Last June 21 at age 51, Dr. David Worthen was voted a special commendation by the American Medical Association House of Delegates.
He was recognized for his contributions to medical education and eye care as a professor at two universities, then for his role as a Veterans Administration medical official, working for "the highest standards of medical care."
The award came at this early age because he also was being recognized for another role, that of a seriously stricken patient, "earning the highest respect and admiration of his many colleagues and friends for his great character and courage."
Late last summer I reported on the stories of 50 other physicians who had been ill, as told in "When Doctors Get Sick," a book being published this month. Virtually every story was moving. Almost every one was by a man or woman who sooner or later dealt with a serious disease or injury with hard and constructive realism, as we might expect of a trained physician.
Many were by physicians who today face an affliction with courage and determination. None, however, showed more courage than Worthen, a man who in life's midstream has had to abandon his career because of the creeping paralysis of Lou Gehrig's disease: amyotrophic lateral sclerosis.
He no longer has the use of his hands and arms. He can walk only with assistance. His speech is clear to his wife, Gaye Butler Worthen, but might not be readily understood over the telephone. She is his voice and his hands, writing letters and articles as he dictates.
Many of the physicians in "When Doctors Get Sick" told how they now view their patients with more patience and compassion than they previously felt. By his colleagues' testimony, Worthen always showed that kind of compassion.
The payoff was one he did not expect. His years of caring for others have helped him become a patient who accepts a grave, almost uniformly fatal disease without being truly defeated by it.
In his article on these pages, Dr. Worthen tells the story of his illness and his reaction as a patient.
What of his reaction as a doctor and patient, and the light it sheds on how a caring physician should care for patients? How might you and I react to so grave a disease? Could we find the fortitude? ::
Dr. Worthen mused on these things a few weeks ago.
"Every physician," he said, "can quickly recall in retrospect hundreds of patients he could have treated better. That fact underlines the key ingredient for the practice of medicine: humility.
"The humble physician can never know enough, care enough or comfort enough. That internal engine draws the physician to new levels of skill, propelled by the feelings of real or perceived need for improvement.
"Two additional keystones to the practice of medicine are objectivity and compassion as contrasted with empathy or pity."
The very things that make one a good doctor can also make it easier to be a patient, he believes.
"The physician's unique role in society," he said, "demands a courage and ability for self-healing that is both a responsibility and a burden." From "inside" his own diagnosis, he reported, the qualities of humility, objectivity and compassion have proved to be a great strength.
His "constant search for knowledge and skill" has reduced his dependency on his doctors, he said. His objectivity has given him "a realistic assessment and prognosis," telling him what he will most likely expect.
Finally, he indicated, his years of feeling he has been compassionate with his patients have made "crossing the invisible curtain of diagnosis" easier. Very simply, they have helped give him "the strength to function and achieve whether inside or outside the diagnosis." ::
ALS is not a preventable disease, given the lack of knowledge of its cause. Still, experiences like Dr. Worthen's may remind us that the more we exercise a "constant search for knowledge and skill" by learning about preventing disease, the better our chances are of facing grave disease later rather than earlier in life. Although, clearly there are no guarantees.
His story also tells us that the more we exercise "a constant search for knowledge and skill" when ill, the better our chances of living well despite the illness.
If there is anything that most patients need to know, it is this: Learn all you can about your illness. Learn all you can about living with illness, not just psychologically but concretely. Ask and keep asking: Are there devices or techniques that can help me? Would physical therapy or rehabilitation help?
Even the best doctors don't tell you everything.