Magical Dinosaurs

Larry Lindahl was a general internist and geriatrician with whom I spent a month during the summer of my M4 year in medical school.  It was supposed to be a time for me to study for my board exams but ended up being so much more.  This man had a wonderful reputation from the residents and students, and my four weeks was one of the few times where reality matched expectation. 

There is a picture of Larry with his grandchildren that sits on his bookshelf in his office.  It is a black and white photo of him reading to his grandchildren.  He is sitting on a couch with both kids flanking him.  All three of them are leaning forward to read.  The chiaroscuro employed in the photo is stunning, giving it the life of a renaissance painting.  Larry’s glasses show his age but the light reflecting off his hair reminds you of his once reddish hair which has since been infiltrated with a more distinguished grey.

”That is such an awesome picture,” one of the residents said out loud one day.  I agreed wholeheartedly. 

Dr. Lindahl’s knowledge as a general internist was inspiring.  I use this word because he was able to speak to you in such a way that was both didactic and encouraging.  Much as the warmth in that photo, he had a way of telling you that you were wrong that both made you feel like you let him down and yet that everything was still going to be alright. 

Every morning he would discuss at topic with us.  We would meet in the physicians lounge and have a conversation.  His example would remind me that the physicians who had the most impact on my education were not necessarily the ones who knew the most or were the smartest, but the ones who shared their experiences, knowledge, and their lives.   Because in a way, these three things were inseparable, and it is unsurprising that my fondest memories were the ones in which all of these things were present. 

People always talk about bedside manner.  In some ways it becomes a terrible cliché.  But, having said this, this man had an unquestionably and authentically kind demeanor that I had not seen during my medical training.  I had never seen someone who made his patients feel so, dare I say, loved.  There was something about his demeanor that was fatherly—which was even more remarkable because he often dealt with patients who were old enough to his father.  For many of our demented patients, perhaps this is what they needed—someone to remind them that things were going to be okay, despite life’s uncertainties. 

I often thought patients came expecting a definitive, curative, treatment but there were many times I would leave the room with Dr. Lindahl realizing that the treatment was many times the reassurance.  Other times, I might leave the room with him feeling sad, but the sting of hopelessness would never be as acute as I expected.  In a way, this was the type of medicine I had envisioned before starting medical school three years ago.  After all, it was never about the cutting edge treatments, the academics, the prestige—everything boiled down to a story, a life, a person. 

In the hospital, Larry Lindahl was no less impressive.  In the sick rooms of patients he would sit on the bed and talk with the patient.  He was never in any hurry, always listening, and always caring.  As much as humanly possible, he would transform a room of disease into a room of healing, and somewhere inside of me the calluses built up from prior bitter experiences began to melt away. 

Larry was a conversationalist.  I knew I liked him when I spoke about not applying to California (“why would you want to be among so many shallow people anyway?” he had said).  When he encouraged me to read up on recent journals, I found myself wanting to do so because I wanted to be like him.  When he asked me what I learned in morning report and noon conference, it would be like a father asking his son how his day was.  When I did not attend (“Uh-oh” had been his initial words); the ensuing guilt was unlike any I had felt on any of my rotations. 

Dr. Lindahl gave a yearly lecture to the residents about the geriatric H&P.  As he had done during our chalk talk about the Beer’s List, he reiterated a phrase “cherchez la femme,” which was a French phrase that meant “look for the woman” who was often assumed to be source of all of life’s ills.  Larry had adapted this phrase for the geriatric population when trying to determine the source of altered mental status.  “Cherchez the drug,” he would say.  He would speak of establishing the narrative.  What was the patient’s story?  What was their living situation like?  In essence, he was telling us that you cannot begin to heal unless you understand the environment in which this healing will take place. 

Larry would always talk about how we should be aware that every doctor has his or her quirks, ways of doing things without any irrefutable medical evidence.  He would implore us to keep an open mind when judging other physicians.  He stated on numerous occasions that were probably many things he did that did not make much sense either.

My final day on the rotation I told Dr. Lindahl that I really enjoyed the last month with him.  I told him that while I wished things could have been a little busier, I learned more than I would have otherwise imagined and I wished more of our primary care experiences had been like this one.   To this, Larry said that he was probably more the exception than the rule.  “I am one of those old dinosaurs who managed to stick around long enough to see things change and who will one day probably be pushed to the side.” 

I should hope not, I remember thinking to myself.  Because dinosaurs like Larry are what the profession needs.  My time with him had both hardened my resolve to pursue primary care and also be the type of physician around whom the system works—not one who works for the system. 

Three months later I am sitting here writing these reflections.  I am on night call for my cardiology rotation; I should be reading EKGs.  Instead, I decided to write this because my patient who recently had an MI status post stenting has lapsed into a lethargic, uncooperative state, refusing to eat or take her medications.  Three days in, we decided to consult the geriatrics service—which, here in Peoria, is Larry Lindahl.  “Is he good?” The cardiologist had asked.  “Yes, he’s wonderful,” someone had said.  And I agreed wholeheartedly. 

And so this morning I was sitting reading up on my patients when I saw Larry walk by with his resident and medical student.  I greeted him and asked him how my patient was doing.  He had discontinued some of her medications that might be causing her delirium, increased her antidepressant, and were hoping for the best.  “Cherchez the drug,” I thought to myself.  Larry went on, “So, we’ll just wait and see what happens in the next couple days and hopefully, I can work my magic.”

I hoped so too.  I hoped because I hurt for the daughter who could not understand why her mother was not like herself even after the surgery.  I hoped because I did not want this woman to spend the last days of her life deteriorating in the hospital, and lastly, I hoped because somewhere deep inside of me, I wanted one more chance to see this dinosaur work his magic.