by Teresa Godbey, MD
2020 Gold-Headed Cane Recipient
This piece was originally published in the November/December issue of the Tarrant County Physician. You can read find the full magazine here.
Let me start and finish by saying “thank you.” Receiving the Gold-Headed Cane is a humbling experience for me, because I am not really a scientist, nor procedurally gifted, not an expert in any particular field of Medicine, have never published a scholarly article, and am not even currently on the front line of the SARS-CoV-2 pandemic. It’s been several years since I got out of bed to come to the hospital in the middle of the night, and even then it was often to call in the person who would do the procedure or make the decision that would be critical for our patients.
With a B.A. in English literature and a lot of courses in languages, I came late to the realization that I needed to apply to medical school. And I would not have done so had I not had a mother who was willing to keep an infant son so I could start all those math and science prerequisites, and a father who’d made it possible for her to be a stay-at-home mother and grandmother. So thanks to my wonderful parents. This decision to go into Medicine seemed to some like an abrupt change of pursuit, but for me, the unifying theme between my undergraduate studies and the practice of Medicine has been the privilege of learning people’s stories. In practicing Medicine, one can even help to bring about a plot twist or be a minor character in the story . . . but to hear what came before from disparate walks of life, then facilitate the ability of the patient to make their story unfold has been my motivation.
Some of those stories still make me smile years later. The patient who volunteered to run a small cemetery in a tiny town was at the cemetery when the grave for her mother, who had died at 103, was freshly dug. She met a young couple visiting in search of ancestral lore. In the process of helping them find a headstone of interest, she managed to back up and fall into her mother’s grave, sustaining a tib-fib fracture. Somehow, she managed to laugh at and see the mythic overtones of that painful experience. So many patients have shared their triumphs in life with me, with luck as well as gumption helping us all along the way. Sometimes luck is better than gumption. There was the decision to call a surgeon to see a middle-aged man, to remove a large obstructive right colon mass even though this mass, surely a malignancy, must have metastasized given its dimensions. The surgery was going to be diagnostic and palliative but proved curative when a plastic cocktail sword was found at the center of a large inflammatory mass.
Then there are the gut-wrenching stories of loss and the staggering abilities of some people to keep putting one foot in front of the other . . . the woman who witnessed one of her sons shoot and kill another. How she managed to grieve the loss of one of her boys, while still being a mother to the one who went to prison astounds me to this day. I can only hope that allowing her to relate this to me was in some way beneficial to her, but her strength and grace were such that I’m not sure I was needed.
It can be discouraging now to practice in an environment of corporate intrusion, such as to be told on which shelf the lubricant must be kept in the exam room, or to be coached to attest to diagnoses based on flimsy or inaccurate data. There are those of you who are gifted with a scalpel, a scope, a cath; those who can calm the chaos of the ER for a quiet moment to see a diagnosis coalesce. I suspect those abilities make it easier to keep a sense of purpose, so for those of us who are PCPs, let this be my plea. Hear the patient. Hear their story. See them. Feel them. There are times that I hear from a patient, “That doctor just came to the door, and never even examined me.” So yes, I know that current guidelines put ever less emphasis on certain parts of the physical exam, but please, keep honing your skills. The time spent on physical exam may not all be of value statistically. But when the unnecessary oral exam or rectal exam turns up a cancer, it changes your story as well as the patient’s. Plus, the patient who gets a rectal exam won’t tell someone else that you just came to the door. For those of us in primary care, using our senses is the only way we can, so to speak, change the ending.
And now, a few more people to thank: Dr. Stephen Eppstein, for driving from Fort Worth to Dallas on the one day of the week he could have relaxed a little, to be the town attending for my Internal Medicine rotation in 1984 . The town attending is the one you can ask the questions you might be embarrassed to ask your regular attending, like: Why aren’t there viral UTIs when there’s viral everything else? Dr. Kendra Belfi, the first female internist I really got to know, and who took such good care of my mother and my aunt. All the wonderful doctors in the Texas Club of Internists with whom I’ve enjoyed education and recreation over the years: thanks for waiting until the old guard died off so you could finally change the bylaws and let women in—in 1997. My son, Noah Boydston, for turning out mostly OK, and loving me even though I was away so much when he was little. Oh, and if you have to wait until age 48 to meet the love of your life, Leighton Clark was worth the wait. Thank you all.