down the hill and saw over 500 people sitting on the grass , including patients and their families . The word was out , “ An American doctor is here to help us .” After seven hours of seeing patients , I watched Ray walk quietly around the hill talking to families ; some stood up quietly and walked away , while others came closer to where our makeshift clinic was located . I asked Ray what he said to them . He responded , “ I told the families if they walked more than three hours one way , they could stay and we would see them , but if they walked less than three hours one way , please go home and come back tomorrow .” I thought to myself : how would that go over if I told patients in a crowded waiting room in Louisville to leave and come back if they had driven less than 30 minutes , but stay seated if they had driven more than 30 minutes . I was overwhelmed with the humility and gratefulness of these wonderful people .
Several days later , we walked over that same hill and were met by a group of elderly Ethiopians . They told Ray that he and I must go to the village mayor ’ s bungalow at 1:00 p . m . where we were to stand trial . A local Ethiopian who had studied in Russia and learned rudimentary English had collected the iron pills we had been giving out to some of the villagers . He discovered some of the pills were just outside the expiration date . He accused Ray and me of trying to poison the people . I was immediately shaking and very scared , Ray not so much so .
Ray and I sat on one side of the small room , and the Ethiopian sat on the opposite side holding a wooden bowl containing the iron pills to present as evidence to the judge . The Ethiopian gave his side of the story to back his accusations . Speaking in fluent Amharic , Ray started by giving his history of helping the Ethiopian people for many years . When the mayor ( judge ) asked if we had given the people in his village iron pills Ray answered that we had done so . Ray leaned over and asked if I had any thoughts on the matter . I have no rational answer for what I did next , but I stood up , walked over to the Ethiopian ’ s table , picked up a fist full of iron pills and swallowed them chasing the pills down with water from my canteen . The mayor started laughing and told us the case was dismissed and we could resume our clinic for the remainder of the week . We made several more trips to the mayor ’ s bungalow , but from that point forward , they were invitations for us to socialize with him .
A few years later I was lying in a sleeping bag on the second floor of a hospital whose windows were shattered , and the outside temperature was hovering in the 20s . We were in the uppermost part of China that lies over North Korea . For the next two weeks , I saw patients and ate with them in their homes . At the beginning of the second week , I was surprised when a Chinese doctor from the region accompanied me , and he and I saw patients together . The translator would summarize what each of us had concluded was the patient ’ s diagnosis and treatment plan before we gave the patient our recommendations . I was fascinated how often we were both in agreement , especially when there was a significant amount of psychological stress contributing to the symptoms . When it came to common infectious diseases or recurring GI symptoms , we found agreement in treating most cases . The Chinese doctor gave me many diagrams and explanations how the “ Yin and Yang ” of Eastern medicine helped him in making diagnoses . I was once again blessed to meet another professional who expanded my understanding of humanity and human interaction .
One morning near the end of my career I received a call from our daughter asking if I would travel to her city and visit the university where she was a second-year fellow . On arrival , she surprised me because I was able to watch her both procure a liver from the donor and place the liver in the recipient , thanks to the Department Chair obtaining permission for me to observe her skills in surgery . Twenty-five years earlier , she had accompanied me on hospital rounds on Christmas Day when she gave patients small loaves of gingerbread . Now I was observing her perform a complicated surgical procedure . My joy in observing her was more profound compared to anything I had accomplished myself .
Just this past Christmas season I went caroling , which included stopping at a home to visit a man in his 90s . I stood in the back of his living room while we sang some well-known carols . Suddenly , our eyes met and he said , “ There is my doctor ,” and he came over and gave me a hug . We had met only once previously when I was supervising his test . The patient developed an arrhythmia during the test , which required hospitalization . While it was not necessary for him to travel to the hospital by ambulance , he had driven to our office with his frail wife . I drove the patient to the emergency room , and I waited with him and his wife until he was admitted . His daughter later told me that action meant more to him than any medical advice or treatment I offered .
During my early years of practice , I thought the joy of medicine came from “ saving lives ,” making complicated diagnoses and performing complicated procedures to help patients survive their illness . After a few years in practice , my wife made an observation , “ When you come home and talk about ‘ this great case ’ or ‘ that fascinating case ,’ most of the time the ‘ greater ’ and the more ‘ fascinating ’ the case , the more critical the condition is for the patient , even if the outcome is successful .”
From that point forward I changed my mind regarding the definition of “ joy .” True joy is limitless , life-defining and transformative , not simply a feeling that happens . Joy brings meaning to life . Joy blooms through connection , especially a connection with other people . From that point forward , my joy came from establishing a bond or making a special friendship with a patient and learning their story and their experience . Patients ’ stories and lives became more memorable than any personal accomplishments achieved during my practice of medicine .
Dr . Dageforde is a retired interventional cardiologist .
This essay was a submission to the 2022 Richard Spear , MD , Memorial Essay Contest .
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