Who We Really Are

When I was a resident in radiation oncology, I thought I already knew a lot about medicine.  After all, I had just completed an internal medicine residency, and had taken and passed my boards.  Needless to say, I was more than a little bit irritated the first time a patient “coded” in the radiation therapy department and I was shoved out of the way by the intern on the code team.  After all, he was an internal medicine intern at the World’s Greatest Hospital, and I was a lowly radiation oncology resident. My protestations of “I can HANDLE THIS!” were lost in the general hubbub of excitement and confusion surrounding a cardiac arrest.  The patient survived, despite my bruised ego.

I found out very quickly that I didn’t know much at all—in fact, I didn’t know how to write a proper history and physical.  On my first rotation, my attending corrected my very first sentence, stating emphatically that “Mr. So and So is NOT just an 86 year old Caucasian male who presents with lung cancer. He is an 86 year old retired firefighter and grandfather of eight who presents with lung cancer.  There is a big difference.  You will see!”  From that point on, I was charged with adding descriptors beyond the age, sex and race of my patient so that I would know that patient as a PERSON, and not just as a disease.

My daughter is going through her internal medicine residency right now.  I remember how easy it was to de-humanize a patient by calling her “the myocardial infarct in ER bed 8”, or the “renal failure in 222”, or the “nursing home placement on the 9th floor”.   If we call them by their disease, they cease to be the living breathing mother of high school age twins, or the father of a disabled son, or the principle of the local school for the deaf.  They’re just diseases, to be treated and discharged, or “buffed and turfed” in the old House of God parlance.  It’s much easier to be detached from a disease, than from a human being that one might just have something in common with.

Because of my first radiation oncology attending, to whom I will be forever grateful, I’ve made a point to pay attention to the person, and not just the disease.  I teach my medical students the same thing—that it’s not enough to just copy and paste the social history—the history of whether the patient is married, has a profession, has children, smokes or drinks alcohol or takes her religion seriously.  I try to learn about the person, and when I do, and convey that to my entire team of physicists, therapists, nurses and front office, I know that the patient gets better care.  It’s just human nature to empathize, and sympathize, if we truly know the human being behind the diagnosis. And it’s especially true for the difficult patients, the mean and angry ones, the ones we would prefer to dismiss.

But sometimes I slip up.  Recently I treated an elderly man postoperatively for rectal cancer.  He was a quiet elderly gentleman, but his son, a tech writer, made everyone in the department miserable with his demands for his father.  I never asked the man what he used to do, before he was eighty six with rectal cancer.  But another one of my patients was a little more curious.  He and the old man were side by side in the waiting room day after day of treatment until finally, the younger man asked me, “Where is Mr. __ from?  I can’t place his accent.”  I said, “I don’t know—I suspect he might be German but I never asked.”  So I did ask.  And was surprised to find out that my elderly patient was Israeli, born in 1925 in what was then Palestine. A true “sabra.”  He grew up in the Holy Land to become one of Israel’s foremost songwriters.  In fact, they still play his songs in Israel and recordings are available on YouTube. And I would never have known that if another patient had not cared enough to ask.

When you and I get sick, as we almost certainly will, we should all hope that our histories state who we really are, and that our admitting interns and residents care enough to ask.  They will be better doctors if they do, and we will get better care.

A Culture of Tenacity

It occurred to me yesterday evening as I walked off my flight from San Diego into Terminal C at Boston’s Logan Airport that I have done this before—landed at an East Coast hub two weeks after a major terrorist attack.  On September 20, 2001, my daughter and I, not without some hesitation, boarded a flight to Boston to look at colleges.  That was a long time ago but the mood there at Logan was strangely similar.  I ducked into Hudson’s Books for a late night snack, since I was waiting for her flight from Houston, and a woman in line next to me said, “Do you have any of those Boston Strong buttons?”  I had been thinking the same thing, just as she said it.

 

Bostonians have a long history of resilience and tenacity.  When I was a horse loving kid I read a story about Paul Revere’s horse, told from the point of view of the horse (of course!)  Apparently Paul did not spare the spur in his midnight ride on Brown Beauty, a mare borrowed from Samuel Larkin—nothing would deter him from his mission, and the good people of Boston, their roots steeped in hardship and persecution and war and famine, have followed suit for centuries.   The blood shed on the cobblestones of Boylston Street two weeks ago was not the first, nor will it likely be the last.

 

What I loved about my training in Boston thirty years ago was that same unflinching and uncompromising commitment to patient care demonstrated by the forefathers in their commitment to freedom.  Yes, the hospitals where I trained had some of the best teachers and most dedicated researchers in the business.  They wore their old school bow ties like badges of honor, and they still do.  Doctors wore white coats, and medical students did not inquire if it was okay to wear shorts to clinic, as they sometimes will in Southern California.   There was a certain formality, which translated into respect—for their peers, for their students, and for their patients.  Especially for their patients.  We laughed about them, we cried about them, we read and lived “The House of God”, and in the end we gave our all for them. I have missed that these last twenty years.

 

It’s good to be back.

Return to Forever

Tonight, a guest blog from my husband:

 
I may be dating myself but I vividly remember hearing Chick Corea’s Return to Forever band play a set in Boston in the early 1970’s. I was in medical school at the time, but that didn’t stop me from scraping together the ticket money to hear the group do some of my all-time favorites like Spain and Crystal Silence. In the 1980’s Return to Forever was re-configured as a jazz rock group with Chick playing synthesizers instead of the acoustic piano. I was particularly fond of the Romantic Warrior album which I listened to on my way to the hospital as a young physician. In 2011 the band was resurrected for a world tour. Although I didn’t get to see the live concert, I enjoyed the YouTube videos. Listening to this music again was magical, and brought me back to the earlier days of my medical career. Like déjà vu all over again, so to speak.

This past week I’ve had another “Return to Forever”experience. It happened when I entered a skilled nursing facility where my father-in-law was staying to recuperate after cardiac surgery. Here’s what I noticed: the name of the facility is the Goldberg Center and the first patient room I came to was occupied by Gussie and Sadie Schwartz, one of whom was screaming “I’ve got a sore somewhere! Get me out of here!” Instantly, I was transported back in time to the decade or so I spent as a young doctor at Boston’s Beth Israel Hospital. Some of you may know this as the “House of God”, the title of an (in)famous book about the mostly funny and sometimes outrageous fictitious exploits of the young doctors in training there. Our present day Gussie and Sadie would have felt right at home there in the House of God.

While I was an intern at the House of God I had my own outrageous exploits which (thank God!) did not make it into the book. My favorite involved an elderly man who was brought by his wife to the ER late one night with chest pain. When I told him that the diagnosis was a heart attack, his wife shrieked and clutched her chest. She, too, was having a heart attack, and like her husband was admitted to the Coronary Care Unit, where they ended up sharing the same room. The following morning as I entered the Unit I found the staff standing in front of their room not reviewing their cardiac status as expected, but laughing uncontrollably and pointing at the name plate on the door. It read “Ike and Tina Weiner” (I swear).

The House of God had a serious role in my life, too. It’s where I met my wife, and where my children were born. Recently, our daughter learned that she will be a resident in medicine there. My wife and I are thrilled by this. We hope her experience there is as meaningful for her, as it was for us. Now, let’s see if she can top the “Ike and Tina” story.