opinion

A physician's reward: “finer than much fine gold”

A message to all physicians from Steven J. Stack, MD, chair of the AMA Board of Trustees.

By Steven J. Stack, MD , an emergency medicine physician in Lexington, Ky., was chair of the AMA Board of Trustees during 2012-13. Posted Dec. 17, 2012.

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“Medicine gives only to those who give, but her reward for those who serve is 'finer than much fine gold.' ” — Dr. Charlie Mayo.

Because we are physicians, our fellow men and women allow us into their lives in ways they do with few others outside their circle of family and intimate friends. Not infrequently, a patient allows himself to be visible and vulnerable to the physician in ways he would do with no other. We all know the great responsibility attached with this trust. We all know the immense impact this has on our own lives.

Many physicians have a folder, box or some other repository where they keep special correspondence received from their patients — I do. Because I am an emergency physician, mine is a small collection, but it is certainly important to me.

As a younger attending starting my career in Memphis, Tenn., I evaluated a fellow physician in the emergency department. He and I both thought he had diverticulitis. A CT scan, however, revealed colon cancer with metastasis. As I sat on the edge of his bed and delivered this terrible news, the full weight of the obligations of our profession was upon me. Fortunately, with the help of an excellent oncologist, he achieved a remarkable remission. For many years thereafter, every Christmas season, I received a letter from him thanking me for being his guardian angel on that day and letting me know he was still doing well. Even when I relocated to Kentucky, the letters found me and let me know that he was well and following my career from a distance.

I suspect every one of you reading this column knows exactly what this means to me and that you each have your own experiences much like this. Truly, this is for me a reward “finer than much fine gold.”

In medicine, we also celebrate the “great saves” and examples of truly heroic interventions. One night, a transcontinental truck driver arrived in my ED by taxi. After hours of unrelenting chest pain, he pulled into a truck stop and asked the register attendant to call him a taxi, not an ambulance, to take him to a hospital. Prompt medical intervention abated his pain and normalized his EKG. A diagnosis of severe and inaccessible coronary artery disease resulted in bypass surgery the next day.

Though he had done well all day, he arrested immediately upon initiation of anesthesia. The surgeon, skilled and decisive, had his chest open and the bypass machine engaged within minutes. Against the odds, when I later visited the man in his hospital room, he and his wife hugged me and thanked us for returning him safely to his family.

A small number of patient encounters touch us indelibly and affect us for life. Even things we come to see as common or routine are anything but that for our patients. I've reassured many parents that their young infant who fell down the basement stairs will be fine; the fear and anxiety visibly dissipates when I am able to reassure them calmly and confidently. A few days ago, a terrified young man entrusted me to re-expand his collapsed lung with a catheter chest tube — trust and terror are appropriate words, by the way, when someone allows a stranger to insert a 6-inch needle into the front of his chest.

The countless other times that reassuring words, a hand on a shoulder, medical knowledge or technical skill have helped relieve pain, restored health or provided comfort get lost in the crowd of many similar experiences. And yet, for each of those patients, these interactions are anything but common and they represent a special expression of trust, respect and appreciation for the physicians in whose hands they place their very lives.

Sadly, we are also called upon to console when our knowledge and skills are insufficient to restore health or avert death. It may seem odd, but comfort and acceptance that it is OK to cry with patients and/or their families take time and experience — it is not something that comes naturally or easily to many. And, lest any nonphysician reading this ever doubt, the shared tears are real, and the impact on the physician deep and lasting. Informing husbands or wives, parents or children that their family member has died is something that never gets easier and always hits close to home. Experiencing the frailty and uncertainty of our mortality so intimately and regularly affects us at our very core.

Christmas morning, 2010, I told a young man in his 30s that he had a dissecting thoracic aortic aneurysm. Death was more likely than survival. He asked the nurse, “Please don't let me die,” but that if he did die for her to promise she would call his girlfriend to tell her that he was sorry they had argued the night before. We all cried. A skilled surgeon, though, repaired his aorta, and he lived. The next year, a few days before Christmas, he called my emergency department to let us know he was well and to thank us for saving his life. Wow, how awesome is that?

In our society, we entrust our tax returns to accountants, our wills to lawyers, our food to farmers, and our cars to mechanics. To physicians, though, we entrust our very lives, without which the rest wouldn't matter. Notwithstanding any other challenges we face as physicians, what a truly remarkable reward, “finer than much fine gold,” is ours.

This holiday season, I am thankful to my fellow physicians whose service to society touches men, women and children so meaningfully and so incredibly. To the many patients who have entrusted their health and lives to my care, I am humbled and indebted.

Happy holidays.

Steven J. Stack, MD , an emergency medicine physician in Lexington, Ky., was chair of the AMA Board of Trustees during 2012-13.

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