|Over the weekend, I attended two commencement exercises, one to celebrate my daughter’s college graduation, the other to celebrate our medical school's graduates. Both ceremonies were replete with pageantry, music, speeches, tears, promises, and unapologetic happiness; in fact, the rituals and emotions were so similar in appearance that it took me some time to identify the fundamental differences between the two events.
The college commencement truly marked a new beginning. These young men and women were now “commencing”
their journeys into adulthood. Their lives will undergo seismic shifts; many will never again sit in a classroom desk or stay up all night to write a paper. "Yesterday" and "Tomorrow" are completely different, and the new college graduate’s friends and family members, many of whom have been down the same path, can guide and support them.
Although the external trappings are identical, the medical school ceremony is fundamentally different because these new graduates have experienced a thousand “commencements”
- The first time a complete stranger unflinchingly trusted them with the most intimate details of life.
- The first time another human being allowed them – expected them – to probe for liver, heart, lungs, spleen, hernia, or cancer.
- The first time they repaired a cut, gave a shot, started an IV, plunged a knife, wrote a prescription, heard a murmur, or slid in a catheter.
- The first time they sensed the pulsation of an aortic aneurysm, recoiled from the odor of an abscess, or felt their hand enveloped by the warmth of the abdominal contents.
- The first time they watched another person die before their eyes.
Abraham Verghese has described the final two years of medical school — the clinical years — as the “cynical years” because students often dilute whatever sense of wonder, optimism, and unselfish compassion they originally possessed. It is no wonder, since, during this time, they have commenced becoming physicians without the benefit of a ceremony marking the accumulating moments that could have warned them of their imperceptible transformation.
I had the perfect seat at commencement to watch the medical students’ animated faces in the moments before they crossed the stage to receive their diplomas. Standing in cap and gown, waiting to hear the title, “Doctor,” and then their names tied together officially for the first time, they could anticipate a few short weeks off before beginning the process once again.
For the new medical school graduates, the "Commencement Ceremony" was merely one signpost in a long arc of commencement experiences that stretches far into the past and extends years into the future.
Posted 3:09 PM
The Unbelievable Dr. Adams
I ran into a colleague at the grocery store. “Can you believe it?” he kept asking. “Can you believe Mark is gone? I mean, he’s really gone! Can you believe it?”
Our medical community is reeling from the untimely death of Mark Adams
, MD, the Chair of Surgery. Mark was an unbelievably gifted surgeon. Twenty years ago, I watched one of our most respected senior surgeons shake his head and tell a room full of people that Mark was far and away the best surgeon he had ever seen. Mark’s talents remained evident to all of us; one of the operating room employees with a special gift for nicknames once dubbed him “Edward Scissorhands” in recognition of his speed, efficiency, and focus. It was the perfect nickname and it stuck.
What a life he lived! He worked hard, wasted no words, and was a model of integrity. I did not know him well, but even I was aware of his passionate intensity for hunting, fly fishing, furniture and boat building, single malt beverages, and motorcycles. Whatever tasks toward which he directed his unbelievably intense gaze, he mastered.
The events of the past few days are truly unbelievable. I keep recalling Mark’s unique gifts, interests, skills, and passions. And, in answer to my colleague's repeated question, no, I cannot believe he is gone. It remains profoundly unbelievable.
Do you have a personal reaction to Mark’s life? If so, click on the Feedback link below. We will post your comments
|The following is feedback received for this blog:|
||My wife called me today to tell me about the passing of Dr. Mark Adams. My wife heard it from her mother who was seeing her primary care physician who new of Dr. Adam's reputation. Dr. Adams was one of the many fine physicians and surgeons who has touched my family's life as I was a kidney transplant recipient in 2000 at Froedtert. Although Dr. Adams did not perform my transplant my wife and I saw Dr. Adams for subsequent post-transplant visits and he was always direct and to the point with us which we always appreciated. You could just tell he was a great surgeon and human being by how he treated you as a person and as a patient, with respect.|
- Mike Dahlke
I had a KP transplant on Oct 23, 1998 after living with diabetes for over 37 years. I had the typical post-operative lab visits but had not seen Dr. Adams in the clinic for over 5 years. I did run into him a few times around the hospital and at the transplant picnic and he had the ability to remember me and the details of my condition. I'm sure he did the same with all of his patients, which had to number in the thousands. Aside from being a top notch surgeon and instructor, he made me feel like a friend. The compassion that he showed for his clientele and his craft will be genuinely missed.
- Daryl Manka
Dr Adams gave me my life back more than once in my 38 years ofliving. After receiving my kidney transplant in January of 2005 ( which heperformed) I had some internal bleeding and Dr Adams fixed the bleeding and I believe saved my life. I will always remember joking around with him at my post operative visits. He was a very talented surgeon.
- Erin Decker
Dr Adams performed my first and then second Kidney transplant in 1984 when I was only 16. I started out being afraid until I met Dr Adams. I can't really explain it, but he just had a way that projected everything would be ok and that I could rely on him. I've known and read about all the accomplishments and accolades he's received over the years and they are a testament to the passion and dedication that dwelled inside him. I have to add that in addition, it's mind boggling to know the numerous lives that are also changed and have been affected to this day because of him. I could hardly believe the news of his passing. I'm still in shock. What has always stayed ingrained in me about Dr. Adams is the way he pin pointed the exact thing that needed to be pin pointed. He just had a knowing, always, on how to solve what ever needed solving. He was respectful and kind and has impacted my life beyond words. My heart is heavy and my prayers go out to his family.
- Mary Wind
Dr Adam not only used the skill of his hands, but the Skills that Really made him stands out. His Heart.
He not only changed my life but the lives of my three children as well. His bed side manner was impeccable He was truly a blessing the first day I walked in his office at Froedtert Hospital in Milwaukee. He gave me back Life on March 03, 2006 with a Kidney. I not only lost a beautiful Doctor. More importantly I lost a Great Friend that will be Heart Felt & Deeply Missed
Much Luv 4 Dr Mark Adam
Kimberly M. Young & Family
THE MAGIC OF DR. ADAMS
I consider myself blessed to have known Dr.Adams for so many years. As nephrologist in Kenosha, Medical Director of the St. Catherine's Kidney Center, I referred innumerable patients to Him for transplant evaluation. He has given life to so many, touched their lifes and the ones of the families in a special way so that all of them came back with new kidney, a pancreas, but, most of all, with a new friend. His caring, integrity, devotion are legendary. He was always available and willing, he went the extra step for all. Indeed he gave our patients kidneys and pancreas but he stole pieces of our hearts , instilling in its place the sparkle of His eyes and warmth of His smile. We shall never be without Him. That is the magic only Dr. Adams could perform and He gave so gallantly ... He was my colleague, my friend, my mentor and inspiration. He was humble and pure at heart. I am saddened by the immense loss and would like to extend my warm condolances to his family, to Dr. Chris Johnson and the entire transplant team, to the girls of his office and to the entire Froedttert Community.
- Rosanna Ranieri MD
I first met Dr Mark Adams in 1978 at which time he told me to ignore the charts and graphs others were creating to plot out the expected failure date of my kidneys. He was the first to allow me to peek through the dark cloud hanging over my head. His comments had an immediate and life-changing effect on me for which I will be forever grateful.
On Thanksgiving Day 1978 Dr. Adams spent the afternoon crafting a fistula for a very young (25) scared, six-month pregnant woman whose kidneys were failing and who couldn't undergo anesthesia. I had the audacity to vomit all over his nice sterile operating room, yet he simply stopped surgery and then, in his own inimitable way, calmly and quietly assured me that it wasn't a problem and that he'd get back to surgery whenever I was ready.
Later, on March 30, 1981, Dr. Adams performed my kidney transplant surgery. My fondest memories of my time in the hospital were the tales of his children, and I will never forget the beautiful sunny April day he checked in on me and then announced he was leaving the hospital to take his children to the park to fly kites. A dedicated surgeon who had his priorities straight.
As a direct result of his skill and dedication, and of others, as well I recently celebrated the 26th anniversary of my transplant, the 28th birthday of my older daughter (the "dialysis baby"), the 20th birthday of my younger daughter, born after the tranplant,and will soon celebrate my 32nd wedding anniversary.
I am only one of many. The enormous, postive impact Mark Adams had on the lives around him will be felt for generations to come.
He will be missed. May we all aspire to be more like him.
- Ann Pendergast Christman
I was so distressed to belatedly hear of the death of Dr. Mark Adams. He was my partner, colleague, compatriot, and friend through my years at MCOW (1977-1989). For those years he was in fantastic physical condition and skied the Birkebeiner. I remember vividly his going through the windshield of a car that hit him while he was bicycling to work on Bluemound.
Mark was a terrific terrific surgeon and certainly got me out of trouble on numerous occasions though I never seemed to get the chance to reciprocate.
I cut down a huge tree in my Elm Grove yard and Mark sawed it up into planks and handmade a beautiful bench of it. I always think of him when I see it. It seems to stand for his dedication to work, care, and friends.
He will be deeply missed.
- Stephen C. Jacobs, MD
I met Dr. Mark Adams in the 80's. I was covering a story of a child named Virgil whose kidney transplant hopes had all but vanished. We had accompanied Virgil on a last wish trip to Disneyland. Imagine the shock when we got the call that the impossible kidney match had been found. Time was of the essence. We got Virgil back to Milwaukee and into an operating room. Dr. Adams was amazing it was remarkable to witness that operation so many years ago..
Today....the day after the tragic plane crash in Milwaukee that claimed the lives of the University of Michigan doctors and others dedicated to life saving transplants....I suggested we call one of the finest advocates of organ donation I've know...to get some valuable perspective on that element of the story. A quick google search led to this website and a tremendously sad discovery.
I got the chance to see how much he adored his family. A couple years ago, I ran into Dr. Adams at the hardware store. He told me how he was delighting in the prospect of building his family a kayak.
Reading this blog, I find that adoration spread to his extended family too...all the people who were given a second chance at life thanks to his skills in the operating room.
- Kathy Mykleby
Dr. Mark Adams along with Dr. Chris Johnson performed the kidney transplant between my brother, Greg Key and I. We were the 100th transplant at Froedtert. Doctor Adams was a great man, he helped us feel calm and re-assured about the procedure. I was deeply saddened to hear the news of his death. The medical community will suffer a great loss.
- Loretta Sue Meinel
I came to the Medical College of Wisconsin in 1985, as an intern in General Surgery. One memory that stands out is being the intern on the transplant service in December. Early in the month Dr. Adams asked me if I was married. When I said I was, he turned to my senior resident and said, "Mike, you take call on Christmas--this intern needs to be with his wife." Later, after I switched specialties to anesthesiology, doing residency and fellowship at MCW, I always enjoyed doing cases with Mark, as he was quite simply the best surgeon I'd ever seen. (Although if something didn't go well, his withering laser beam stare could be quite intimidating!) Eventually, after being on the anesthesiology staff at MCW for a couple years, an opportunity presented itself at the Mayo Clinic in Arizona. I asked Mark to write a letter of recommendation for me. The letter included the line "I could not recommend him to you more highly, although I hope he stays here with us in Milwaukee."
When I told him that I got the job and I was leaving, he smiled and said, "I hope you get sunburned!"
Nearly 10 years later, here I am doing a transplant case, when my surgical colleague says to me, "Say, Karl, did you know that surgeon in Wisconsin who just died of an arrhythmia, Mark . . . ." I didn't want him to say the last name, because right then I knew.
I could go on with anecdotes, but suffice it to say I'm honored to have had the opportunity to know and work with Mark Adams. It has been said that we all die, but not everyone lives. Mark clearly lived, and I like to think that maybe I lived a little bit more having had a chance to know him.
- Karl Poterack
I decided to look at the news at Froedtert Hospital today and found such a sad heading that Dr. Adams had passed away. I worked at FMLH for 20 years, but have been gone for 6 years now, but I do remember his wonderful demeanor and of course his good looking manner and enjoyed knowing him. I am so sorry for all of his family, friends and co-workers. I know you will all miss him.
- Brenda Holfert
I gave my husband a kidney in 1998. Dr. Adams was the surgeon who put my kidney into my husband. Dr. Adams was a very professional, caring, dedicated doctor who obviously had an enormous talent for what he did for others. He has been taken away far too soon, but his work on this earth will live on in others for many years. Dr. Adams saved many lives and because of that, his legacay will live on. There is no answer why such a person leaves us so soon when he can do so much to help others here, but my husband and I are greatful with our lives, that Dr. Adams came into our lives when he did. We will never forget him and our sympathies go out to his family, colleages, and patients, whom he has touched over the years. We are very saddened. How ironic that Dr. Adams saved my husband's life, only to be outlived by him in the end.
- Cindy Fredericksen
Well, it has been 4 almost 5 months now and I think I can finally sit down and write this. I worked with Dr. Adams as his assistant for the last 9 years. As you do when you work closely with someone we shared many family stories, happy times and stressful times. That morning when I came in and his door was still closed I could not be prepared for what I was told. I thought his flight from New Orleans came in late and he was resting.
Indeed, he was resting. The essence of ones being is a strong thing, and as I intently listened to what I was being told I could see him walk from his office through mine and smile as he always did. He walked right behind Jon and went around the corner. Surely Jon was wrong. His brown shoes were neatly tucked away under his desk and his lab coat hung quietly in the closet. Surely, this moment was an awful mistake and he would be walking back through that door with his helmet in hand, smiling and asking what was on his calendar for the morning. I sat for a moment in anticipation of that happening, but it did not.
I quietly went to his desk and sat in his chair. I watched his dream catcher gently swaying in the corner, right where we hung it when we moved down here. I heard him laughing as he teased me about climbing up into his bookcase to dust and strategically place every item which had its own story and purpose. He was quite sure that worker's comp would not cover "secretary falling out of bookcase". His computer screen was dark and his desk was in its usual state of organized mayhem. I took the letters for signature out of his in-box and I took his "blue" pen and placed it in my pocket. He was lost without that pen, and I was going to be lost without him.
I still see him in the halls, every so often, when I come around a corner or get off the elevator and head towards the office. There he is at the end of the hall in his blue shirt and Khaki's, coffee in hand, smiling. One blink and he is gone, but the warmth of that moment is still there and it is that moment that starts that work day.
Everything that Dr. Adams is, was, and always will be is enveloped in this office, the halls and the College/Hospital itself. You can see him, hear him and feel him everywhere because in one way or another he touched everyone.
Until the next time I see you Dr. Adams........
- Trudy Becker
I was a recipient of a kidney transplant on May 29, 1984. Dr. Adams was such a wonderful doctor and so nice. I saw him about year ago and I will always remember what he told me. He told me that I would live to 100 years old and based on that, I really, really take care of my kidney. I will not ruin the wonderful work he did for me. He was a wonderful man.
- Mary Kuether
My first transplant was 3-22-88, which Dr. Adams performed. He was great doctor no two ways about it. Like people said in comments before mine, he would always remember you. He would always stop and say hi, eventhough you wouldn't be seeing him that day. I remember once I was sitting in the hallway no where near the transplant floor, he stopped sat down and asked how everything was going. That really impressed my family. He was a great guy and doctor. Thanks for being you. Thanks for the many years you added onto my life.
- Tom Park
Dr. Adams i met in the spring of 1982 i had previously had a transplant at uww of madison,
Dr. Hauns Solinger preformed my first TX.
Dr. Adams took me on a personal tour of the transplant unit at that time. I was looking to put my name on the transplant list at Froedtert &at the UWW. after my first transplant had failed.Little did i know that i would recieve my 2nd 3rd & 4th at the hands of dr.Adams, among the many other surgeries preformed by Dr. Adams if it were not for the skills of him i would not be here today. Thanks to Dr. Adams & the nurses and staff of 4se.
- Michael W. West
PS. i will never forget Mark B. adams
I just recently found out about Dr. Adams and was deeply saddened. He explained the whole transplant process to my family and I since having a liver transplant was my only major surgery i ever had. I had a liver transplant15 years ago him and he was the best. He took away the questions and any fears from us. As I look towards the possibilty of another transplant, his wisdom and advice will give me comfort.
- Greta Melcher
I was just reflecting back on my liver Transplant. I celebrated 5 years on 9/15/2011. I owe that to Dr. Adams and the Froedtert Transplant Team. I thank them deeply for what they have done for me.
The first time I met Dr. Adams was for my interview to get onto the transplant list. He was very intimidating, I was SO nervous. I later find out that he is not so intimidating and that he has this face he puts on just so the paitients know he means business. I also found out he was quite a practical joker. I never knew that side but I heard a few stories.
In the days after the transplant he would come to my room with his little entourage of students and examine me and ask a few questions. By the 7th day I was asking him timidly if I could go home. "Sorry, not today". By the tenth day I was not so timid and just wanted to get out of there. This time I begged, "Please, please, please can I go home. He said Yes and I let out a howl and wanted to hug him right there and thank him for all that he had done. I guess that would have been a little awkward in front of his students.
I wish I would have known more about him when he was alive. Thanks to him, I"M ALIVE. I'm sure there are many more patients out there that feel the same way. God Bless Him and I'm priviledged to have known him.
- Wendy Childers
I was a young teenage boy when I first met Dr. Adams. I had had a kidney transplant performed by another doctor. several years before (1987) and at that time, I was one of the first children to receive a kidney transplant at Children's Hospital of Wisconsin. At that time a lot of things were very new and experimental. I went through a couple rejection episodes which were treated with experimental drugs at that time. These caused some very unpleasant side effects. Day after day doctors would tell me "You can go home tomorrow." Well, tomorrow would come and numbers in my labs wouldn't cooperate, so I'd have to stay. After 49 days in the hospital, I finally was able to go home. Well, that transplant lasted four and a half years when it failed not because of rejection, but because of an obstruction. It was making urine, but it would "backup" and not make it into the bladder. I was on dialysis from 1992-1995. Remembering the events that took place during my transplant, I did not want to go on the waiting list for a new one. I waited about a year or so and my mother really wanted me on that list. We set up a meeting to talk to Dr. Adams for talk to him about going on the list. I was very vocal about not wanting to be on the list. My mother expressed to him that she wanted me on the list. Being that I was a minor, she pulled rank. but Dr. Adams told her that he was hesitant in putting me on the list because of my attitude on the subject. This frustrated my mother because she was the parent and my decision was being considered and not hers. She understood the doctor's position though. She explained to him that my decisions was based on fear from the last transplant and that once he had another one, it would be worth it and not a waste (he thought I would care enough take care of it properly if I did get one.) After some arm twisting, I decided to tell the doctor that I wanted to go on the list. I was on that list for a very long time. A nurse told me that one day she was in church and had a prayer said for me to receive a transplant soon due to many complications I was having with the dialysis. She was the one that received the call on Good Friday of 1995. The kidney was from a young lady who was killed in a car accident. The kidney was severely bruised and would normally not be used for transplant. Dr. Adams didn't pass this opportunity up for me because he said this kidney is a very good match me and it will probably heal in my body. That was in 1995. This April (God willing) I will have had this kidney for 17 years and if it wasn't for Dr. Adams, it would have gone unused in fear it was no good. It's been pretty useful for me. Thank you Dr. Adams. I am proud to be one of your success stories. You truly made a difference in many peoples lives. I'm glad mine was one of them..
- Bryon (B.J.) Nelson
My Mom had a kidney transplant back in 1984. This kidney has lasted her 27+ years. Thank you Dr. Adams for giving life back to my Mom.
- Cindy Burg
Posted 8:56 AM
The Medical Resident’s Spelling Quiz
The medical resident had the perfect strategy to always get personalized service whenever he wanted. As new medical students rotating onto his service, he offered us a deal: “Okay, rookies, I am going to give you a short spelling test of common medical terms. If you get all five words correct, I will do one of your history and physical exams for you. If you miss any, you will have to run and get me a cup of coffee whenever I want for the next two weeks. Deal?”
We were all pretty confident spellers, being college graduates and all. “Deal,”
He rubbed his hands together. “You first, Campbell. Here are the words and their usual pronunciations:
- “Spell the name of the specialty that takes care of the eye (“Op-tha-mol-o-gy”).
- “Spell the name of the bony plate that the olfactory nerve passes through in the skull base. (“crib-a-form”)
- “Spell the name of the operation to fix a hernia. (“her-ne-or-a-fee”)
- “Spell the name of the chemical that is used to check for blood in the stool. (“gui-ack”)
- “Spell the name of the bony plates behind the maxilla (“ter-goid”)
- “And for bonus points, tell me the difference between a regimen and a regime.”
None of us got more than a couple of them correct. He spent the rest of the month with a smile on his face and a cup of coffee in his hand.
Answers to the Medical Resident’s Spelling Quiz:Ophthalmology
(most leave out the first “h.”)Cribriform
(most leave out the second “r.”)Herniorrhaphy
(most give up.)Guaiac
(most leave out the first “a.”)Pterygoid
(most leave out either the “p” or the “y.”)
And for the bonus points, a “regimen
” in medicine is a prescribed course of treatment. A “regime
” is a government, although some authorities insist the words are synonyms.
If you did great on the Medical Resident’s Spelling Quiz, try this grammar quiz
from the University of Iowa Carver College of Medicine!
Posted 9:54 AM
Stereotypes of People With Cancer
The CT scan showed that her already incurable cancer had worsened. I walked into the examination room dreading what I might find. Despite the scan results, she smiled, stood up and grasped my hand in both of hers. I expected to see a woman in suffering; instead, here was a person glowing with contentment.
Don’t all patients with advanced cancer suffer? Is her situation unique? An article in the Journal of Clinical Oncology [JCO 2007 (May 1); 25:1691-97
] reports a study of nearly 400 relatively functional people with advanced, incurable cancers. These people had been referred for hospice care and were not expected to live more than a few months. The study found that:
- Half of the patients reported no suffering whatsoever, and one-quarter reported either minimal or mild suffering. One-tenth, however, reported severe or extreme suffering.
- Greater suffering was associated with depression and anxiety.
- Suffering was most closely associated with malaise, a sense of illness, weakness, and pain.
- Suffering was more closely associated with physical symptoms than either psychological or existential concerns
- A few of these terminally ill individuals worried about their own deaths, however, they were far more concerned about pain, stress, loss of function and control, and dependence on others.
I learned that my stereotypes of what "dying people" were supposed to feel and experience was wrong. As caregivers, we are charged with relieving pain and suffering when they occur, but we also provide support and a continuing presence when needed.
As frequently happens, my patient was also my teacher that day.
Posted 8:31 AM
“Hello, Mr. Jones!”
I reach to shake his hand as I enter the exam room. “You look great! How are things going?”“I’m doing just fine,”
he replies. “PLEASE call me Ken,”
he adds. “Um, okay,”
I respond, but I will probably never call him by his first name.
Ever since I was in training, I have addressed patients by their last name: “Mrs. Thompson,”
or “Mr. Silverman,”
or “Ms. White.”
Despite this, some patients insist at every opportunity that I address them by their first name. Occasionally, patients call me by my first name. I don’t protest when they do this, but I continue to call them by “Mr.”
Names are a funny thing in a professional setting. When I am getting an X-ray or lab test myself, the technologist usually calls me “Bruce.”
Their training must assume that by adopting an unearned sense of intimacy, the patient is put at ease. When I was in medical school, however, most of my role models maintained professional distance and decorum whenever they addressed their patients. These mentors would never have dreamed of addressing a patient by his or her first name.
What does using a first name imply? In social settings, taking the step to using a first name implies intimacy and friendship. On the other hand, calling someone by his or her first name can also assume a sense of power over that individual. Even the ancients felt this.
So, I continue to address my patients the old-fashioned way. My philosophy of patient care seeks neither intimacy with my patients nor power over them. If I begin using a patient’s first name, I worry that the important relationship between patient and physician will be irreparably altered and also realize that, for some of my patients, a dreadful day will arrive when they will need a physician who is objective rather than one who is intimate.
|The following is feedback received for this blog:|
||I agree with you - addressing patients by their last names (especially in your first encounter) is respectful and sets the tone for a professional H&P. As a general rule of thumb, I think of last names as an extension of the white coat - wherever you'd find it appropriate to wear the coat, you address your patients formally. So, in pediatrics you might not wear the coat... and perhaps not in psychiatry. Otherwise, it's a good idea. |
By the way, LOVE your blog. Will add you to my blog roll. :)
- Val Jones
||Thank you for treating your patients with dignity. Being addressed by my first name by a medical tech who is half my age does not put me at ease; it makes me uncomfortable and angry at the presumption. Having to wear one of those hospital gowns is bad enough!|
Posted 10:26 AM
Years ago as a medical student, I worked as a nurse’s aide in a Chicago area emergency department. One weekend night, a middle-aged woman came in with leg pain after a relatively minor injury. An X-ray confirmed a femur fracture and the young resident physicians, who I admired very much, prepared her for admission to the hospital. They checked her labs, treated her pain and filled out forms. Soon, she was resting comfortably. I transported her to her hospital floor.
A short time later, the attending orthopaedic surgeon strode in from the parking lot and rummaged through her X-rays, which were still in a box in the ED. “Did anyone do a complete physical examination?” he barked. “Go up and do a breast exam!”
I wondered, How can he look at an X-ray of her leg and conclude that she had a problem in her breast? But, sure enough, there it was: a huge, ulcerated and long-neglected breast cancer stuck to the chest wall and growing out through the skin.
How could he have been so sure? His experience had taught him to recognize the bone metastasis and to know the most likely source. Now, years later, I realize that all physicians learn to make associations like this one through experience and training, but I distinctly remember how amazed I was at the time. I wondered, How will I ever be able to remember everything that I need to know as a physician? I’m still wondering.
Posted 10:22 AM
Hearing the Stories Again
Two weeks ago at a national meeting, I stopped by the evening reception to renew friendships and find a friend with whom to go have dinner. Soon, I was sharing stories with former colleagues and their families.
As the reception broke up, several of us gathered in a circle with two outstanding retired surgeon-scientists, true giants and mentors, each of whom has influenced my career. From one, I had learned surgical technique, from the other, a philosophy of patient care. Both had modeled meticulous adherence to the precepts of cutting edge, evidence-based surgical management of head and neck cancer. At the same time, both had shared the stories that defined their approaches to patient care.
I had not expected to see either of these mentors at the meeting. One of them no longer lives in the United States.
Yet here they were, bursting with the tales that permeated my fellowship experience. As the evening progressed, I discerned the camaraderie in which I had been immersed twenty years before. I strained to hear every word, refreshing all of the true and not-quite-true legends. I ached with laughter and longing. It was a rare opportunity for which I was very grateful.
The evening ended and we each went our own ways. I finally understood that my mentors had taught me not only the techniques that permit cancer to be cured, but also the stories that allow patients to be healed. Rachel Naomi Remen
, in her book, Kitchen Table Wisdom
, writes that a story is the container for meaning
. I am grateful that the stories have continued to unwrap and teach their own subtle lessons years after I tentatively ventured into practice on my own.
Posted 10:08 AM
The Peanut Gallery
I was getting increasingly frustrated. Every time I tried to ask my patient a question, her husband would answer. And, even more annoying, he was sarcastic. Are you having more trouble with your mouth lately?
From in front of me: Yes, there is quite a bit more pain.
From across the room: Of course she is, Doc! Otherwise why would we be here? Jeez, can’t you see that things are worse?
After a few minutes, I recommend scheduling some biopsies in the operating room.
From in front of me: I understand. I hope this will help get us some answers.
From across the room: C'mon, Doc! Why can’t you just take the samples right now? This will cost us more! Why do we have to keep coming back? Maybe we should go see an expert!
I kept my composure this time. Fortunately, I had recently read a quote from noted physician and writer William Carlos Williams who once observed: There’s nothing like a difficult patient to show us ourselves.
Amen. And I might add, not just the patients are difficult.
The following is feedback received for this blog:
||This is a great blog/format. Too many patients know too little about their health and medical care, in part because they see MDs on a pedestal and are afraid to speak with them. I am a big fan of personalizing medical care, which helps patients "take ownership" of their health and better manage their lives.|
Posted 8:40 AM
She was sitting in the examination chair with her arms tightly crossed. When the medical student had gone into see her, she had refused to allow him to check her pulse or blood pressure. She was disheveled and clearly agitated. As I entered the room, I greeted her and extended my hand.
“No! I can’t touch anyone! My boyfriend has an infection!” I have something on the top of my head and I think it might be from him! Just give me something!”
I carefully washed my hands in front of her and looked at the scalp. She had a small area of swelling on the top of her head, but it was merely a small cyst. Not a problem. No treatment required.
“Who told you that you couldn’t touch anyone?”
“I’m not sure. It has been weeks.”
Imagine going weeks with no human contact! What right is more basic? Surrounded by a sea of people, alone, unclean, and untouched.
After a discussion on the importance of hand washing, I gave her “permission” to again touch and be touched. She was a foot off the ground as she left. I did not give her much, but yet, what a difference that small gift made.
Posted 10:45 AM
Engaging with Patients: The Writing of David Watts, MD
David Watts, MD
is an eloquent physician-writer and poet who illuminates the joys and trials of Medicine. His recent book, Bedside Manners: One Doctor’s Reflections on the Oddly Intimate Encounters between Patient and Healer
, includes stories that reveal his insight, imperfections, humor and compassion. The essays capitalize on his special gift to describe encounters with the elderly and the disenfranchised.
There is particular power in his story entitled “Evening in the Two Worlds.” An older gentleman is learning for the first time that he has widespread cancer. Dr. Watts does not pre-plan the speech with which he will break the bad news. He depends on his relationship with the man to guide the encounter. He writes: My words will not form until they are spoken, reading the twitch of his face, the subtle motions of head and trunk, the silent conversation that will tell me how to deliver the news.
I am as good at this as anyone, and as bad. This conversation, like a blossoming, moved so slowly as to be imperceptible. Yet when remembered, remembered as lightning speed.
After he finishes the discussion, he reflects on the power of his words and the need to maintain hope: The moment will tolerate only truth, but that truth has to contain promise. It’s about words, words and the weight they carry.
Dr. Watts’ example rings true with those of us who have the privilege of trying to use mere words to clearly, respectfully and compassionately tell a fellow human being that he or she has cancer.
The words we share can sting with their message and their power. Compassion and presence remain our overriding responsibility, and, at the final stages of disease might well be the best gift we can offer.
The following is feedback received for this blog:
We have always respected the power of words. Doctors must especially be aware of what and how they say things. Dr. Watts has proven to be sensitive to this need.
- Joyce Harvey
Posted 9:13 AM