When I say he was tall I mean that he was 5’10 and I was 6’1 and nobody knew I was taller. He was barrel-chested—not fat but not in good shape but confusingly strong. In a moment of frustration he could slam his fist down on the table so hard you wondered why it didn’t go crashing through the floor into the basement.
He was not handsome. He had a thick auburn beard which he sometimes trimmed to just a moustache—one that would have looked ridiculous on somebody else, but somehow made him more of an icon and less of a mortal. When he lost his moustache to chemo was when I knew he was going to die. The gravity of the situation before that point was lost on me. The missing moustache got me to pull my head out of the sand.
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All names in all stories have been changed. While these stories reflect real events, some case details may be altered to protect patient privacy.
Jeane is a nurse in a surgical office. She is one of the nicest people I’ve ever met, and it’s genuine—not ass kissing. She just turned fifty and wants to run the Chicago marathon this year; it will be her first.
She has worked for Dr. Schuler for ten years. Schuler has a surgical personality; he is a perfectionist and very demanding of those around him. Jeane had to work for him for three years without making a single mistake before he trusted her.
Right now she is on the phone with Our Lady hospital trying to get their medical records department to send over a CT scan for patient we saw about twenty minutes ago. The patient has a large aneurysm on the largest artery in her body—an abdominal aortic aneurysm or AAA. If a triple A ruptures the patient will die almost every time. Schuler wants to see the CT to help decide if he should repair the aneurysm endovascularly, by snaking surgical tools up through the artery and fixing it from the inside, or by cutting open the patient’s abdomen and repairing it from the outside.
Schuler walks out of the most recent patient’s room, scribbling billing information on his chart. Seeming not to notice that Jeane is on the phone, he says, almost without looking up, “Dress his wound with collagen mesh, give him a prescription for compression stockings, schedule a follow-up ultrasound for three months and get him a return to work letter.” While he was saying this, Jeane was speaking into the phone. Although it was a statement rather than a question, Schuler’s tone of voice seemed to ask “did you get all that?”
Jeane glances at him and nods without interrupting whatever it is she’s saying into the telephone. I don’t know how she can multitask like that without making mistakes, but if she couldn’t pull it off she wouldn’t be able to work for Schuler. And if he weren’t a demanding perfectionist, he wouldn’t be able to cut people open with the confidence that they will be better off for it.
We’re not cutting anybody open today. We are seeing people in his clinic. We are doing a mixture of follow-up with his own patients, and seeing new people that other doctors have referred to him. I am learning how he doctors, and why he is so good. I want to will myself to have a fraction of the interpersonal competence he has with his patients. I don’t care if he teaches me anything about medicine.
We head toward exam room one to see the next patient. She was referred for a painful skin condition; that’s all he knows so he gives me no other explanation before we go in. Sitting on exam table is an obese girl in her twenties. She is nervous, in some pain, and wearing a paper top that barely covers her breasts. I can’t imagine having two men in the room will make her any more comfortable.
Schuler introduces himself and gives her a second to size him up. He tells her that I’m his student, clarifies who her primary care doc is, and asks a couple of questions about how long she’s had the skin problem and what it does over time. He has her press one arm against the paper top to avoid exposing herself. She raises the other arm so he can see the lesions in her armpit.
He calmly looks at it for what seems like two seconds and says, “you have hidradenitis suppurativa. Your doctor sent you to me because medications didn’t help you and there are a couple of surgical options. One of those doesn’t help very many people so I’m going to talk to you about the other one and you can ask me any questions you have.” Within two minutes, Schuler has a half-naked complete stranger feeling good about going under general anesthesia and waking up with a large surgical wound. Because of the hospital the patient uses through her HMO, he won’t even be doing the operation; the patient has agreed to let one of his partners do it because he gained that much trust. That is what I’m here to learn.
In a normal clinic day Schuler sees twenty-four patients in four hours. Today we’re seeing twenty-six. He scrawls a note in the girl’s chart and tells Jeane to schedule the surgery at the girl’s hospital.
He moves quickly toward exam room two, grabs the chart, and gives me some of the patient’s history. We have twelve to go. My feet are killing me.