1.28.2019 4.22 2024
…when I was in the Cardiomyopathy Unit recovering from my cardiac arrest⁰. It came as a complete surprise to me. I was lying in my room, still in the resolving fog of my two-month period of heavy sedation and marginal brain perfusion, when a dignified gray-haired doctor came up to my bedside. “Dr. Ed Koh? Ed? I’m Jim. We were interns together.”
You could have knocked me over with a feather. My mind flew back to July 1981,] when Jim and I were two of ten newly-hatched doctors starting their medical internship training. At the time Jim was a handsome young man who radiated health. He had a head of curly light-brown hair, and a mustache,
The man who stood in front of me now no longer had that raw animal energy, but when I saw his well-groomed short-cut hair and the alert, intelligent look in his crystal blue eyes I recognized that he was the same man that I had known thirty-seven years ago.
Ours was supposed to be a “gentleman’s internship”, with one-in-four call and night floats. However, what they didn’t tell you is that, being a community hospital, there were no fellows to carry the burden of night call. At five o’clock or so all of the attendings went home, so after that if a sick patient came in, you were on your own, meaning the intern and their JAR (junior assistant resident), who was theirself only a year or so out of medical school. If two sick patients came in, your JAR got the sicker one, and you got the other one.
As a result of this setup, the year turned out to be quite an intense one. If your patient needed a temporary pacemaker, you put it in under the guidance of your JAR. If your JAR was tied up you called your attending in from home and did it under their guidance. If your patient needed a Swan-Ganz pulmonary artery cathether, same deal. Over the course of the year I counted seventeen occasions where I put in either a pacer or a Swan, seventeen more than I would have had I been working at one of the academic centers in Boston.
Naturally over the course of the year I became a kind of mini-cardiologist. I had always been interested in reading EKGs (electrocardiograms), and I was very stimulated by my rotations in the CCU (coronary care unit) and ICU (intensive care unit). When patients died I pored over their rhythm strips to try to figure out what had happened to them. I was sometimes even right. Without fully realizing it, I must have developed a reputation among my fellow interns as someone who cared intensely about my work as a young doctor.
Over the years I had lost track of Jim’s whereabouts. “I thought you went to the NIH!(National Institutes of Health)”
“I went there for a few years to do a research fellowship, but then I came back to Boston to do a fellowship in cardiology.”
“Where are you working now?”
“I’m the chief of cardiology here!” My jaw dropped. “In fact, every cardiologist who has taken care of you during your stay here works for me!”
Tears came to my eyes. I owed this man my life. He and his teams of crack physicians had rescued me, literally from the jaws of death, using inventions of modern cardiology which were simply not available decades ago: LVAD (left ventricular assist device), ECMO (extracorporeal membrane oxygenation), and cardiac catheterization with stenting. They had shocked me seven times, performed CPR for thirty-two minutes, and done a series of complex procedures over the course of an intensive seven hours which made it possible for me to be alive today.
What could I say? “Thank you, Jim. Thank you so much.” He took my hand into his and we stayed like that for a minute.
“I came by the CCU last week and saw your two sons in your room playing guitar and singing. If I should ever be in the same position I would like my kids to do the exact same thing for me.” Tears welled up again. David and Jonny had sung and played to me for hours, so I heard (I have no conscious memory of it), and every doctor and nurse who took care of me during that time commented on it in an affectionate and appreciative way. “Tell them they can come back anytime!” was a typical refrain from the staff. In this time of crisis my family had come through for me big-time.
My internship had been a very difficult year for me. I had started off being on top of the world, graduating with an MD-PhD from the Harvard-MIT Program, defending a ground-breaking thesis with Dr. Walle Nauta as my mentor, and winning a residency slot (for the following year) at Harvard’s Beth Israel Hospital. My personal life was on an upward trend too; I had begun to date my beautiful, wonderful wife-to-be Carol. I was at the top of my game.
That summer my dad had his first stroke. Although he had no measurable functional deficit from this, he underwent a profound personality change which left him “lobotomized”. He went from being the most dynamic, pain-in-the-ass person one could imagine to being as passive as a vegetable. Given how fundamental my relationship had always been with my dad, this was extremely upsetting for me.
My year as an intern started with upsetting events too. Two weeks into my internship I was assigned a cardiac patient who did not wish to be given an IV (intravenous), admitted to an ICU, or resuscitated. (See my blog post “I become a doctor”.) Shortly after meeting him, he dropped dead in my presence, and I was helpless to do anything but watch his heart slow to a standstill and then pronounce him dead. My colleague Lynn came to be with me during this seemingly interminable vigil (which lasted about twenty minutes in reality–she only had this time because she was post-call and having trouble getting out of the hospital), and we sat against the wall and commiserated upon this new phase of our lives which we had entered.
Between these different stresses I became quite depressed over the course of the year. I remember that one day on rounds my SAR (senior assistant resident) Bruce essentially had to dictate to me the order list that I was writing on my patient. “Colace 100 mg po bid for constipation…” while at the same time giving me a pep talk to help me get through the rest of the day. By the time I finished the year I was happy to leave for my anesthesia residency.
Unfortunately, my depression that year was not an isolated incident. Years later, I learned that I had bipolar disease, or manic depression, which made me prone to recurrent bouts of either hypomania (hyper mood) or black depressions which interfered with my ability to work. Over the years I lost at least four jobs to circumstances which could be attributed, at least in part, to this illness. And in terms of career advancement, it likely prevented me from reaching the promise of my first twenty-eight years.
And so it was that I said tearfully to Jim, “I hope I wasn’t too much of a fuck-up that year!” Jim made a soft clucking sound. “Oh no, not at all!” He didn’t elaborate, but I could tell from the expression on his face that he was sincere. Somehow, despite my shortcomings, I had won enough respect from my fellow interns that now, thirty-seven years later, I was remembered in a positive way by one of the most accomplished of those colleagues.
When he was leaving, he said “Ed I will try to keep track of when you are being discharged to rehab and try to visit you again then.” I was very touched that he said that.
Last month Carol and I went to visit the CTU (cardio-thoracic unit) and CCU after an appointment with my cardiologist. We took a group picture with one of our favorite intensivists and two of the nurses who had taken care of me. When we got home I posted the picture on Facebook with the caption “So grateful to be alive!” Over the next few weeks I got over a hundred and fifty likes, loves, and comments from friends and colleagues from all walks of my life. I felt like Richard Dreyfuss in “Mr. Holland’s Opus”, being celebrated by his students and colleagues at the end of his career, except that instead of being greeted in a large auditorium I was being greeted by my real friends over the Internet.
Almost losing my life has given me some new perspectives on that life. I started fast, fueled by the dynamics of my Korean-American family, and probably by a dormant illness as well. As I ran into more and more difficult challenges, my ability to deal with them became more and more hindered by that illness. I did not end up becoming the superstar that people expected in my youth. In the end, however, I was able to finish out a long and productive medical career, winning the respect, affection, and gratitude of hundreds of colleagues, students, and co-workers along the way. And, together with Carol, we were able to raise a healthy and happy family.
I left a message for Jim before my discharge to the rehab hospital, but we were unable to connect with each other again. However, I hope to do so sometime in the near future. In the meantime, I will always be grateful for the affirmation he gave me that day in my hospital room, the reassurance that my colleagues saw my real self through the obstacles that life had placed in my way.
Thanks for reading.