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.

The Face Of Hope

With special thanks to Dr. Dingle Spence.

Thirty three years ago my husband and I went to Jamaica for a belated honeymoon.  We got married on the last weekend of my internship year, and immediately flew back to Boston for me to start my second year of internal medicine training.  Seven months later in the dead of winter, we flew to Jamaica to a lux resort in Ocho Rios where I spent a blissful week drinking sweet rum laced drinks and sleeping them off on a white sandy beach where the water was warm and turquoise, a far cry from the sodden gray snow banks of Massachusetts. We managed to get into the town once, long enough for me to buy a wood carving of two lovers kissing, made from Lignum Vitae, the national tree of Jamaica.  The sculpture still sits in the window by my front door.

Two weeks ago I finally had a chance to go back to Jamaica, as the invited guest of Dr. Dingle Spence, radiation oncologist and palliative care/oncology specialist at the Hope Institute, a small cancer hospital run by the Jamaican Ministry of Health.  I was there for two working days, spending the first at the large urban Kingston Public Hospital, a 500 bed hospital which houses the only government funded radiation oncology unit on that side of the island.  In the morning we did teaching rounds with the ear, nose and throat surgical team, along with the residents and medical students.  Patients and their families waited outside our conference area and were brought in one at a time, to be examined and questioned by the team such that each had our full attention. Several patients had advanced disease, and I learned that one major problem is that the pathology department is overwhelmed with cases from all over the Caribbean, and that oftentimes it takes two to three months to get a pathologic diagnosis.  By that time, many cases have progressed so far as to be incurable with the resources at hand.  Still, the dedication of the team, and in particular that of the head surgeon Dr. Natalie Whylie was very apparent and heartfelt.

That afternoon, I had the opportunity to see several patients with Dr. Spence—all with various forms of advanced lung cancer requiring radiation to palliate symptoms of shortness of breath, and hemoptysis—coughing up blood. Simulation at Kingston Public Hospital is done the old fashioned way—by taking an X-Ray with markers on the skin in the approximate area of the tumor, then shifting the “field” to match the tumor accurately. On that day, all of the X-ray machines in Radiology were in disrepair, and non- functional.  We escorted the patients to the Emergency Ward, where the radiology tech told us that the ER was too busy, and that we would have to come back later.  All three men, quite ill from their cancers, took a seat in the waiting room without food, water or complaint.  Three hours later, when we were called back to do the simulations, they were still there.  We simulated each in turn, then escorted them back to the radiation department, where they waited some more until it was their turn to be treated on the Cobalt machine later in the evening.  The therapists work 12 hour days on that machine, and we left before those patients had their turn.  After a short visit to the private radiation oncology facility in Kingston, where cash paying patients can be treated on a linear accelerator, we returned to Dr. Spence’s home high up on Jacks Hill.

The second day was spent at the Hope Institute.  Founded in 1963 by the Jamaica Cancer Society, the hospital has grown to 45 beds, for patients receiving chemotherapy and radiation and for end-of-life hospice care.  Since patients frequently travel long distances for cancer care in Jamaica, beds are often used to house patients for prolonged courses of treatment.  The wards had clean crisp linens, and the smells of fresh cooked meals in the large recently modernized kitchen wafted through the rooms.  The nurses had an air of easy familiarity with their charges and the atmosphere was upbeat, despite the fact that many of the patients were gravely ill.  I was asked to lecture on several subjects, and given an air conditioned auditorium and three hours which I doubted seriously that I could fill.  As it turned out, the nurses, therapists, residents and students who attended felt comfortable enough to ask questions, and a home cooked midday meal helped pass the time quickly.  My old Resident’s Manual, given to me at Massachusetts General Hospital in 1982 and carried with me for over thirty years as a souvenir, was a major source of interest, because it contained information pertinent to the treatment of patients with the equipment that is available to cancer patients in the public sector of Jamaica, equipment that has long been abandoned or replaced in our own country.

The thing that struck me the most about my experience in Kingston was the fact that despite the human suffering that I saw, in a country short on both technology and morphine, the patients remained hopeful and even cheerful in the face of extreme adversity.  I asked my host, Dr. Spence, how this could be, coming from the land of complainers, myself chief amongst them. She replied, “Most people in Jamaica have a deep faith.  They truly feel that they are in God’s hands, and what will be, will be and only God knows best.”  As I watched her move from bed to bed, giving comfort to the dying with only her soft voice and her cool touch upon their feverish foreheads, I realized something that sometimes I have forgotten in my excitement over the technology that I have available every day, without even thinking about it.  In the end it’s not about the technology at all.  For the most desperate among us, it’s about faith, and about love and human kindness.  For this reminder, I will be forever grateful.