RBG and Dad

From the 9/25/2020 newsletter

Director’s Corner
 

RBG and Dad

 
Adina Kalet, MD MPH
 
 

In this Director’s Corner, Adina Kalet tries to reconcile the awesome vulnerability of being a patient, the potential transformative power of our profession, and the lessons learned from the life of an American hero.
 
 
This week, the death of Justice Ruth Bader Ginsberg has been on my mind and, as I considered what to share in my column, I realized how important she has been to us. I have benefited from, and been moved by, her critical and prophetic message that, “Women belong in all places where decisions are being made.” For women of my generation, this was not the norm and it is still far from a guarantee. Thanks to the work of RBG and a handful of others, some of us now find ourselves “at the table,” making decisions and expanding our spheres of influence as we attempt to make the world a better place. Her work led directly to transformative change. Many of us who would have otherwise been sidelined are now heard in ways that would never have been possible without her. 
 
Ruth Bader Ginsberg was an American hero and transformational leader, par excellence. People on all points of the political spectrum have noted her uncanny ability to listen, her impact on society, her brilliance and courage, her prophetic legal mind, her ability to see things as they should be for all people, and her perseverance. I have medical colleagues who take on the challenges inherent in medicine the same way.
 
 
This week, the chance to be heard became personal.
 
 
I am writing this column while sitting in a hospital waiting room, the daughter of someone suddenly thrust into the medical system. In my new unwelcome role, I feel vulnerable and less assured of the value of my personal “power and influence.” I had planned to write about RBG’s life and legacy. Instead, I find myself searching for parallels between how she leveraged her knowledge of the legal system for change and my need to exercise my familiarity with the medical system to make certain my father stays safe. Like her, I remain vigilant, paying attention to everything that is happening around us, and advocating on my father’s behalf. It can be exhausting.
 
My dad is a remarkably fit 84-year-old retired engineer who presented this past Tuesday to his internist with classic symptoms of exertional angina in a crescendo pattern. Dad’s EKG had developed non-specific T-waves that suggested something amiss. He was walked down the hall to the cardiologist who then called the interventional cardiologist who scheduled a cardiac catheterization. He was admitted to the ER for monitoring. His first troponin levels (an indicator of heart muscle cell damage) were equivocal, suggesting heart muscle cells were spilling their contents but he didn’t appear to be having a full-blown heart attack. 
 
For context, my dad sees a doctor in the large academic medical center where I did my residency training and spent the first thirty years of my career. I know this place and these people – warts, glory, and all. Even though I had confidence in his care team, I was terrified. I knew too much. I never left his side because, over the years, I have seen all of the things that can go wrong even when everyone is well meaning and highly qualified. 
 
From the patient’s (and the daughter’s) perspective, hospital care separates individuals from everything familiar. There are endless streams of humans with uncertain duties, repeated handoffs between nurses, physicians, and other staff, long (ten hour!) waits in the ER until a “clean bed” becomes available, no proffered food, malfunctioning cardiac monitors for a patient with a heart problem, a mix of disturbingly poor and remarkably skillful communications, and moments of caring and compassion juxtaposed with moments of “ghosting.” Even as someone who knows medicine and trained in the hospital where we now sat, the experience was dehumanizing.  
 
Further, I could see the contrast between the technical, sophisticated wonders of modern medicine – cardiac catheterization suites with cutting-edge technology and physicians with impeccable expertise – and the troubling implications of the corporate commodification of healing in healthcare systems. Some patients in the city are offered luxurious private rooms with gourmet meals and spectacular views of the river while others – in the public hospital down the street – are offered no amenities. The public hospital’s professional expertise is, fortunately, comparable, but is also distinguished by the staff’s ability to offer excellent care despite their lack of resources. 
 
What’s the bigger picture here? How might we make healthcare more equitable? RBG had a wider vision of society, and she pushed the legal system to treat everyone equally no matter their gender or status. In the same way, visionaries in medicine envision a future where every person is entitled to safe, high quality, compassionate, cost-effective healthcare. We must include the most vulnerable patients, even as she fiercely advocated for all members of society. We will face challenges along the way, just as she experienced blatant interpersonal and institutional sexism during her career. 
 
She demonstrated that to be transformational, we need to be persistent. There was a moment, early in her time at Harvard, when RGB and the small group of women classmates were challenged by the law school dean to defend why she “took” a man’s spot in law school. They demonstrated their value with their actions and dedication. They showedthat they belonged. Later, despite graduating at the top of her class and being part of the law review, she could not get a clerkship or even a job with a law firm. She chose an alternative path, doing comparative international law research, joining a law school faculty, and creating her own way forward. She ended up changing the world. 
 
To achieve transformation, we will need to engage – like RBG did – in necessary, nuanced, and difficult conversations. She had a clear moral compass. She was able to change her mind, to be influenced by others, and to learn deep and abiding truths about human dignity from those whom she loved and especially from those she didn’t know. With these character traits, it is possible to engage in respectful, caring, civically responsible, and sometimes fierce dialogues on contentious issues, including the inequities in health care and society. “You can disagree without being disagreeable,”she said. “Fight for the things that you care about but do it in a way that will lead others to join you.” Although being patient enough to work through issues can be a huge challenge, her long view of history allowed her to dissent while remaining part of rich, mutually respectful, humble relationships with those with whom she fundamentally disagreed. Her ability to persuade without fracturing human connections is one of her most important legacies and lessons. 
 
 
I accompanied my dad on his journey this week. Happily, he had the best possible care and had a wonderful outcome despite the frightening situation. I advocated for him, speaking up and influencing the system when it faltered. But mostly, we realized that the outcome was a result of the fundamental commitment of his medical professionals to care for someone in need. 
 
RBG, too, depended largely on the goodness of people working in the legal system, although she did not allow that faith to keep her from being a vigilant advocate when she felt it was needed. She believed in the goodness of others, but also that she had the responsibility to drive the change. She persisted and the world is a better place because of it. May we all be inspired by her courage and passion. 
 
 
 
Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.