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Never Sit on a Patient's Bed

February 6, 2017

During assembly on Monday, February 6, Ellie DesPrez (English, chair), who is on sabbatical this school year, spoke to students about one of her current projects: interviewing doctors and nurse-practitioners whom her father, a teaching physician, mentored. Dr. DesPrez's prepared remarks follow:   

Good morning, everybody.  Before I start, I want to welcome a visitor, Aisha Sultan. Some of you met her last year when she talked with Dr. Smith’s class about being an American Muslim after 9/11. Today, she’s here as my friend and writing buddy, and I’m grateful.    

It’s nice to be back here. It’s also quite scary. This is my nineteenth year on the Burroughs faculty, and I’ve never given an assembly speech before. And the experience of writing this one has been a bear! I outlined it last May — no kidding. Then I started composing it by voice memo on a car trip a month ago. I scrapped those drafts, and a lot of printed ones, too. I made whole slideshows that I’ve dumped. I’ve rehearsed finished versions you won’t see today. I’ve spent hours and hours and hours on it — including plenty in the middle of the night.    

Serves an English teacher right. Right? Turns out it’s hard to write for an audience you care about as much as I care about this one. And it’s hard to write about a topic as close as the one I’ll share today. But I applied for my sabbatical in order to have more time to write. Struggle time counts.
I am the mom of all current Burroughs students named Hurwitz. One of them precipitated my latest revision this past Friday night by reminding me that 8:15 is early, and suggesting I make my talk’s themes clear up front.
So…my key words for today are mentorship and vocation. I’ve synthesized them into a thought that we can call, for lack of a better term, my thesis. Here goes. A sense of purpose, of vocation, can hold a person up, even in times of deep crisis, but finding that sense of purpose is a challenge; our strongest mentors are the ones who help us find our vocation.
I’m the daughter of someone who often made me run to dictionary. If a word came up that neither of us could define, he’d say, “Look it up!” and point to the big dictionary on the stand in our hallway. He was a scientist and doctor. He was also better read in literature than I’ll ever be. Until he lost most of his vision in his late 60s, he read swiftly, and hungrily. After that he just kept on reading by listening to books. He said that having to slow down and listen, rather than reading so fast, was an upside to going legally blind.  Seniors, I remember his saying, specifically, that before he went blind, he hadn’t realized that Faulkner was a poet.
I want to talk about a few word roots, now, even though it’s early. I can’t help it; I’m an English teacher! And now you know I’m also my father’s daughter.
First, the word “sabbatical.”  
If you look at it, you can see its root: sabbath. Like a Sabbath, a Shabbat, a rest day after several days of work, a teacher’s sabbatical leave is a pause after several years in one school. It’s a time to restore, and to pursue projects that can feed that teacher’s work back at school.
Here’s another one: “vocation.” Its root word, vocare, means “to call.” Think “vocal,” “invoke,” “voice,” and so on. If you were to look “vocation” up the big dictionary, you’d see words like “job” and “trade” listed as synonyms. But you’d also see the older sense in which a vocation is not just someone’s job for pay; it’s something someone feels called to pursue.
Now, for “mentor.”

Every student here who is past the ninth grade has learned about Athena and Telemachus from the Odyssey. Quick summary: Athena, goddess of Wisdom must help young Telemachus, but in order not to freak him out with all her godliness, she disguises herself as Mentor, a god fatherly old friend. Telemachus’ own father, a soldier-king who went to war when Telemachus was just a baby, has been missing since that war ended. Now his mother is trapped. Her home has been overrun by a pack of opportunists who feel entitled to hold an ongoing house party there — at her expense — until she chooses one of them to marry, which she doesn’t want to do because she still hopes her husband will come home. Telemachus is stuck. Corruption has taken over his home and his country. But he’s young, outnumbered, and too scared to move.
Athena calls him out. As old man Mentor, she spurs a courage in Telemachus he didn’t know he had. She helps him plot his course as he sets out to find his father.  With her walking alongside him, Telemachus can move from passively complaining about injustice to actively pursuing a remedy. She helps him hear his calling, his vocation, and then follow it.
During my sabbatical, a book-length project has been calling me. I tried letting it go to voicemail. But some time in mid-October, I finally picked up. Now that project has me on the line for the rest of my sabbatical year, and probably for a good deal of time after that.
The mentor at the heart of the project is my father, Roger DesPrez. Now you know he modeled a love of books and language for me, a love that is definitely key to my vocation. But this year I’m researching the way he mentored people who weren’t his children: doctors and nurse practitioners he worked with in his long career as a teaching physician.

For 32 years, he worked at the Nashville Veterans Administration Hospital, and supervised Vanderbilt University medical trainees there. He retired from the VA at age 68, and shortly thereafter lost his central vision due to a disease called macular degeneration. As soon as he got adjusted to that change, though, he went back to work.

For his last 13 years, he was the consulting physician at Vine Hill Community Clinic, a sliding-scale facility staffed by nurse practitioners. Nurse practitioners report that when they called him in to consult on a patient, they would be his eyes, answering his questions about what they saw in the exam. In turn, he taught them how to use their other senses in diagnosis, modeling classic skills like auscultation (listening with a stethoscope), palpation (pressing), and percussion (tapping). He worked at Vine Hill until shortly before his death at age 82.

It was around then, during his last two weeks in August of 2009, that I first really noticed his power as a mentor. I was lucky enough to spend that time with him and my Nashville family. He had sudden kidney failure. Some treatments were proposed, but he was an expert diagnostician — the first to know that the cause was a returning cancer. He knew that any time he might gain by further intervention would be short and ravaged. Instead of that, he chose hospice care at home.    

Thus began a period that his doctor — one he himself had mentored years before — recently described to me as “the two-week party on the porch.”
The house I was raised in has a broad front porch that faces a well-traveled street. At each end of that porch of hangs a bench swing. Almost every morning of those last weeks, my father got up and put on his khakis and seersucker jacket. Almost every afternoon he sat out on the swing. Visitors dropped by daily, one or two at a time, often on their way home from work. He had helped to train a lot of them.   

That August was mild for Tennessee. It was a sad time, of course, but it was joyous, too.  His cognitive and motor skills did slide as toxins built up in his blood. But what didn’t fail him was his delight in one-on-one conversation. Almost none of his visitors said a goodbye that sounded final. He asked them about how their work was going, and how their families were doing. They talked about interesting cases and office tensions and research breakthroughs; about books and movies and politics; about spouses and children and grandchildren. His visitors just sat with him, and chatted.   
I watched this gentle parade. It made me wonder. I wanted to know more about his impact on all these people. About five years after his death, I felt ready to investigate. I started by interviewing a few of my father’s former chief residents.
If you have a doctor in your family, you may already know that to become fully qualified, that person had to complete four years of supervised work after graduating from medical school. That postgraduate period is called residency because, a long time ago, young residents, actually resided at the hospital. They were the hospital’s house staff because they housed there, at least several nights a week. The sleeping-in-the-hospital part of medical residency has gone by the wayside. But for most doctors, residency is still the most demanding part of medical training. Each year, the chief doctor in charge of a group of residents invites one of them to stay on an extra year as chief resident, an apprentice leader.
In the summer of 2014, I asked a few of my father’s former trainees for interviews. They eagerly said yes. Now, I’m at twenty-five interviews and counting, and some folks are contacting me to talk. Some have shared some funny stories; some have gotten teary; several have done both. This first clip starts with a funny bit.

Dr. Ann Costello, with whom I spoke by phone in December, owns her own medical practice in Ithaca, New York. She was my father’s chief resident in the 1981-82 academic year. Here’s a picture of them at Vanderbilt’s graduation that May (thus my father’s faculty robes). At that time, about 12% of doctors in the US were women and women chief residents were rare, but Dr. Costello said she always felt fully included at Vanderbilt and the VA. I do think she was the only one of my father’s chief residents who gave birth shortly before her chief year started. At the beginning of this clip, she recalls confiding in my father about how her husband, John, another resident, fretted over the time their baby daughter spent with sitters.

        "I’d say things like, 'Oh, you know, John’s worried if we don’t spend enough time with her, she won’t know who we are,' and I remember your dad saying to me, 'When she needs the keys to the car when she’s sixteen she’ll remember who you are.'  […] So much of what we did as far as medical things go back then is so out of date now, the medical part of it. But your dad, I think what he was really amazing at is that he was so respectful of the patients. He was so kind, and never looked down on anybody. And I remember he would always say, 'Never sit on a patient’s bed, because that’s their home when they’re in the hospital.' People who were down on their luck, people who had abused themselves, I think he just felt real compassion for people. He was not judgmental at all. He got it, you know, that it wasn’t easy to be good all the time."   

 A lot of people have recalled my father’s teaching them not to sit on a patient’s bed--or sit in a patient’s room at all without asking the patient’s permission first. You’ll hear that in the next clip too.
After his chief resident year, Dr. John Tisdale moved to the D.C. area where, along with his team at the National Institutes of Health, he’s working on therapies for sickle cell disease. I caught up with him at a restaurant in Washington when I was there for a conference. In this clip, he answers this question: Do you see links between how Roger DesPrez mentored you and the way you interact with your patients? There’s a pause in the middle of Dr. Tisdale’s answer when he gathers his thoughts. Please just wait through that pause quietly.

        "So, one of the big things that’s missing in the way that we take care of patients is to understand the context. So, we’re really well trained about how to take care of diabetes. Right? But being able to take care of diabetes requires that the patient have some significant resources available to them. So if you don’t know the context, like where do they live, what’s their job, how do they make money, do they have money, do they have insurance, do they have all of these things that are necessary to make whatever plan that you’ve made feasible, then it could be that you’ve come up with a really good plan for them, but they can’t execute it. So, your father was very much into figuring out the context for the patient. Classic DesPrez was…he’s the attending on the service, you know, you present this complicated patient, and the resident and all, they have these complicated plans for all this stuff that’s going on, then we go see the patient. And your father would ask for permission to sit down, turn the chair around, sit backwards in it, sit with the chair backwards and say, 'Who loves you?' It matters. It matters a lot."

In my reading this year, I’ve encountered a certain quotation many times. Sir William Osler, a giant in the history of modern medical education, said, “Ask not what disease the person has, but rather what person the disease has.”   

Our story — including where come from, our context — can have huge implications, both for our health baseline, and for the supports available to us when we’re in crisis. One who comprehends that can see how a question like “Who loves you?” can be both personal and clinical. It’s based on the premise that everyone deserves love and care, whether they are getting it or not, and it honors the fact that no matter what, each patient has a whole story worthy of nonjudgmental attention. A human story, complete with context, can empower a doctor to make better informed, more responsible clinical decisions about how to serve an individual patient. 
I’ve started to think that mentorship is like a radio signal that waves through time as well as space. I heard something of my father’s voice in stories Dr. Tisdale and others told me about a teacher who helped them understand their own vocations. But after a while, I started wondering how that signal got to Roger DesPrez the first place. Who were his mentors? The generation before him is long gone, so whom could I ask? I vaguely knew the names of two older doctors he had admired during his own residency days in New York. But I couldn’t find details about my father’s personal relationship with them. The mentorship signal I was tracking faded there.   

Until…one day this past October, when, too lazy to get up off my couch and check the dates of my father’s residency in my notes, I just Googled “DesPrez” and “Cornell.” What I hit was an index for the papers of one of his mentors, Dr. Carl Muschenheim, which looked to be housed in the library archives of the Weill Cornell Medical Center in Manhattan. A phone call later, I knew that two fat file folders full of original, undigitized letters between my father and Dr. Muschenheim were there. The papers of his other mentor, Dr. Walsh McDermott, were there, too, along other promising primary sources. Our Hurwitz relatives in Brooklyn said, “Come on,” so I did something I definitely couldn’t have done without this sabbatical: I just flew off to New York for a week for a research trip!

To get to the cluttered reading room of the archives of the New York Hospital, now called Weill-Cornell, I had to take a freight elevator to a tiny bright yellow vestibule on the twenty-fifth floor, and then ring a bell — twice — to summon the archivist to unlock the door and let me in. As per archive policy, I had to be watched by the assistant archivist for each of the thirty-five hours I spent there taking notes. She was very strict. My time there was a prize.

If you’ve never worked with archival documents, you don’t yet know the thrill. Looking at a scan on a screen is fine, but actually holding a handwritten or even hand-typed, hand-signed letter is a whole other sort of electric.

Here’s one little sample of something from Dr. McDermott’s papers. I really dig it, of course, because it’s a marked up rough draft! Check it out: yellow paper, red pencil, typing and handwriting. This guy helped invent isoniazid, the first antimicrobial to make headway against tuberculosis. He would also totally get an A from me if he attached this draft to his revised paper.
This is part of a draft of an essay called “Medical Education.” He’s recalling his own residency days here. He says, “The awesome thought was drummed into me that the responsibility for other human beings demanded that I perform just as effectively at 3 o’clock in the morning as at 3 o’clock in the afternoon.” I’m sure Dr. McDermott went on to instill that sense of ultimate responsibility for each patient in his residents, including my father. And I know from interviews that my father relayed that sense of critical, interpersonal responsibility to the residents he trained. So there’s one radio wave: a deep sense of responsibility, flowing from a mentor to an apprentice, who becomes a mentor, who relays it to an apprentice, who becomes a mentor, and on and on.

I know that a key way in which my father conveyed that sense of responsibility was simply by walking the ward with his chief resident early in the morning, checking on all the patients before the rest of their team got to the hospital. One former chief resident, who’s now a faculty member at Vanderbilt Medical School himself, told a funny story about battling it out with my father to see who could get to work earliest. When they both arrived one morning at 5:15, my father said, “OK, I’ve had enough.” But that early morning mentor-and-apprentice time of walking the halls together and checking in every patient seems to have left a deep impression on many of my father’s trainees.

It certainly had a big impact on Dr. Andy Alspaugh, who was my father’s last chief resident back in 1994-95.

A few weeks ago, I spoke on the phone with Dr. Alspaugh, who is now a medicine and microbiology professor at Duke University Medical School. In this recent picture, he’s receiving a teaching and mentoring award. He was modest about that when I told him I’d read about it on Duke’s website.
As my father did with him, Dr. Alspaugh likes to walk and talk with his trainees. He says there’s a current tendency for doctors and trainees to spend more time with patient data on screens and less time with actual patients. He always insists on bringing all his trainees around to each patient they discuss. He finds that that approach — walking together and checking in with every patient in person — seems odd to some of his students, but it’s actually more efficient than talking together around a computer.

I asked Dr. Alspaugh if there were any other through-lines that connect the way Roger DesPrez mentored him with the way he mentors his trainees. Here’s what he said. 

        "Probably one of the most important stories that I can tell about your dad, the way that I was changed more than anyone [by him], and the strong message that has come through to most of my trainees is…what do you do with patients or people in your lives who have suffered unspeakable tragedy. How do you even begin to approach them? He just kept saying, ‘It’s your presence.’ It’s your physical presence there. And it’s your commitment, and the expression of the way that you care. And it’s just being there. He said, ‘That’s the first thing you do, and you just need to recognize your insufficiency in that situation.’ Because it’s not like you’re bringing a whole lot to the table. You’re not bringing wisdom. While you’re present, yes, you need to think like a clinician. You need to say, ‘Is there something clinically that I could or should be doing, or is there not?’ He would never say, ‘I understand how you feel.’ He would just sort of say, ‘I just need to be here,’ and he would just sort of sit."

At times, all you can do for another person is sit with them, even if you’re their doctor--or their teacher, or counselor, or parent, or sibling, or friend.   

My research and my memories both verify that for Roger DesPrez, the vocation of medicine demanded both intellectual attention to the relevant scientific data, and interpersonal attention to another human being. I also know, because I saw it, that the practice of paying such attention held his mind and spirit up through a long life that included some profound tragedies. His apprentices still quote him saying “It is privilege to care for sick people.” I saw that caring for others helped him, too.

In this talk, I’ve touched on two vocations: health care and teaching. I also know that, although some of you will work in patient care some day, and others of you will become teachers, the world of purposeful callings is large and varied, and most of you don’t know yet what will call to you. That’s as it should be. 
But no matter what path you finally choose, with luck, each of you, each of us, will be strongly mentored at least one time and maybe more. We’ll learn by walking alongside someone else. We’ll start to soak up not only whatever techniques they’re overtly teaching us, but also how they move in the world. We’ll hear how they talk with their fellow human beings. We’ll even see our mentor’s failings and flaws. But we’ll see them in the context of a full story of someone who can show us how to follow what calls us. Either then, or, more likely, much later, we’ll realize the deep impact of our mentors.
And if we’re really lucky, we’ll get to be mentors, too. I believe that each of you may well play a key part in someone else’s education. And you don’t have to be any sort of teacher, per se, for that to be true. You just have to gain deep experience, and then share someone else’s path as their honest, caring guide while they grow into their own vocation. A lot of you will do that some day.

Thank you.