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Lunch with Lynch

From the June ACP Hospitalist, copyright © 2009 by the American College of Physicians

By James S. Newman

At ACP’s annual meeting, held in April in Philadelphia, I had the distinct pleasure of running into Edward C. Lynch, MACP. I saw him walking through the convention hallway, gastronomic delight in hand. Luckily I spotted him first so he didn’t have time to beat a hasty retreat. We sat and ate the extraordinary fare provided by the College.

Dr. Lynch was my residency director, over 20 years ago. It feels strange to call him Ed. It is often hard to switch to a first-name basis with people you’ve worked for, learned from and respected. (This might explain why my ex-students call me “Dude.”) Dr. Lynch was born in Fayette, Mo., and migrated to St. Louis; Rochester, N.Y.; Fort Bragg, N.C.; and eventually to Houston. He was and is an outstanding teacher, a distinguished clinician, and a role model. He is a long-standing member of ACP and was awarded a Mastership in 2000. For generations of internal medicine residents at Houston’s Baylor College of Medicine, he ran the best morning report, with a minimum of angst and a maximum of education.

It is not unusual at a meeting like the annual ACP extravaganza to see people from your past, to hear their stories and get their updates and, even better, to dish out the dirt. It feels like finding a lost epilogue to a book you enjoyed. Eating lunch with Ed was an opportunity to hear about his life, and how the institution had changed over two decades. The Baylor I knew as a resident is gone, lost to time. Dr. Lynch is now in semi-retirement, traveling with his lovely wife, Nell, and looking forward to his next challenge. He was in the process of planning medical missionary work. Talking to him, I felt like I was learning again, this time how to stay involved, and to stay young.

Our lunch meeting made me pause to contemplate residency. I’ve changed since then (thank goodness!), but I also reflected on how my memories of that time, especially internship, are ingrained into my cortex. How much of it was the sleep deprivation, fear and loathing? Did the intensity of action, walking the tightrope without a net, make it a better experience? Will the residents of this modern era remember each painful, thrilling day of learning with such vividness? Times have changed, and likely for the best. Our patients are better served by not being fodder for a learner’s education.

I teach by anecdote. In the context of medical education, anecdotes may be highly compelling and entertaining, but perhaps not always accurate. Nonetheless, those intense months of residency were ripe with meaning and learning. Like old war veterans who relive battles, dragging out those old chestnuts, I air out those moldy stories, but in some odd way, they are still fresh in my mind.

I rely on my anecdotes. Years of students have heard of my medical misadventures. How I pushed my resident, Moises Bucay, down the VA hospital hallway and almost killed the chief of staff, how we unwrapped maggot-infested wounds in the emergency department, fished in vain for veins, and ran to codes and checked our own pulses, and how we managed to care for patients without the Internet, or even electronic records (often with no records at all). They nod their heads and generally laugh politely at my well-worn tales, like humoring a crazy uncle at a family gathering, but hopefully there is a message in there somewhere. These cases have an n of 1; this is my EBM (experience-based medicine).

It is good not to be a resident anymore, though sometimes as a hospitalist I still feel that way: up late at night writing up admissions, struggling over complex decisions, dealing with distraught families, staring at the admit board and wondering if I will make it through the shift. The difference is in me, though. I do this because I enjoy it. It’s not a transition to something else, it’s my life. I had better like what I’m doing.

What lessons come to mind sitting on a bench in a large conference room, eating lunch with an old mentor? It left me thinking that as my own career passes haltingly along, I should not live for retirement. I should stay busy and keep learning. I should fight the forces of entropy. I should remember that the past is an interesting place to visit but not somewhere you can live, that despite technologic advances and guidelines, there is still something to be said for experience.

And finally, I learned something that Ed should have already learned: Watch whom you eat lunch with.

Dr. Newman is a hospitalist at the Mayo Clinic in Rochester, Minn., and editorial advisor to ACP Hospitalist.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated