Sunday, December 20, 2009

Why I'm a Geriatrician

I was probably destined to become a Geriatrician from the time I was a kid, although I didn't know it then. I was definitely destined to become a Geriatrician in the summer of 1983, although it took me the greater part of a year to figure it out. I can remember the day like it was yesterday. I was doing my cardiothoracic surgery rotation at UTMB in Galveston, Texas. I had five hospitals to go to and 13 patients to see before morning rounds. The first hospital on my way in from our apartment was St. Mary's Hospital. It was a private hospital and there was an elderly woman there who'd had an aortic aneurysm repair. I had been seeing her two straight weeks. As this was my first stop, I would wake her up at 4:30am every morning, and in her Texas accent she would cuss me out something fierce every morning. On the last day of my rotation I was leaving her room and she called out, "doctor". Now, I wasn't a doctor, just a medical student, but I turned and went back to her. I remember the moment like it was yesterday. She said, "I'm sorry for yelling at you every morning." To this day I remember feeling, I'm the one waking up this poor lady every morning, and she's apologizing to me. I felt genuinely bad and told her, "you're the patient, I'm waking you up every morning. It's ok if you yell at me." And I meant it. Whether I knew it or not, that was the moment that I realized that I wanted to take care of older people the rest of my career.

I subsequently focused some of my fourth year elective rotations on Geriatrics, working with Tom Cole and Dr. Derek Princely. I even wrote a paper on why I thought that Geriatrics should be a primary care speciality. I then went on to do my internal medicine residency as Cedars-Sinai Hospital. But, it was always a Geriatrics residency. I read everything I could about Geriatric Medicine. I tried to see my patients through the eyes of a Geriatrician. I was fortunate to have as one of my mentors, Mark Levinstein, a Geriatrician who spent a year at Cedars while I was there. I even took the initiative and did a research project that I ultimately published on the value of the white blood cell count and the peripheral blood smear in diagnosing bacterial infections in the elderly. I obviously then did my Geriatric Fellowship at UCLA before beginning my career with Kaiser-Permanente in Woodland Hills. But I'm getting ahead of myself.

From a young age I always wanted to be around "the old people". Whenever family was in the house, I always wanted to sit around and talk and listen to the older people. I was close to my grandparents. My grandfather and I shared a love for sports. He always had the Dodger game on the radio or television. My grandmother was just about the nicest and most non-judgemental person I've ever known (a gene I think I inherited). My grandparents would take me to the horse races at Hollywood Park or Santa Anita. When I was 17, we traveled to Chicago to visit our relatives. I always had an affinity for being around older people. I also had an affinity for wanting to change the world. I was writing letters to the President of the United States when I was six years old, telling him to get us out of the war in Vietnam (yes, my father was an anti-war protester). I wrote letters to Menahem Begin with my ideas of how to solve the problems in the Middle East.

Once I realized that I wanted to be a Geriatrician, however, my life began to revolve around that concept. The paper I wrote as a fourth year medical student was but one example. I digested everything thing I could about Geriatrics, about the politics of health care as it related to Geriatrics. It's funny, but I've always told people that being a Geriatrician is not a job, it's a life. You have to be a doctor, a clergy person, a social worker, an economist, a financial planner, even a politician. And I've been and done all of that. From the moment I made my decision, everything I have ever done has been focused on trying to not only be the best Geriatrician that I could be, but also to try to make society a better place for seniors to live.

I have been quite fortunate to have had some great mentors. I've already mentioned a few, but that was just the beginning of a list that I look back upon in some degree of awe. John Morley, David Rubenstein, David Solomon, Al Sui, Joe Ouslander, Dan Osterweil, Dave Reuben, Mark Beers, Fran Kaiser, Richard DellaPenna. This virtual who's who of Geriatricians were my source of information and inspiration. These were the people who touched my life during my training and first years as a Geriatrician. They inspired me to want to make a difference.

Somewhere pretty early along the way I realized that just seeing patients was not enough for me. I wanted to touch more lives than the ones that only I could see and personally care for. This lead me to pursue administrative duties while at Kaiser-Permanente. It ultimately led me to leave California to move to Denver to join a company called GeriMed of America, a geriatric medical management company whose purpose was in line with my goals and dreams. When this didn't work, I founded Senior Care of Colorado with Don Murphy. I would create my own practice and allow myself and others to practice Geriatrics the way it was meant to be practiced. There was always one obstacle clearly in the way of this path. It was the government. Medicare is a federally legislated program. Congress determines how it is run, how physicians are reimbursed, etc. It wasn't long before I got involved with my congressmen and senators. I believed that this was going to be necessary in order to make a bigger difference. That, unfortunately, has been a frustrating path (more on that another day).

Senior Care of Colorado grew from six physicians and two physician assistants over nine years (2001 to now) to close to thirty physicians and thirty five physician assistants and nurse practitioners. I find myself employing over 150 people. Is this what I signed up for? It has to be, because I'm still the young medical student feeling guilty because an elderly woman apologized for yelling at me. I'm still the idealist wanting seniors to get the best possible care. I revered my grandparents and I love working with seniors. Their stories and insight are of great value. We live in a society that sometimes forgets this and treats our elderly like children. In fact, I was reminded of this today by the sudden death of Fern Osborne. Those who knew Fern knew her to be a tireless and headstrong support of senior issues. She was someone to look up to and she will be sorely missed. I am fortunate, however, to interact with many children who care deeply about their parents and try to juggle everything that society throws us in dealing with very complex issues. Some children have their frail elderly parents living with them at home. Others visit them daily in their assisted living, retirement and nursing homes.

Being a Geriatrician is about making a difference. It's about doing whatever it takes to help seniors live a better life. It's about listening and understanding. It's about being there for people who are vulnerable, and their families. When I think about it, it's not ever really been a hard decision to see me having gone in this direction. It is who I am, and who I always will be.

1 comment:

wassben said...

After all these years I get to find out why you became a Geriatrician. You need to get this piece into publications that will inspire others to enter this wonderful field of medicine.
Your wrting is great because you write about what you know. Get in the habit of using more dialog. It will help you when you start writng either novels or non-fiction. Your dad