What is it that makes a good doctor?  The much vaunted ‘bedside manner’—what does it mean?  I think it’s the old “give a damn” factor at work, a factor I have reported on in earlier blogs here and here.  Good bedside manner is not suavity, not glad-handing, not telling a patient what they want to hear; it is something else entirely.

This blog is another one of my reports describing what it is like for the shoe to be on the other foot, so if you are only interested in reading about pediatric eating disorders, you can stop here.  But it’s all interconnected, isn’t it? My care, as a doctor, of your child as a patient, some other doctor’s care of me as a patient; several other doctors’ and nurses’ care of my family members as patients. Not all of us are doctors or nurses, but all of us are patients at one time or another.

This past week was a blur of medical care in the ICU, two ICUs, in fact.  At the end of the first day my husband Steve and I landed at Good Samaritan Hospital under the care of a doctor, Derek Taylor.  It had been a nightmare before finally getting to Dr Taylor, despite the gravity of our situation and the potential for acute worsening. Steve had not been seen, spoken to, or examined by the doctor we were told was to care for him until late that night, after a day spent with EMTs in the ambulance, the emergency room and then the ICU.  When Dr Taylor did arrive, he was apologetic.  Have you ever noticed how it is the good ones who wind up apologizing?  It never seems to be the rough ones, the indifferent ones, the cold ones who apologize (today I had a receptionist bark “wait behind that line for your turn!” and then a few minutes later “I said behind the line, your feet are over the line!”).  People like her never apologize, but Dr Taylor did.  And then with lines of weariness all over his face, he sat down and explained what was going on medically.

“I know you are anxious for the procedure to be over with,” he said  “and that you have been told that it would be done ‘emergently’ for hours.  If you want me to call in the team right now I will, but you know— I am exhausted and I would prefer to be fresh and give you my best effort.”  This made big brownie points with my husband who believes that doctors never admit to being tired (and hence human) even when they should.  Because Dr Taylor had made the effort to explain to us what was going on, what the risks and benefits were, and made himself a person with both his apology and admission of exhaustion, we felt enormously comforted and taken care of.  We could draw a breath and agree to wait, if it was his judgment that waiting was wise.  It’s hard to judge what is wise when no one will talk to you, when you have only the dimmest ideas, yet the most acute fears, of what is happening.

Clearly this was a good doctor.  We both nearly wept with relief after the terror of the long day.  But it wasn’t really Dr Taylor I wanted to write about this time, it was another specialist altogether.  This other specialist is an intensivist (an ICU doctor) and his name is Dr.  Brian Young.

I have to say I was relieved when Steve was put in the ICU.  I know from many years of observing adult medicine floors that the quality of nursing in the ICU would be way above the quality he would otherwise have received.  And it was.  We had super-competent nurses who made his safety and even comfort (in as much as they could affect this) their priority.  In the first ICU I had not been welcome to remain overnight, even though I certainly insisted on doing so (and did).  At Legacy Good Samaritan I was welcomed; they seemed to understand how strongly we felt about not letting our husband/father and step-father be alone when he was ill and frightened.  When I left to take a shower or get fresh clothes, the nurses were kind and respectful of our adult children, who took turns staying at his side even as he slept.  

Divergence: as a resident at Kapiolani Children’s Hospital when I was a young doctor I was impressed to see how the Hawaiian and Samoan and Tongan families stayed with their sick children around the clock.  No child was ever left alone and frightened even when it meant that a family member slept on the floor on a woven mat.  Steve and I are 62, even sleeping on a hospital bed and in a recliner, respectively, was stressful and gave us new respect for those who will sleep on a floor so that a sick child is comforted.

I don’t know what time it was when Dr Young came into the room on his ICU rounds.  He was alone.  He introduced himself and told us what he knew about Steve, in fact I had seen him sitting outside the door for some time, carefully reading Steve’s chart.  He asked Steve to tell him what, from Steve’s perspective, had been going on.  Then he said “Tell me about yourself, Sir, what do you do for a living?  What do you like to do?” and he sat there for forty minutes talking quietly and listening and sharing Steve’s life with him.  It was nothing short of remarkable.  I don’t know when I have seen this in a primary care physician, much less in a crazily-busy intensivist.  I knew that Dr Young had had a patient “code” and finally die within the previous few hours, he had been there from early morning until late at night.  The ICU is a high speed, intense and technologically advanced place.  It’s the last place one would expect to see this level of “good doctor” expressed.  But there he was: the good doctor. And the second good doctor within one day.

What did they have in common?  They gave a damn.