During my time at Tulane, we had an outstanding pathology department. Consistently voted as best teachers by the students, the faculty were not only excellent in making their subject come alive (a deliberate oxymoron) but also in modeling for us the ideals and behaviors of a good physician. None was more revered by us than the chairman of the department, Dr. Charles Dunlap. A Harvard graduate and a gentleman of the old school, his cadenced delivery while smoking his pipe, his self-deprecating erudition, and his gentle approach with students endeared him to all of us. On the last day of our rotation, he continued his long standing tradition of addressing us as future doctors, sharing his long experience, both good and bad, regarding what it means to be a physician. This lecture was attended not only by us, but also a number of prior graduates stretching back decades who wanted to again be inspired by his words. He requested that we not record his talk, and we dutifully honored his wishes. (I wish I had and exact transcript of his precise words, for his metaphors and imagery were powerful and remarkable.)
The words he shared with us have stayed with me to this day. In speaking to alumni from other classes, his message also had profound and lasting effects on them. He spoke about the sacred trust between patient and physician, and our duty to never abuse their faith. We were not to take financial advantage by performing services unnecessary to the patient’s welfare. We were never allowed to develop sexual relationships with those we cared for, even if initiated by them. We were to respect our colleagues, and not disparage their reputations to others. We had an obligation to maintain and advance our own knowledge of medicine, and pass our knowledge on to future generation of physicians. We owed a duty of care not only to our patients, but also to our families and our communities. In order to help patients from all walks of life, we needed to understand and appreciate humanity in all its kaleidoscopic forms. He urged us to go to plays, read the classics, learn to appreciate all kinds of music, and take care of our bodies along with our minds.
He talked of the challenges we would face caring for people with chronic and fatal diseases, and our need to share our feelings of frustration and failure that were inevitable in our task. We needed to establish trusted relationships with friends and family in order to share our feelings, and not keep them bottled inside us. He cautioned us about the risks of suicide and substance abuse in our profession caused by our failure to establish healthy outlets for our fears and inevitable mistakes. Our duty was to recognize the causes of our mistakes and to learn from them, so as not to repeat them in the future. He advised us to remember that “the patient is the one with the disease.” While we needed to have empathy, over identifying with patients would surely cripple us over time.
One of the most crucial pieces of advice he imparted to us was never to tell someone when they were going to die. This is not only an inexcusable act of hubris, as none of us know the answer to the question, but also robs the patient of hope – a necessary component of life. I’ve seen too many colleagues tell someone with a terminal illness that they have so many weeks or months to live, and saw the devastation caused by their words. When confronted with this common question, he advised us to be honest by saying, “No one can tell you how long you will live. Some people with this illness can die in a few weeks, most in a few months, and some can carry on for years. Since we can’t predict where you fall in this spectrum of possibilities, let’s assume the best possible prognosis for you, realizing that you may not reach that goal. In the meantime, let’s focus on what is important to you, and set short term goals on how we can achieve that.” He warned us that “If you tell someone when they are going to die, they will stand and piss on your grave.”
I have never received better advice on being a doctor. Though he’s been gone many years, I honor his memory by doing my best to practice my profession the way he prescribed, and attempting to teach the students I’ve had to do the same.