Lessons from a mentor
The following poignant essay by Bill Shimp MD, brought tears to my eyes. Bill joined Park Nicollet in 1976 and left in 2000. He served as vice president for the hospital and consultative care from 1996-1998 and as Chief Medical Officer from 1998-2000. Bud Green, an early founder of Saint Louis Park Medical Center, is the mentor.
I met the man who would become my mentor and role model over forty years ago. I was a medical student on a medicine clerkship at the local county hospital. He was in the private practice of hematology and oncology, the latter a field that was just taking root as a medical subspecialty. I was impressed that an attending physician with a busy practice would devote so much time to a teaching institution, though later I learned the culture of his group practice was to encourage and reward its members for participating in academics and teaching. At that time there was a great demand for his services, given his excellent reputation and the rarity of community oncologists. The hospital was fortunate to have him.
Short in stature and sprite in his walk, he exuded enthusiasm and confidence as he attended to the many cancer patients under his care. With ease he struck a balance between the compassionate physician and the bright academic. His teaching style was a comfortable blend of didactic and interactive. I looked forward to each encounter I had with him. I considered his patients lucky to have him as their doctor. I wanted to be the kind of physician he was.
Later, when I became a medicine resident at the same institution, he continued to inspire and motivate me. He encouraged me to join his group practice as a general internist, and I felt honored by his offer. Upon completion of my residency I enthusiastically signed on as his partner.
Now his colleague, I of course referred my cancer patients to him. His consultations were as instructive and homespun as ever, and patients reported their confidence in him as they expressed gratitude to me for sending them there. I found our shared cancer patients to be the highlight of my practice — so much so that, at his urging, a few years later I decided to take leave of my general medical practice to pursue subspecialty training in medical oncology. He helped pave the way for me with letters and phone calls of recommendation. Importantly, he arranged for our clinic to loan me the money I would need to help fund my sabbatical.
To my delight, one of my fellowship assignments brought me to my mentor’s oncology clinic for private practice experience. I was thrilled with the opportunity to work with him again.
During that time, I had a chance to see all sides of him – which sadly included the courage and strength he had to muster when suddenly he and his wife were faced with her own cancer diagnosis, and then the lingering downhill course to her death. It was astounding and heartbreaking to see him work on a daily basis with cancer patients while he himself was in the midst of such tragedy. Though he appeared distracted at times, his patients continued to receive the best of care.
On one of those busy office days, Allen came in for a routine visit. He was eighteen years old. My mentor had treated him for acute lymphocytic leukemia and he had been in remission for almost a year. His blood counts were a little off, however, and I ordered a peripheral smear so we could look at it under the office microscope. Noting the presence of recurrent lymphoblasts, my mentor became upset, uttered an expletive, and asked if he could have a few moments by himself. He emerged from his office a little later, dreading the hard task of telling Allen about the recurrence. He was feeling frustration and disappointment in a most personal way, and it showed.
Tearfully Allen and his family accepted the news. Hospital admission was immediately arranged for a course of re-induction chemotherapy. Because the first course had gone quite smoothly, we were hopeful that a second round would go as well — though we were now pessimistic that we could actually cure his disease.
Two weeks into the hospitalization, however, things were not going well. The expected problems with fever, anemia, neutropenia, and bleeding were more severe than usual. Platelet transfusions failed to improve the thrombocytopenia. In this setting we visited Allen, febrile to 104 degrees, shaking, tearful, purpuric, and oozing blood everywhere. As we entered his room, Allen sat up in bed with outstretched arms. My mentor returned the gesture by opening his own arms and sitting down on the bed beside him. The two of them hugged as Allen sobbed.
“Doc, am I going to die today?” Allen asked. Through his own tears my mentor replied, “Yes, Allen, you are.” I was shocked by the candid question and by its equally candid and prompt response. How did my mentor have the certainty to say such a thing? The two of them continued to hug and cry for what seemed to be a long time. Finally, Allen kissed my mentor’s cheek and thanked him for being his doctor. My mentor thanked him for being his patient. Then they looked at each other for what might be the final time.
Wiping our tears as we left the room, we found it impossible to engage in our usual practice of discussing the case and writing orders in the chart. Handing me the chart and saying, “You write the note,” he retreated to a patient lounge at the end of the hall and did not emerge for another ten minutes. In solitude he dealt with the tragedy of the moment, and his intense personal reaction to it. Though our busy day seemed to have no room in it for any such “down time,” everything else was put on hold until his personal imperative was met.
Allen died later that day. No one was surprised, least of all my mentor.
To this day, I can say that I have never witnessed a more tender and poignant moment in oncology. It was an unforgettable event that has burned a permanent image in my memory. On that day, my mentor showed me that it is okay to remain human and vulnerable in the privilege of caring for the most courageous people we will ever meet. While I always knew I needed to bring my best science-based game to the care of my patients, he showed me how the human element pervades everything we do, and we must attend to that. Maintaining the traditional “distance” between doctor and patient, I learned, is not always easy, convenient, or even appropriate.
As I emerged from fellowship to once again work alongside him in our clinic, my mentor continued to teach by example. I am forever grateful to him for what he taught me about the human side of oncology. Now well into his nineties, he remains a dear friend and is my greatest medical hero.
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