Greg and Megha…

For this post I asked two of my close friends and colleagues to write something for the blog. They provide a unique perspective in that they were both the co-chiefs at the time of my diagnosis. To give their writing some context I emailed them and asked them:

What was it like in the program after I was diagnosed? What kind of logistical barriers did my absence present? I knew you both before—what are your thoughts on my return?

 More importantly than chiefs, they are both close friends to Fleur and I. Gregory, or Greg as I call him, now practices Family Medicine in a small neighboring town. He was the one person in the program I would always bombard with questions—no matter what I asked him, he always seemed to know the answer. He is full of confidence, a trait that led him to proclaim on one of his first days in the residency, “Hi my name is Greg. I’m awesome.” It is this belief in himself along with the knowledge to back it up that made me want to practice medicine with him. I would often tell him in passing that once he graduated not to move too far and not to sign a long term contract so we could eventually open up a practice together. Greg has one of my closest friends since moving to Lansing- I regret not spending more time with him since the surgery, as I have not seen too many people since the diagnosis.

Me, Megha, Greg, and his wife
Me, Megha, Greg, and his wife

As an Emergency Medicine intern, the first call I placed was to Megha Tewari. She must have sensed my nerves as she said, “good job” at the end of our conversation.[1] But as time passed and I got to know Megha better, I realized that it was her big heart that allowed her to say those words to me. If I had to describe her to someone else I’d say “Megha doesn’t take any bull$*!% but she has an enormous heart. If she believes your intentions to be solid, then she will be your greatest supporter. If not though, then look out.” She reminds me a bit of my younger sister in that way. When I was in the hospital for a month, Megha would visit me daily, often bringing me great food.

I know they were indispensable to the program and wonderful physician, but more importantly they are both amazing people. This is what they wrote:

Gregory Lawson:

As physicians we are continuously faced with illness. Those we know about or those we would like to know about. Our job is to try to figure out how to help our patients feel better, be it physically or emotionally first by figuring out what is wrong then figuring out how to fix it. We do this day in day out, focused on our patient’s needs but with just enough detachment to remain objective. The question now remains what happens when the patient in question is someone close to you; what happens when the patient is you?

That is one of the many things running through my mind on that day when Chris left the residency continuity clinic at about 1pm saying he had an emergency. This was very uncharacteristic- My first thought was his son Christian. I sent a text soon after he left asking if Christian was the emergency and his response was classic Chris ” Oh God no, Christian is fine, it’s me thankfully” On one hand I was glad Christian was okay on the other hand I was filled with worry about what could possibly be happening to Chris.

My name is Gregory Lawson and one of many people that are blessed to call Chris a friend. At the time when this all started I was in my third year of residency and I was serving as one of the chief residents for the program. I remember getting a call later that evening from Chris telling me he just left the neurologist office and apparently there was a mass in his brain per the MRI. ‘They think it is benign’ and things are already in motion with logistics and processes with everything ending up with a proposed surgical excision soon. He would need to be out for a little bit and we would figure out coverage with regards to his calls and clinic patients. I remember asking him if anyone else knew and how we should handle communicating the information, at the same time keeping in mind that we do not have a complete picture of what was going on. What was interesting was his manner of delivery. Eloquent, concise and complete, I did not detect any fear or worry. In fact, I hung up the phone feeling reassured. That is one of the characteristics that Chris has that few physicians possess. He has a way to make you feel better just by talking to him. The effortless ability to reassure and encourage.

I got home and after a few minutes of going through our conversation in my head I realized that my objectivity in that situation was ‘waining’. The more I thought about a brain mass that was causing symptoms the more I became less comfortable. How does one deal with such information? I would imagine that with my patients I’d probably talk to them and then I’d refer them to a neurosurgeon and for the most part I am done with management until their recovery. How do you treat a friend and colleague?

On some level we all were in the Kluber Ross stage of denial, chatters of ‘we don’t know what it is’ , it might be a cyst’ it could be anything we can’t know much of anything until after a biopsy and therefore after surgery were all around. There was some sense of anxiety in the air even though everything appeared business as usual.

Chris had his surgery at University of Michigan. Through this time we were kept updated by his wife about what was going on at the other side. After a few days he was transferred to Sparrow Hospital. I saw a missed call from Chris on the day he was transferred to Sparrow hospital and he had apparently left a voice message on my phone.

The voicemail went something like “hey Greg, its Chris……some words, some more words…bye” Basically, the only words I could understand were, hey Greg, its Chris and bye and those were slurred. This was the moment that for me it became less abstract and more real. The emotions that coursed through me were fear, helplessness and a sense of anger at why this would happen to someone like Chris. I prayed for the first time in months. We had done some reading about epidermoid cysts after we initially heard about the diagnosis and apparently it’s very rare, therefore there was not a lot of information about it, much less about the outcome of surgery.

With this in mind it was important to figure out the logistics of how to manage Chris’ absence within the residency. How long will he be gone? What will happen to his patients? How will Fleur cope? Will there be family to come help Fleur who was close to term with Cormac? Would we need coverage for Fleur who is also a resident in the Program? What can we do to help? How much privacy can we ensure for them? Should the residents round on him? Won’t that be awkward? How far out do we anticipate we would need coverage?

One thing was clear; the whole program was on board as they are our Family.

Megha (who was the other co-chief resident at that time and one of our closest friends) and I worked on the task of filling in the calls that were assigned to Chris and some assigned to fleur while trying to balance the total amount of calls that each resident had. Most were gracious and we didn’t have to use the “c’mon he has a brain tumor” card. There is a delicate balance being friends with Chris and also having a responsibility to the program. Are we working based on what we hope for as opposed to what is more likely?

This is someone that is loved by everyone in the hospital, always received good evaluations from his rotations, someone that up until a few weeks prior we all went to a coffee shop to study, Megha and I for our certification boards and Chris for his USMLE step 3. Was that why he seemed to miss the stop sign, or why his car seems to not keep a straight line on our way to the coffee shop? Why didn’t he let us know he was having symptoms?

As I mentioned earlier, we don’t have a wealth of information about outcomes of surgery on epidermoid cyst and prognostic data. What we do have is Chris and the effort and strength he has. What we have is an ability to see the great improvements; from being unable to understand his voice message to now talking with him without any apparent deficits in speech. From him being in a wheel chair, to him climbing up and down the stairs. What we see is a continuous improvement and what we hope is for continued strength and perseverance.

I am not in a position to determine when we welcome him back to work but I can’t wait for the day when he comes back to work looking dapper as always, stethoscope on hand going to see his first patient.

Megha Tewari:

Cormac, Fleur, and Megha
Cormac, Fleur, and Megha

Chris asked what it was like in the program after his diagnosis. It seems that the overall sense I got was that everyone of us was affected by his diagnosis and subsequent surgery and recovery process. All of us had our own way of dealing with it. I am going to share the things I noticed at the time of his symptoms. This may be a lot or you may think it is a skewed opinion, but it is how I experienced that month.

“I am going to ask Chris to throw another poker night party”. This was my thought when I wentin for 8 am didactics[2] on Wednesday morning in March 2013 for our residency. I saw Chris come in about 10 minutes into the lecture, and leave within 20 minutes. This was very unusual for him. He is usually the first few residents to walk in to the lecture room, and the last one to leave. I didn’t pay any more attention to this and thought I would just talk to him next day during Thursday afternoon didactics. Being a chief resident along with Gregory Lawson, one of our job descriptions was to keep a tab of all the residents attending didactics every Wednesday and Thursday. I had become quite adept by this time, to notice when and who came in. On Thursday the following day, when I noticed that Chris and Fleur were both absent, I got a bit concerned. This was very atypical for Chris. The Chiou’s apart from being colleagues, are also one of our closest friends. I texted Chris to see if everything was alright. Fleur was in her last trimester of pregnancy at this time, and I was concerned for her health and the health of the baby. If you know Chris, you will know that he always responds to his texts immediately. When I did not get a response from him ‘red flag’ went up. My co-chief Gregory Lawson worked with Chris in the same office and is also a good friend of the Chiou’s, so I asked him if he was aware of anything going on. He implied that something was up, but was not quite sure. That evening Greg and I were studying together when he got a phone call from Chris. He spent about 20-30 minutes telling us what was going on. He talked about his symptoms, his recent onset of double vision- which ultimately made him talk with his PCP and get an MRI of his brain. We talked about the fact that he used to have headaches ever since he started medical school, and even joked about his gait being abnormal. He told us that they were not quite sure what was going on, but they were going to see a local neurologist and go from there. Hearing all this,I was quite taken aback. I had a 6th sense of something being off for that last 2 days, and I was shocked when we got this phone call. I was glad Greg was there. We talked with Chris and tried to be optimistic. Once we got off the phone, we spent about 2-3 hours going over logistical concerns and coming to the realization that if this was something serious, we would need to brainstorm ASAP to help figure out how to cover for both Chris and Fleur during their absence. At first, it was all about- how does this sort of thing happen/how can we help Fleur and Chris etc. Once the shock stabilized, we started shifting gears to practical decisions that needed to be made.

Megha, Greg's wife, Christian, Fleur, Cormac, and me
Megha, Greg’s wife, Christian, Fleur, Cormac, and me

Over the course of next 2-3  we worked on how to keep things smooth with the residency,while making sure Chris and Fleur had all the time and peace of mind they needed to deal with this crisis. When we started out, all we knew was that his MRI was “abnormal”. We talked about many ‘what if’ scenarios. I recall Chris was on an office rotation along with having a few weekend calls scheduled that he had to cover. Fleur, being towards the end of her pregnancy, was scheduled in the office. As chief I made all the call schedules for our inpatient service. I remember that by default I had loaded them with calls towards the end of the residency year. I wanted to make sure they were not worried or concerned about how to juggle residency obligations while going to see neurologists, getting tested etc. Greg and I had long discussions with our Program Director (PD), on how to work around this. It was his first year in our program as PD, and he gave us full reign to brainstorm. I was very appreciative of his thinking and thankful for his confidence in us. During residency things are very fluid and to have an inpatient service fully staffed by residents 24×7 is a challenge as things can change last minute. So not having to go through the process of getting things approved from our PD was a relief.

We started off by talking with residents who were on non-essential rotations like electives or on rotations that could spare a resident for a day or two. We know going in, that these last minute changes to schedules are always received with dissatisfaction and we were apprehensive going in. One of the things we noticed was that few of the third years (senior residents) had a tougher time agreeing to do more shifts on the inpatient service. They challenged our every decision and gave us the impression that they had no faith in our leadership. Usually, the inpatient service is more taxing because of the hours we work. The shifts are usually 12- 14 hours, and may include overnight shifts. So when we asked our seniors to assist and help out, we were met with some resistance. This was a very surprising and shocking thing for us, since these people were our colleagues (and close friends), Greg and I expected them to be the frontrunners in volunteering for coverage. We had known them for the last 3 years and it was disappointing to see that they were the ones who did not support our decisions. We were blamed for overloading them towards the end of residency and not giving them time for their family. On the flip side, the second years, the residents who were in the same year with the Chiou’s went above and beyond our expectations. Some of them, like Shimia Isaac even cancelled their vacation to help cover. I was taken aback at the positive response most residents had. Even the ones who never volunteered for extra work, came forward to do whatever it took to help the Chiou family. It was a humbling and a teaching moment for us to see their love and support for Chris and Fleur.  Another interesting situation that we faced was how to manage keeping our outpatient offices fully staffed while borrowing residents from the office to cover inpatient service. We have anywhere from 2-6 residents in each office every day to see patients in the outpatient clinics/offices. Patients usually can schedule appointments in the office 2 months in advance, and to take a resident out of office, meant delegating these patients to another physician or canceling their appointment.any an attempt, 4-6 hour shifts we managed to cover that entire week successfully. Patients were happy with their care. The week ended with half of our residents being mad at us, and the other half applauding us for being able to juggle things at the last minute.I recall that every time I would see Fleur during this time period, she would apologize for the inconvenience and told us how grateful she was for making sure things remained smooth in the residency. If this was the least I could do to help them, I tried my hardest to make sure they had nothing to worry about regarding their residency obligations.

Personally, I don’t think any of this was hard. Our residency makes us feel like we are a part of a big family. Having something happen to one of our own, we banded together to keep our loved ones/ our friends and seeing kindness and genuine goodness in our Family Medicine group was an emotional time.

 

[1] I mentioned in an earlier post that telephone conversations from the Emergency Department are usually contentious, and typically end with the phrase “you don’t know what you’re doing!” or “you’re an idiot!” I’ve never heard of a conversation ending with “good job”.

[2] During our third year of residency in FM, we have lectures, and workshops 5 hours every week. These are referred to as didactics. One hour on Wednesday morning, and 4 hours on Thursday afternoon. Along with getting some education, we also use this time to socialize with our fellow residents. Even though we are in the same residency, due to different rotations, office locations we usually only get together as a program during didactics.

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