A Doctor and a Gentleman

“This is my vow: to perfect my medical art and never to swerve from it as long as God grants me my office.”

Paracelsus

He was, above all, a gentleman. Always meticulously dressed in conservative clothes; polite; articulate; kind to his patients. Long ago he had decided to practice in an underserved suburb. He declined numerous requests to stay at the flashy medical center, and set off, on his own, to deliver care to people who really needed him. Over the years his practice grew enough that he could afford to hire three partners. It is not unusual for doctors who practice together to eventually develop animosity toward each other. There are always disagreements about how to split the money, and differences in practice style.Sometimes it is the spouses who cannot stand each other.

Not with this man. You spoke to him for five minutes and you were transfixed. He was clearly devoted to his career and his patients, so convincingly that no one ever thought of questioning his decisions. All of us looked up to him.

Over the years, time began to pass him by. Treatments that were accepted thirty years ago were clearly outdated, or even damaging to patients.  Insurance companies took over the financial part of the business. Patients no longer paid in cash at the time of the visit. There were many forms to fill out; many meetings to attend; many staff rules to follow at the hospital.  There were times that I could see a clearly befuddled expression in his eyes when a hotshot young cardiologist would consult on one of his patients and in five minutes change all of the regimen that he had prescribed over the many years that he had supervised this care.

He decided to slow down. Less hours at the office. Fewer nights on call. He continued to be the dignified, articulate gentleman, but he no longer gave his opinion at the department meetings. Many times, I noticed that he would stare at me in the middle of a conversation as if he had no idea what we were talking about.

The inevitable outcome came in the middle of the night towards the end of March. He was recovering from a respiratory infection. He had not had much sleep for a few days. A nurse woke him up: one of his hospitalized patients was asking for a sleeping pill. Would he tell her what he would like to give him?

“One hundred milligrams of Dalmane,” he said.

“I’m sorry?”

He repeated his order. One hundred milligrams.

The nurse was silent. Dalmane capsules only came in 30 or 15 milligram doses. One hundred milligrams was impossible to accurately dispense. Plus it would be a potentially serious overdose.

She expressed her concern.

He insisted on the hundred milligrams. Then he added a rude comment; something in the order as to why a poorly trained nurse was questioning him.

She held her ground. I will not, cannot, follow this order.

Call your supervisor, he says.  More rude comments followed.

The supervisor got on the line, reiterating the nurse’s concern. 

Now he was furious. He threatened to come to the hospital to write the order himself. He warned her about serious consequences. That she would lose her job… The supervisor did not yield. He slammed the phone down.

The next day a few of the staff medical leaders were summoned to the chief of staff’s office. The nurses gave their story. Other nurses signed statements about how he was making more seemingly innocent mistakes. How sometimes he would stand in the middle of the hallway, looking like he did not know where to go next.

There was a meeting with his partners. They agreed to take on all of the hospital load. Then came the time to confront him. They asked his wife to come along. I was chief of medicine. It was my responsibility to lead.

I started with a long introduction on how much the hospital, indeed the whole neighborhood, loved him. How much good work he had done.  Maybe it was time to smell the roses; put the stethoscope away and enjoy his well-deserved leisure.

He smiled. No reason to quit; I still enjoy myself. What else would I do?

Travel; golf; all the books you’ve never read…

I’m not quitting. A bit defensive there. And why are all of you here?

His wife was quiet. She did not try to help us. Clearly, she had to know that he was forgetful, but she said nothing.

You can’t keep on practicing, he was told. You can’t come to the hospital.  You need a thorough medical evaluation before we allow you back.

A loud tantrum followed. He was healthier than all of us put together, he said. He was a doctor, for God’s sake. He knew when people were sick.

Still, you cannot come back. See your doctor. 

His wife began to cry.

He left in the midst of screams and threats.

His children eventually persuaded him to have his checkup. In those days there was no medicine to be prescribed. Just go home and wait.

Mercifully, the end was swift. Within months he was in a nursing home. He stopped eating; lost weight; failed to recognize anyone. He died two months after he was institutionalized.

The older I get the more I think about him. I think about when is the right time to quit, and how. About not having to put my colleagues through the same painful ordeal that his peers were forced to undergo. About hobbies, and grandchildren, and all of the incentives that I need to cultivate so that retirement will not seem like a wasteland. Stop while you are ahead.

Will there be someone who gently tells me that it is time? How much longer will God grant me my office?