2012 Annual Competition Winner - "Lessons from My Father"

by Kristin D’Silva

While he was not a physician, my father taught me the skills I would need to become one. He grew up in a generation that lacked the benefits of modern medical technology, a generation that relied primarily on the art of taking an informative history and conducting a thorough physical examination rather than on MRI’s and laboratory results. My father taught me that while technology aids significantly in the diagnosis and treatment of disease, it is important to remember that each patient has a unique story that cannot be revealed via scans and diagnostic tests. While he passed away unexpectedly during my first year of medical school, the principles he instilled in me guide me as I interact with patients.

Lesson 1: Take Time to Listen

Mrs. Jones (name changed) was an eighty-seven-year-old nursing home patient who was sullen and withdrawn. Although most of the staff believed she was unable to communicate due to dementia, my father, who was working as a nursing home administrator, began to talk to her, and she began to tell him stories about her childhood, the Great Depression, and her lengthy career as a symphony pianist. When he heard this, my father, who loved music, insisted on taking her to the living room where a majestic grand piano stood. At once, Mrs. Jones began to play beautiful classical pieces from memory, to the shock of the other staff members and patients who had not known that such tremendous skill lay dormant in this quiet, diminutive woman. Simply listening to the stories people tell can enable physicians to improve the quality of life and health of patients. Likewise, making assumptions about patients can impede health care delivery.

Lesson 2: Embrace Learning

For most of his career, my father was a clinical microbiologist, and he introduced me to the wonders of science. He would show me specimens with his microscope, and I was fascinated by the unique shapes and strange colors that suddenly became visible, as if by magic, when I looked through the eyepiece. He also loved books, and our home was filled with all kinds – encyclopedias, novels, and textbooks – that I spent much of my childhood perusing. My father instilled in me a thirst for knowledge that has driven me to become a life-long learner.

Lesson 3: Care about Others

My father genuinely cared about people, and he could become friends with a complete stranger in minutes. He sincerely wanted to learn about others’ interests, values, families, and hobbies. Although he enjoyed talking to people of all ages, he had a particular fondness for children, and he would entertain them with magic tricks, making coins, handkerchiefs, and balls disappear and reappear. Watching my father interact with others inspired me to enter a profession where caring for people is paramount.

Lesson 4: Competence and Compassion

At my White Coat Ceremony, a distinguished faculty member named Dr. Foster said, “To be a physician, one must be competent. But when competence fails, one must be compassionate. We teach our students to be both competent and compassionate.”

Although these words were planted firmly in my mind, I finally appreciated their wisdom when I received a phone call that caused my world to implode at 7 A.M. on February 29, 2012. Leap Day. My mother told me that my father had suffered a cardiac arrest while walking our dog. He was resuscitated by a kind neighbor, who happened to be a critical care nurse. When I arrived at the ICU, my father was on a ventilator, an aortic balloon pump, and more drips than I thought possible to attach to a human being.

My family and I waited anxiously for signs of movement, anything that could possibly indicate that my father had some neurological function preserved. As the days wore on, we began to lose hope. Although his brainstem was intact, an EEG showed seizure activity. He began to cough violently, and a tracheostomy was performed to help him breathe more easily. My mother, brother, and I began to discuss when to switch to comfort care. By day 10, we had begun to accept the looming inevitability of death, but my brother was reluctant to allow the doctors to disconnect the ventilator that kept my father alive. My brother is an engineer, and to him, the human body is akin to a machine that can be fixed if reprogrammed properly. Therefore, he could not come to terms with the fact that, at a certain point, even the most competent physician can no longer stall death.

The cardiologist arrived to speak to my family. And that is when I learned the meaning of Dr. Foster’s words – that when a physician has exhausted all scientific options, all he has left to give is compassion. The cardiologist looked my brother in the eyes and said, “This is the medically right thing to do.” And with that, he assumed the burden of responsibility himself so that my brother would not be tormented by guilt. Minutes later, the aortic balloon pump and the ventilator were turned off. In a final act of compassion, the cardiologist, knowing that the hospice would not take over care until the next morning, prescribed my father morphine to ease his suffering. Two days later, my father passed away peacefully.

As physicians, we rely on science to guide our clinical decisions. But often, even though scientific knowledge grows exponentially with each passing generation, science fails. Unlike controlled experiments in test tubes, life is filled with uncertainties and unexpected events that disrupt the orderly realm of medical knowledge. After the multitude of medicines and procedures are exhausted, the physician has only one option left – compassion. And to the patient and family members, what matters most is that compassion remains even when competence has failed to deliver a cure. Although modern physicians have more tools to use than their predecessors, the most important ones are still the kind touch and comforting words employed by countless generations of healers.