COMPASSION IS WHAT SUSTAINS ME: CAROL COTTRILL

It seems so fitting that Carol Cottrill’s medical specialty is the hearts of children - both physical and emotional. Her career path began when her 4th child was born with congenital heart disease.  Growing up on a family farm, she learned to balance compassion and necessity, a skill she would use in caring for her daughter and later during 18 years as medical director of UK’s pediatric ICU. Her daughter’s illness introduced her to wonderfully compassionate doctors and nurses who….

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FRIEND TO THOSE WHO ARE AILING: DANESH MAZLOOMDOOST, MD

Danesh Mazloomdoost, MD has inherited a tradition reflected in his name itself. In his family’s native Iran, Mazloomdoost means “friend to those who are ailing.” His life in medicine seems almost preordained by his family history. His father (a U.S. trained anesthesiologist who specialized in pain management) and mother (who trained in anesthesiology in Iran and retrained in psychiatry in the U.S.) built their practice around a comprehensive mind-body approach to pain management, long before such….

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SUSTAINING AN ALTRUISTIC SPIRIT: TERRY BARRETT

Terry Barrett is Chief of the Gastroenterology Division of the Department of Medicine, University of Kentucky College of Medicine. He came to Lexington in 2013 from Northwestern University Medical School in Chicago.  Becoming a Doctor.   Although there were no doctors in his family, he always felt a parental expectation of excellence and high achievement. He had a poor impression of the competitive nature of pre-medical education he witnessed among his peers.

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“Of all the things a doctor can do for a patient, it is crucial that they touch them and let them know the doctor is on their side.” As a physician, Bill would arrange the chairs in the exam room so he could sit right next to the patient, non-verbally communicating that he was on their side.


Geralyn Wojtowicz is a physical therapist who says “I learned more from Bill Witt than anyone else about how to interact with patients. They loved him. When he entered the exam room he always met them eye to eye, shook their hands and called them by their name, treating everyone with the same level of respect, regardless of age, race, title, sexual orientation or social status.”


Determined to be a doctor

Like his family doctor, Bill realized that he “just wanted to help sick and injured people- I always wanted to take care of people.” At age thirteen, he taught first aid for the Red Cross and got his Boy Scout first aid merit badge. He was on ski patrol in the Minnesota winters and a lifeguard in summer. He took EMT training and worked on an ambulance during home games of the Minnesota football Vikings and baseball Twins.


Inspired by his own early childhood experience, we wanted to be a pediatric cardiac surgeon “and repair children’s hearts.” Though he scored in the 98th percentile on the MCAT, he had a B average in college (mostly due to playing music). He was an alternate for five straight years and remembers thinking “if I ever get in, I’ll show you.”


From alternate to top honors

In medical school at the University of Minnesota, he almost lived in the labs and the hospital, driven to excellence and perfection. “I loved every specialty I rotated on.” He worked in a free OB clinic. He got over 50 deliveries by sleeping on a gurney outside the delivery room and asking the exhausted residents if he could do the delivery. He rarely went home. He was allowed to finish medical school in three years and was elected to AOA, the medical honor society. He was first in his class.


Choosing a career in anesthesia

Bill remembers seeing a crying toddler standing alone after a circumcision “crying his poor little eyes out” with a bloody bandage wrapped around his penis. He thought “What has gone wrong with medicine? Why do we allow this?” Infant boys were strapped down on a papoose board and given no anesthesia for circumcisions because, as one board- certified OB-GYN said, “they don’t feel pain at this age.” He decided to learn about anesthesia before training in pediatric heart surgery. He wanted to learn how to control the procedural pain being inflicted by well- meaning physicians.


Ballard Wright was chair of UK anesthesia and permitted Bill to try some novel approaches to pain control in ICU patients. Determined to do a better job than had been done on him at age two, he transferred from surgery to anesthesia and prided himself on his care of children.


Rocky Raccoon

During his anesthesia residency, children were still being held down and a mask put over their face to administer anesthesia. Bill went to a magic store and bought a raccoon doll he named Rocky Raccoon. Before surgery, he would enter a child’s room, crawling on his knees to avoid intimidating the child. He told the parents he knew how stupid this looked but that it was important to the child. “I’m going to be a little silly so your kid thinks I’m a kid, too. Just bear with me. I know this child is the most precious thing in your life.” He loved the way young children kept looking back and forth between him and the parents, taking their emotional cue from the parents’ facial expression.


He’d show the child Rocky Raccoon on his left hand. In his right hand he had ketamine in a medicine dropper. After dropping one drop in each of the child’s nostrils, we would say “Oh, Rocky just sneezed. Did he get any on you?” The child would quickly be in twilight and ready to go to the OR. He had already told the OR nurses to keep it quiet- no music, no talking- saying “we are not going to have a traumatic experience that could affect this child for a lifetime.” He gently transitioned the child from his lap to the operating table and the anesthesia mask.


Rewards of academic anesthesia

Eventually, Bill was appointed chair of UK anesthesia- the youngest in the country at age 40. He loved pediatric anesthesia, especially the little heart patients, though it was heartbreaking seeing the blue lips of cyanotic heart disease. He always saw the child and parents the night before and took as much time as necessary. He continued his Rocky Raccoon routine to put little kids to sleep without emotional trauma.


He always made parents a series of 4 promises. “I’ll do the best I possibly can. I won’t do anything to your child I wouldn’t do to myself or my own children. I won’t do anything for which there isn’t some evidence for doing it. I’ll tell you the truth and the rest is up to God. These are the only four promises I can give you with the absolute guarantee they will not be broken.” He admits he can’t imagine handing over his own child- “It’s such a huge thing.”


He started UK programs in cardiac anesthesia, creating a cardiac anesthesia group with defined protocols. Initially, he was the only anesthesiologist in the group but was on-call 24/7 until others could be recruited.  He had joint appointments to neurosurgery and hematology/oncology to teach residents and fellows. He smiles when he goes to his Cardinal Hill Hospital appointments with Dr. Salles, who he adores, and sees the signs to the Pain Clinic and the Pre-Anesthesia Clinic- both of which he started.


His main self-care strategy? “God.”

Though he grew up in the church, he didn’t like it. He is grateful now to his parents for that foundation. It gave him something to go back to. “At some point in life, you will have enough stress that it puts you on your knees.” At the suggestion of a friend several years ago, he attended a men’s retreat at Gethsemani Abbey near Bardstown and had a life-transformative experience in the middle of the night.


“God created coincidence to protect his anonymity. Throughout my life, somebody has appeared for some random reason, and has changed my life. I’ve never prayed for material possessions. The only thing I have prayed for since that night at Gethsemani is wisdom.” He has a pastor friend who has said to him- “Doctor Witt, you don’t have a medical practice- you’ve got a ministry.” Bill says “I do believe in a soul that goes on after death but I don’t know in what form.” He agrees he will always be a physician and that his work is indeed a ministry.


Living with pain

Bill has spent over 30 years studying pain. He has had a craniotomy, broken bones and 2nd/3rd degree flash burns but the spinal cord pain he experienced after the accident that caused his quadriplegia “is another universe of pain altogether.”  He never knew pain could be like this. “Having a steam iron on my skin doesn’t do justice to it.” He has experienced flashing lights, colors and hallucinations. He is currently using a medication mixture of his own design per intrathecal pump and high dose oral Lyrica. Pain is always present and flares at times. “Before we found the right combination, the pain was teaching me. I thought I knew about pain. I didn’t have a clue how bad pain can be. God’s busy teaching me right now about what pain can be.”


From the Grand Ole Opry to quadriplegia

Bill played guitar and sang solo country music in coffeehouses as an undergraduate and after residency. He later formed a five man band named Stampede. After winning a Kentucky state competition, Stampede played the Ryman Auditorium, “standing on the same floor that Hank Williams stood on.” He played for UK HealthCare and physician CME events across the state and organized an event featuring Stampede, Vince Gill and Floyd Cramer, the “Stampede for Kentucky's Kids,” to benefit the construction of UK Children’s Hospital. “My voice isn’t as strong as it used to be. I can’t sing anymore. But life is still the ultimate gift; one for which I am very grateful (although typing with my tongue is tedious at best).”


He shopped around to find a colleague to close his tracheostomy. “A guy with a hole in his neck is inherently scary.” He didn’t want to scare children- his own children and grandchildren and other children- even though this limits future treatment options and risks shortening his life.


“Throughout my career, my greatest fear was quadriplegia. I never feared death. I feared quadriplegia. Now it is my daily experience- but it does not define me.” Quoting Werner Erhard, Bill says “The truth is never to be found in a different set of circumstances. The truth is always and only to be found in the circumstances you’ve got.


Medicine as a career

He says “Medicine is a calling more than a business. To be truly satisfied with their careers, physicians need to find a way to serve- to meet people’s needs- asking themselves where they can be of the greatest service to humanity with their minds and their hands.” His medical school dean and advisor, Dr. William Sullivan, said: “With your performance in medical school you can go anywhere. Why don't you talk to my friend Ward Griffen in Kentucky. He's a University of Minnesota graduate, along with Ed Todd, Pat Hagihara and about half his faculty.” He feels fortunate and proud to have come to a state that needed him and created so many programs for people who needed them.


“If you go into medicine for wealth or prestige, you just made the biggest mistake of your life. If you go into medicine for any other reason than feeling called to do it- something you were meant to do- then don’t do it. You will hold a special place in society, but it comes with a cost. Unless you are willing to be peed on, pooped on, puked on and remove a bandage to find a wound covered in maggots- don’t go into medicine. It comes with the territory. People aren’t always squeaky clean and sometimes they are really mean. Medicine’s not for you if you’re not willing to have compassion for all of life, including the dark side.”


He believes our Lexington Medical Society mentorship program is a way to keep compassion alive for both the medical student mentee and the practicing physician mentor. Bill’s son just finished his second year of medical school.


Final thoughts

Bill says “Doctors are practicing in a field that is God’s workshop. It’s not us doing the healing and the curing. We can prescribe medicine, speed things up and slow things down. Ultimately, selfless service is what medicine is all about. But so many doctors seem to hate their work, in large part due to government and institutional interference, and just want to retire. Life is so fragile- so precious. You can’t do it over. Don’t do something you hate.


”Despite quadriplegia, Bill Witt continues to be a physician with a ministry.

William O. “Bill” Witt, MD chaired the UK Department of Anesthesiology for thirteen years, during which time he created a chronic pain service, a full-time cancer- related pain service, the nation’s first full- time patient-controlled postoperative pain service, the first full-time pre-anesthesia clinic and one of the first accredited pain fellowships in the country. Retiring as Chairman, he was offered the directorship of the Duke Pain and Palliative Care Institute. He elected to stay at UK, fearing that what he had created could collapse without an institutional commitment of space and faculty.


When he retired from UK he wanted to fulfill his dream of “a medical practice exactly my way” and Cardinal Hill Hospital was eager to accede, down to the slightest detail. Five years later, in 2015, his dream turned to a nightmare when a home accident caused a C-3 cervical spine fracture and quadriplegia. Personal childhood illness inspired him to become a physician and, as he points out, he will always be a physician.


On being a pediatric patient  

Bill’s career in medicine was inspired by his experience of strep throat and tonsillectomy at age two. This future chair of anesthesia vividly recalls being forcibly restrained and smothering under a mask for ether anesthesia as he struggled to get free. Today, we require parents to be with their small children but back then they were required to leave. He cried and cried until the mean nurse put him in a room by himself, slammed the door and said ‘shut up you little brat.’   

BY JOHN A. PATTERSON MD, MSPH, FAAFP

He says-“I knew right then- that was no way to treat children.”


His family doctor’s kindness

Bill’s strep throat led to rheumatic fever. He recalls Dr. Whittemore coming to his house after a full day to listen to his heart murmur. He would interrupt Bill’s constant chatter with “OK, Billy, breathe real quietly now. ” Bill studied the doctor’s face. He remembers the stubble of his beard, the smell of his cigarettes and the smell of his sweat. Although he didn’t even understand this man was a doctor, he recalls “an almost God-like experience of having him come to my house to help me. Thinking about it to this day makes me emotional. I just wanted to be like him.”


“What impressed me most was his touch. He would squeeze my shoulder and say ‘I’m going to take care of you, Billy’.” Bill received regular penicillin shots (the standard treatment then for rheumatic fever) but he never cried even though the shots hurt. “I just knew that he would come and touch me and reassure me. Throughout my teaching career in anesthesia and pain management, I always told medical students and residents ‘don’t ever leave a patient’s bedside without touching them’ . Michelangelo said ‘to touch is to heal.’”

JOHN A. PATTERSON MD, MSPH, FAAFP

Dr Patterson chairs the Lexington Medical

Senator Alvarado earned his bachelor's degree in biology from Loma Linda University (California) in 1990, and then went on to receive his Doctorate in Medicine in 1994. He completed his medical residency in Internal Medicine and Pediatrics at the University of Kentucky in 1998. Society's Physician Wellness Commission and is certified in Physician Coaching. He is on the family practice faculty UK College of Medicine and teaches nationally for Saybrook School of Integrative Medicine and Health Sciences (San Francisco) and the Center for Mind Body Medicine (Washington, DC). After 30 years in private family practice in Irvine KY, he now operates the Mind Body Studio in Lexington, where he offers integrative mind-body medicine consultations specializing in mindfulness-based approaches to stress-related chronic conditions and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org