Tuesday, Jan. 20, a busy morning lay ahead for the staff of the cardiovascular surgery clinic. There were several new patients to see. No doubt, many of them were anxious to hear whether the skills of the surgeons they were going to meet could help them live another day. There were countless follow-up visits and postoperative wound checks to perform. And of course, the mundane, mind-numbing, time-robbing tasks of 21st century medicine awaited them, too—the drudgery of completing prior authorizations for prescriptions, haggling with insurers to approve appropriate care and having to click endlessly through a maze of electronic health records (EHRs). It’s always a challenge to stay on course and on time in a busy clinic, especially for some of our surgical colleagues who have a tendency to attempt to defy the laws of physics that govern time and space by wildly overbooking their sessions. A dear orthopedic colleague advises new patients to “bring a thick Russian novel to read,” because their wait times may run several hours. War and Peace, anyone?
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One particular cardiovascular surgeon working on this particular day did not exactly fit the surgeon’s stereotype. By all accounts, not only was he talented, thoughtful and caring, but he respected the time constraints of his patients. So when the son of a patient whom he had recently operated on arrived unexpectedly at his clinic demanding to speak with him, he set aside time later that morning to meet.
The patient was an elderly woman with a history of cardiovascular disease, emphysema and two prior heart valve surgeries in need of further valve repair. Many surgeons would have considered her far too frail to submit to additional surgery. Yet Mike Davidson, MD, had acquired a reputation as a brave surgeon who was willing to operate on the riskiest patients and who achieved a remarkable degree of success in the operating room. He was beloved for his bedside manner and for his willingness to talk patients’ families through the intricacies of surgery, no matter how long it took.1
Three months earlier, the woman’s surgery had gone well enough that she was discharged to a rehabilitation facility to be closer to her home and family in central Massachusetts. However, her health had declined, and her son, who served as her healthcare proxy, called Mike seeking his advice. Mike reviewed her medical management at the facility and concluded that she was receiving the appropriate care. However, over the course of the next few weeks, her condition worsened. At the family’s request, she was taken off life support in mid-November and passed away a short time later.