Cover Story
Role Reversal
By Cathy Madison
Four physicians tell how their own encounters with trauma and illness changed the way they live and practice.
Last Halloween found Ron Hanson, M.D., on his bicycle, happy to have finished work early enough to enjoy the waning of a pleasant fall day. An avid biker, the St. Cloud otolaryngologist was doing about 22 mph along a country road, when a car traveling at highway speed hit him from behind, spun him around, and sent him flying. Because Hanson was attached by toe clips, man and machine did a complete somersault before the bike detached. He then went head over heels solo, cartwheeling about 50 feet along the road before landing in a ditch. Dazed but conscious, he army-crawled back up to the shoulder, flagged down help, and in due time, found himself strapped to a backboard.
In an instant, the physician had become the patient. What Robert Klitzman, M.D., author of When Doctors Become Patients, calls the “magic white coat” was gone, taking with it many attributes doctors take for granted: control, authority, invulnerability, and distance from death and illness.
Ann Wasson, M.D., an obstetrician/gynecologist at United Hospital in St. Paul, began to grapple with mortality when, on an early morning run in September 2007, crippling chest pain forced her to stop and sit in hope that her pain would go away. She had to creep slowly from house to house, resting on one curb after another, to make her way back home. Janet Vittone, M.D., an internist at Mayo Clinic, faced a serious medical problem in November 2001, when she looked in the mirror and saw dimpling under her left breast, cancer’s signature. Brian Bonte, D.O., a family physician at Hutchinson Medical Center, doffed his magic coat in 1995, when, at age 38, he sought a second opinion to confirm his self-diagnosis of multiple sclerosis (MS).
None of these physicians has returned to life as usual after spending time as a patient. Instead, they have developed the “unique double lenses” that come from having been on both sides of the stethoscope, as Klitzman puts it. After battling trauma, cancer, or progressive disease, each has returned to professional life with what seems to be a renewed commitment to the practice of medicine, a restored faith in humanity, and the insider’s perspective that brings them closer to the patients they treat.
Ron Hanson, M.D.
When Hanson came to rest in the ditch after being thrown from his bike, he wondered at first whether he was dead or alive. After realizing that he was indeed breathing, he discovered blood running down his head and felt severe abdominal pain. He also understood that he needed help, and that the car that hit him wasn’t going to stop. But as a physician, his first instinct was to run through a differential diagnosis.
“Even then, dazed, I was running through the possibilities. Lacerated liver? Pneumothorax?” he recalls.
Even after waving down help, Hanson had trouble relinquishing the control that physicians take for granted. He remembers well the moment when two individuals, one of whom happened to be an off-duty emergency medical technician, finally arrived at his side. Although they were able to get him stabilized, Hanson wasn’t ready to let them take over.
“I wanted to move, to make the diagnosis. They let me run through what I needed to run through, but it was clear that … they knew far more about my situation than I did at that point. Their job was stabilization and safety, and here I was in diagnostic mode,” he says. “But I wasn’t a doctor at that point. I was a trauma patient.”
As such, he was able to see firsthand how the people physicians seldom see—the paramedics, ambulance personnel, and even good Samaritans—deliver the care and assistance critical to a successful outcome. He was delighted to learn how good they were at their jobs and says he was pleased with the quality of the care he received from everyone he encountered throughout the experience, including the staff at St. Cloud Hospital with whom he worked daily. He now saw them through different eyes. “Competence and confidence are two words that come to mind,” he says.
During the hours immediately following the accident, Hanson discovered that physical contact—“someone touching your leg, putting their hand on your hand, looking you in the eye”—was much more important than he’d realized. He also remembers lying on the table in the ER thinking about a study he had seen in which 75 percent of physicians surveyed said they wouldn’t choose their profession again. “I remember feeling comforted that I had one of the 25 percent who were glad they made the decision they did and would give it their best effort,” he says. Even the one night he spent in the hospital taught him something new: that night nurses keeping watch over multiple patients are much busier than most physicians realize.
As a result of his collision with the car, Hanson suffered a wrist fracture, rib fractures, deep abrasions on his buttocks, hips, and extremities, and delayed-onset herniated discs in his neck, from which he still suffers “long-term aches and pain.” Having chosen conservative therapy for his neck, he uses a cervical traction device and works out at the gym to build strength in his left arm. He recently had bilateral inguinal hernia repairs and plans to get back on his bike after he heals from the surgery.
Hanson, who has returned to his duties at St. Cloud Ear, Nose, and Throat, admits that his practice has changed. He tries to be more patient, spending more time answering his patients’ questions and making sure not to trivialize common complaints. He tries to remember how important touch is. And since the accident, he’s found it difficult to be around people with negative attitudes; he prefers optimists, of which he is one.
“I feel like I sort of got away with one here—I could have so easily been killed or become a paraplegic—chances were very high,” he says. “To have not had that happen … I’m so thankful for that lesson, and I want to remember it every day.”
Ann Wasson, M.D.
In March of 2003, marathoner Ann Wasson began to feel chest pain when she ran. At first she thought she must be terribly out of shape after the recent birth of her second child, but the pain continued. It intensified when going uphill and became worse in cold weather. Sometimes she felt pain while at rest.
After about six months, she made an appointment with a cardiologist. Although her symptoms could be considered classic heart attack symptoms, the 43-year-old Wasson’s stress test and CT angiogram results looked fine; both she and her doctor shrugged their shoulders.
Still, as years went by and the pain continued, Wasson looked for answers. She blamed exercise-induced esophageal spasm, but the beta-agonists that should have alleviated it didn’t work.
Finally, after putting her kids to bed the night of the curbside episode, she drove herself to United Hospital. Emergency room personnel determined that her cardiac enzymes were elevated. “I was still in disbelief that this was a heart attack. I wanted it not to be real,” she says, adding that denial may be the wrong word to describe what she was experiencing. “It was more a desire to just have the problem go away by itself. In medicine, you’re so used to treating other people that you feel like you don’t need treatment. If you’re a plumber, you should be fixing your own problem. You shouldn’t be calling another plumber.”
She also admits that her inclination to treat herself was excessive—that anyone who thinks they may be having a heart attack should call 911. But for her, “it would be so embarrassing to call an ambulance. What if it wasn’t what I thought it was? I didn’t want to trouble anybody, and I didn’t want to be wrong. Now, I feel really foolish and more so being a physician.”
Like Hanson, Wasson experienced a profound loss-of-control moment. Hers hit when she was on the exam table, threaded with the angiogram catheter, and the cardiologist asked someone else to take a look. “If I’m in the OR and I ask for help, that usually means I’m in trouble or something’s wrong or something’s weird,” she explains. Something was indeed wrong; she had a dissection in her circumflex branch. Her doctors put it bluntly: Most cases like hers are diagnosed at autopsy. “That got my attention. Of course, with the Versed, I cared a little less,” she says with a chuckle.
Today, Wasson lives with her dissection, which could not be surgically repaired, and confesses that she sometimes feels that she’s a ticking time bomb. But she hasn’t stopped running. Her condition has improved over time, with the development of collateral blood flow, and she knows that after the first two or three miles, her body will produce its own nitrous oxide, dilating her arteries and relieving the pain. In fact, a year to the day after her emergency angiogram, she ran a 10-mile race pain-free.
Yet facing her own mortality has changed her priorities and raised her awareness of life’s uncertainties. She spends more time with her children, now ages 6 and 8, occasionally taking time off during the workday to take them ice-skating among other things. She also volunteers for WomenHeart, an organization devoted to educating women about heart disease. And she spends more time with her patients, especially on long-term issues such as lifestyle choices and obesity. “It’s hard to address that issue because I don’t want to offend them and have them not come back. But I take a very gentle approach and talk about what it will mean to them in the future,” she says.
After researching her own rare and perplexing problem extensively on the Internet, she is more convinced than ever that patients are their own best health advocates. Not only are they more invested in the outcome, but they also have more time than their physician to do the necessary legwork. She also encourages her patients to seek second opinions, because, as she points out, doctors are not infallible—whether they’re diagnosing their patients or themselves.
Janet Vittone, M.D.
This cannot be happening to me, Janet Vittone recalls thinking as she spotted the telltale signs of breast cancer in the bathroom mirror after putting her 2-year-old son to bed. Earlier that evening, he had playfully jumped on her, causing pain that surprised her with its severity. Vittone hadn’t considered cancer; only 38, she was breast-feeding and had no family history of cancer. But the dimpling was undeniable.
“It was really scary,” she says of the discovery. “As a physician, I knew exactly what that meant.”
After receiving a formal diagnosis of Stage 2 invasive ductal carcinoma, anger and frustration set in. Vittone chose an aggressive course of treatment that eventually included a double mastectomy and preventive hysterectomy. She encouraged her mother and two sisters to get mammograms. Seven months after her diagnosis, her younger sister was also diagnosed with breast cancer, then her mother a month later, and her older sister four months after that.
What had been her private pain became a family ordeal, one that reaffirmed the extraordinary kindness and efficiency of her colleagues, as each of her family members sought treatment at Mayo. “I remember lying on the table for my radiation treatment, when the technician asked how I was doing. My sister was one floor up having her surgery that day, and I started bawling,” she says. “It was just very comforting and helpful to know that someone cared.”
All family members are now cancer-free, and Vittone has new wisdom to impart. Her experience has underscored what she already taught students at Mayo Medical School: the importance of touching and hugging, how to cry with patients and let them know it’s OK to express emotion, to hold someone’s hand. But now when she treats cancer patients, she can reassure and educate them in a way few other physicians can. She can describe the effects of chemotherapy and even show them what her reconstructed breast looks like.
“I know what it’s like to be bald and to tell my kid that I might die. It gives me more credibility, and I can better help them understand that they’re not alone in this world,” she says. She also offers patients her home phone number and encourages them to call with questions and concerns.
Vittone, who has told her story many times, is still surprised at the impact it has on people she’s never met. After a national magazine article about her family’s ordeal was published, her sister gave a copy to a lawyer friend, whose wife read it, recognized her own cancer systems, and made an appointment to see a doctor. “Sometimes we don’t know who we touch,” Vittone says.
Brian Bonte, D.O.
Brian Bonte, another avid biker who used to log about 2,000 miles a year on his high-tech cycle, first realized that something was wrong in 1987, when he had to struggle to keep up with his wife during a long-distance ride in northern Minnesota. She beat him to the finish line, despite being on an old bike and not having trained as rigorously as her husband. Bonte continued to notice his decreased stamina as well as bladder instability and left-foot drop. Slowly, he acknowledged what he recognized as early symptoms of MS.
In 1995, he wrote up his physical and history and sought a confirming evaluation. When his physician suggested that he had benign, relapsing, remitting MS instead of the primary progressive type, he wanted to believe it was true. But he knew better, because he hadn’t noted any relapses.
“It’s not unusual to want the best of a bad situation,” he points out. “You want to be in control of all your faculties. Denial is a very, very strong entity that we all deal with.”
Bonte’s symptoms stayed quiescent until 1999, when he “came out of the closet” and shared his diagnosis with his practice partners. Since then, he has scaled back his practice, giving up obstetrics in 2000 and general call in 2003, to conserve his energy and maximize his productivity. Support from his colleagues has been extraordinary, he says. Although they make sure that no one else takes the closest parking space, they say they don’t think of him as disabled—even as he rides his scooter to the nurses’ station and calls himself the “token cripple.”
“You don’t know the depth of kindness in humanity until you’re disabled, and that goes across the spectrum,” Bonte says. “People are really willing to bend over backwards.”
Because Bonte’s affliction is obvious—the physician who used to bike to work started using a cane, then a rolling walker—patients relate differently to him. Previously they’d use secondary problems (“my right pinky hurts”) to get their foot in door, possibly because they were afraid to admit their primary symptoms and perhaps have their worst fears confirmed. Now, perhaps reluctant to waste his time, they get right to the point. “They’ll say, ‘I don’t want to share with you my minor complaints, but I’ll tell you my more serious complaints.’ We get to the crux of the problem faster,” he says.
His disease, he adds, has made him more empathetic across the board. “When I order an MRI, I can tell them how loud it is, how long it takes, what it’s like to lie there on your back. And when they tell me they got a headache from the spinal tap, I can say, ‘I know what you went through—it sucks.’”
Having developed a new respect for the importance of listening, he also spends more time with his patients now and finds that doing so makes his practice more rewarding. Before the MS started taking its toll, he saw 30 to 35 patients a day. Now he sees about 17.
“Unfortunately, I had to learn the hard way to slow down, but I’m glad [MS] has enabled me to do that. I’m not seeing as many patients a day, but I’ve got a closer relationship with those I see,” Bonte says. He has become an MS expert as well, giving talks and comanaging with neurologists about 50 to 60 MS patients. He also still works at a free Twin Cities clinic once a month.
Yet it hasn’t been easy to accept the limitations that being a patient, especially one with a progressive disease, entails. Physicians, after all, are trained to solve problems. But sometimes, Bonte now knows, problems can’t be solved. They must simply be dealt with, and with any luck, the patient will have the support from family and faith in God that have helped him along his journey. No one knows what God is going to throw our way, he points out; all we can do is learn to deal with whatever happens. That means continuing to fulfill one’s purpose for as long as one is able.
“We’re trained to be physicians, but sometimes we forget why we’re doing that. I cherish every moment, so I can do what I was designed to do,” he says. “If this was the reason why I got MS, then I’m glad. I hate the disease but I love what it’s done for me. I have MS, but MS does not have me.” MM
Cathy Madison is a Minneapolis freelance writer.