Would You Destroy Your Friendship to Protect a Friend?

 

After medical school, I did my post-graduate training at a hospital in Tennessee. There was a dominant family in that city’s medical community – the “Smiths.” The original Dr. “Walter” Smith had retired ten years before, and now three of his sons were big shots in the hospital he had helped build from a small local hospital to a 400-bed regional medical center. Everybody talked about how brilliant Dr. Walter was, and his sons were top-notch docs as well. They played a big role in my training over the next few years.

The oldest son (Dr. “David” Smith) sort of took me under his wing. He thought I showed great potential, and we enjoyed working together, even though we occasionally butted heads. I generally followed his lead and very much respected his expert counsel. But I was young and arrogant, so I sometimes struggled to just shut up and do as I was told.

During an argument during a Code Blue, he once screamed at me (in front of a bunch of nurses and staff), “Just because you’re a genius doesn’t mean you’re always right, Mr. Hotshot!” I screamed back, “Just because you’re old doesn’t mean you’re always right either!” He was in charge of the code, so I just shut up and followed his lead after that. But I was pissed. So was he, obviously. The patient ended up dying, and after the autopsy, it turned out that his diagnosis had been right, and I had been wrong. It didn’t matter in the care of the patient — there was no chance the patient could have survived regardless of what we did. But I felt horrible. I later apologized for my arrogance, and he graciously accepted my apology. I was so incredibly relieved.

Anyway, despite our occasional disagreements, he thought enough of me to keep working closely with me — I learned so much from him. One day, he came up to me at the nurse’s station and said, “Hey Bastiat. My Dad is in the nursing home with Alzheimer’s. Because of who he is, they say they’re giving him really good care there. But I don’t trust them. Do me a favor and take over his care for me, would you?” I was flattered that he would trust me (over all his partners and colleagues) with the care of his father, the venerated Dr. Walter Smith. So of course, I agreed.

On my first visit, I found Dr. Walter walking up and down the hall of the nursing home, giving out M&M’s to the patients. He thought he was still rounding on patients in the hospital, and he thought the M&M’s were pills. I looked at the nurse, and said “Please shoot me if you ever see me…”

“I know.” She said.

But the nurses kept buying him bags of M&M’s. It kept him out of their hair, and the other patients liked the treats.

It was painful to see a respected physician reduced to such humiliation. He should be remembered as a brilliant physician who saved lives, not some crazy old guy who thought candy was medicine. My God. Even now, nearly 30 years later, I can’t get that image out of my head.

I didn’t think that they were doing a great job with his medical conditions, so I changed things up quite a bit. I spent several months tuning things up, making everything perfect. But it didn’t matter. He continued to deteriorate, and he died a couple of years after I took over his care. David and his brothers thanked me for my efforts, futile as they may have been.

When I completed my training, Dr. David asked me to join his medical group. I declined his generous offer because I wanted to start my own practice. He thought I was making a mistake:

“Starting a practice from scratch in the days of Medicare and HMOs is impossible. Don’t let your stubbornness and your arrogance lead you into an impossible situation.”

Me: “I’m not being arrogant. I’m sure this will work.”

Dr. David: “How can you possibly be sure?”

Me: “Because I’m the best.” *smile*

Dr. David: “Right. Ok.” *walks away shaking his head, muttering something*

I called him once in a while, but not like I should have. My solo practice did well, I got busy, and I sort of lost touch with him over time.

Several years later, a colleague of mine met with me and said, “Hey Bastiat – look, um… I know that you and Dr. David were pretty tight. And he’s a hero of mine, as well. I mean, he’s brilliant, obviously. But look. He’s losing it. He’s making too many mistakes. Some days he says stuff that doesn’t even make sense. He’s going downhill fast. The hospital is starting to get nervous.”

Me: “Yeah, well, his Dad died of Alzheimer’s…”

Colleague: “And so did two of his uncles and a few other relatives. His younger brother is already in a nursing home.”

Me: “Ah. I didn’t know that.”

Colleague: “Right. But look – he’s sort of the king of the hospital staff, you know? He can be a bit aloof – even arrogant sometimes. A few of us have tried to bring his mistakes to his attention, or point out something that wasn’t right, but he just dismisses us without even listening. I really think he can’t see that anything is wrong. But I’m telling you, he’s going to hurt somebody. He’s making too many mistakes.”

Me: “Crap. Tough situation.”

Colleague: “Why don’t you talk to him? He always thought you were brilliant. You’re one of the few residents that came through here that he really respected. If you talk to him, he might listen.”

Me: *pause* “…and I’m not on the hospital staff anymore, so there’s no downside to me pissing off some important people…”

Colleague: *pause* “Well, yeah. That too.”

I had moved to a nearby town, and was out of that hospital system now. So this really wasn’t my problem. I just wanted to walk away. But I also didn’t want my friend David, who had helped me so much in my development as a doctor, to be remembered as the old demented dude who played doctor while his colleagues tried to cover for him. He should be remembered better than that. So he needed to stop.

At some point, we all need to stop.

And to be fair, it can be difficult to recognize when that time comes, exactly. Especially if you have Alzheimer’s disease.

So I met him at his house one Friday night. We sat in his living room and chit-chatted about stuff, had a lovely visit. I told him how much I admired him, and that he was a great doctor and a great teacher, and that I could never repay him for all he had done for me. I also apologized again for any times that I offended him. He said nice things about me. And then I took a deep breath, and laid the hammer down:

“Look, David. I’ve been talking to the other docs. They say you’re getting Alzheimer’s, like your Dad and everybody else in your family. You’re starting to make mistakes. Lots of mistakes. Simple mistakes. You need to retire. You’re in your mid 70’s. Your mind isn’t what it once was. It’s time to walk away. Congratulations on a brilliant career. But you’re done. You need to stop.”

David: *angrily* “What the &%$# do they know about my mental state?”

Me: “David, they’re doctors. They know what Alzheimer’s looks like. And they’re the ones trying to correct your mistakes. Mistakes that you never made before. Come on, David. You need to walk away.”

David: “After all I did for you! This is how you pay me back?!? Of all people, I just can’t believe that you turned on me, you arrogant son of a %$#@&!!!”

Me: “Can’t you see that I’m on your side here? Do you want to be remembered as a brilliant physician, or as a doddering old fool? Go write books or something. But no more patient care. Please. You’re going to hurt somebody.”

David: “I’m not quitting. End of discussion. Get out of my house. Now.”

He gave me the most cold stare. It hurt.

I paused, took another deep breath, and said, “Look, David. You’ve got until Monday afternoon at 5 p.m. If you haven’t withdrawn your hospital privileges and your medical license by then, I’m calling the state medical board myself, and asking them to do an evaluation. I swear to God.”

David: *coldly* “You wouldn’t.”

Me: “You can join me while I make the phone call on Tuesday morning if you want.”

He just stared at me for a moment, then launched into a tirade of screaming obscenities and insults. I walked out while he was still screaming at me, got into my car, and drove away with tears in my eyes. I looked back and saw his wife watching me from the kitchen window. She was weeping. She must have heard everything.

On Monday, he canceled his hospital privileges and his medical license. The brilliant career of David Smith MD was over. Just like that.

There wasn’t even a write-up in the local paper. He should have had a parade or something – at least a big glitzy dinner to celebrate the king of the local medical community retiring – but he just sort of quietly disappeared from the medical scene.

Over the next couple months, I got several phone calls thanking me – including one from his wife and three from other family members. They didn’t know what to do at the time, either. Soon thereafter, his son had to take over his finances. Sometime after that, he was in a home.

I called him a few times. He wouldn’t speak to me. I wrote him a couple of letters. He didn’t respond.

He never spoke to me again.

Dr. David Smith died last week, of Alzheimer’s disease, in the same nursing home that his father Walter died in.

I tried to help Walter and failed. I tried to help David, too. And it feels like I failed at that as well. Maybe I succeeded in helping David, I guess. But it sure doesn’t feel like it.

I hate to remember him like this — my last image is of him screaming at me in a bloody rage from his front porch. It hurts to know that that’s how our relationship will end. I can’t fix it now.

All I know is that this hurts.

Again.

And now, it always will…

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  1. Seawriter Contributor
    Seawriter
    @Seawriter

    You did help David. Even though it doesn’t feel like you did, you did.

    • #1
  2. OmegaPaladin Moderator
    OmegaPaladin
    @OmegaPaladin

    Goddamn man, now I know why your liver is in such a state and your bourbon always flowing.

    Alzheimer’s disease is evil.  It’s utterly and totally evil, and the sooner we erase it from the universe the better.

    • #2
  3. Franco Member
    Franco
    @Franco

    You absolutely did the right thing, as I think you know. 

    I think you mis-titled this post. You were protecting dozens of patients. You are true to your profession and basic moral principles. The fact that he cursed you out has nothing to do with the reality of the situation and proves true the diagnosis. 

    Many years ago my mother was at home riddled with cancer. She became demented towards the end and said some horrific things to me out of her paranoid deluded state. It meant absolutely nothing to me because she was not herself. Your friend and mentor was already gone. 

    • #3
  4. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    You didn’t fail. At all. You demonstrated the courage to make an incredibly difficult decision. You blessed many people with your actions: David’s wife and family; the other doctors who agonized watching him deteriorate; and the patients who were under his care. Maybe someday you’ll be able to move past that last scene and mostly remember the admiration and respect you had for him. In some ways, the man you saw on that last night wasn’t David, but the frightened, bitter and ill man he had become.

    • #4
  5. kedavis Member
    kedavis
    @kedavis

    And, assuming you believe in Heaven etc, he’s now viewing you fondly again.

    • #5
  6. CRD Member
    CRD
    @CRD

    I think that Dr. David would thank you now if he could bridge this temporary gap. God bless you for being a good friend!

    • #6
  7. Blondie Thatcher
    Blondie
    @Blondie

    I am sorry for your loss, doc. Both times. Alzheimer’s is a horrible disease. 

    • #7
  8. Marjorie Reynolds Coolidge
    Marjorie Reynolds
    @MarjorieReynolds

    You did the right thing, imagine the legacy he’d have if he had harmed a patient.

    I know my father was very happy when his Alzheimer’s progressed and he went back to his youth. He called us, his children, by the names of his brothers and sisters and we would hear him laughing and singing to himself when we put him to bed. He had been a builder so we would often find him laying imaginary tiles or pushing a wheelbarrow here and there. I don’t like to think of the early years when he knew what was happening to him.

    It’s quite likely your friend slipped into a place of peace like that too. It would have been harder for him to do so if he had been left alone to make a fatal mistake and you saved him from that.

    • #8
  9. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    Sorry for the loss and the experience. 

    Your friend was already dying when you lost the friendship. 

    • #9
  10. Juliana Member
    Juliana
    @Juliana

    Doing the right thing can leave one with the worst feeling in the world…a feeling that we need to be forgiven but won’t be. I hope you are able to come to a place of peace with what you know you had to do.

    • #10
  11. Chuck Thatcher
    Chuck
    @Chuckles

    Reading this makes me lumpy.

    • #11
  12. Django Member
    Django
    @Django

    Doc, when I grow up, if I ever do, I want to be at least half the man you seem to be.

    • #12
  13. kedavis Member
    kedavis
    @kedavis

    Juliana (View Comment):

    Doing the right thing can leave one with the worst feeling in the world…a feeling that we need to be forgiven but won’t be. I hope you are able to come to a place of peace with what you know you had to do.

    I think he has been forgiven, just not “in person.”

    • #13
  14. Jim McConnell Member
    Jim McConnell
    @JimMcConnell

    Seawriter (View Comment):

    You did help David. Even though it doesn’t feel like you did, you did.

    Doc also helped an unknowable number of David’s patients by that intervention. Sometimes it is painful to do the right thing.

    • #14
  15. Dr. Bastiat Member
    Dr. Bastiat
    @drbastiat

    Django (View Comment):

    Doc, when I grow up, if I ever do, I want to be at least half the man you seem to be.

    #metoo

    I don’t feel like that man either.

    • #15
  16. OldPhil Coolidge
    OldPhil
    @OldPhil

    Franco (View Comment):

    You absolutely did the right thing, as I think you know.

    I think you mis-titled this post. You were protecting dozens of patients. You are true to your profession and basic moral principles. The fact that he cursed you out has nothing to do with the reality of the situation and proves true the diagnosis.

    Many years ago my mother was at home riddled with cancer. She became demented towards the end and said some horrific things to me out of her paranoid deluded state. It meant absolutely nothing to me because she was not herself. Your friend and mentor was already gone.

    My wife’s Mom did the same thing to both of us in her last 6 months or so. Really depressing.

    • #16
  17. Hartmann von Aue Member
    Hartmann von Aue
    @HartmannvonAue

    Doc B.- as others have commented above: You did help “David” Smith, his wife, his whole family, and his patients. That is moral reality. It hurt, sure. You’re also quite right in recognising that it will continue to hurt for a while. But you loved the man enough to do it. God bless and protect you. 

    • #17
  18. Gossamer Cat Coolidge
    Gossamer Cat
    @GossamerCat

    Dr. Bastiat:

    On my first visit, I found Dr. Walter walking up and down the hall of the nursing home, giving out M&M’s to the patients. He thought he was still rounding on patients in the hospital, and he thought the M&M’s were pills. I looked at the nurse, and said “Please shoot me if you ever see me…”

    “I know.” She said.

    But the nurses kept buying him bags of M&M’s. It kept him out of their hair, and the other patients liked the treats.

    It was painful to see a respected physician reduced to such humiliation. He should be remembered as a brilliant physician who saved lives, not some crazy old guy who thought candy was medicine.

    In dealing with dementia in my mother, the hardest lesson for me to learn was that the humiliation was only in my eyes when I saw her in the throes of some confabulation.  So what I see here is a physician who never stopped caring for people, not a crazy old guy giving out candy.  We still cannot treat Alzheimer’s, but one of the things that we have  learned how to do is to let them live with dignity by trying to understand the world from their point of view, not ours, an  accommodating it as best we can.   

    Unfortunately, that only works when their delusions can do no harm.  So you had no choice but to do what you did. 

    • #18
  19. Caryn Thatcher
    Caryn
    @Caryn

    This was David and your relationship:  “I later apologized for my arrogance, and he graciously accepted my apology.”  The man you met with so many years later was no longer David and he knew it.  He was frightened–for very good reason–and just couldn’t “graciously accept” your exposure of what he feared.  But you did good, great good.  His weeping wife and all those who didn’t have your courage knew and know that. 

    Were you able to go to his funeral or to see or speak with any of his family?  I’m sure they would tell you what he couldn’t.  As many before me have said, you most certainly helped David and, even more, his patients.  You did a very good and courageous thing.  I’m so very, very sorry for your loss.  It’s a huge loss on many levels.

    • #19
  20. Dr. Bastiat Member
    Dr. Bastiat
    @drbastiat

    Caryn (View Comment):
    Were you able to go to his funeral or to see or speak with any of his family? 

    I wasn’t invited to his funeral.  Which was extremely upsetting to me.

    I hope that means that his family forgot me.  

    I hope that does not mean that his family remembered me.  

    I thought about calling to find out which it was.  But I decided that it might be best if I didn’t call…

    • #20
  21. kedavis Member
    kedavis
    @kedavis

    Dr. Bastiat (View Comment):

    Caryn (View Comment):
    Were you able to go to his funeral or to see or speak with any of his family?

    I wasn’t invited to his funeral. Which was extremely upsetting to me.

    I hope that means that his family forgot me.

    I hope that does not mean that his family remembered me.

    I thought about calling to find out which it was. But I decided that it might be best if I didn’t call…

    They might have thought it would be painful for you to attend.

    • #21
  22. MarciN Member
    MarciN
    @MarciN

    Dr. Bastiat: Soon thereafter, his son had to take over his finances. Sometime after that, he was in a home.

    I think you are missing something in wondering why you haven’t heard from them. You insisted he retire. That was a first step. They had to do quite a lot after that. I suspect they felt you were part of the family.

    You should reach out to them. You’ve all been through a lot. Together.

    You had the hardest part. Making the decision to finally act, to stop the wondering, to act, is the hardest step to take in our journey on this earth.

    You got them over that.

    As you know, I have had some tough calls to make and moments to get through with my mom. Her cardiologist was a very dear friend, and he helped me through the worst of it. He wrote me a beautiful note when she passed away. I will always treasure it.

     

    • #22
  23. Caryn Thatcher
    Caryn
    @Caryn

    I agree with Marci.  Do reach out to them.  If a phone call might be too painful, take the time to write to them.  We already know what a good and touching writer you are!  Tell them of how much he meant to you as a mentor and friend (borrow freely from what you’ve told us), tell them how much you miss him and, if appropriate, how much you miss them.  Remember the man he was, not what he became.  I can’t imagine decent people wouldn’t find that incredibly touching.  They do sound like good and decent people–else you wouldn’t be hurting so much.  

    • #23
  24. James Hageman Coolidge
    James Hageman
    @JamesHageman

    Everyone everywhere should read this. Thank you.

    • #24
  25. Keith Lowery Coolidge
    Keith Lowery
    @keithlowery

    Faithful are the wounds of a friend;
        profuse are the kisses of an enemy. – Proverbs 27:6

    • #25
  26. Skyler Coolidge
    Skyler
    @Skyler

    That was heavy.

     

    • #26
  27. Phil Turmel Coolidge
    Phil Turmel
    @PhilTurmel

    We’re here for you, Doc.  As the responses above bear out.

    I will now go pour a bourbon with which to toast your personal courage.

    • #27
  28. Keith Lowery Coolidge
    Keith Lowery
    @keithlowery

    @drbastiat

    In 2014 my father-in-law was diagnosed with Alzheimer’s. He died the day after this past Christmas.  When he was diagnosed, I wrote him a letter to approach the painful subject of what his diagnosis meant.  At this point I had known him for 35 years.  Here’s a snippet from that letter that came to my mind when I read your post:

    The problem for your family is deeply rooted in their love and respect for you. They instinctively want to extend to you the dignity and respect which your life and faithfulness engenders. Without exception, your entire family shares a desire to treat you as an adult with all the responsibilities and privileges that go along with that. But the challenge for your family is to find the balance between giving you the maximum freedom possible while still protecting you from any decisions you might make that are clouded by your condition.

    So the circumstances may arise, in some cases may already have arisen, in which you perceive your capabilities very differently than your family does. This presents the risk of conflict and interpersonal struggle between you and the rest of your family. It occurs to me that the solution to this tension is found in Paul’s statement in 1 Corinthians 13:7 in which he says “love always trusts”. For you to be able to make the necessary transitions in the coming months and years in a way that is harmonious for yourself and for your family, you will need to make the choice to trust that your family has your best interest at heart. To trust that over time their perception of your capabilities may actually be more accurate than your own. This is a hard thing but it can be made manageable by drawing on a reservoir of trust that your family loves you and only wants what is in your best interest. I’m sure it is a painful thing to face the prospect of second-guessing your own perception, but that is one of the implications of the diagnosis you have received. It’s not in your best interest to soft-pedal that fact.

    Love, it seems to me, is doing what’s best for another person even in the absence of their understanding or appreciation. Sometimes love is unwelcome, but it is still love in any case.

    • #28
  29. EJHill Podcaster
    EJHill
    @EJHill

    Look, if he did as you asked then he knew. Of course, he knew. But that doesn’t mean dementia patients don’t carry grudges, he probably just didn’t remember why he was mad at you.

     

    • #29
  30. Dr. Bastiat Member
    Dr. Bastiat
    @drbastiat

    Caryn (View Comment):
    I agree with Marci.  Do reach out to them.

    You and Marci are probably right.  Maybe I will.

    Not in the mood right now.  Maybe later…

    • #30
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