In treating rheumatic diseases, he championed use of the drug you know works and escalating it as fast as possible—and at the highest safe dose tolerable—to get control early, and then deescalating. With treatment options and goals, he would plan ahead and apply the decision tree model. How long will we keep a patient on a drug—especially prednisone—before evaluating whether it’s working or not? What will we do in each scenario? We need to decide that on the day we begin the medicine, so we know the agenda for the next visit.
He would advise, “Prednisone is not the real medicine. It’s what you use while you’re waiting for the real medicine to work.”
Fellows’ Thoughts
If I [HA] were to sum up his teachings in two words, those words would be “decision tree.” The last decision tree he mentioned when asked about how he felt about his hospitalization was, “Either I will die here, or I won’t.”
We weren’t prepared for the latter; Dr. Lightfoot would probably roll his eyes knowing this. He would often roll his eyes in exasperation and, sometimes, even throw his hands up with the eye roll.
Listening to the presentation of a patient after Dr. Lightfoot himself was admitted and unable to talk because he was intubated, he rolled his eyes up when told he had a borderline positive anti-nuclear antibody (ANA) with sepsis. Seeing him do that, I couldn’t help but laugh. That’s a memory I’ll cherish. Despite his predicament he could still express exasperation at the borderline ANA.
Another fellow, Kirk Jenkins, MD, noted: “I finished residency knowing—and relying on—guidelines, but he taught me how to think.
“Mentors transcend boundaries. Their teachings are not confined to one topic but rather encompass any topic you need advice on. Literally any topic—from work to home life and everything in between.
“For all of us who learned from Dr. Lightfoot, I can say with confidence that he did that. When we complained, he would say not to tell him ‘Life is hard,’ but to tell him information he could use to advise us.
“He made me [HA] a better physician, a lifelong, curious learner and a better person.
“If teaching is a science, then mentoring is an art and Dr. Lightfoot was the Bernini of mentoring. His tool was his exceptional mind, and his oeuvre the numerous minds he chiseled.”
