Urology pearls

Longtime physician faces time of transition

Shahar Madjar, MD, Journal columnist

After 17 years of working in the Keweenaw Peninsula, it is time for me to make a change.

A lot has happened during these years: I joined the hospital when it was a small, rural, independent facility (Keweenaw Memorial Medical Center), and saw it turn, as many other independent hospitals, into a part of a much larger network.

I saw nurses and doctors come and go, and others joining the hospital to replace the ones that retired, or moved away in search of greener pastures. Administrators have also been replaced, every now and then, bringing with them new approaches of management, and new points of view on how healthcare should be delivered.

I am not going to retire! The average urologist in the U.S. retires at 68 and I am not there yet. Instead, I will continue to provide urology care for my existing and new patients as I have done before, for several years, at the Baraga County Memorial Hospital in L’Anse and at Schoolcraft County Memorial Hospital in Manistique.

Most of my patients to whom I have delivered the news about my plans, expressed their wish to continue their care with me. Those of you interested in seeing me in the future should contact the facilities I have just mentioned and schedule an appointment.

It is a time of transition, then, and for reflection too. I ask myself, What should I take with me to my new locations and what should I leave behind? Here is a partial “To Do Before Departure” list:

≤ Take the large replica of the painting ‘The Doctor’ by Luke Fildes (the original was created in 1891). My replica is a large, fading poster in a glass picture frame. It’s currently hanging on the wall of my office, next to the door. It was given to me by a grateful patient who believed that I will love the painting. It depicts a Victorian doctor sitting next to a dying child. The child is lying on a few chairs, over pillows. He seems asleep and frail, his face pale. In the background, the child’s father stands devastated. The doctor is leaning forward toward the child. The doctor wears the expression of great empathy and deep concern. He seems compassionate and caring. It is believed that in creating this painting, the artist, Luke Fildes, was inspired by the loss of his own son, Philip, who died of typhoid fever on Christmas morning in 1877. The original painting is at the Tate Gallery in London.

≤ From the locker in the operating room, take the Birkenstock Classic Slip-on Clogs (extra comfortable when standing for long hours in the OR), and the surgical loupes–a pair of magnifying glasses that my mentor gave to me as a gift–they still work wonders when microscopic dissection is necessary).

≤ From the bookshelves in my office, retrieve all books, including Campbell’s Urology. Campbell’s is a 4096 page, 3 volume textbook. Nicknamed “The Bible of Urology,” it holds everything there is to know about urology: the natural history of diseases and their diagnosis and treatment. And a “how to” sections describing the art and technique of urological surgery. Looking at it, opening it, leafing through its glossy pages, reading it, I’m reminded of how expansive the science of urology is: kidney stones; kidney, bladder, and prostate cancer; urinary incontinence in women; enlarged prostates and erectile dysfunction in men. The list goes on and on; in each chapter, an important lesson.

≤ Take the white coat hanging on the backside of the door.

≤ A small flashlight (good for finding your way in the dark, but also to help decide whether a scrotal mass is benign or malignant: If the light goes through the mass (if the mass transilluminates) the mass is most likely a hydrocele and is benign; if the light doesn’t trnasilluminate, the mass can be malignant and more testing is necessary).

≤ Take my Littmann stethoscope: with it I can hear the sounds of the patients’ lungs and hearts. It is also a reminder that good doctors have to LISTEN to the stories their patients tell them.

≤ Leave the large cork-board behind, but don’t forget to take with you all the ‘Thank You’ notes pinned to it. Of all my possessions at the hospital, I hold these ‘Thank You’ letters dearest to my heart. In them I find a meaning expressed in my patients’ words. These letters motivate me to keep working, and inspire me to perform my job to the best of my ability.

EDITOR’S NOTE: Dr. Shahar Madjar is a urologist at Aspirus and the author of “Is Life Too Long? Essays about Life, Death and Other Trivial Matters.” Contact him at smadjar@yahoo.com.


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