In medicine a big deal is often made on who made the diagnosis. I’ve run in to a few physician friends who had no idea about my tumor and their first question is: who made the diagnosis? As much as I could downplay the discovery of the tumor as a step in this process, I have to say that without the diagnosis I’d probably be dead. Even though the suspicion and quick action by Dr. Pearson connected me with a neurologist, it was Dr. Kaufman who ultimately made the diagnosis.
I did not like Dr. Kaufman before I met him; he heads the neurology department here at Sparrow and has always been known as a tough person to work for. His residents often fear him, the only good words about him prior to our meeting actually came from a colleague of mine, and good friend, Noshir Amaria. He told me that he had known Dr. Kaufman since medical school and that through his tough exterior he is actually a very kind man. Even with this prompting from Noshir, I still was skeptical of Dr. Kaufman. This completely changed when I met him on the day of the diagnosis. Not only has he been incredibly kind during this whole ordeal, constantly offering to help in any way that he can, but I realized that there is a method to his madness: in his eyes training future physicians is not a job that should be taken lightly, if properly training them means that they fear him, then so be it. I realized that he is kind to all his patients, not only me. The ultimate goal in this field is the optimal treatment of patients. By pushing his residents to learn, by being compassionate to his patients, and by being an incredibly hard worker he no doubt accomplishes this goal. He is a tall, imposing figure, but once I became his patient I now liken him to a ‘gentle giant’. I asked him to write a piece about the process of my diagnosis. He did not hesitate and immediately composed this:
An Atypical Clinic Day:
I just hung up the phone after talking to my good friend Randy Pearson. For the last two years I had spent every Saturday during the fall with Randy along with many Tuesday and Thursday afternoons looking after our university’s student-athletes in football. Randy proved to be one of the best doctors I had ever encountered. He is very well read but surprisingly low key. His style is simplicity in action. His mantra perhaps could be ‘common things occur commonly’. He is never upset, never worried and never in a hurry. Today’s phone call from him was different. He sounded worried, his was voice ever so slightly upset and above all he made it quite clear he wanted me to see his family practice resident Dr. Chris Chiou right now.
“Dave, Chris is one of the nicest young men you will ever meet. He is one of my Sparrow residents in family medicine. He is in my office right now and he is complaining of a double vision. He says he has been unsteady for maybe a few months but after talking to him it may have been even years,” Randy then added, “I am a little concerned about him after examining him neurologically. I need him to see you today”.
When a man like Randy Pearson is ‘a little concerned’ there was no further need to talk to me about urgency. I asked that we get an MRI with attention to the posterior fossa right now and then send him over to my office as soon as it was done.
Although it has been a year since that conversation, I recall going to review the MRI prior to seeing Dr Chiou. This is something I very rarely do. I almost always examine the patient first, come to a clinical conclusion and then confirm with the imaging. However, not this time. I realized as soon as I saw the plum-sized mass in this young doctor’s posterior fossa his life was about to change. The tumor was putting pressure on his cerebellum and had the most vulnerable part of the central nervous system, the brain stem, in harm’s way.
Even prior to seeing Chris Chiou I realized based on my thirty years of being a neurologist, this was not going to be a picnic. He needed a neurosurgeon to evaluate him within the day and the path for Chris, a man I had never even formally met, would be brutal or if unlucky, much, much worse. Yet, I also realized that something Randy said actually gave me hope. “The symptoms were there for months or maybe years” I recalled Dr. Pearson saying. If that was true, the mass could well be benign and maybe even curable if neurosurgery could be performed in an ultra-delicate but timely way.
I then walked in to meet Chris knowing I would have to tell him something no man wants to tell another. Yet I had to do it in a way that did not shatter him so he would stop thinking or be unable to act in a timely way. I also needed to let him know there might also be a chance this could be cured. Given the years spent in talking with people about such issues I also knew if I created panic or was unable to establish a bond of trust, all the work Randy had done to move him through the system quickly could be undone, setting back the process inappropriately.
When I opened the exam door to talk with Dr. Chiou, what I saw almost brought me to my knees. I was not at all distracted by his fit and athletic features, good natured personality and smiling face. Nor did the upbeat demeanor of this young primary care resident, who appeared to be in the absolute peak of health, startle me. It was not Chris’s calm and poised manner. What stopped me cold was the person sitting next to him. It was his petite, very pretty and elegant physician wife Fleur that stunned me. By all appearances she must have been more than eight months pregnant. I silently thought to myself: ‘all of this and Chris also has a wife about to give birth any second’. Yet there they were. Husband and wife. He with an ever present smile and she arm in arm with him to provide her support for whatever was ahead.
I took a very deep breath and introduced myself. I pointed out I was David Kaufman, chief of neurology here at MSU and also at Sparrow. I was nice and proper but all the while thinking this is too much for any couple to bear. I said in a fairly formal tone: “Chris you have an issue we need to take care of.”
Dr. Chiou looked up at me with his ever present smile while I talked. When I was done, the smile was just slightly less than when I walked in the room. Then he said, “Dr. Kaufman, I certainly know who you are and your receptionist also let me know I have had an appointment made by you to see one of the neurosurgeons.” Fleur looked at the floor just for a second and then raised her eyes and looked directly at me while hugging Chris’ arm just a little tighter. I then turned to Chris, and noticed the smile returning to his lips. He quietly asked, “what am I dealing with?”
In those ten seconds I realized I had walked into a room filled by two of the most remarkable people a person could ever meet. It also struck me maybe these two would beat this thing, get their baby delivered successfully, adapt, go on with their lives and continue their love for one another. Only a doctor is allowed the privilege to meet and then help such remarkable people at the moment of their greatest need. The fact this couple happened to be two young physicians at my own hospital, just starting their lives together made it beyond a privilege in my view. It was essentially, spiritual.
I examined Chris and confirmed he had a cerebellar-like syndrome. He had classic rotatory nystagmus with a down beat component. There were subtle signs of dysmetria and a gait that was ever so slightly wide based. I also determined he most assuredly had increased intracranial pressure, but his visual system was fully intact with no loss of peripheral vision from the pressure. Most importantly there was no sign of impending brain herniation that could cause sudden and extreme worsening. That reality gave us the luxury of time. We had an urgent but not emergent situation. This is always a blessing when trying to map out the safest and best therapeutic strategy.
I then turned to Chris paused and then thought for a moment. I asked him to confirm what Randy had mentioned to me just a few hours before. “Your unsteady feeling, did it just happen or was it going on for months.” Fleur answered, “I think Chris has mentioned this to me for years. Yes I am pretty sure of that.” He nodded yes and for the first time, I found myself smiling right along with Chris, as I realized he now had a chance.
Chris asked me to write about our first encounter. A year had come and gone. Randy and I spoke about the series of events that happened to Chris only once during that year. I had followed Chris’s situation from afar, seeing him only periodically and then realizing I had little left to offer him. Then just a few weeks ago he walked into my office. In he came with that smile, his year old baby and physician wife at his side. I told him “I know the biopsy is benign, the follow up MRI was clean and so far so good”. Chris’ gait was a bit unsteady but otherwise was absolutely with the program. I then leaned in and said to him, “what are your plans?” He told me: “I want to go back to work and start helping people”. I found myself agreeing right along with him as he flashed that impossibly bright smile. I then wondered to myself what other life, except that as a doctor, allows a person to witness such things and meet people like Chris.
 Dr. Kaufman is a professor at Michigan State University’s medical school.