Justin Bowles: David O. Hough, MD Endowed Memorial Award Essay

Read essays by Justin Bowles and Sarah Rodriguez, the CHM seniors who were selected to receive the Hough Scholarship for 2012.


 

“Hope is not the expectation that things will turn out well;
it is the belief that there is meaning no matter how things turn out.”
~ Vaclov Havel

Justin BowlesTen ED residents and four medical students crowd around a small round table, early in the morning, to hear reports about the overnight admissions into the ICU. My mind quickly wanders away, as it often does, as off-going residents rattle off endless amounts of information on what feels like dozens of patients. My hypnosis is induced by their speech so full of disease acronyms and treatment colloquialism as if to eloquently disguise their conversation to even the most astute HIPA informant. My attention is brought back as one resident’s voice lightens, as if he had just remembered a funny joke that he had been meaning to tell. “And we also got one of Dr D’s clinic patients.” All present take one look at the name on the admission with his admitting diagnosis of acute alcohol encephalopathy and the room erupts in laughter. “I heard you cured him,” one resident says. Others add, “What, you saw him sober,” “How many days was it until he was back?” and many like comments. “Yeah, pretty dumb huh? He was sober for the first and I really thought he was going to quit.” Dr D laughs at herself, joining in on the fun.

The joke dies out and the new patients are divided. Dr. D volunteers to see this patient, saying that she might as well do it since she knows him already. I also volunteer.

As we walk to the patient’s room I ask”Dr. D do ED residents have clinic patients?”

“No”, she laughs. “That is what we call people who come into the ED so often that sometimes they name one of us as their PCP. This guy is in drunk almost every day. We know them so well that we even throw birthday parties for them.”

“So you thought you’d cured him?” She chuckles.

“One day he came to the ED for postsurgical pain. He hadn’t drunk for three or four days because of his surgery. I almost didn’t recognize him. He was so smart and nice. I just couldn’t help myself. I just had to tell him how different he is when he is drinking. He told me how he overcame a cocaine addiction 10 years ago but alcohol took its place. I had no other patients to see, so I talked with him for nearly an hour. By the time we were done, he seemed like he had really decided to quit. When I finally came out of the room, my attending was worried, wondering what was taking so long. I explained that this gentleman was going to stop drinking. He essentially said “Dr. D that is so cute that you would think that.”

“How long was it before he was drunk again?”

“I don’t know; days I think.”

This resident exemplified to me what it means to “have the spirit of the healer”. The spirit of the healer is hope. It is not an empty hope that everyone will always get better or even that our interaction with others will always have a positive effect on their life. It is a faith that some of our interventions do make a real difference. It is possible to improve health, attitudes, habits and cultures. Healing like this does not happen at every bedside or clinic visit. Its prevalence varies with different personalities, populations, and problems. The chance that any single interaction is the one that will make a difference is very low, but like Dr. D, the healer has faith that this may be that moment. This hope can withstand ridicule, rejection, repeated failure. The healer can continue to face each patient encounter with hope because they know that it has been proven that the more times we attempt an intervention with skill, competence, and compassion the more likely we are to succeed.