The challenge to be a good doctor

What makes a good doctor? Obviously there are certain technical skills and standards that have to be mastered, but what else contributes to make a meaningful difference? I think it is something ‘human’.

My dad was a doctor who lived his profession.  He saw patients early, he saw them late, he worked on weekends, he made house calls.

This past week, I decided to follow in my dad’s footsteps and make a house call. I went to see Gary who was an AIDS survivor. This wasn’t a sad story, but in fact was a celebration of living. Gary had almost lost his life to a severe pneumonia that sent him to the ICU. Fortunately the doctors recognized the symptoms and put him on medications to stop the HIV virus. He slowly improved and was able to leave the hospital. That was seven years ago and he’s doing so well that I’m no longer concerned about his immunodeficiency. Measurements show his immune system is stronger now than ever. Instead, I’m more concerned about Gary’s elevated cholesterol and lack of exercise. With the antiretroviral medications we have today, I expect him to live for decades more.

I could see that my home visit meant a lot to Gary. I wanted to restore some dignity to the patient. I wanted to show I was listening to his concerns. I wanted to show his time was as valuable as mine. He was also a human being.

I wish I had time to visit all of my patients at home – the ‘old fashioned way’. Of course, in the 21st century, it’s much harder to do. What I’ve observed in the doctors I admire most, is that they actually listen: They make that connection where real understanding between two people occurs. That is where healing takes place. That is the path to greatness.

I’ve posted a few stories here on Small miracles about AIDS survivors and other patients. Of course all of their names have been changed to protect their privacy. These are real stories that inspire me to work harder and to be a better doctor.

Now I want to honor a few other ‘great doctors’ I know using their real names. I want to recognize them and say ‘thank you’:

Dr. Tim Babinchak – you taught me how to think as a young doctor in training
Dr. Joe DeSimone – you taught me what compassion really meant
Dr. Greg Kane – you inspired me to work harder than I ever thought possible
Dr. Chusana Suankrati – you amazed me with your dedication to patients and student education.
Dr. Jonathan Sporn – you are a beacon of hope for those in need
Dr. Alexander Palesty – you care deeply which is important to those around you

And to the many other doctors who I think of now…
You inspire me, RW

The story of Rose, AIDS survivor

I just had lunch the other day with ‘Rose’, one of my AIDS patients.  It was the greatest thing, to see her – just like a ‘normal’ person. 

Who would believe that just last year, Rose nearly died from a terrible opportunistic infection called ‘Cryptococcus’. 

When Rose came into the hospital, she was thin, wasted and very weak.  She had been having fevers for sometime.  AIDS had been ravaging her immune system and without those defenses, she was extremely susceptible to infection.  Certain types of infections tend to occur in advanced AIDS, and she was now fighting a battle with Cryptococcus neoformans, a nasty fungus.  By the time she came in, this fungus was ‘everywhere’ – it was growing out of her blood. 

We put her on the most powerful medicine we could – amphotericin, or ‘ampho-terrible’.  It was a difficult medicine to take, especially for someone so sick.  Her blood levels dropped to less than half of what they should have been, her electrolytes were profoundly deranged , she felt weak and feverish.  There weren’t any options though – we had no choice but to try and treat her, or face certain death. 

HIV needlestick!

A good friend of mine who works as a nephrologist was putting in a dialysis catheter. She had done many ‘lines’ before and this one was just routine. The catheter looked like a very large needle with tubing attached. The catheter or dialysis line provides access to the blood stream to provide the patient with life saving hemodialysis. When the kidneys fail, a patient will die in a very short time without dialysis, as toxic levels of metabolites build up.

She accessed the neck veins and got a good flow of blood, indicating the line was in position. She finished up the placement and was preparing to give some fluids to flush the line clean. Now that the ‘hard’ part of placing the line was done, her attention lapsed ever so slightly. While preparing the fluids, she inadvertently stabbed the needle through her glove and into her finger. A lancinating pain ran up her arm – it was a bad ‘stick’ or injury. The needle had penetrated through and through her finger.