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Getting High with Patients

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Daniel Dilling, MD
Loyola University Medical Center
Chicago, IL, USA

As members of ISHLT, we work in the rewarding but stressful fields of thoracic transplantation, MCS, and pulmonary hypertension. Caring for patients who are either extremely ill or who have been rescued by our lifesaving therapies. We see them often and our appointments are sometimes long. They are in the hospital periodically and we see them for procedures too. We get to know them well. We see them through the worst of times and through the best of times. We get to know their families and loved ones well too. These are rich relationships. I always teach students and trainees that transplant medicine is really just plain old internal medicine, but "on steroids" -- and so, too, our doctor-patient relationships are also more in-depth and intense than average.

I recall a riveting description at the ISHLT meeting in Chicago in 2010 where Heather Ross, MD described a fantastic journey she had just taken to the North Pole and back to Toronto with one of her patients who had undergone heart transplantation some years earlier. I remember thinking to myself at the time about how very well you would get to know that one patient, spending a few weeks with them every day skiing 8-10 hours in getting to and from the North Pole. Lucky her!

I occasionally see patients outside of the hospital or clinic. It can actually be a bit off-putting at first, given the different context. There is one patient who I have run into twice at rock shows (once U2 and another time Wilco - it seems he and I have similar taste in music). More recently, our team participated in an annual fundraising activity for the Respiratory Health Association of Metropolitan Chicago. Touted as the "Hustle Up the Hancock," our team of nurses, doctors, a social worker and a dietician was joined by several of our lung transplant recipients - and 4 of them climbed with us up the 94 floors and 1632 steps successfully (see photo). We were joined by one of them for a celebratory team brunch. It was amazing to have hours of time to chat with patients about everything except their medical needs. I learned about families, dreams, letdowns, likes and dislikes in a way that you just don't have time to hear about in the clinic. I felt lucky; I never have enough time to get that much info.

Is there a down side to knowing these patients so well (and even sometimes personally)? When a patient gets very sick and if they die it is harder for us. These are the patients whose funerals we attend, where we feel as though a friend or a loved one has died. These are the patients whose deaths prompt the need to bring a psychologist (or at least a therapy dog, as happened recently) into our lung transplant office to help our staff deal with the loss. These are the rich relationships that brought us into this specialty‚Ķ and sustain our "on steroids" interest in what we do. ■

Disclosure Statement: The author has no conflicts of interest to disclose.

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