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David Alfery is a cardiac anesthesiologist who shares his experiences in the operating room and intensive care unit. In this discussion, he reflects on the lessons he learned about life, death, and the balance in between through his encounters with patients. He offers a unique perspective on the profession, providing insight into the secrets and experiences of life as a cardiac anesthesiologist. Tune in to hear more about his journey in this field and the impact his patients have had on his life and career.

David Alfery is a cardiac anesthesiologist.

He shares his story and discusses his book, Saving Grace: What Patients Teach Their Doctors about Life, Death, and the Balance in Between.

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show we have David Alfery. He is a cardiac anesthesiologist. He’s the author of the book “Saving Grace: What Patients Teach Their Doctors about Life, Death, and the Balance in Between.” David, welcome to the show.

David Alfery: Thank you, Kevin. Happy to be here.

Kevin Pho: So we’ll talk about your book in a little bit, but first off, briefly share your story and journey to where you are today.

David Alfery: Well, I grew up in the North and always wanted to be a doctor. I went down to New Orleans, to Tulane University, and had a little detour to Bourbon Street, where I was a bartender for a couple of years during college, and I quit pre-med. I had a little too much fun. I finished college and decided I’d better grow up, so I went back and took my pre-med requirements, went to LSU medical school, and decided I wanted to be a cardiac surgeon.

So I went to the University of Kentucky, in the general surgery program, with the idea that I would go all the way through. One of the interns didn’t show up that year, so our call was much worse, and I had a month of every-other-night call on neurosurgery, where you’d get to the hospital at 5:30 in the morning, you’d work all day and all night, you wouldn’t go to bed, and you’d get out about eight o’clock the next night. You did that 15 times during the month, and by the end of the month I had just absolutely had it, and I decided to leave surgery.

The chairman of the department of anesthesia grabbed me one day, and he said, “David, I heard you’re leaving surgery.” I said, “Yeah, I’m thinking about going into ER medicine.” So he brought me to his office and spent about 30 minutes describing anesthesia, and he said, “Look, you know, you’re the ICU doctors of the OR. It’s really an exciting specialty.” So I went off for about a week and thought about it, came back and saw him, and I said, “You know, Ballard, I think I will do anesthesia. I’ll give it a try.” He said, “Well, I know the program chairmen at this program and this one,” and he listed a bunch. I said, “Well, how’s San Diego?” thinking the weather would be pretty good there. He said, “Well, they’re a top-five program. They’ll be filled, but I’ll call.” Then later that day, I got a call from his secretary saying, “You’re going to San Diego. One of the residents just dropped out.”

So two of the most monumental decisions in my life were based upon a half-hour conversation and the fact that the temperature in San Diego averages 70 degrees each day. I went out to San Diego, did my residency, stayed for an extra year of cardiac training, and then went to Nashville, where I had a 36-year career as a cardiothoracic anesthesiologist.

Kevin Pho: Now, as you reflect back on your anesthesiology career, tell me, what were some of the biggest rewards or surprises that you’ve had during your professional career?

David Alfery: I think probably the biggest surprise was that even though so often your patient is asleep for 95 or 98 percent of your interaction with them, there was still this intimacy that you got with the patient, this sort of shared humanity, if only in the 10 or 15 minutes you saw them in the holding area before you put them to sleep. There was still this bond that is based upon, you know, trust of your physician. When you think about it, we’re going to take the patient, bring them closer to death than they’ll ever come in their lifetime, and then bring them back, and they trust us after a 10-minute conversation. It was just one of the amazing things about medicine, this connection between physicians and patients.

Kevin Pho: All right, so let’s talk about your book. It’s titled “Saving Grace: What Patients Teach Their Doctors about Life, Death, and the Balance in Between.” So what led you to write the book?

David Alfery: Well, you know, you go through your career, and there are a lot of amazing things that happen, and you think, “Gosh, I’d like to tell this story someday.” I finished my career, and I looked around to see what had been written from the perspective of the anesthesiologist, and I couldn’t find any book that really described life in anesthesia, life in the OR and in the ICU, from the perspective of the people at the head of the table. So I said, “You know, I’m going to sort of tell our secrets and divulge this secret place where I worked for 36 years and show it in a way it’s never been shown before,” basically from our perspective, which is far different from the surgeon’s. So it’s a real inside, sort of behind-the-OR-doors look at the profession.

As I wrote it, I thought, “Well, I’m going to be talking about all these things that I did,” but in that process, I realized how much they had shaped me. In fact, the patients that I took care of shaped my own personality, and that’s why the subtitle is “What Patients Teach Their Doctors about Life, Death, and the Balance in Between.” I learned so much about life from my patients.

Kevin Pho: So without giving away all the secrets from your book, tell us some of the biggest misperceptions that we have about anesthesiology and some things that you would like to clear up.

David Alfery: That’s a great question. You see on TV the surgeon is the captain of the ship, and they’re barking out orders, and the anesthesiologist is at the head of the table, kind of hunched over, obsequious: “Yes, sir. No, sir.” It’s not that way at all. It’s very much a team sport. There’s real equality in the operating room. Everybody has their job, and, you know, with this culture of safety that we have now, anybody at any time in the operating room can stop an operation from proceeding if they detect something not safe. The person scrubbing the floor can speak up, and the operation stops. So there’s real equality in the operating room that is not depicted on TV. It’s hard to really imagine the excitement that goes on in the operating room when things go bad. It is really very dramatically life and death in a matter of seconds to minutes.

Kevin Pho: You mentioned that you also learn a tremendous amount from the patients as well. Can you share a couple of stories of such patients and how they changed you?

David Alfery: Yeah, there’s one in particular. I had gone on a mission trip to Romania with a group called Operation Smile, and on that trip we were taking care of kids for orthopedic operations. Normally they do cleft lips and palates, but I was with some orthopedists. I had a little girl named Lydia, and she had the worst clubfeet you could imagine. She couldn’t walk. She hadn’t walked in years. Her feet were basically pointed directly to the ground. She also had syndactyly, and to the non-doctors out there, that’s this webbing in the hand between the fingers. Her hands looked like flippers, and she had some other congenital abnormalities.

We took her to the OR for something called a forefoot osteotomy, which is where they’re going to take a chunk of bone out of each ankle, bend the feet up, and screw them together, and she’d be able to walk, but not walk well. She’d walk with a staggering gait. Her other problems would not be fixed.

We’re at the end of the case, and we’re doing two operations in the room at the same time on two tables, so my partner is putting his little child to sleep. I had a medical student along, and I said, “Take the mask on her. She’s waking up. I’m going to help Mike get his patient to sleep.” As my patient’s waking up, she’s crying, and I ask the medical student, “Ask her if she’s hurting,” and he does, and she continues to cry. So I went back to the table, put the mask on, brought her out from anesthesia, and she’s just weeping. I said, “Lydia, why are you crying? Are you hurting?” She shook her head. “Why are you crying?” And she said, “I’m normal. I’m normal.” That was what was going to be normal for her: having those feet wedged back up, still with the flipper hands and her other problems. The name of that chapter is “Expectations,” and it really helped me set my own expectations.

Kevin Pho: You hear about so many things that are wrong with medicine and health care today. You hear about studies about burnout among physicians being close to 60 percent, and so many doctors are leaving medicine early. So talk about how, in this environment, you can maintain that connection with patients. What are some tips and pieces of advice you could share with some of the physicians listening to this about how they can maintain that connection with patients despite all the distractions and obstacles that impede us from optimal patient care?

David Alfery: Yeah, that is such a huge challenge today. I think that when I would be with a patient, I would try to distill it down and boil away everything that I possibly could boil away: boil away the regulations that I was working under, boil away the HIPAA things that I had to do in terms of the record, and just focus on the fact that this is a human being in front of me, and remember what a privilege it is to be a physician. You know, society gives us this awesome power and responsibility, and we’ve got a patient’s life in our hands, and to just cherish that. So I just tried to focus on that one-on-one patient, just that moment, regardless of all the other noise about me.

Kevin Pho: What are some of the other key points that you want readers to come away with after reading your book?

David Alfery: Well, I want them to realize that their own doctor is very much like them, that at the end of the day we all have the shared humanity, that we have the same aspirations, the same fears, the same frailties. Secondly, that we’re not here for a long time, and we’re all heading to the same destination, and that’s going to be our death. So it’s like, it’s an old cliche, but it’s how you spend your days. I like to say, each day, work on your eulogy, not your resume. If you live that way, you’ve lived a really productive life. In the epilogue, I quote this 20th-century poet, Heartsill Wilson, who says, you know, be careful how you spend today, make it count, because you’re trading a day of your life for it. I make the point that that’s a high price we pay for that day. Live it as though your life depended on it.

Kevin Pho: We’re talking to David Alfery. He’s a cardiac anesthesiologist, and he’s the author of the book “Saving Grace: What Patients Teach Their Doctors about Life, Death, and the Balance in Between.” So David, as you were writing this book and reflecting on your career, how difficult was it for you to write it? Is it something that you’ve always wanted to do?

David Alfery: Yeah, I always wanted to. I was an English major way back in college, and I had done a lot of medical writing, but this was so different. I found that it was really an emotional process. There were passages that, even as I describe them now, I get teary, just because they’re just so emotional. I guess one of the things I also want readers to realize is that, you know, your doctor cares about you.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

David Alfery: Make every day count. Live honorably. Be kind to others. Realize that we’re all in this together. As I said, work on your eulogy, not your resume. Live a giving life.

Kevin Pho: David, thank you so much for sharing your story, time, and insight. Thanks again for being on the show.

David Alfery: Thank you for having me, Kevin.