Off The High Dive

Thomas McGarrity, MD

I’ve never been much of a daredevil. However, by the third day of most vacations I become restless. A need to push myself. An hour-too-long hike or a bike ride with one too many hills leaves me sweaty, lightheaded (hypoglycemic?) and rubbery legged (lactic acid?) Satisfied, sated. The high dive at the community pool always gets my goat. Rising high above the concrete deck taunting me “You Wimp!” I get in line behind the antsy pre-teens and in front of the pushin’ and shovin’ teens. I wrap my arms together, resting on my bulging abdomen. The line creeps forward. Then I rise alone on the stairs. I look out from the board, no one is watching. I check to make sure the last diver has cleared. I lurch forward, small hop and jump. Mid-air I steel myself from toppling over, then plunge, contact, submerged. Survived.

I’ll be retiring soon. The 30th of this month. Then gone. Before you ask, “I haven’t a clue.” Forty-three years at one institution. My job hasn’t been a forty-hour work week. I spent many rewarding weeks on hospital rounding on the inpatient and consult services. I have learned so much from patients, medical students, residents, and fellows. In exchange I have shared lessons on organ physiology, Irish literature and basketball legends. I don’t have hobbies. I exercise, I read. I don’t golf, caddying for doctors during high school cured me of that pastime. I could attend GI Fellows clinics, but I don’t want to be that senior attending who relies on a wealth of experience but hasn’t read the latest journals. I plan to volunteer for the Communications Professional Ethics Humanities Courses for the first- and second-year medical students. That would be more to my liking. Universal skills that are essential for all care givers.

Should I step away from medicine entirely, view life from a different perspective? Volunteer at the Food Bank, provide service, and make people feel better. My snarky second son says I should volunteer as a greeter at Walmart. “You’re good at that sort of thing,” he smiles.

These past decades have been a wonderous time in medicine and gastroenterology. I graduated from medical school in 1979. The first case of AIDS in the United States was reported in 1981. The COVID pandemic which descended in the spring of 2020 had similarities to the AIDS epidemic. AIDS and COVID patients often died alone. AIDS families often abandoned their sons. COVID patients passed in respiratory isolation. Care givers heroically tried to fill their void to provide care and comfort. In both cases anger and distrust were directed at the medical and research community. There was one big difference, it took 15 years for effective AIDS therapy to become available. Whereas, with COVID, an effective vaccine was developed, tested and available within a year.

The face of gastroenterology has changed dramatically over this time period. The Gastroenterology Fellowship at Hershey Medical Center began in 1973. Our first female fellow arrived in 1987. Today our Division celebrates the diversity and many hues of our attending staff and fellows more reflective of our patients. There have been wonderful advances in gastroenterology. Peptic ulcer disease was discovered to be primarily an infectious disease in the early 1980’s. Endoscopy evolved from being a primary diagnostic to a therapeutic tool, effective in staunching bleeding, and treating cholangitis. Screening colonoscopy has markedly decreased the incidence and mortality of colorectal cancer. As gastroenterologists have become endoscopists, we are at risk of reducing our practice and patients to procedures, “the colon in Room 2 is waiting for you.” These technical advances should supplement but not replace the privilege of being a clinician, serving at our special place at the bedside. Striving to cure some and comfort many.

I’m in one of my last out-patient clinics. I’m saying goodbye to Dawn, at 52 years now my longest patient. She was an angry teenager who didn’t want to be sick when I diagnosed Crohn’s disease. For years her disease dominated her life. I attended to her during multiple hospitalizations and surgeries. Fortunately, biologic therapy became available, which has put her in deep remission from debilitating intestinal and perianal disease. She told me that with prior therapy she was always aware of her Crohn’s disease, but with the biologic therapy finally, “the spigot was turned off.” I remind her that I have used her metaphor when counseling other patients about the need and benefits of more aggressive therapy. She complains about her teenage son who can’t wait to get off to college. “Oh Dawn,” I say, “you were such a difficult teenager.” We smile. We face directly to each other, her cheeks stained with tears, my eyes glistened. She promises to be more faithful with her weightlifting program at the gym to prevent osteoporosis.

“Take care of yourself.”