October 18, 2017 | Bethany Doran, MD
Career Development

I. Preface

Joseph Rogers, MD, FACC, currently the interim chair of medicine at Duke University Hospital, came to Duke University in 2004 from Washington University in St. Louis, where he had built the cardiac transplant and mechanical circulatory support program.

When he first came to Duke, there were only three other heart failure physicians (Paul Rosenberg, MD; Adrian Hernandez, MD, and Michael Felker, MD) and one cardiothoracic surgeon (Carmelo Milano, MD), who focused on heart failure. Over the span of 13 years, he and his colleagues have grown the heart failure program to 16 full-time cardiologists, three cardiothoracic surgeons, a robust nursing infrastructure and a productive research program. He is a dedicated physician, and despite his administrative obligations, it is not unusual for him to be at the bedside of his patients in the middle of the night, helping the cardiology fellows and the rest of the team save lives.

During one of my first interactions with Dr. Rogers, there was a patient who was not doing well. She had a poor outcome after a valvular surgery at an outside facility and lay with painful contractures in the CT ICU when I met her. I knew that he had built a program that provided aggressive care for patients who had few other options, but it was difficult for me to see her in pain. I tentatively asked him, "Dr. Rogers, is there ever a time we stop?" and I was met by his unwavering gaze as he told me, "Bethany, we never give up." I was about to present the next patient when he paused and said, "let's go see her." We witnessed her suffering together, as well as her daughter's, and involved palliative care the next day. I had been trained to provide comprehensive care and never give up on saving a patient's life. But that pause trained me in a different way that day.

In medicine, there is a concept of the "hidden curriculum." These are the experiences that shape us as physicians modeled through our perception of our interactions with the health system, as well as the physicians around us. They are the structures of medicine that we operate within, and the institutional and cultural rules that we learn and that influence our future development as physicians and human beings. These are separate from the messages we are given in large groups, or institutional policies we follow, and sometimes even the way we describe ourselves and our mission. To me, these lessons are the art of medicine, the experiences that we keep as part of our own narratives or of those around us.

The experience with Dr. Rogers taught me a major lesson during training. Although our practice at Duke is often to test the limits of human resilience to be able to save as many as we can, there are times we must pause in the face of another's suffering to ask whether we are serving the very patient we have built our careers on. It is that pause which makes us human. Although he did not intend to teach me the lesson he did that day, I believe it to be as important as any of the other things I have learned in fellowship.

Stay tuned for an extensive three-part interview with Dr. Rogers, who spent the first part of his career building systems to provide his patients with the longest length of life possible, and recently completed a trial, PAL-HF, to explore how to provide care to heart failure patients nearing the end of their journey through life.

This article was authored by Bethany Doran, MD, Fellow in Training (FIT) at Duke University.