I first came to Galveston in 1993, looking to live and learn in an entirely different part of the country, and at an entirely different kind of hospital than where I had gone to medical school. I was in the north, I thought it was time to go south. I was at a huge hospital with a huge name and huge reputation, I wanted to try someplace smaller, more intimate and congenial. When I told the pediatric program director at Rainbow Babies & Children's Hospital that I was ranking UTMB Galveston #1, he furrowed his brow and said with condescension, "Why would you want to go to a place like that when you could so easily stay here?" I had many reasons delineated, but my answer to him in that moment was:
"I really like the people I met there."
It was clear from the condition of the facility that UTMB, a "state hospital," was not ripe with resources; the parking garage back home at RB&C was decorated cuter than the wards of the children's hospital at UTMB. I understood that this facility was in large part dedicated to the care of patients who could not receive or afford care anywhere else. I could see that the nature of such a place attracted doctors and nurses who believed in providing this kind of care, a self-fulfilling roster of caregivers who chose to "go to a place like that" precisely because it was "a place like that."
Everybody I met on my interview day was genuine, warm, welcoming, sincerely dedicated to their mission, and also frankly honest about some of the challenges of working at a "state hospital." But none of those limitations ever kept any of them from putting forth their very best efforts with every single patient...99% of which consisted of talking, listening, touching, and holding hands through recovery and sometimes all the way through tragic death.
One of the residents I went to lunch with said something that has always stuck with me: "Even as a resident here it's like being a small town doc. You'll see kids in your clinic, then you'll see them out at the post office and grocery store and they run up and hug you because you are their doctor."
I never made a better decision in my life. Clearly I was meant to come here...20 years on I have cared for many kids who needed somebody like me at an institution like UTMB. They do come up to hug me in the grocery store....and now many of those kids are grown with kids of their own. The love of my life was here in Galveston waiting for me to arrive, and we now have three wonderful children who have gone to preschool, played baseball, and marched in the band with those same kids I've cared for in the hospital and clinic. I cannot distinctly separate my life as a husband and father from my identity as a "small town doc," nor do I want to. This is the life I chose when I constructed my rank list back in 1993.
On Thursday I met with my neurosurgical counterpart at UTMB, a doctor I've known in passing for 20 years and shared a few patients with in consultation. He chuckled and referred to UTMB as the "red headed stepchild country bumpkin hospital." We don't have an intraoperative MRI at UTMB, maybe in 2 or 3 years but I can't wait 2 or 3 years. "There's nothing good about this, you know" he tells me bluntly. The first step is to get that whole sausage out of there and slice and dice it in pathology to better define the prognosis and next steps of treatment. "I know you're a doctor, you're one of us, all that...but when we're in that OR you're just a guy with a glioma I need to resect. And I've done that a million times on everybody from prisoners to bank presidents. And I'll do it exactly the same for you to the best of my ability. I can do this."
What's in it for me staying here? I have his phone number already in my phone. I may even try to wrap my arms around his substantial frame in the grocery store should I see him there. Everybody I know and love who is bustling around the hospital can pop in to see me for a few minutes or all afternoon as I awaken and recover, or as I wither and die. My wife and kids can spend as much time with me as I need or they want, and can come on a moment's notice without feeling rushed or as if they are inconveniencing somebody with yet another trip back and forth to Houston, all the while missing out on their own important milestones in middle school and high school.
"I really like the people I met there."
It was clear from the condition of the facility that UTMB, a "state hospital," was not ripe with resources; the parking garage back home at RB&C was decorated cuter than the wards of the children's hospital at UTMB. I understood that this facility was in large part dedicated to the care of patients who could not receive or afford care anywhere else. I could see that the nature of such a place attracted doctors and nurses who believed in providing this kind of care, a self-fulfilling roster of caregivers who chose to "go to a place like that" precisely because it was "a place like that."
Everybody I met on my interview day was genuine, warm, welcoming, sincerely dedicated to their mission, and also frankly honest about some of the challenges of working at a "state hospital." But none of those limitations ever kept any of them from putting forth their very best efforts with every single patient...99% of which consisted of talking, listening, touching, and holding hands through recovery and sometimes all the way through tragic death.
One of the residents I went to lunch with said something that has always stuck with me: "Even as a resident here it's like being a small town doc. You'll see kids in your clinic, then you'll see them out at the post office and grocery store and they run up and hug you because you are their doctor."
I never made a better decision in my life. Clearly I was meant to come here...20 years on I have cared for many kids who needed somebody like me at an institution like UTMB. They do come up to hug me in the grocery store....and now many of those kids are grown with kids of their own. The love of my life was here in Galveston waiting for me to arrive, and we now have three wonderful children who have gone to preschool, played baseball, and marched in the band with those same kids I've cared for in the hospital and clinic. I cannot distinctly separate my life as a husband and father from my identity as a "small town doc," nor do I want to. This is the life I chose when I constructed my rank list back in 1993.
On Thursday I met with my neurosurgical counterpart at UTMB, a doctor I've known in passing for 20 years and shared a few patients with in consultation. He chuckled and referred to UTMB as the "red headed stepchild country bumpkin hospital." We don't have an intraoperative MRI at UTMB, maybe in 2 or 3 years but I can't wait 2 or 3 years. "There's nothing good about this, you know" he tells me bluntly. The first step is to get that whole sausage out of there and slice and dice it in pathology to better define the prognosis and next steps of treatment. "I know you're a doctor, you're one of us, all that...but when we're in that OR you're just a guy with a glioma I need to resect. And I've done that a million times on everybody from prisoners to bank presidents. And I'll do it exactly the same for you to the best of my ability. I can do this."
What's in it for me staying here? I have his phone number already in my phone. I may even try to wrap my arms around his substantial frame in the grocery store should I see him there. Everybody I know and love who is bustling around the hospital can pop in to see me for a few minutes or all afternoon as I awaken and recover, or as I wither and die. My wife and kids can spend as much time with me as I need or they want, and can come on a moment's notice without feeling rushed or as if they are inconveniencing somebody with yet another trip back and forth to Houston, all the while missing out on their own important milestones in middle school and high school.
Galveston and UTMB are my home and they are inexorably entangled. I need to believe in my home and my colleagues, as countless families have believed in me. What I have is not likely curable, but rather controllable for a period of time. I think that process, whatever the duration or final outcome, needs to be filled with the support and presence of the family and friends I have made here for the past 20 years, not all alone in a gold-plated marble-walled palace.
We have an appointment at MDA at 7:30 am on Tuesday. Eager to see what they have to say.
We have an appointment at MDA at 7:30 am on Tuesday. Eager to see what they have to say.
-kpb 8/31/13
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