Before graduating SUNY Downstate in ’72, I already knew that medicine becomes a part of your very identity and that it is, indeed, a jealous mistress. But I could not anticipate how medicine would mold me beyond my years in primary care pediatric practice – how it would engage me as a sometimes too observant patient with leukemia, and as a survivor of life-threatening complications. Nor could I anticipate that I would be given a late-in-life opportunity to be the Keynote Speaker for a high school health professions day.
Whether practicing or retired, medicine never leaves your mind or your heart. It remains in your blood. As Perri Klass (M.D.) has said, “There are doctors. And there is everybody else in the world.”
When I began my primary pediatric care practice, it took a long time before I was convinced that I was a proficient doctor – that patients trusted me explicitly to diagnose accurately, to intervene wisely, and to forego treatment (usually antibiotics) when viral illnesses were self-limited. I learned to not reach beyond my limits. But I also learned to persist and challenge a hematologist when a patient with persistent “post-viral splenomegaly” turned out to have a glycogen storage disease.
But in 2002, at age 56, I found myself tiring easily and getting short of breath on an exercise bike. I thought I was just out of shape, but an observant ER doc said to me, “Ron, you look kind of pale.”. In my mind there still resides a tape of my nurse’s voice, whispering to me the result of a Hemocue: “Dr. Bashian. Your hemoglobin is 5.8.” Promptly hospitalized, I was immediately diagnosed with acute lymphocytic leukemia.
Thus began a new and still continuing medical chapter in my life – as a vulnerable patient, dependent on the wisdom of oncologists, and the tender ministrations of nurses who strengthened my will to survive. Although my bone marrow normalized, post-treatment myelodysplasia necessitated a bone marrow transplant in 2005. That curative bone marrow transplant has kept me alive, although graft-versus-host disease ensued because the best match that could be found was an imperfect one. With medical titration, I have tottered since then between an immune system which, unsprung, will attack my body, and a suppressed immune system that cannot effectively ward off all infections.
And thus began yet another phase – repeated hospitalizations for pneumonia, totaling over 300 in-patient days since 2005. Well, you know, you can make community there if you search for it or make efforts to make it happen. From non-alcoholic patient organized “happy hours” to a Kentucky Derby floor-wide pool to my parodying of the dread speaker pronouncements of “Dr. Red.”, relational learning, and memories. Even a richness of life developed during those recurrent in-patient times, each of which interrupted the presumptive continuation of outside the hospital living.
Episodes stick in my mind – like the time when sepsis was first suspected by my slurred speech and blood pressure dipping below 60 mm systolic. I remember when an adrenergic infusion made my head pulse with renewed circulation. And when, upon my return from the ICU, an ID doc said to me “we weren’t sure you were coming back.”
Life after the practice of medicine has been rich and fruitful. Early on, I volunteered and began teaching high-risk inner-city youth at Covenant House DC – where half of them raised their hands when I asked if they know anybody who had been shot, and the director said that they all knew somebody who had been shot. For all I know, I’m still known on the streets there as “Dr. Ron.”
Then I trained to be an ADHD coach, ADHD being an early and passionate interest in my practice. Coaching students these past seven years, helping them get through school, has been immensely rewarding. Also, I managed to teach peer-reviewed literature to senior biology majors at a local university.
But still – enduringly – medicine retained its magnetic pull on me, keeping me reading, from 2010 on, viewpoint articles from practicing physicians in NEJM and JAMA. Collating those articles, now some 6500 words and links (available through the Alumni office), I have assembled a rich assortment of real-life slices of life from the trials, successes, failures, critical comments about our health care system, depression, victories, burn-out, and hopes which doctors confront all the time.
On their health professions day, students will select articles from that assortment. I will be speaking to three successive auditoriums filled with students – facilitating dialogue, answering questions that I can, listening to their answers, acknowledging what questions may not have answers, and sometimes marveling with them at the brave and enduring courage of physicians.
I still dream sometimes about seeing patients, of being late as I often was, of trying my darndest in labyrinthine dream settings to help patients as a doctor is charged to do.
The roots are deep. Medicine stays in your blood.
Ron Bashian, M.D.
American Academy of Pediatrics, Fellow