today when she leaned over to check her phone messages and discovered the sad news that Mr. Spock, sometimes also known as Leonard Nimoy, had passed away due to complications of chronic obstructive pulmonary disease.  She looked up at me and said wistfully, “He was my first girlhood crush.”  To which I replied, “Mine too.”  In 1966, while my thirteen year old contemporaries swooned over the mop headed Beatles, I was madly in love with a guy with chiseled features, a low pitched but perfectly modulated voice, and above all, pointy ears.  I found him irresistible.

Some girls want a boy who will bring them candy hearts on Valentine’s Day and flowers for their birthday. Others prefer a tougher nut to crack.  To Spock’s adoring fan girls, he represented the latter, the “strong silent type” whose deep human emotions lurked well behind that cool Vulcan exterior. Secretly we all believed that we were the one, and of course the only one, who could penetrate Spock’s personal deflector shields to get to that emotional reactor core.  The challenges would be great, but so would be the rewards. Since Spock was significantly older, and entirely unavailable, we turned our attentions to the dark quiet boy in the back row of math class who sat scowling at his paper, pressing his pencil lead so hard into the paper that it snapped off.   He was no Spock, but he would have to do.

My girlfriends and I have hopefully long outgrown our attraction to emotionally unavailable men–candy hearts and flowers are most welcome these days.  Leonard Nimoy tried for a time to outgrow his identification as Mr. Spock, even titling his first autobiography “I Am Not Spock.”  He became a writer, a director, a poet, a photographer, and even at times a very bad singer, but despite his many accomplishments his admiring Trekkies continued to flock to Star Trek conventions to get a glimpse of the man with the pointed ears.  In later life, Nimoy embraced the character that made him famous—when you have become a cultural icon, resistance, as they say, is futile.

What is it now, nearly fifty years later,  that still draws us to the Vulcan mindset, where war, and rage, and yes, even passion were considered “highly illogical?”  Perhaps it is a longing for a simpler world and an earlier time, where each one hour television episode had a story with a beginning, an ending, and a moral and no one had any trouble figuring out who the good guys were.  Spock stood at Captain Kirk’s shoulder as a moral compass, a conscious reminder to put thought before action and to behave ethically towards all species.  We could all use a little Spock these days.  Leonard Nimoy, you will be deeply missed.

Medicine at the Crossroads

 

        “When you look for the bad in mankind expecting to find it, you surely will.”    Pollyanna

 

I try not to spend too much time on Facebook, but it’s always been a good way to keep up with “friends” in the Scottish Deerhound world.  The deerhound, being a rare breed, tends to link people across the country, and indeed the world, who have similar interests.  Lately though, the deerhound people haven’t been discussing dogs much.  Instead, they’ve been discussing their terrible experiences with the world of medicine.  One owner described being admitted through the emergency room of her local hospital for stroke-like symptoms.  By the evening of her second day of admission, she complained that she had not yet been seen by a physician.  Another complained that a family member had just been diagnosed with Type I diabetes, but was initially given an appointment with an endocrinologist in six weeks—completely unacceptable in this situation by any standard of care.  I am of course compelled by pride to speak up and defend my profession, but not without an increasing sense of embarrassment for what used to be considered a noble calling.

After I published my piece on the fatal shooting of Dr. Michael Davidson, I was contacted by Carey Goldberg, reporter and co/host of CommonHealth (http://commonhealth.wbur.org/) and asked what struck me the most about the nearly 200 comments left on the essay when it was picked up by KevinMD.com.  Here is what I replied, “There were several reasons that Dr. Davidson’s death hit me particularly hard, even though I never met him.  One reason was that I trained at the Harvard teaching hospitals, Beth Israel for Internal Medicine and MGH for Radiation Oncology, so this hit close to “home” especially with my daughter being there.  But more importantly, I come from a medical family–grandfather was a dentist, father (now 89 years old) is a world renowned plastic surgeon–and in my lifetime of 61 years, I have seen the sad decline of public affection and respect for physicians.  When I was a child, people would stop me on the street to tell me how wonderful my father was.  Now, when I sit in on conversations among people who do not know I am an MD, I hear nothing but derision if not outright hatred.  There are many, many more people, as evidenced by the response to my blog piece, who feel slighted not only by “the system” but also by their physicians.”

And why not?  Articles such as this, http://www.nytimes.com/2015/01/30/business/medicare-payments-surge-for-stents-to-unblock-blood-vessels-in-limbs.html on the front page of the New York Times continue to erode patients’ faith in their physicians to “do the right thing.”  Patients despair when they cannot get appointments to see their doctors in a timely fashion and when they are seen, that their doctors don’t spend enough time with them or explain things to them.  They despair over the cost of care in increasingly difficult economic times. But doctors are in despair also, at the ever increasing bureaucracy of medicine, the insurance conglomerate which makes documentation, authorization and billing a nightmare, the takeover of large segments of medicine by for profit corporations and the heightened expectations for positive outcomes fueled in part by misleading advertising by those same corporations.  Many have come to feel that the sacrifices, both personal and economic, that they made in order to go to medical school were just not worth it.

I do not pretend to have any answers to the multiple crises that contributed to the death of Dr. Davidson, or the current climate in which doctors and patients must function.  I wish I did. But I do have a request for both my patients and others, and my physician colleagues, as well as my Facebook friends and the media.  Let us try once again to see the good in one another again, and not just the bad.  We’re all human, and at some point we are all going to get sick.  For better or for worse, we depend on one another.

In Memoriam–Dr. Michael Davidson

In 1994, I was working at my first radiation oncology job in San Diego at Grossmont Hospital when I came into work to hear disturbing news.  One of my colleagues in medical oncology, a compassionate man known for his gentle nature, had stayed late at the Cancer Center the evening before to finish up paperwork.  With his back to his ever open door, he sat at his desk never once considering that he was in danger.  A disgruntled relative of a former patient surprised him from behind, and beat him viciously over the head and body causing broken bones and contusions, and leaving him for dead.  He managed to call for help, and he survived after spending two weeks in the hospital.  He returned to his practice of treating cancer patients after a long convalescence—after all, it was his calling in life.  He died many years later, suddenly at age 69.  I do not know if that beating years earlier contributed to his early death but the knowledge of it certainly changed my life.  I worked late, and was alone in many offices at night after that, but I remained cautious and vigilant about security, never again taking safety for granted.

Yesterday I got a hasty text message from my daughter, who is a second year internal medicine resident at Boston’s Beth Israel Deaconess Medical Center.  She told me that a doctor at Brigham and Women’s Hospital, a fellow Harvard teaching hospital, had been shot at work and that the hospital was on lock down.  She didn’t know how much was in the news yet, but wanted to let me know since I had trained and worked at these hospitals.  I was as shocked as she was, but I should not have been.  The doctor, Michael Davidson, was a highly respected young cardiovascular surgeon—a rising star in his career, and a husband with three children at home.  The gunman, having sought out Dr. Davidson, fired two shots at close range before retreating to an exam room and taking his own life.  Dr. Davidson was given immediate medical attention by his colleagues at his own hospital, one of the top trauma centers in Boston.  He died of his injuries late last night.  As it turns out, the shooter, Stephen Pasceri, had no history of violence and his gun was licensed.  But he did have a history of dissatisfaction with the “medical system” and sadly his mother had been a patient of Dr. Davidson’s, and had passed away two months ago.  Not much has been said in the news about her, but such is the nature of cardiovascular surgery—these doctors do not operate on healthy patients and not every outcome is successful.

When I visited the Hope Institute in Jamaica in 2013, I saw many patients dying of cancer, without the benefits of affordable chemotherapy, state of the art radiation therapy and even without a readily available supply of morphine.  But I did not see anger, in the patients or their relatives, who were cared for under the loving guidance of Dr. Dingle Spence.   Here in America, quite the opposite is true: we have come to believe that every disease is curable, that every outcome should be positive, and that death, in the words of Dylan Thomas, shall have no dominion.  Most of us, however do not take to the wards fully armed, looking for our doctors. Today I am in despair for his wife, for his children, for the surgical residents he would have taught, and for the thousands of patients that Dr. Davidson could have helped if his life had not been taken.

When we graduate from medical school, we take the Hippocratic Oath, which in the modern version not only exhorts us to heal the sick but to exhibit warmth, sympathy and understanding.  Let our patients and their families extend those same traits to us as we complete our daily rounds.  Let our clinics and hospitals be places of healing, and not of killing.  Please, please let us do our jobs.

Addendum January 22, 2015.  This was submitted by a colleague in the Comments section but I want to bring it forward to the actual page.  Please take the time to read and consider signing.

Dear colleagues,

The violent death in Boston of Dr. Michael J. Davidson, an inspiring cardiac surgeon who devoted his career to saving lives and improving the quality of life of every patient he cared for, is a senseless and horrible tragedy.

There was an incident in the past where a patient at a VA hospital made a threat to shoot a physician.

VA physicians are federal employees. Federal employees have enhanced legal protection against violence. The threat of violence toward a federal employee by itself is illegal. Police officers were able to conduct an investigation and speak with the patient. Once the patient understood that the threats could lead to prison, the volatile situation was defused.

Laws protecting federal employees against violence provide an additional tool to help direct an individual away from violence. Unfortunately, this protection does not extend universally to all healthcare providers.

The White House has a “crowd-sourcing” system where the executive office reviews proposals with at least 100,000 signatures obtained within a 30 day period.

http://wh.gov/i220E asks that the legal protections against violence currently provided to federal employees be extended to all healthcare providers.

While no law reduces risks to zero, our effort would be well worth the energy if it could prevent even one senseless death.

Please take a moment to sign this petition, and consider spreading the word. Everyone can sign this petition including your friends and family.

Thanks.