EQ 4 the Dr. in U

“There were only half a dozen other people in the waiting area.  What were the odds that we would just happen to meet here?  I gave up on my half -hearted attempt at distraction and headed to the outer waiting area.  Bill, what are you doing here?” I asked.  “Nothing” he replied unconvincingly as he glanced around the room, looking very businesslike in his dark suit.  He looked every bit the banker that had been his lifetime career choice.  I was confused, what would a banker be doing in MSTI during business hours?  Then I remembered how much this little excursion was going to cost.  No wonder he was here.  Anybody needing cancer treatment could certainly use a loan.  I figured he was trying to open a branch office.  What a great idea.  We could be his first MSTI/IIB (Idaho Independent Bank) customer.

We had just built our dream home.  Sketched on a Southwest Airlines napkin and built by one of the region’s premier architects/builders MikeFalash.  We were not only cash poor we were poor, poor.  The required 20% down to avoid PMI had drained every ounce of our reserves.  Just enough left to get my required physical.  Now, you may ask, why I was required to have a physical at such a young age.  There were two reasons actually as they were very clearly conveyed by my wife.  The first she said is “because I love you” and the second “because I said so.”  “Take your pick” she said, “either will do but you are getting a physical, and while you’re at it have them check out that mole on your back.  It looks kind of funny.”

It was December 14, 2000; my regular doctor wasn’t in.   Instead, I met a very likable PA who poked, prodded, listened, and now – since I was over 40 – explored all appropriate orifices, finally ending with that funny mole just below my left shoulder blade.

The examination took only seconds after which he proudly announced it was “most likely a Blue Nevus.”  Pinch, poke, slice and off to the lab it went.  Have a nice day, and give me all your remaining money.  I was out the door minus one small mole, and only slightly aware of an unusual squishy feeling where there had been none before.

Two o’clock that Friday afternoon the phone rang and I checked the caller ID.  My Doctor’s office was on the line and I prepared for the lecture I knew I deserved.  He got right to the point.  Too much fat, too little exercise, more fish less sugar, and then the part I wasn’t expecting.  You have a MALIGNANT MELANOMA.  “We received the lab report this morning and you do have a level III melanoma.  I am sorry to give you this news on a Friday afternoon, but I thought you should know as soon as possible, and you have an appointment Tuesday morning with Dr. Randall Burr – he is the best dermatologist in the state.”  Now it was sinking in; melanoma plus appointment in two days equals serious.  As if he had heard my ‘pretend it doesn’t exist and it will go away’ strategy.  He then said “now don’t do anything silly.”  There must’ve been more to the conversation.  I am sure he would have covered when, where and what did he mean by silly, but I already exceeded my “holy crap” brain capacity and confused level III with stage III.

Oh, the difference one little word can make.  Level III relates to the 1 mm thickness of my aberration, while Stage III is defined as having spread to surrounding tissues and or one to three lymph nodes.  Version two had the bonus pucker factor of having a 10-year survival rate of between 22 and 37%.  I was plenty puckered.

Four sleepless nights and multiple martinis later, we showed up at Dr.Burr’s office.  My bravado was unshakable.  I was overconfident and in control… because I was wearing Depends.  Not really, but I had gone to the bathroom four times in the last hour just to avoid finding out whether “scared the bleep out of me” was something that could really happen.  Then the magic began.

We were both invited into the examining room.  I was relieved knowing that Patty would be there as her attention to detail was legendary.  She had just one year before landed the contract to manage an International Membership Association and left her safe, secure job with the state Commerce Department to join the ranks of the self-employed.  So let’s just take a moment and total each of our current stress points.  We had been married just over two years, self-employed, times two, plus new house, no cash, add cancer carry the one and well, you get the picture.

Dr. Burr not only got the picture, he painted a new one starting first by treating both of us.  Instead of having Patty sit idly by on the sideline, he invited her to join him in the examination.  She was not alone as Dr. Burr included a group of interns in a connect-the-dots kind of class.    He talked about the potential spread of the disease and made six small dots on the skin, indicating the locations of possible lymph nodes serving that quadrant. The plan was to not only remove the mole and surrounding tissue, but the appropriate lymph node(s) as well.  Prior to surgery, a radiologist would inject radioactive dye around the mole, tracing its movement to the correct node which would be removed, sliced, stained and hopefully found clear of any cancer cells.  He further explained that if I were a gambling man, I could ignore this step and hope for the best, but having spent the weekend viewing stage III case studies I opted for plan A.

Now that the serious part of the exam was over the embarrassing part was about to begin.  There was plenty of skin yet unexplored, including my soon-to-be-more-public-than-I-wanted private parts.  Gently grabbing me by the elbow he directed me to a spot in the center of the group.  Yes, there was now a full-fledged class including one female nurse and another really young female intern.  “Drop your pants down around your ankles” he said.

Before my shorts hit the floor my masculinity was headed for cover.  Now fully exposed with my face glowing like a lighthouse, he instructed me to turn around very slowly.  Trying to regain a small semblance of composure I said “It’s actually fairly difficult to turn around fast with your pants like this.”  The class chuckled politely and I was hoping they weren’t laughing at, well, you know.

He found only one other suspect mole.  It didn’t look unusual to me, but he asked his assistant for a “number 10” and recited what I am sure must have been one of his favorite lines.  “You know my nickname don’t you?”  “No” I said.  “Benihana!” he replied, deftly removing the culprit with barely a pinch.

I am sure there were plenty of highly recommended treatment options he could have completed right there in his clinic.  He chose instead to forgo the procedures and revenue in favor of referring me to Dr.Lung for this new advanced procedure.  Even the way he conducted that process was unique.  Instead of written descriptions or delegating the process to someone I was not yet comfortable with, he requested a portable phone and personally set up the appointment with Dr. Lung’s office.  Looking back at it now I realize that through that simple gesture he was bringing himself down to my level; but the most amazing experience was yet to come.

After answering all of our questions (we had none – we were still too shell-shocked to talk) he reached into his pocket and pulled out a card, turned it over and began writing.  Like everything he had done before, he explained what he was doing while he was doing it.

In every step of the process he seemed more like a friendly fifth-grade teacher than a renowned physician.  When he finished his scribbling he looked directly at the two of us and said “I am so busy here (to that point he had made me feel like I was his only patient) that if you have any questions, I may not have time to give you my full attention.  So please, if you have any questions please call me at home.”

I don’t know about you but this was a first for me.  I have never had a doctor, let alone other service professional asked me to please (twice) call him at home.  In the 14 years since, this gesture has never been repeated.  In fact businesses have become so personal contact-averse that they actively discourage phone contact of any kind in favor of more manageable e-mails easily sent by keyword auto response.

Back at MSTI I still hadn’t made any connection between my brother-in-law affectionately known to clients as “Banker Bill” and Dr. Lung.  We invited Bill to join us but he declined and left for “an appointment” as soon as our names were called.  Toward the end of our appointment, when official business was completed Dr. Lung looked at my wife and said “you look just like your brother.”

Dr.Lung went on to explain that Bill had coached his daughter’s basketball team.  Now it makes sense.  Bill’s presence was no coincidence and he wanted us to know without saying a word that he was on the team.  My allergies seem to be acting up as I write this in January 2013.  I was no longer just a patient.  We were connected.

There is one more connection left and it was the most amazing of all.  If you’re bored with this story, too busy, too cynical to care or haven’t cleaned your screen doors lately, you can skip this part, but I wouldn’t.  The lesson contained is life-changing.

It was Saturday morning.  My surgery had been scheduled first thing in the morning the following Tuesday.  The phone rang; I was outside doing anything I could think of to keep myself busy and distracted.  Patty picked up the phone to hear a particularly cheerful voice.  “How are my friends the Morgan’s? This is Randall” the caller said.  Patty thought for a moment and didn’t know any Randall.  She briefly considered hanging up on this tele-intruder before she heard “it’s Dr. Burr.”  Now he had her full attention.  Was there a problem, some emergency or mistake?

Her mind whirred.  There must’ve been some problem, something overlooked, a change in schedule as these are the only reasons you would ever get a call at home from any “normal” physician.  But Dr.Burr is anything but average.  He has all of the same challenges every other M.D. practice owner has.  His insurance is too high, reimbursements too low, time with patients too short, and HIPAA rules that are completely indiscernible.  There are literally thousands of real stresses that drag healthcare job satisfaction well below the 50th percentile.  Instead he focuses his attention on the eu-stressors that energize his life, practice, and fortunately for us his patients.  This is one of three similar calls we received from Dr.Burr.  Each one less concerned about my physical progress than my emotional wellness as if it was inextricably linked to his own.

My surgery was perfect, lymph nodes clean and semi-annual checkups are long since over, but the lessons I learned continue to unfold as I share them with others.  It is not so much in the answers or actions the story inspires, but in the questions I hope this story encourages.  I’ll add a few questions of my own to stimulate your creative juices.  We will start as we always should with the end.  It is the energy, the eustress of exciting goals that gives us the resources, creativity and tenacity to find our way.

1. Did the calls Dr. Burr made from his phone, on his time and from his home, did they make energy or did they take energy?

2. Who decided he should make those calls?  Was it a requirement of his profession, an industry-standard or some other unspoken expectation?

3. If those calls had been expected, would they have generated the same results for either patient or physician?

4. Take a moment and list all the people, policies, accepted practices, and of course regulations that should have discouraged Dr.Burr from making those calls.

5. What do you do now, have you done in the past, or could you do in the future that energizes your soul?

6. Who decides for you?

7. If not now, when?