The Art of the Bedside
Catherine deVries, MD ‘84, CRT, thought she‘d grow up to be a forest ranger. Paul Szal, MD ‘77, wanted to be a physicist. Mai-Sie Chan, ‘97, MD ‘01, thought she might pursue physics or engineering.
Instead, all three practice medicine. With home bases from Bangor, Maine, to Wyoming, to San Francisco’s Chinatown, they are Stanford School of Medicine alumni who know people, their troubles, their fears, their triumphs, and their families. As Stanford alumni, they know the science of clinical medicine extremely well. They also exemplify the art—and the heart—of clinical medicine.
Small-Town Medicine in the Big City
“On any given day, I might take romance advice from a patient in my office, run into a couple more patients on Grant Avenue at lunchtime, and then greet a Chinese Hospital nurse who remembers entertaining me with Jell-O treats when I was a kid,” says Mai-Sie Chan. “On those days, I think: This is what it must have been like to practice medicine years ago in a small town.”
Chan’s road to this “small-town-in-a-big-city” practice was complex. Her internist-cardiologist dad, Shu-Wing Chan, didn’t push his four children into medicine; instead he encouraged them to pursue what interested them. So Mai-Sie chose science and Chinese culture, diving into both as an undergraduate at Stanford, where she studied Mandarin and biology. “By sophomore year, I’d committed to the idea of medical school,” she says. “Although I loved physics and math, many of my role models—including my father—were in medicine. And I began to realize that, beyond studying, I really loved working with people.”
During medical school, Chan maintained her interest in Chinese culture through a dance group, language studies, and an international elective at West China University of Medical Sciences in Sichuan province. At one point, she felt drawn to the high-tech possibilities of ophthalmology. But a sub-internship in internal medicine at Santa Clara Medical Center, a county hospital that served an economically, culturally, and ethnically diverse population, put her on a different path. “I realized all the challenges and the pleasures of a broader and more flexible practice,” she says. “And I felt a deeper connection with patients.”
Suddenly, casual conversations with her father took a more serious turn. “He encouraged me to explore everything, but when the subject of working together came up, he became very excited,” she says. “And then other physicians and people in the community got excited as well. I was new blood, and frankly, there weren’t that many women practicing in Chinatown.”
Six years later, Chan says it doesn’t feel like she’s just going to work every day. “I feel as if I’m part of a larger Chinatown community.” Patients spanning generations have embraced the father-daughter colleagues. “Some still think of me as very young, so they give me relationship advice and bring me food,” she says. “But they also acknowledge me as their doctor.” The key to establishing these deeper relationships, Chan believes, is seeing each patient as an individual, and having the patience and interest to listen.
Chan treasures her life as part of Chinatown and recently took on the job of performance improvement medical director at Chinese Hospital. But her community involvement extends far beyond office and hospital. At last year’s Chinese Hospital holiday gala, the theme was Dancing with the Stars. And there was Dr. Mai-Sie Chan, Dr. Shu-Wing Chan’s daughter, in an eye-catching red dress, tearing up the floor with her partner in an Argentine tango. The 500 audience members—including her parents—were delighted.
The Gift of Empathy
Radiation oncology, with all its sophisticated tools, may be among the most high-tech of the specialties, and Paul Szal readily confesses that technology was part of what drew him to the field. But today, it’s not just the science of oncology that impassions him; it’s the art of healing.
Szal began by studying physics at Johns Hopkins, just as his older brother was finishing med school there. He had heard their dad’s tales of the Depression, and thought, “Well, whatever happens, we’ll always need doctors.” So he headed to California and Stanford School of Medicine for a change of scenery.
“I had the opportunity to do a tutorial in cancer with Henry Kaplan, the pioneering radiation oncologist who built the first medical linear accelerator in the West at Stanford, and I was hooked,” says Szal. “For a guy who cared about physics, this was the perfect match.” Szal had a heart-to-heart with Kaplan, who assured him that despite all the progress in cancer, there would be work for the rest of his career, and gave Szal his blessing to head to Boston for a residency at Harvard’s Joint Center for Radiation Therapy
After his residency, Szal decided to evaluate a variety of opportunities. His first stop was Bangor, Maine, population: 31,000. There, Peter Lambert, a professional leader in oncology, welcomed Szal and his wife to the community. “We looked around, and loved what we saw: grass and cows out one window; coast, lakes, and woods out the other.” The tech-minded man who had grown up in suburban Jersey was hooked.
Twenty-nine years later, Szal still considers choosing Bangor a splendid decision. “We’re in the middle of the state, and patients may drive two hours to get here,” he says. “Maine is very economically diverse; much of the state is very poor. So I see a broad range of patients, from bankers to fishermen, lawyers to woodsmen. The conversations vary tremendously, whether they are about their life’s work or the best way to treat their cancer.”
Szal says he’s learned much from his patients. “They’ve taught me empathy–something you get better at in your profession as you have more life experience. And they’ve taught me that you’ve got to have hope,” he says. “Even when we can’t realistically talk about a cure, we can say that we can make things better in some way.”
Sometimes when Szal is fly-fishing or cutting up blown-down spruce with a chainsaw at his second home on Deer Isle, he thinks back to his days at the Joint Center in Boston. “Most people were leaving to do academic medicine. But I thought about making a life with a family, and being connected every day to the clinical work I love.”
The Language of Touch
Catherine deVries is an internationally recognized social entrepreneur, a clinical professor of surgery, a bioengineering scholar working with students on devices that will function well in under-resourced countries, and a part-time rancher in Wyoming. But at heart, she’s a clinician, someone who knows the value of touch.
Like Mai-Sie Chan, deVries is a doctor’s daughter (Pieter A. deVries, ’44, MD ’47). And like Chan, she initially had little interest in following her father’s path. “My father was never around for dinner. Every holiday, there was some emergency,” she says. “If you had told me I’d be doing pediatric urology one day, I’d have said you were out of your mind.”
But the little girl who wanted to be a forest ranger ended up doing graduate work in pathology at Duke. Then, her fresh-out-of-med-school husband matched at Stanford, and they moved west. Slowly the decision to go to medical school began to make more sense, and when deVries found her calling in urology, she never looked back.
Then life delivered a tragic jolt. DeVries’ husband died while she was chief resident at Stanford University Medical Center, leaving her with two young children. She moved to Georgia, but always felt at home in the West, and eventually welcomed the opportunity to return.
At Stanford, deVries had set her sights on an even broader horizon. She had been greatly influenced by faculty member Donald Laub, MD, who helped found Interplast, the nonprofit that performs free reconstructive surgery in developing nations. Inspired by Laub’s work with Interplast, in 1995, deVries launched IVUmed, an organization that provides pediatric urology care, plus medical and surgical education, to physicians and nurses around the world. Today, IVUmed has provided care and services in nearly 30 countries in Africa, Asia, and the Americas and has expanded its work to include general urology, women’s health, neglected tropical diseases, and international resident and fellow rotations.
Working in countries where she and her patients don’t speak the same language is less of a barrier than you might think. “I work with a translator, but I still speak directly to people,” deVries says. “Patients have to trust you, so I want them to know I’m connected to them. It’s great to be a good technician, but we have to remember that the first language we have as human beings is touch.”
DeVries has been on the other side of experiencing how trust is built. She’s had three serious surgeries that could have affected her life and career—once for breast cancer and twice on her neck, for thoracic outlet and cervical disks.
“When I talk to new graduates, I always say, ‘Follow your heart.’ Sometimes that leads in strange and interesting directions you might not have imagined. People get stuck in mortgages or family obligations and feel they can’t make changes. I say, we never know what’s going to happen in this life. Medical school is already delayed gratification. Do what you want to do.”
That philosophy is part of what led deVries back to the West. It’s what keeps her on horseback at her ranch in Wyoming, and what motivates her work with students, patients, and fellow professionals around the world. “Life is short,” she says. “We have to live our lives in the time we have.” And as deVries, Szal, and Chan all demonstrate, choosing the life of a clinician can deliver the gifts of a lifetime.