Acknowledgment: Linda Davidson Meyskens served as coauthor.
My last post in my ASCO Connection blog (which I call "White Coat Conversations") explored the experiential and epistemological "Search for Spiritual Humanism." While considering a relevant topic for this edition, I found myself looking to the past. Often in my life, past and recent events have conspired to lead me toward something of importance—in this case, the topic of “the physician as patient.” I will provide some background so that you will understand how this topic came to be of relevance to me, both personally and professionally.
I have struggled throughout my life with a wide variety of chronic health challenges. I was born with a poorly defined medical problem accompanied by a number of congenital abnormalities, the most visible of which were my unusual hands and arms. I developed complex neurological changes at about age 2, and over the next 3 years suffered regular grand mal seizures accompanied by three episodes of near death. Control was finally achieved with barbiturates, which slowed my mental development and led to an unusually introverted personality. As I entered puberty, it was clear that my cognitive function had returned in abundance, but my physical growth was markedly stunted, and the decision was made to discontinue the drugs. Fortunately, the seizures did not recur. In my third year of medical school at UCSF, a series of dramatic events led to the diagnosis of my underlying problem: a rare congenital variant with the tongue-twisting name of sponsyloepithesial tarta (incomplete) secondary to prenatal exposure of my mother to animal foot-and-mouth disease during World War II.
At the age of 45 I developed a rare form of insulin-dependent type I diabetes, thought to be immunologically mediated via exposure to the Coxsackie B virus. Only recently has it been recognized that animal foot-and-mouth disease and Coxsackie B are from the same family of viruses. I responded well to my health challenges and my life was fully lived from 1994 until 7 years ago, when I experienced a series of unexpected professional setbacks. These led to extreme stress along with increased difficulty in controlling my diabetes and a bizarre arthritic paralysis that was misdiagnosed over the next few years. Finally, 2 years ago, the correct diagnosis of myasthenia gravis was made—another rare immunologically mediated disease. Treatment was initiated and by late November of last year I was feeling great and driving for the first time in 3 years.
And then, 2 weeks later… the results of an arteriogram were definitive and could not be ignored. The grave expression on the face of the cardiologist confirmed my worst fears. My situation demanded a dramatic intervention that culminated in triple-bypass surgery and a complex 46-day in-hospital recuperation. Unfortunately, my full recovery was delayed by the impact of the COVID-19 pandemic on medical practices, but a recently completed cardiac rehabilitation program (bootcamp, really!), as well as the process of writing a series of my memoirs, has restored my cognitive function to near pre-surgery status. Happily, I was recently able to pen my first poem in almost a year.
I have long had a deep respect and appreciation for nurses, not only as caregivers, but as valued academic colleagues. While at the University of Arizona, I collaborated with nurses on both prevention and treatment trials, which resulted in several well-received publications. At UC Irvine, I was further engaged as I actively participated in the development of the nursing program during its formative years. During that time, we had many profound discussions about physicians, nurses, and other caregivers as patients. For those interested in learning more about this topic, I strongly recommend The Physician as Patient: A Clinical Handbook for Mental Health Professionals, by Dr. Michael F. Myers and Dr. Glen O. Gabbard, published in 2008 by American Psychiatric Publishing, Inc.
My personal experiences have led me to participate in UC Irvine’s Art of Doctoring course, which is offered to medical students who have completed one or more of their clinical years. Although the care of a sick physician is among the most difficult of professional duties, the course this year will open with a 2-hour session on that topic, with yours truly as the lead speaker. Confrontation of one’s own mortality is among the most challenging of encounters and requires deep reflection by the hardest person to understand—the one in the mirror.
My recent hospitalization led me to reflect on the profound and essential role that nurses have had on my life… not only during my recent surgery, but throughout my personal and professional life. They have left an indelible imprint on my subconscious, and inspired the following poem, and here I offer my reflections on “the physician as patient” in the most personal way possible.
A visit to the healing place,
home for forty-six days and nights.
Distant past, present, and future
coming together on the seventh floor.
I sensed that my heart was unwell,
skipping beats in the middle of the night,
awakening me to the urgency
of that moment.
An arteriogram brought
unwelcome news, blood no longer
flowing where it was supposed to go.
A triple bypass necessary or
my life would be short.
An easy decision. Sternum split,
veins removed and reattached,
remodeling the flow
to be lifegiving.
Now three months later
healing from my wounds,
physicality returning, my mind injured,
repairs slowed by the damage within.
From three decades ago a remembrance
of my life at age three
My mother screaming,
“Frankie is dying
Looking down from heaven I saw
A nurse and my mother holding my hands.
The panic in my mother’s voice calling me back,
releasing me from the pull of the gleaming light.
I floated down to my mother’s arms and
opened my eyes in fright.
Burnt forever into my mind.
Seven decades have now passed.
I have seen dying and death again and again.
Ten thousand patients, countless nurses
imprinting compassion on my soul.
Each nurse offering their quiet wisdom
to every patient, as I have become.
Kindness blossoming into a tenderness
that has bound me to them forever.
Florence Nightingales in disguise.
Welcoming clumsiness with a smile
and understanding. I will remember
their gestures for eternity in my soul.
Now three months home again
Memories beckoning me
to recall another life, as if I were still
a baby , hearing…
Taking my hands in hers, the nurses on earth
offers healing to the weakened body.
Angels living in my consciousness,
roses in a Spring bouquet,
their beauty and kindness imparting
Protecting me in a celestial embrace.