It’s All About the Patients, Stupid—They are the Real Heroes

I was at the Hollywood Bowl recently—a magnificent outdoor concert facility built in 1919, featuring incredibly diverse music from jazz to pop to classical to Broadway. Small boxes are available for seating and my wife Charna and I have a series—four seats in a box. We invite another couple, and Charna, who is an amazing cook, prepares an incredible meal, and life is good. This evening we were going to experience an all-Beethoven concert—two romances, then Symphony no. 8 and ending with Symphony no. 5.  The guest artist and conductor was Itzhak Perlman. Perlman was born in 1945 in Israel to parents of very modest means—his father was a barber. At age four Perlman contracted polio and has had no movement in his legs since that time. He became a violin virtuoso in high school and has never looked back. He is truly one of the great musicians of his generation.

When Itzhak Perlman came out on the stage that evening, walking slowly with his ever-present crutches, the audience was first quiet then burst into applause. As he made his way across the stage and up a three-step platform, however, the applause stopped then began again—as if this was a major accomplishment—Perlman waved his hand to indicate that the acknowledgement was not necessary. He didn’t consider what he did to be remarkable in any way, just a normal part of his life and his job.

While listening to the first of the two romances I could not help but reflect about the lives our patients lead, and the way we all, as caregivers, often forget the courage they exhibit every day, whether it is a day coming to dialysis or a day recovering.  Each day these folks get out of bed with the same desires, hopes, dreams that healthy people have. But, in addition, they have the concerns and worries about their health, that day and in the future, about how long they will live and be able to provide for and be with their families, how they will be able to continue to be productive members of society.

How many of us, however, when we make rounds in the dialysis facility, think about these issues and what our patients are really going through and thinking? What is the balance of conversation between discussing lab tests and the need for being compliant with instructions compared with how things are really going in the patient’s life? We have become very complacent about the patients we treat—we oversee an incredibly complex technical procedure, carried out in seriously ill patients, generally safely and effectively. But is that really the best we can do? Next time you make rounds think about what each patient is going through—not just when on dialysis, but holistically, and think about how you can really make each patient’s life better. If our discipline can learn to do this effectively not only will patients be better off, but so will we!

As Hippocrates said almost 2500 years ago: “Some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician.”

I look forward to your comments, until next time.

Striving to bring quality to life,

Allen R. Nissenson, MD

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