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From the Heart
April 3, 2019

Patient-Physician Relationship: Lessons From My Tragedy

Author Affiliations
  • 1Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel
  • 2The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
JAMA Cardiol. 2019;4(5):405. doi:10.1001/jamacardio.2019.0661

On August 4, 2006, I was heading north on the highway to my hometown with my younger son at my side. The sun was rising in the cloudless blue sky when on the 7-o’clock news, the anchor reported 3 more casualties in our troops. I paid no attention. My older son was in enemy territory, fighting to restore peace to our northern border, but I was confident he was unharmed. He had said so himself: “What could possibly go wrong?”

My family took refuge down south from the ongoing missile attacks, but I was on call that Friday in the coronary care unit (CCU) and had to return. In fact, my son and I missed sleeping in our own beds and were looking forward to having some quality time together at home, willing to pay the toll of running to a shelter each time the sirens went off.

After arriving at the hospital, I headed toward the internal medicine ward, where one of my patients with atrial fibrillation required cardioversion. I was reviewing her file when a cardiology fellow approached me and said, “Where were you? We were looking all over for you! You are urgently needed in the CCU!” He looked distressed, but I refused to get anxious. The CCU was quiet when I had left earlier that morning. What could possibly go wrong? I went to return the file to the cart, but he was yelling at me, “just leave the file here!”

“They will never find it,” I said calmly and returned the file to the cart.

When we approached the CCU, the door was open. The CCU fellow was working at his computer. No one was running. Then, the cardiology fellow grabbed me from behind by my shoulders and pushed me into the fellows’ on-call room. There, sitting solemnly on the couch with their eyes fixed on the floor, were 2 of my colleagues, my best friends. One of them was Arab and the other, Jewish. With them was an army officer. “Your son was killed in action tonight,” he said. Seven words, and my world shattered to pieces. I knew my life would never be the same again.

“I am on call,” I finally mumbled. “Somebody will have to cover me.”

“Don’t worry about that,“ said one of my friends. My car keys were taken away from me, and I was escorted out of the hospital. I buried my eyes in the ground, hoping nobody would be looking at me.

My son was attacked from a close range. He never had a chance. After this initial attack, the military physician who was walking at the end of the line immediately rushed forward to help but never made it to his patients. He was killed en route.

During the Shiva, the hospital delivered food to my home every day at lunchtime. I never found out who organized this. Returning to work was not easy. Our hospital has only 400 beds. Everybody knows everybody. I would walk the hospital corridors, feeling that all eyes were on me, curious, pitying, wondering. I would find myself taking care of elderly patients with debilitations and dementia, thinking how unfair life is.

Most of my patients knew about my loss and reacted in different ways. Some would walk into my office and start talking about my son, telling me how they found out and how it made them feel, catching me off guard. And when they would see the pain in my eyes, they would apologize for bringing it up. One patient, whom I had been following up for many years, missed his appointments a few years in a row. When I reprimanded him for neglecting his health, he admitted to not being able to face me after my tragedy. Another patient openly stated that he was not sure I was still fit to take care of him and wondered if he should be looking for a new cardiologist. He remained with me at the end.

One day, one of my old patients came to see me in my office for his annual checkup. I had referred him for a mitral valve replacement 10 years earlier, when he was 73 years old, and saw him ever since. He sat across my desk and asked how I was feeling. “I’m fine,” I answered, using my standard response. He stared at me for a long moment, as if contemplating my answer, and then slowly nodded his head and started telling me his story.

“I was 12 when the Nazis put us on a train to Auschwitz. When we stopped at one of the stations, my mother bought a rock from one of the local farmers and paid for it with her wedding ring. This was the best deal she ever made. After the train started moving again, with the help of the rock, we were able to break through the barbed wire blocking the car window. Jump, she said, I am right behind you. I jumped, and when I looked back, I could see the train moving away. I never saw my mother again. Over the years, I learned to cope with the void, but I never stopped missing her. With time,” he said, “the pain becomes slightly more bearable.”

In the 21st century, we are told by hospital administrators to treat patients as clients. To me, this, somehow, has never felt right. We meet patients at their worst moments in life, sometimes in the most intimate of circumstances. And once in a while, a special bond is formed between patients and their physicians—unlike any other profession I know.

In memory of my son, Daniel.

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Article Information

Corresponding Author: Avinoam Shiran, MD, Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal St, Haifa 34362, Israel (av.shiran@gmail.com).

Published Online: April 3, 2019. doi:10.1001/jamacardio.2019.0661

Conflict of Interest Disclosures: None reported.

Additional Contributions: I thank all individuals mentioned here for granting permission to publish this information.

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