Page 5 - Mecklenburg_Medicine_November-December-2017

President’s Letter
Saying Goodbye
By Stephen J. Ezzo, MD
It is seldom a good thing to enter an exam room and
unexpectedly find everyone crying. You are rendered somewhat
discombobulated, as your mind is faced with several options. Part
of you wants to hold them and give reassurance, even though you
don’t know what has brought on the tears. Part of you wants to cry
along with them. And part of you — let’s be honest here — wishes
a wormhole miraculously would open up so you can slip into it and
return later at a less emotional time.
So imagine my confusion and worry a few months back when one of
my long-time patients was scheduled for a well-exam and I had not even
said, “Good morning,” when her mother sobbed as she hugged me.
“It’s our last visit with you,” she explained.
“Why? Are you moving? What’s wrong?” My head was spinning.
“She’s 18 and now has to find another doctor. We don’t want that.”
Relieved, I took a deep breath, let out a small laugh and reassured
her that was not the case, and I would be there for them until she
turned 21. Most likely, what I said was something along the lines of,
“Sorry. But you’re stuck with me for another three years.”
The visit improved greatly after that, but in reality it only delayed realizing I am human and would not get everything right. I hope
the inevitable. Three years from now I will have to say good-bye,
and that will not be easy.
It is an aspect that is unique to my specialty. All my patients
at some point are going to leave, and often many of them will be
healthy and not want to go. Nor do I want to send them off. Early
in my career it was not so difficult, as I had cared for most of them
only a few years. But now, the ones who are aging out have been
mine from the start. Often I held them in my hands on the first day
of life. Seeing them depart is not sweet sorrow, just sorrow.
From a purely clinical standpoint, I know it is the right thing
to do. I have not cared for an adult patient in more than 30 years,
and I am fortunate to have so many excellent family and internal
medicine colleagues who will provide a seamless transition of care.
Still, I am never in a hurry to make the hand-off.
I never liked the idea of 18 years as a transition point. This
is a time of upheaval as teens are either off to college or to the
work force (or both). With all the changes, responsibilities and
independence I thought it unfair to require a new physician as well.
When you come home sick on college break the last thing you need
is a new, strange place to receive care. Moving out to 21 allowed my
patients to have another safe, comfortable place to come home to.
For me, the rewards of caring for this age group are
immeasurable. I do not deceive myself into thinking the care I
provide is better than anyone else. No, the benefits I reap are mainly
selfish. While I find joy in all my patients at any age, every now and
then it is nice to have an adult conversation with someone other than
the parents. I learn so much as I listen to them tell me about their
classes, their work, their hobbies. If I am lucky, at times I can relate
my own similar experiences, which I believe allows my patients
to see me less as a doctor and more as a person. For them to hear
Mecklenburg Medicine • November/December 2017 | 5
I struggled with physics, calculus, or Beowulf in Middle English
breaks down a lot of barriers.
So do I bend the rules? You bet I do. Sometimes it can take a
while to get established with a new physician, so I let them know
I will be available during the transition phase. At times, one of my
21-year-olds is close to finishing college, so I will hang on to them
until they graduate. For many of my patients in college, I have found
that upon graduation they are ready to move on.
As you can see, I am somewhat of a pushover whose use of the
word “no” is rather limited (which is one of the reasons I sit here
writing this as MCMS president for the last two years). It’s difficult
to square this fact with the paisano tough-guy image I strive to
present to the world. Maybe the way to look at this is not so much
refusal to let go as being protective and not wishy-washy.
To my patients as they enter adulthood: Thank you. Thank you
for the privilege of caring for you. It has been my pleasure. Thank
you for putting up with my bad jokes, my eccentricities and my
other duties that at times limited my availability. Thank you for
teaching me about subjects I had little concept of. Thank you for
that you take some small part of me with you as you leave. I am
proud of each and every one of you. Remember the words of Dr.
Benjamin Spock, “Trust yourself. You know more than you think
you do.”
To those former patients who now have children I care for: I
cannot adequately express what it means that you have put your
trust in me. It is both flattering and humbling. Having this honor
allows me to think I did some things right. I truly enjoy getting to
know you again — this time as a parent and friend. What a great
journey we continue on.
While this internal debate will persist in me, I am intrigued by
recent studies that indicate the human brain does not fully finish
developing until the mid- to late-20s. Maybe the AAP will revise its
age recommendation?
“The pediatrician…is the legitimate adviser to the judge and
jury, and a seat for the physician in the councils of the republic is
what the people have a right to demand.”
— Abraham Jacobi, MD
Trivia question: The term “bacteria” (Greek for “staff”) was
proposed for use in 1928. Prior to that, what were they called?
Answer on page 12.