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Wednesday, June 10, 2009

Better Day

Yesterday I felt so much better. I drove down to Santa Clara to get my heart biopsy, after which I was seen in the clinic by one of my transplant cardiologists, Dr Nishime. She is a great doctor. She really listened to me, gave me hope and let me feel that I wasn't alone in this. This was the theme of the talk that I gave at Yale which I will include below. I remain optomistic.

The Doctor as a Patient
Kevin R. Anderson, M.D.
June 5, 2009
Yale University

It is a great honor for me to be able to return here to Yale to celebrate the life and career of Dr. Bernie Lytton. As a young faculty member here, Bernie was always a friend and a mentor. When one considers the process of becoming a doctor, it takes years to get where we are. Our education begins in college and medical school; followed by prolonged training in residency and fellowship in our chosen field. We continue to learn as we practice and study and research. This process never ends.
Contrarily, there is no such preparation to become a patient. It is abrupt, awkward and ultimately unsettling. All that defines us as physicians and surgeons is lost when we become ill. Namely, we lose control. Normally, in our ordered lives we call of the shots. As a patient, we are completely dependent on others. This transition is not an easy one.
May I share two examples which illustrate this on my own journey. Last year I was diagnosed with restrictive cardiomyopathy and primary amyloidosis. To confirm the diagnosis I underwent a right heart catheterization and cardiac biopsy. Afterwards, still lying on the fluoroscopy table, with a cordis in my neck, the cardiologist informed me that my cardiac index was 1.7, half of what I should normally be pumping. She suggested that I be admitted to the unit for a continuous dopamine infusion while I wait for the work-up to be done. My immediate thought was that dopamine is what we give really sick patients in the unit that are ‘circling the drain’. I certainly wasn’t that sick. My second thought was that of my work schedule. I had a full clinic the next day and many surgical cases the following week. She understood. I hadn’t yet become the patient. I then asked, “Will I need a heart transplant?” Her unexpected answer hit me like a sledge hammer. “Only if you are healthy enough,” She said.
She left me alone on the table to answer a page. As I lay there alone, I realized for the first time in my life the literality of my own mortality. It was as if someone had turned on a light and I could see the door at the end of the tunnel. Life, now, had an expiration date and death was on the calendar. I silently wept.
The following week, I was sitting in my office. I had just done two cysto cases and was waiting to return to the OR to do a percutaneous stone case and, finally, the laparoscopic nephrectomy that I had had to cancel from the week before because of my biopsy. The phone rang and it was my cardiologist. She simply informed me that the biopsy was positive for primary amyloidosis, kappa light chain type, involving my heart and that I would need to stop working immediately. As I thanked her and hung up it was as if my heart were already ripped out of my chest. This emotional pain was far worse than any physical pain that I would ultimately feel a month later when my heart was physically removed. I have always been defined by my responsibilities to others; I was lost not knowing who I was. But I still had work to do that day. I wondered if my fragile emotional state would affect my ability to operate. But as you all know; that is when the years of training kicks in. Whatever you are feeling, when you walk into the OR you leave your life outside as you focus on the task at hand. The case went beautifully. As I spoke to his wife after the case and explained that the tumor was contained. I realized that this man would now live longer than I would. But that was not a sad thought. It was oddly reassuring.
As I walked away, I became a patient fulltime. To be a patient is to wait, to wonder, to be poked and tested repeatedly, to be tired all the time, to silently be afraid, to feel alone in a crowd, to submit, to trust your doctor implicitly, to wait some more, to leave your family and friends behind, to be cut open, to be poisoned. To be a patient is to always hope even when no one knows the answer. To be a patient is to cherish the beauty of the moment.
The doctor as a patient has the special challenge of never second guessing your own doctor, to be completely compliant, even when you might do it differently. I avoided telling people I was a doctor so that they would not change their normal routine or protocol. To demand being treated as a V.I.P. is to risk sub-standard care.
Many people have asked me if I have learned anything from this experience and if I would be a different doctor to my patients. I have been changed profoundly. First of all I am extremely grateful, and the only way I can repay the gift I have been given is to give back. From the day I left my goal has been to return to work. This I will finally do in 2 weeks.
All patients, regardless of the severity of their condition, need three things. First, they need to feel that they are being heard. This is difficult as we often minimize or dismiss extraneous symptoms that to us seem irrelevant to the diagnosis at hand and explain them away as benign. We must train ourselves to accept their report with the weight that they assign it.
Second, a patient will never leave my office without hope. Not false hope, but hope in something that together we can do to extend either the quantity or quality of their lives; even if it is only to achieve a personal goal within the next two weeks. The quality of their life is directly proportional to the degree of their hope.
And lastly, I will remember than many patients feel very alone in their illness. I can help them by showing them examples, or introducing them to others who have overcome similar challenges.
I have been very fortunate to have outstanding doctors, caring nurses and friends and family who have supported me. But there are no words to describe the constant companionship that is the love of my life, my wife, Barbie. I owe her my life.
We surgeons are not usually a self-reflective group. We prove things by randomized double blind studies. Sometimes we are blind to the impact of our own life. Even though my life expectancy now falls below the mean, median and mode. I find a symbolic life extension as I reflect on the lives, that through my efforts, have been increased in years and those years filled with quality. Equally, I find the same fulfillment in having had the privilege to teach others, medical students and residents, this same art.
By this accounting, Dr Lytton, the consummate physician, surgeon and professor, should be near immortal. To all of you I give my heartfelt thanks. I am truly a lucky man.

9 comments:

Dana Nanigian said...

Kevin,

Great speech. I will apply your suggestions in my own practice. Thank you for enlightening us. I am also glad that you are feeling better.

Dana

Anonymous said...

Hi Kevin, it was very nice to see you at the support group. Thanks for the kind words. You look great considering what you've gone through. Walking down the street, people would have no idea that you're sick. It was a pleasant surprise to see how well you're doing. I enjoyed your speech, it was very inspiring. We are very lucky to have such great doctors and surgeons. I thought the heart transplant was a piece of cake, I've had worse surgeries than that. having faith in medicine is very helpful, I was never afraid of dieing which was very surprising.Being from a medical family, I as well have faith in medicine. Keep coming to support so I can see your progress.Love your heart transplant buddie, Matt Mccuskey

Anonymous said...

Dr Anderson (Kevin),

Awesome speech. I look forward to seeing you in two weeks at work, you are a inspiration to others. Take Care, Susan

Darlene Anderson said...

Wow Kevin, that's a very powerful speech. I am certain it caused a great deal of reflection among the listeners. Thanks for sharing.

Rachelle said...

Wow! I feel like I understand a litlle more what you have been through and more insight on how precious life really is. Thank you for sharing.
Rachelle

Rebecca said...

dad, that was beautiful.

i love you.

- rebecca

Jennifer said...

Kevin,
How wonderful that you are able to share your experience. I truly feel that looking at life through your eyes is such a gift to all read or hear you speak. We can all, in the medical and nursing professions, apply it to our practice. Thank you so much for sharing from your heart.
I am so looking forward to your return to work in a couple of weeks.

Love,
Jennifer

Aunt Renie said...

This is so powerful, Kevin.
I have no words, but to say THANK YOU.
Love, Aunt Renie

Anonymous said...

Kevin and Barbie, if I can call you that. My father was just diagnosed with Primary Amyloidosis this last week, your blog fills me up with hope, and faith. I thank you for opening yourselves to share your story. My prayers are with you and your loved ones.