What Our Patients Teach UsJune 20, 2016
Alumni—from across the country—share expressions of patient healing on a path towards
Edited by Jennifer Schaffer Leone
Rafael Campo, a celebrated physician-poet, has identified that, “Every interaction
with a patient is in some sense a form of poetry.”
In the five vignettes that follow, Philadelphia College of Osteopathic Medicine alumni
invite us into an empathetic space. They give a literary voice to their patients,
and subsequently reveal the sadness, hopelessness, and joyfulness of being a physician.
I met her as she sat at her daughter’s bedside. Although she looked as horrified,
disheveled, and confused as any family member I’d seen coming to terms with unexpected
loss and spending a night in the intensive care unit, I felt her expression grip my
soul. Her daughter was nearly a decade younger than me and—as she thought until that
day—emerging from a past of drug use to a future of opportunity.
I couldn’t confirm for her why her daughter’s heart had stopped beating, even though
she repeatedly asked me over the course of the following weeks. It may have been triggered
by respiratory arrest associated with a severe asthma attack. Regardless of the cause,
her daughter had diffuse anoxic brain injury and would never regain all of her prior
I watched the mother grieve, and I joined her on this path of many questions and not-as-many
answers. Our morning encounters at the bedside invariably included a mixture of half-smiles
and tears; a description of events at her home with the rest of her family in an attempt
to maintain normalcy; and a commitment to give her daughter at least six months with
a tracheostomy and PEG tube to declare herself and the full magnitude of her neurologic
deficits before any discussions of withdrawing care. She demonstrated extraordinary
hope to confront a challenging reality. I struggled with that reality and, internally,
questioned whether her optimism subjected her daughter to greater pain than benefit
if—in a not-so-distant future—her daughter might suffer from decubitus ulcers and
recurrent urinary tract infections. She wouldn’t give up (and, seemingly, neither
would her daughter).
I encountered her a few months after her daughter left the intensive care unit. The
tracheostomy is now gone; her daughter appears to be smiling and, perhaps, laughing
in response to familiar faces and conversation; and she found her daughter a residence
at a skilled nursing facility with capacity for water therapy. I won’t forget her.
I won’t forget the charge to merge realism and optimism into a realistic optimism.
John Raymond Dahdah, DO '13
Physician, Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania
As a pediatric oncologist, when I reply to casual questions about what I do for a
living, I am accustomed to hearing responses like this:
“Wow. That sounds so depressing. I could not even imagine!”
Stomp, stomp, stomp! I’m sitting on the rolling stool in the exam room, playing hide-and-seek
with a three-year-old boy dressed in his finest white cowboy boots and cowboy hat.
He is smiling and giggling as he tries to hide from me behind the exam curtain. I
can see his little feet moving up and down and hear his boots hit the tile floor.
How can this be the tiny baby I knew with the sarcoma growing inside his cheek? He
couldn’t eat because it affected his ability to suck. Failure to thrive, nasogastric
feeds, central line infection, status post chemotherapy, 54 cGy of radiation—you’d
never know it today. Together, we are talking about preschool, futbol, and games of
hide-and-seek. We are all smiling as we are bathed in the light of his joy. He is
thriving. This is the farthest thing from depressing.
“How can you possibly deal with kids dying?”
I hate this. I don’t want to do this. I am filled with emotion as I walk up to the
PICU to talk with his parents. The death talk, DNR/DNI decisions. Dread. This is the
last thing I want to do at 7:30 p.m., after a long day in the hospital. This is the
worst part of my job. “Thank you for being so honest with us,” says his mom as she
wipes tears from her eyes an hour later. We have both cried. His dad squeezes my hand.
As I walk out, I take a deep breath and consider what a privilege it is to do this
work. Remember, Kara: you are walking with people during the most difficult times
in their lives. Be grateful. Be honored. Breathe in. Breathe out.
“That must be the worst job in the world. How can you do that?”
Ping. Another email hits my inbox. Some new task to attend to, no doubt. But wait—this
is a name I haven’t seen for a while. My mind flashes back to her sitting in her hospital
bed, wearing a hot pink wig, looking as sassy as ever. The room is covered with teen
paraphernalia. She has been living here for the past six months. Throughout all the
bad news—“acute myeloid leukemia,” “not responding as well as we would like,” “we’ll
need more intense chemo,” and bouts of nausea, rigors, fevers—there was, more often
than not, a smile under that wig, and a desire to chat about her favorite nail polish
color. I click on the email and am hit with a selfie—an image of a vibrant young woman
in an urban park. Far from where I sit in sunny California, she reports, “Dr. Davis,
this is me in Washington Square. I’m doing a lot of yoga these days. I am almost through
my first semester at NYU, and I am loving it. I feel great—thanks to you. I wouldn’t
be here without you. Love, M.” When people ask me how I can do this job, I answer
that I can’t imagine doing anything else.
Kara L. Davis, DO '04
Pediatric Hematologist-Oncologist, Bass Center for Childhood Cancer and Blood Disorders,
Lucile Packard Children’s Hospital at Stanford, Stanford University School of Medicine
As a hospice and palliative care physician, I am afforded countless opportunities
to learn from my patients. There is true privilege in being present during a patient’s
most vulnerable time in life, as one is allowed to bear witness to many extraordinary
and often selfless acts. Learning to be present with my patients during these times
has taught me much about what empathy means.
Hilde was in her 90s and had suffered a fall resulting in a hip fracture. I learned
from hospice staff that she was a Holocaust survivor and that her name was among those
on Schindler’s list. Given her life’s history, I entered the room with humble respect.
She put me at ease with a gentle smile and, with her family, we discussed her goals.
She was not a candidate for surgery, and she accepted this with grace. She declined
steadily after this but lived her last days in comfort and with dignity. I visited
her multiple times in the hospice unit before her passing, was reminded that the simple
act of holding someone’s hand is often just as effective a therapy as a medicinal
I am always reminding myself that my patients all have their own stories, having sacrificed,
loved, laughed and said goodbyes to their loved ones just as their grieving families
do with them now. Sometimes, if I find a patient is alone and in their final days
or hours, I will sit at their bedside to provide some kind of presence for them, hoping
it is worth something. I think about the privilege it is to play even a small part
in this person’s life journey, and often I will think of Hilde and thank her for that
Brendan Flynn, DO '00
Medical Director, Blue Ridge Hospice, Leesburg, Virginia
One of the attributes of being a “good doctor” that I learned as a resident was taking
time with my patients. As a junior resident, I often found this “extra” time spent
explaining and educating not constructive to my growth as a physician. However, as
I grew in my discipline and became a private practitioner, I realized that this additional
time was beneficial not only for my patients, but also for me.
Recently, I saw Mrs. May, as I will call her, in consultation for postmenopausal bleeding.
She was very nervous about seeing me because she had not seen a gynecologist in several
years, and she felt that this one episode of vaginal bleeding was insignificant. After
an ultrasound, I explained the need for an endometrial biopsy and possible surgery.
During the procedure, she was tense and not easily distracted. Afterwards, she tearfully
told me about having a similar surgical procedure for a miscarriage and being terrified
of a cancer diagnosis.
I know God was with us at that moment. I grabbed her hands. We did not talk about
the results or plans for follow-up. Instead, we talked about how good God was, how
He never places us in situations that are too great for us, how we are victorious
regardless of what we may face. Mrs. May told me she felt so much better afterward.
But perhaps she did not know how much our encounter was a blessing to me. I do not
talk about faith and spiritual beliefs with all of my patients, but I do recognize
the impact that spiritual empathy plays in the lives of many who allow me to care
Chavone Momon-Nelson, DO '05 MBA, FACOOG
Physician, Obstetrics and Gynecology, Carlisle OB/GYN and Carlisle Regional Medical
Center, Carlisle, Pennsylvania
I have been volunteering at the Women Against Abuse shelter at an undisclosed location
in Philadelphia for the past eight years. I say “undisclosed” because the women who
are accepted to this shelter have passed an extensive lethality screening, a screening
that determines a women’s risk of dying at the hands of their abuser. They are asked
questions such as “Has he ever choked you?” and “Has he ever had a weapon possession
charge?” Over 8,000 callers last year did not reach this level of danger and had to
find other forms of shelter, which leaves only about 60 kids and their mothers occupying
a temporary safe haven.
What the lethality review doesn’t take into account, but is implicit in each of the
20 questions it asks, is the effects on the children who see, hear, feel, sense, the
dangers in their home, the place that is supposed to protect them, to shelter them
from evils and fears outside, not within.
Will (not his name) was 13 at the time, the same age as my middle daughter. He and
his mother stood out immediately. Reserved, quietly awaiting their turn to see the
doctor on our monthly “Doctor’s Night,” he had his face in a book, oblivious to the
frenetic children running around, climbing on chairs, begging for attention. Will
really didn’t have any medical issues, but his mom wanted him to get “checked out.”
His past medical history and physical exam were perfect, but my knowledge of how early
childhood trauma adversely affects the developing body and mind did not reassure me
that all would be well. I asked about his favorite author. “Rick Riordan,” he said
without hesitation. “The Percy Jackson Series,” he blurted out. These were my daughter’s
favorites as well; she had recently met the author and had a signed copy of his latest
book. I asked Will if he would like me to bring back a few books in the series that
he hadn’t read yet, and he agreed, not as excitedly as I would have thought—but then
I remembered the empty promises that so many of the children we care for here must
have heard over the years. I told him I would come back in the morning, before school,
with the books. He looked at the floor for several seconds, then looked up at me with
his light brown eyes that had seen more than any child should, and walked away.
The next morning, I signed in at the security desk of the shelter and had the guard
call Will’s room. My daughter, having heard his story, had given me the signed book
to give to him. As I waited for Will to come down, I watched as child after child
signed out to go to school, some in donated clothes that I recognized from our clothes
drive, some with backpacks filled with homework and the secrets of living in a domestic
violence shelter that each one of these children brings to school each day.
Will finally came down with his mother and, this time, looked deeply into my eyes,
saying without a word that I had not let him down. I gave him the signed book as well
as a few more, and he immediately went back into the trance from when I first met
him, book in hand, transported to a fantasy place where children his age had immense
powers and were heroic. He opened the signed copy last, and traced his forefinger
over the signature from the author as if he were signing it himself.
“Thanks,” he said, as he prepared to go to school. “Keep this safe,” he said to his
mother as he gave her the signed copy. “I promise,” his mother said, as she kissed
him goodbye, and tucked the books under her protective wing. I stood there motionless
as they walked in separate directions, the security guard my only companion, both
of us knowing that we were in the presence of young heroes and their mothers, who
will hopefully, someday, be safe.
Daniel R. Taylor, DO '97, FAAP, FACOP
Associate Professor, Drexel University College of Medicine, and Director, Community
Pediatrics and Child Advocacy, St. Christopher’s Hospital for Children, Philadelphia,