Losing Dr. McWonderful

It was time to make my quarterly appointment with my rheumatologist.

I called the Veteran’s Administration Health Care Appointments number and waited, as usual, through several repeats of the recorded announcements about suicide prevention, the VA’s suicide hotline, improved women’s health availability, and how glad the VA is that it can serve me, an American veteran. Finally, a real person came on the line. I rattled off my name and social security number, and told her I needed to make an appointment with my rheumatologist.

“I’m sorry, ma’am. I can’t make that appointment. Dr. McWonderful left.”

“What?” I was sure I’d heard her wrong.

“I’m sorry, Ms. Wren, but he’s left your medical center.”

I was so shocked I couldn’t speak. My rheumatologist had just … left? Taken off? Without any warning? But … “Oh, no,” I managed.

“I’m very sorry.” The clerk, one of many in a VA call center somewhere, obviously didn’t know me, but her voice was nonetheless sincere. I wondered how many of Dr. McWonderful’s other patients she’d had to break the news to recently.

“When did he leave?” I asked plaintively. Oh, stupid Wren! She wouldn’t know that! “I mean, no. I mean what … what can I do? I still need to see a rheumatologist.” I kept my voice as calm and steady as I could, but inside, I was panicking. “I’m taking medications that suppress my immune system! I have severe rheumatoid arthritis and my medicines aren’t working and I’m in pain and Dr. McWonderful renews my narcotic pain prescription and I’ll be out of it soon and if he’s not there how do I get it and I’m shocked and frustrated and now, I’m friggin’ scared, too!”

I didn’t say any of that, of course. Instead, I just kept breathing as she offered to connect me with the rheumatology department clerk. She took the time to read off the phone number for me so I could write it down, just in case the VA’s massive phone system disconnected me. I thanked her. “Good luck to you,” she said. “I hope you get a new doctor soon.”

Naturally, I got the clerk’s voice mail. So I left a message with all my pertinent information and questions, and asked, politely, for a call back ASAP. I haven’t heard from them yet.

Since I started blogging in 2009, I’ve read other people’s accounts of losing their rheumatologists. Sometimes they were glad--they didn’t like their rheumy in the first place, so they were OK with trying a new one. Others were less easy with it. They weren’t delighted with their doc, but hey, better the devil you know, right? And then there were the ones who were truly upset.

They spoke about their rheumatologists as if they were good friends. They wrote about how much they trusted their doctors, and how compassionate and understanding they were. Their loss was traumatic. They didn’t want to change doctors. They looked upon changing with trepidation, fearful that a new doctor would be cold, less understanding, less caring.

I’m a member of their ranks, now.

I liked Dr. McWonderful from the start. The VA has a spotty reputation--some of it earned, some of it undeserved--and VA patients generally don’t choose their own doctors. Instead, as in any “universal” health care set-up, they’re assigned a primary care physician who then refers them to specialists within the local system. I consider myself lucky that I got Dr. McWonderful, a man about six years my senior--as my rheumatologist.

He’s been caring for me and treating my RD since late 2008. I’ve seen him every three months, like clockwork. Although he saw at least 28 patients each Saturday--the overflow clinic day I always saw him on--he invariably greeted me with a big smile and an exceedingly gentle handshake. He always asked how I’d been feeling, and he listened to my answer and addressed my concerns. His exam was always quick but thorough, and if he noticed something that needed a closer look, he took the extra time it needed without rushing. He discussed every single medication he prescribed with me, explaining how it worked and why he wanted me to try it.

Although, like most doctors, he was compelled to type his notes and other pertinent information into my records via computer, he always turned the screen so that I could read it as he typed--and not only that, he read what he was typing out loud, too, so I always knew exactly what was going into my medical records. We looked at my lab results together and discussed them, so I understood what they meant. And he ran down my computerized list of medications with me and checked “refill” on those that needed them as I watched.

And then, when most doctors would whisk back out of the room and on to the next patient, he’d turn to me and say, “And what do you have written down to ask me this time, Ms. Wren?” Dr. McWonderful knew that I always brought notes with me so I wouldn’t forget what I wanted to ask him. I’d grin, and together, we’d work our way down the list. He’d answer all my questions and explain anything I didn’t understand.

As the years passed and I got to know him better, I learned that he spent a month each summer in Ghana, volunteering his rheumatologic expertise with Doctors Without Borders. At home, he not only worked for the VA, he was also a doctor for the county, bringing rheumatologic care to the impoverished right here at home. He expressed deep concern for those who couldn’t afford health care, and he was delighted when the ACA passed and went into effect.

I asked him one day what inspired him to be a rheumatologist. “I have five brothers and sisters,” he said. “Four of them have severe rheumatoid disease.” He always called it that, stressing that it was far more than just arthritis. “I grew up seeing how hard the disease was on them, so I decided to be a doctor so I could help them. I’m an internist, as well, but rheumatology is what I love.”

When I didn’t get a call back within a few days from the rheumatology clerk, I used the VA’s medical email system to ask all my questions and express my concerns again. On the third day after I’d sent it, there was a reply waiting for me. To my surprise (and delight), it was from Dr. McWonderful himself.

First, in response to my concern that perhaps illness had forced him to leave, he said no, he was fine, but that he’d been wanting to move back home, closer to his family. The VA medical center there suddenly had an opening for a rheumatologist. His family needed him, so the opportunity was too good to pass up. He wrote that I should expect to continue taking Enbrel for another three months, since the VA requires a six-month trial before it will approve a switch to another medication. Please be patient, Ms. Wren, he wrote, and give it time to work. And finally, he told me that he’d renewed my narcotic pain reliever for another month.

I’m still devastated that this fine doctor will no longer be taking care of me. I’m not the weepy sort, but I cried when I found out he’d left, and I still tear up when I think about it. I feel like I’ve lost a dear and trusted friend. Yes, I’ll get a new rheumatologist before long (I’d better start being a squeaky wheel since, at this writing, it hasn’t happened yet!), but I hardly dare hope that he or she will be as good, or as compassionate, or as friendly and human as Dr. McWonderful. I’ll always have a special place in my heart for him.