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 Curbside Consultation

Recently a friend of my husband’s in San Diego had a mammogram which showed some suspicious microcalcifications in her right breast.  She underwent a stereotactic biopsy which revealed ductal carcinoma in situ, the earliest form of breast cancer also known as Stage 0 breast cancer.  This type of cancer is non-invasive and does not metastasize, however, if untreated it can progress or recur as a more serious type of breast cancer, so at the very least excision of the abnormal area is indicated, and in some cases radiation and/or mastectomy are necessary.  My husband asked if I would speak to her regarding her breast cancer, and somewhat reluctantly I said yes.

 

Why reluctantly, you might ask.  Isn’t that the nice thing to do?  I said to my husband, “I think it’s a mistake to do consultations over the phone.  I have no access to the mammograms or pathology report, and I cannot examine her.  These things are important to have and do to give someone an informed opinion about her case.”  He said, “But can’t you just talk to her a little bit and recommend a surgeon, and maybe give her a bit of information about radiation therapy?”  I agreed to do it.  A few days later we connected by phone.

 

Having practiced in San Diego for twenty one years, and having a major interest in breast cancer, I know every surgeon in San Diego and Riverside counties who specializes in breast cancer.  Likewise, every radiation oncologist and medical oncologist.  I am a virtual referral encyclopedia—tell me where you live and I will tell you where to go.   In this case I recommended the surgeon whom I would choose to operate on ME, if I had breast cancer.  Same thing for radiation oncology.  I did this for my husband’s friend, and we discussed her case at length.  Because of her relatively young age, excision alone was a bad choice, so we discussed the pros and cons of excision plus radiation versus simple mastectomy with or without reconstruction.  At the end of the conversation she thanked me, and then mentioned that there were actually TWO areas in the breast that were biopsied and were positive, and they were not particularly close together.

 

That little fact, which I would have known if I had had her pathology report and her mammograms in front of me, changes everything.  If a woman has multifocal disease, there is a good probability that she may be better off removing the breast.   I backtracked and covered that point, but I worried that I had made an anxiety provoking situation much worse by confusing a new breast cancer patient.  In the end, she sought the care of an excellent breast cancer surgeon, and I know she will be fine.  But I have the lingering feeling that in trying to do the nice thing, I did the wrong thing.

 

Think of this when you stop your doctor friend on the street to ask about a friend or relative who has recently been diagnosed with cancer.  Curbside consultations do no one any favors.  If you or a friend or relative need an opinion, get an INFORMED opinion—present to the consulting physician with your history, your radiology, your lab work, your pathology and your body to be examined.  Then, and only then, you will be assured that the recommendations that you receive are the ones you should truly follow.  It could save your life.