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

Prayers for the heart

Felix always seemed to have a ready smile for those around him. Even the first time I met him in the hospital when he was suffering from an infection in his abdomen. Unfortunately, he had complications following a surgery and now required antibiotic treatment. I realized he would need long term therapy, so he would need a PICC line (which stands for Peripherally Inserted Central Catheter). With the PICC line, he could finish his antibiotics at home.

Felix went home and continued his treatment. A short time later, however, I was called urgently to the Emergency Room. Felix had returned with fevers and chills. He felt very ill and appeared ashen. I listened to his heart and heard an unnatural sound – it was a heart murmur. Blood cultures confirmed he had a heart infection, or ‘endocarditis’. The PICC line had to be removed. I called the thoracic surgery team to assist – but unfortunately they wouldn’t operate on Felix. They said his condition was too poor.

I knew this meant he would die. Without functioning heart valves, the heart would soon become exhausted, his lungs would fill with fluid, and he would pass away from us. It was an awful prospect. He was so young. Even though he was gravely ill, he still managed to smile at us. His mother looked to me for an answer. I tried not to take away Hope, but it was a bleak prognosis. Without the surgeons help, I didn’t know how much time Felix would have left.

I decided to use a powerful antibiotic called daptomycin. This medicine would at least kill off the germs responsible for damaging his heart. Each day I made rounds, expecting to find an empty room. Each day I found Felix, still smiling, with his mother close by.

Day after day became week after week. Felix hung on. His heart somehow kept going and his lungs remained clear. After THREE weeks, the surgeons seemed to realize they could operate after all. Felix underwent valve replacement surgery and had an uneventful recovery.

I could hardly believe his good fortune. Medically speaking, he shouldn’t have survived. Those were impossible odds to overcome and I never knew ‘how’ he did it… until just recently when I bumped into his mom. She told me her secret “I prayed for him every day” – then I knew, of course! I smiled to myself, this really was a fantastic miracle.
RW

Miracles of healing with hyperbaric oxygen therapy

I just finished a continuing medical education course on wound healing and hyperbaric oxygen therapy in Columbus, Ohio.

It was an intense week listening to many presentations and case studies. I heard many miraculous cases from our instructors, particularly regarding hyperbaric oxygen or HBO. This therapy consisted of pressurizing a patient in an oxygen chamber, so that very high amounts of pure oxygen could be given. It was considered safe and effective. The results were amazing.

One young girl had severed her ears after an assault. It seemed like such a horrible injury, I wondered how possibly she could be treated. A team of doctors including plastic surgeons and wound healing specialists using HBO worked very intensely to save her ears. It was fantastic to hear at the end of three weeks she recovered with a very good cosmetic result.

Another young lady lost both her legs below the knees from an accident. She wasn’t healing well because of her depressed condition. She endured many weeks of wound treatment including including HBO. Slowly, she improved and her wounds healed so she could be fitted with artificial limbs. Our teacher held back tears as she told how the patient returned to the wound center, rose out of her wheelchair and walked easily for her care team to see. She had persevered and chose to live in the best way she could.

Another doctor told us about a few patients with diabetes who were cured from their disease with an experimental procedure that used stem cells and HBO. I was amazed to hear their pancreatic function recovered and they no longer needed to inject insulin because of the disease. It was just incredible.

I felt lucky to have received such important training. I’m looking forward to improving lives with hyperbaric oxygen and other wound care techniques!

RW

Rabies Hero, Dr. George Baer

There are some people who accomplish so much in life, they shine like beacons for the rest of us. Dr. George Baer is one such figure who contributed so much.

Although he passed from this life on June 2nd, he is immortalized as a ‘Rabies Hero’ – a pioneer in the field.

I first ‘discovered’ who he was after picking up a copy of his book ‘The Natural History of Rabies‘. That book was part of my introduction to rabies, after having learned firsthand about that horrible disease on a clinical rotation in the Philippines – see my blog “My first patient with rabies“. I read everything I could find about rabies and I learned what an important figure he was.

Dr. Baer had a long and productive scientific career. He worked for the public good out of a genuine compassion and concern for humanity. He served as head of the CDC rabies laboratory for a number of years. He went on to work in Mexico, where his efforts led to dramatic improvements in reducing rabies transmission.

Among his great contributions was the development of an oral rabies vaccine. That led to eradication of wildlife rabies in most of Europe. Even up-to the time of his passing, he was busy working on an improved vaccine for influenza.

Dr. Baer influenced so many people around the world. He is an inspiration we will never forget.

RW