A heart wrenching lesson. Conclusion. Part 3 of 3.
“No cancer.” I kept repeating to myself. “Regret” I said. “He ate himself up alive” I repeated. “He just willed himself to die”. “There was nothing I could do.”
There was nothing anyone else could do. He squandered his own life day by day just by neglecting to live. Once he got into a rut, momentum then carried him along. He never considered that at some point he should re-evaluate and re-calibrate the trajectory of his life. And so without a ‘do-over’ button, he was devastated.
I returned to my ward to see my patients. My staff and the intern had already rounded on the patients and written orders. I checked their charts to make sure there was a note. I couldn’t concentrate on anything. Instead of lunch I bought a coffee and a muffin and went to the library. There was a secluded desk tucked into the stacks, one that I liked. It was unoccupied. I sat down and spread out my ‘lunch’ and tried to think this out.
What is there to learn here? How can one—how can I—avoid falling into such a rut? The deferment of gratification, in this case extreme, is a problem. But that is how I got here. I rotted in my room in my parents’ basement and studied while my friends were watching TV, out playing football, going to movies, going on dates with girls. As it is I made it to university (into PreMeds, barely, from the waiting list) Am I not better off for sacrifices and having worked hard at my studies? Or am I on a blind self-deceptive trajectory like ‘him’? What I did wasn’t easy that was for sure. But his wasn’t either. Was his wrong and mine right? Well, I had to do that because I am partially dyslexic. Studying like the others would have gotten me nowhere. His goal: an RV etc. Mine? Exactly what? And the difference is…what? Am I now to just drop the drudgery and do the things my heart pines to do…live for the moment? What will I think of that down the road in 5 years…25 years? Will I regret having done that? So if I stick with medicine, how much am I willing to put into it? As much as I have been until now? What quality of doctor am I going to settle for? How am I going to triage my opportunities, so that I can maximize my present, and not jeopardize my future?
Maybe that is the proper perspective: Maybe I need to ask myself how each choice I make will look in retrospect, at the end of my life. Not necessarily how the choice turned out because I can’t demand that I be a prophet. I will judge the choice itself, without foresight. Was it the right choice, regardless how it turned out? Which choices will I regret? Which option will I be gratified that I took? Well, I will not compromise my profession, which I plan to do for the rest of my life, where my dignity and self respect comes from. I want to be a scientist. I have the ambition to advance the practice of medicine, no matter to what extent. My parents, Sarah’s parents are low percentage shot survivors. We will never abandon them. I want to have children; revel in them in the intimacy only available in a family. These are the bedrock decisions I was confident I would never regret.
I resolved to make myself some rules to make sure I don’t slide into the abyss of my patient. My first rule will be “Optimize today without jeopardizing tomorrow.” I contemplated that in my life so far, I regretted things I left undone; I rarely regretted things that I did. “If I am not sure whether to do or not do…if I am even weighing it…I will just do it!” (By the same token, the best rule for my big mouth is “If you don’t know if you should say or not say…keep your big mouth shut!”. ) If I am weighing something I will learn from versus cost…always go for the learning. If I am weighing experience vs. cost…lean towards living. Similarly if I find I am weighing doing things because I want to or doing something else for the money…don’t go for the money if its only for the money’s sake.
How did this affect my life?
I had a choice to continue with my residency or go out to be a GP in a small town in the Maritimes. That is how Labor Day afternoon, 1975, after driving for 2 days in my little Chevy Vega, with my wife and everything I owned packed into the back seat and trunk held in by bungee cords tethering the trunk to the bumper. So I arrived in Campbelton New Brunswick (population ~ 1300 including suburbs). The next morning, I walked onto Water Street and hammered in a sign, across the street from Gorham’s Drug Store: “Joseph A. Fisher, Physician and Surgeon”. I was granted admission privileges at the Campbelton Soldier’s Memorial Hospital. That is where my son Arie was born. That story and more will find their way to this blog.
In 1978 I was back in Toronto as a first year Anesthesiology resident. Through an introduction by my friend and classmate Lorne Greenspan, I was introduced to a group that had taken over two very lucrative Internal Medicine practices in Denver Colorado that were looking to take on another partner. They were Board eligible and needed someone who was Board certified; after some interviews, they offered me the job. My mouth was watering. . .finally get some money—actually, lots of money. . .have a beautiful house in the suburbs overlooking a lake and the Rockies…a ski chalet in Vail. . .My clinical experience left me eligible to write my US specialty examinations for Internal Medicine (ABIM). I passed. Now what? Why wasn’t I happy? Well, Dr. William Noble had offered me a one year fellowship to work in his lab and do an interesting research project. I was pining to do just that. Money, skiing, on the one hand. Research experience, my family in Toronto, and severe poverty brought on by having to support a house and a baby, on the other. I applied The Rules to the decision, and chose research, family, poverty.
After my fellowship exams I was offered jobs at ;the Mayo Clinic and Stanford. The offer at Stanford was amazing. I would be inducted into their newly established Cardiovascular Research Institute (CVRI), The position came with a house in the suburban foothills and a 99 year lease. Free medical care and tuition at Stanford for my chilldren. An obscene daydream for this kid who came from nowhere, grew up on the streets at Dundas St. and Spadina Ave. hanging out in a gang of other not so genteel boys. How could I not take it? In the end, Sarah and I decided the right thing to do was stay with our parents in Toronto. We would let go of the CVRI and world class career. Be whatever type of doctor I would be in Toronto. And not regret the choice.
How did that work out? Well, to make the story short: When I worked in Dr. Noble’s lab he told me I had to go to the Physiology seminars held in the Medical Sciences Building. every Thursday at 04:00. One day our Thursday experiment went late and didn’t finish cleaning up until 4:00. It was at least a 20 minute walk. Now what to do? Say “too late” and go home and play with my little kiddie? Or, arrive a bit late and fulfill my commitment and most likely learn something—no matter how small. What would I regret? Not doing. Not learning.
I went. Dr. Victor Hofstein was then a research fellow was presenting a neat way to measure cardiac output. I immediately saw that it could be done more easily and more accurately. I tried to tell the group but I was met with total silence. Charlie Bryant, a great scientist working at the Hospital For Sick Children, spoke up “Maybe he has something there.” but the audience was skeptical and the idea passed. I went back to Dr. Noble’s lab and proved to myself that there was something to the idea. No one else at the lab agreed. But it was “gold”. At some point I did a Hail Mary and called NASA with the idea. They didn’t know what to do with it, but they couldn’t dismiss it out of hand. They invited me to Houston where I gave a seminar and demonstrated the methods in front of about 25 people, mostly astronauts. That led to my actually getting on the NASA shuttle program in Houston. Then the Challenger crashed and all the programs, including mine, were closed. Others I am sure started up again. I was small fry, self funded, and couldn’t recoup.
There was then a back door that returned me to science. There were a few kids in the neighborhood that were interested in going to medical School Their parents approached me to involve them in some research so their progeny could improve their application to medical school. We agreed that they would secretly pay me an amount of money that I can pass on to their children as “wages” for their work. I needed to make up a real research project. This led to the experiments on tracheal tone experiments, which led to sequential gas delivery which led to the first effective treatment for CO poisoning, non invasive cardiac output, gas targeting, Thornhill Research Inc., and the whole shebang.
Main lesson for me: Just always choose ‘do’ over ‘not do’; ask what is ‘the right thing’; what is the best choice if the money were the same; which choice will I not regret having made today, if tomorrow I were to find out that I have only 6 months to live? Those are the right choices.
