Monday, September 26, 2011


Doug Cooper’s homage to his wife, presented as a 67th birthday gift, is a story about the power of love to overcome cultural taboos through persistence and patience, and to triumph over a near-fatal illness and daunting physical disability. It is also a celebration of optimism over despair by two people passionately committed to each other “for better or worse, in good times and bad, in sickness and in health.”


This tribute from husband to wife will remind those who read it of the “better angels of our nature,” as it inspired this physician, who was fortunate to have shared a brief moment of their lives.


Tina entered the critical care unit of Orange Regional Medical Center because of a catastrophic illness. I was part of the intensivist team providing her care through her 100-day hospital ordeal. Probably because Tina, Doug and I grew up in New York, shared common experiences and social values, are of the same age, and went to rival colleges in the same years, we developed a natural rapport. As I have been accorded in the book a disproportionate credit for Tina’s survival, I must state that our ultimate success resulted from the efforts of the entire health-care team and, in no small measure, the efforts of Doug and Tina themselves.


Intensive care specialists learn to cope with the possibility of bad outcomes, in part, by de-personalizing the patient into a series of physiologic challenges, much as the combat soldier might resist making very close friends when the chance of death is ever-present. The battle for life, then, consists of attempts by the medical staff to raise blood oxygen, combat infection, preserve nutrition and urinary output and avoid hospital-acquired infection.


The physician thus runs the risk of partially replacing the patient as the object of care by worrying about the frequency of reportable iatrogenic complications, medico-legal risks and reimbursement considerations.


Dr. Jerome Groopman in his excellent book How Doctors Think describes the biases and decision-making consequences of such distractions, as well as the dangers of projecting one’s own concept of meaningful existence onto others. He specifically singles out the important role of the patient or patient-advocate in refocusing the physician on what is objectively possible and beneficial.


Such a bias crept into my own thinking as my mounting feelings of hopelessness at returning Tina to a level of function worthy of the effort were rejected by Doug. His exhortations for better care were often viewed by me as selfishly motivated and without sufficient regard for the burden and suffering the illness was creating for Tina. My attempts to gauge her feelings during Doug’s infrequent absences from her bedside revealed that her goals mirrored his. I attributed her attitude to a desire not to hurt or disappoint him, or to stereotypical Asian stoicism.


Doug tirelessly directed the attention of the health care team to seemingly trivial aspects of her care, asking detailed questions and demanding satisfactory answers, even occasionally suggesting changes in her care plan. My periodic annoyance, hopefully not always apparent, served to refocus my attention away from the pathophysiology and back to Tina. What I did not initially realize was that Doug’s persistence was improving his wife’s care. I began to marvel at the tenderness he lavished on Tina, which both sustained her morale and dispelled all lesser explanations I might have conjured up to explain the dynamics of their relationship.


Eventually, Tina left the hospital and went home to a cocoon of nurses, catheters, and ventilators; and I saw her several times a year in my office. Doug’s and Tina’s mutual affection seemed to grow stronger with time and was uplifting to watch, given the relentless burdens Tina’s illness imposed on both of them.


Doug dedicates this book to Tina, his “good soldier”; but in a larger sense, the story is also a tribute to his powerful advocacy for her survival. I believe their love saved them both.


My participation in Tina’s care made me a better physician and provided me with one of the most rewarding experiences of my professional career.


I want to thank you both, Tina and Doug, and wish you continued years of happiness and joy together.


Richard F. Walker, MD, FCCP
April 26, 2011

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