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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…
Published in General
I’ve spent a lot of time wondering about that. I don’t think he knew. I really don’t.
I suspect that he didn’t want the state licensing board to do a long, drawn out evaluation. He’d rather pull his own license than have it pulled after a year of defending himself.
I also suspect that his wife had something to do with it. She obviously knew, and I’m sure she heard us arguing. I’d guess that the two of them had some difficult conversations that weekend, and that she won out. I’d say she had it worse than I did.
Of course, I don’t know. Just guessing.
Dr. David would never hurt anyone. He cared deeply for his patients. If he even suspected, he would have stepped down well before that.
He was a good man.
You did the right thing. It just really sucked to do it. That happens sometimes in this corrupt world. It’s just the nature of things. At least you weren’t betrayed and crucified or forced to drink hemlock.
It may be worth pointing out few people get invitations to funerals. I know I did not send out any when Janet died.
This is true. Word gets sent around and people do get forgotten. It’s a trying time. When my husband’s parents died, I sent email to everyone I could think of, as did other spouses, but surely there were people no one thought of or all thought someone else would have called. Last week was also within the Omicron surge and flu season (such as it is so far), so they may not have sent word far and wide for in-person attendance.
Well, if you want the opportunity to attend the funeral, you can’t wait TOO long. If it’s not already too late for that.
I heard about his death after the funeral. On freakin’ Facebook.
As tough as it was to see a guy getting on in years suffer what your friend did, it was equally hard or harder to see a young man suffer a painful death. I worked with him briefly. He was in his late 20s with two kids and a beautiful wife. He went home, not feeling well. Went to a doctor who referred him to a specialist. Word was that he was patient #1 for that type of brain cancer. I had no idea what to say or even whether to say anything. After all, I didn’t know him very well. Eventually, I sent a letter saying that we all were thinking of him, we all cared. Those of us who with religious faith were praying, and those without were doing our best to send healing thoughts his way. We all wanted to see him back at work. He replied, saying, “Thanks. You nailed it.” He went downhill rapidly. His best friend put together a fund, to which I contributed, that was meant to help pay for his kids’ education. Sometimes life just plain sucks.
You are not the only one who feels that way.
I can’t help thinking that David had watched his father live with Alzheimer’s and he was really angry when it happened to him. He would be in a position to be extra angry about it. It sounds like he took it out on you. Perhaps his family knows that–I gather they did know the personal sacrifice you made because they called you afterward to thank you.
Perhaps they are dealing with exhaustion and grief and not thinking much beyond minute to minute.
Yeah. One of the most painful moments of my life was one particular visit with my mother in the nursing home. She would go through these loops of conversation, asking the same questions, making the same comments over and over again, and then, she stopped in mid-sentence, looked me in the eye and said “Johnny, I know my mind isn’t working right, but I’m trying.”
My dearest friend in the world had the unenviable job of taking the car keys away from her father. He lived another 10 years and never forgave her. Their last moments were strained.
Between her experience and mine with my mother who suffered from dementia, I’ve written myself a series of letters to be opened as I get older, reminding myself that if my kids take my car keys away, it’s because they love me. Or that if they forget to restock the liquor cabinet, it’s because they don’t love me.
I’ve heard similar tales from many families. Losing that freedom is extremely hard to take for a lot of people.
Thanks for lifting the veil so that we can see what can happen behind the scenes in a medical setting. We all must be aware that doctors, et al. are fully human. They are not gods.
This story reminds me of professional athletes who keep playing well beyond their prime. Some are smart and quit while at the top. I really thought Tom Brady would do that after Tampa won the Super Bowl . . .
I had a stroke in 2010, and I learned then that friends aren’t the type of people who only show up when times are good.
As you say, he should be remembered as the man who was in full control of his faculties, not the diminished facsimile he became. The man who shouted at you and broke off contact was not, in fact, the friend you remembered. That friend was already gone, and you protected his memory.
But it’s easy for me to spout trite pseudo-wisdom. I can’t imagine what that experience must have been like. I am afraid I would not have had the courage to do what you did.
Painful. But not uniquely so in the life of a physician. Better than medical and diagnostic brilliance is having the spine to do the right thing. You did the right thing. Twice.
Sadly, CMS is now refusing to cover an FDA approved treatment for Alzheimer’s on the flimsiest of excuses.
Sometimes the sequence is reversed. When I was young my father would say harsh, soul-crushing things to me. I got the proverbial “sticks and stones” as well. Now in his 90s my father has nothing but nice, though very generic, things to say to me, about me.
Like David, he isn’t the same man. He is not long for this world. Should I remember the man as he was his last few years?
I have been blessed to see both outcomes from (nearly) the same situation.
My Grandmother knew she was losing it when she sat a a red light one day and couldn’t remember what a red light meant. She went to her doctor and he ended putting her on Aricept. She could have been the poster child for Aricept. It worked really well for her and she was able to retain the ability to drive. She knew her limits – later she decided that she would no longer drive at night. Eventually (almost a decade after the Red Light event) she surrendered her keys when my mom asked her to.
She recognized her limitations and (most importantly) accepted the judgement of people she respected when she wasn’t able to continue making them herself.
My mom, on the other hand, could not follow my grandmother’s good example and I ended up bearing the brunt of it. Mom’s issues were a form of dementia brought on by her alcoholism, and it killed her about a year after I took the lead in an intervention. She held a grudge against me until the last time I saw her, but that meeting actually went very well – I told her I loved her and she responded in kind. She was warm and rational for a short while and that was the last I ever saw her. She slipped back into a coma and died a week later.
God bless you, Doc – take comfort that you did the right thing.
My (adopted) paternal Grandfather is remembered as spending most of his life as a prideful, bitter person. I only remember him from the last time I saw him (fall of 1989) where he was warm, engaging, and genuinely desiring to talk to me. I had last seen him previously when I was a senior in High School (Feb 1984).
That is how I remember him and how I describe him.
Yes, remember him at his best and forgive him the worst.
Yes. Sometimes it may be a fight. Sometimes it may be walking away quietly and sometimes it may mean an angry separation. But if we wouldn’t sacrifice the friendship, then there wasn’t really much of a friendship.
If I were passing out advice, I’d say don’t waste time trying to imagine what someone else thought or is thinking. And then I’d add you shouldn’t listen to me. I only know this tiny tidbit of a decades-long story so anything I’d think would be based on the tidbit and likely be wrong.
I’ve since heard that Police Departments will provide the service (I haven’t confirmed) But a friend claims she called her police department and explained the situation. Her mother was placed on a BOLO. When pulled over, she was cited and had to go to the DMV to retest. All the ire was then funneled towards the cops and the DMV.
I take it she didn’t pass?
Not even close.
That said, my dad got a five-year renewal when he was well into his 80s, so I don’t think the DMV is a sure thing. He wasn’t a great driver at the best of times …
My father continued to drive until he was past 90 and could barely see out of his one good eye. My brother who saw him more than the rest of us – all of we five siblings lived 1000 to 2500 miles away – finally reported him to the Florida DMV. They did revoke his driving privilege but they only did it via mail. So guess what? He continued to drive. I thank God every day he didn’t kill anyone.
I was out of sight of my family in the early 80s. When I returned my grandfather didn’t remember me. He very kindly said, “You seem like a very nice young man, but I don’t remember you.” Actually, that worked out quite well.
I had spent the intervening years at the USAF academy and UPT. I am forever grateful that, during the week I had off between Water Survival (Miami, FL) and proceeding to learn to fly the B-52’s (Castle AFB, CA) my dad asked me if I wanted to go see him. I jumped at the chance.
He died the day before I took my checkride in the B-52.
I am no Stoic philosopher but the Stoics always say something like, “If you have done everything right and people criticize you, don’t worry about it because you have done what is right. If you haven’t done something right, try as hard as you can to do what is right.”
If you did something wrong I would tell you. I am not known for either tact or subtlety. More importantly, wiser Ricochet members would have told you what you did wrong. You didn’t wrong so you shouldn’t feel bad.
I just got off work and I am on my second bourbon in honor of and your friend. May he be having the best Bourbon in heaven.
You did what had to be done. I’m sorry you were put in that position. He was looking back at his long wonderful career you were looking at his future.
@drbastiat It is especially tough when our logical minds and our emotional minds do not align. You know you did the right thing with David logically. It doesn’t feel right because he got emotional with you and you cared about how he felt emotionally.
I will say a prayer and sip a bourbon for you.