Something remarkable happened last Wednesday afternoon.
As I think I've written before, our Harvard Medical School Class of 1967 has experienced a rebirth of our comradeship in the last couple of years. After our 55th reunion – which I didn't attend because of the death of my wife just a couple of months before, and I wasn't ready – several of my classmates decided to use that great new technology, Zoom, to have regular meetings of our class. We have always been a cohesive class, helped by the set-up of our beginning at HMS – living and eating together at Vanderbilt Hall for the first two years, having so many classes and experiences together, being relatively small at maybe 100 or so until we got an influx of Dartmouth students for year three. So as the reunion rekindled the connections, Zooming seemed like a natural thing.
Karl Singer, Bob Holmes, and Phil Landrigan put it together as a monthly event, centered around presentations from our classmates on their own scientific interests (sodium depletion in long distance runners) or their medical experiences (Vitamin A supplementation to poor areas of the globe that has saved the sight and lives of millions) or more recently personal interests and events (part-ownership of a minor league baseball team, a session on our members' experiences serving in the military during the Vietnam War, and upcoming a session on what women of our class have experienced as women in medicine.) Other presentations were from experts outside our class, usually from HMS (gender affirming care.) All the sessions start with chit-chat among us. Attendance has been generally from 15 to 30.
In late 2022 I suggested a presentation on Alzheimer's Disease. My wife had just died of it after a very long course, and I had read a book by Harvard professor Arthur Kleinman about his own experience when his wife suffered and then died from the disease – The Soul of Caring. (See my blog article on Arthur and the book here.) Arthur made his presentation to the class and I added a few words myself, and then something remarkable happened – everyone on the Zoom call was energized to reflect themselves on how they had experienced frustration with the lack of humanistic care in our system, both as doctors and patients. It was a very moving session. Sensing this common interest, I contacted Arthur wondering what we could do as a class to promote humanistic care at HMS. He referred me to a class-organizing activist in community medicine, second year student Eana Meng, and one thing led to another and we established a Humanistic Medicine Initiative (HMI) for our Class of 1967. We have a working group of 14 – 2 students, 4 faculty, and 8 HMS 1967 class members. We have had a couple of notable triumphs. We held a HMI dinner meeting at the Harvard Club of Boston, with 6 HMS 1967 alumni, 4 faculty, and 10 students, which was illuminating, energizing, and a lot of fun. We came up with a new definition of Humanistic Medicine. Under the leadership of faculty member Kathe Miller, we recorded a video, entitled “If I Knew Then What I Know Now,” for incoming first year students, where Kathe got 13 of us to sit for her to record our advice to the incoming students. The advice was wide-ranging, but most of it centered on humanistic topics, how to care both for patients and for the students themselves. In addition, HMI working group member George Lewinnek published a book he had been wanting to write on advice for young doctors, with a distinct humanistic medicine bent.
We have also had a remarkable incidence of synchronicity. In our search for how we could help the students best, Eana and her classmates centered on their desire for mentors. They wanted to connect with our class to see what wisdom they could glean. I told Eana I wasn't sure about “wisdom,” but I was sure we had lots of experience to share. Coincidentally, Andrea Schwartz, the head of the Aging and End of Life Care Theme at HMS, and her team including student Micayla Flores who also had come to our HMI dinner at the Harvard Club, were thinking of alumni mentorship at the same time, though with a different angle. They thought that if they could connect students with alumni to discuss how aging was going for them, and how they had experienced their careers and their lives, that might grab the students' attention to their own subject of gerontology. It was really quite an imaginative leap. And at the same time, UC San Francisco gerontologist Louise Aronson was President of the HMS Alumni Association, and she was looking for a way to get alumni involved with the school and with mentoring. It's like there were four different avenues (students, HMS 1967, the Aging Theme, and Alumni Association) all heading to a common interchange and crashing into each other, in a good way.
So last semester, 6 HMS 1967 alumni mentored present HMS students, and it went great. This year, all the HMS Class of 2028 are required to have an alumni mentor for four sessions. So far, it seems to be going great. There is great enthusiasm among all the ranks of alumni, and especially so, it seems, in our Class of 1967.
All during the year, as we met for our HMS Class of 1967 Zoom sessions, we updated our class on what the HMI was doing. It was on everyone's mind. There were many questions and observations. Many people wanted to make financial contributions for HMI at HMS. We have clearly become a class centered on humanistic medicine, it seems.
Gerry's Presentation
And then, last Wednesday, the remarkable thing that I'm referring to in this post happened. Our classmate Gerry Rogell, eminent ophthalmologist from the DC area, wanted to present the case of his wife's Covid, and the medical problems that ensued from it. He introduced his presentation by saying that he had had difficulties with her care, and didn't have anyone or any group to discuss it with, that others had had more difficulty with family illnesses than he had and that he feared he would appear self-indulgent and callous to talk to Diane's illness with them. But he knew that if he presented it here, to his HMS 1967 classmates on Zoom, that we would understand, and that we would be sympathetic. In other words, he trusted us to be caring. And he knew that, as doctors, we would all understand in a way that only fellow doctors can.
What happened was that, despite all the precautions they had taken, toward the end of the pandemic, Gerry and Diane had finally contracted Covid. He got off light but she didn't, she got what seems to be an autoimmune encephalitic reaction to Covid that exacerbated a pre-existing neurologic condition very severely, and he had to care for her through hospitalization, rehab facilities, home care, dealing with doctors and nurses, and having to cope in ways that he hadn't before. He thought her medical care had been good overall, but there had been one untoward incident when Diane was ready for discharge but the doctor had done early rounds and left before Gerry got there, and Gerry wanted to talk to him about possibly tapering steroids instead of just stopping them cold, and what complications to look for, and the nurse put her foot down and wouldn't contact the doctor. Gerry was in a tough spot, being both a caring husband and a knowledgeable doctor, and wanting to be cooperative and respectful as a patient should be, but also wanting to serve his wife's best interests as he understood them as a doctor. In the end he cooperated and they left without discussing the case with the neurologist, but then Diane had a stroke. Would tapering steroids have prevented that? Unknowable, but Gerry was understandably pissed and felt that he had let Diane down by not insisting. He complained to the hospital about the nurse's obstruction and got back a letter defending the nurse and the hospital. Gerry felt dissed and is still pissed.
Diane is still debilitated from the post-Covid events. She can't walk unaided, and her understanding and decision-making are compromised. They hope to move from their home to an institution for older people in New Hampshire, but Gerry is unsure if they can prove Diane's status as able to live independently, which is a requirement. Our society's provisions for these cases is not terrific. People are left to cope in ways that are uncomfortable. Just when their situation is most impaired, they are called upon to make decisions and provisions and it's very hard.
After Gerry finished with his story, our class commented. Everyone was warm and supportive. Everyone told Gerry he should not be beating himself up about failing her, because he had not. He had done and was doing a fabulous job. We all realized how we are in the same boat, how we too are coping with a defective system of care, and there are always some bad actors in the system. We are all trapped in our time of aging, if the 60's and 70's were bearable, the 80's threaten not to be. I told Gerry that what he had gone through, and was still going through, was a trauma, and he needs to think of it in those terms. We get married, and we don't know what will happen, but we know that something will, and the key is, will we meet the moment? I felt I did meet the moment with my wife, and that was comforting to me. Larry Kadish and George Lewinnek and I all emphasized that he was meeting the moment with Diane, exceptionally so. I said, You are a really good person. We can't save them, but we can help. I welcomed him to what I called the worst club in the world. Polly Walker said she remembered when she and Gerry were bicycling together and he told her he was going to marry Diane. Not that long ago, really, or maybe really long ago, I don't know. Judy Chused offered, in addition to observing that when things go wrong we always look back and say “what if,” that her internist daughter is also the CIO of the hospital in question where the nurse had obstructed Gerry from contacting Diane's neurologist, and where the hospital had callously informed Gerry that everything they had done was right, and the Judy would most certainly be bringing the case up to her daughter. Larry Kadish, formerly Medical Director of a major hospital for many years, someone who understands hospital procedures well, offered that contacting the Joint Commission directly would certainly get results.
Most eloquently, psychiatrist Ed Bayard told of his coping with the long illness of his wife, who finally died just this August. He noted that the long illness brought them together in a way that was almost unimaginable. It's hard to say these things have silver linings, but they do prove and reaffirm love and caring, and that's not nothing. We record all these Zoom sessions, but wouldn't you know it, the recording function failed just before Ed's pièce de résistance. Maybe we'll be able to get him to reiterate it, because his contribution was really magnificent.
I think that a meta-comment I made was also important. I noted that he had said at the outset that he was turning to us because he knew he could trust us to understand, to be kind, to be caring, and to give him support – not in those words, but that is what he meant. We are his class, and that means something. Gerry agreed. He talked about his comfort with this community that we have, that we have created.
One of the strengths of our community is that we are all both doctors and spouses, which is a tricky situation. We try to be spouses first, but we can't help using our medical reasoning, and it actually does make a difference many times. But it's hard being both patient spouse and doctor. Do you insist on seeing the doctor when you have been discharged with insufficient discussion? As a patient, maybe you give way. As a doctor, maybe you insist. It's a dilemma frequently noted in essays in JAMA and NEJM by those who have been placed in this situation. Gerry knew that we would understand the dilemma better than any other group.
Would this session have happened the way it did if we hadn't done all the work we have done on humanistic medicine? I don't think so. It has brought our whole class together. We have discussed it, recognized it, tried to help the current undergraduates with it, tried to help HMS with it. We have a common understanding. George Lewinnek emailed me after the session that I should be proud that the HMI has really worked. I think we should all be proud, because so many of us have done this together, not least George.
Our class gestated medically together. We lived, ate, and studied together. Then we differentiated in different medical pathways, in different areas of the country. But our togetherness formed bonds, and we have reaffirmed those bonds through the wonder of technology. We see each other how we are now, more mature, more experienced, with more yesterdays than tomorrows, with much of our lives played out. We have had our triumphs and our failures and our heartaches, and we know that nobody bats a thousand. But still, possibly, if we work at it, it seems we have each other. And we can treasure our yesterdays and honor them with our todays. And all of us can still learn – indeed, we can't help it. And with our mentoring, we can pass our experience on to our successors, maybe even our wisdom. And wonder of wonders, we can do it together.
I talked to Gerry on the phone after the Zoom meeting, and I know Jeff Newhouse called him as well. He feels so warm and affirmed from the whole experience. I assured him that everyone on the call feels the same way. Who benefits more, the giver or the receiver? Gerry did a service to the whole class, really.
It's all pretty remarkable, all of it.
Budd Shenkin
