In the Heart of AVP José E. Rodríguez: Healing and Forgiveness

On February 1, 2024, José E. Rodríguez, MD, FAAFP, presented an experience at the sixth Healthcare Stories event at Kingsbury Hall. The theme, “Promise,” aimed to share stories that addressed imagined futures, potential pathways, new opportunities, vows, commitments, and moments of growth, as well as journeys that took unexpected detours and relationships that changed.

Rodríguez later reflected, “this experience was life changing for me. I am not a nervous speaker, and I enjoy presenting as it gives me energy as an extrovert. But sharing this personal story was different. Writing it down is one thing but sharing it in a room of over 400 people who came to hear the story is quite another. After my presentation, people who I had not seen for months or even years came to hug me.”<

“When I was on stage in front of that audience, I was transported to the time that the story happened. I could see Joe’s death, and I could feel the despair that followed. I could also feel the kindnesses shown me by my teachers and Joe’s family,” said Rodríguez. “Most importantly I could feel myself getting over the horror of his death and my role in it. While I always knew I could not have done anything differently, I have felt responsible for his death since it happened. But after telling his story, it was like I gave myself permission to forgive. Forgive myself? I found healing in sharing the story. Now I want to do it again next year. I hope they invite me back.”

Transcription

This transcript was created with Notta.ai and is presented here in its entirety.

Moderator: José serves as associate vice president for Health, Equity, Diversity, and Inclusion at University of Utah Health, but I just have to say that José, and the work his office does, is absolutely the cornerstone of everything we do here at University of Utah. It is vital for ensuring that every patient that comes through the doors receives the best possible care. José has a lot of stories to tell. His side hustle is that he wants to be an author, and in fact I might have heard a rumor that he may have the opportunity to publish something soon. So, while we're waiting for Jose's next book, please welcome him to the stage.

Dr. Rodríguez: You know, if I knew that so many people would be here, I would have brought the book and sold it tonight.

I'm delighted to be here with you, and I'm going to share a story that happened a long time ago, but that lives in me right this very second. Like it was mentioned, I'm a family doc, and I did my residency in the Bronx in Montefiore Medical Center at residency program called the Residency Program in Social Medicine. It was a special program. It was a time for great growth for me. The thing about it, though, is that when we served on inpatient units, the residents served in pairs.

I had a practice partner the entire time I was in residency, and his name was David Edelheit. He was a wonderful partner. David and I went through the internship year, which was hard, and then, you know, the after internship ended, we became senior residents on the inpatient floor. Different from other services, we shared our service and so as senior residents, sometimes we were there together, but on days that David had clinic, I was there by myself with the interns and on the days that I had clinic, David was there by himself.

On this day, David was at clinic. David and I had kind of an unspoken agreement, a promise if you will, that we would take care of the patients, we would take care of each other, and we would take care of the interns.

As new second-year residents, we took over a floor of 26 beds and I remember a patient, we'll call him Joe. Joe was from Harlem, he was a father of three kids, he was a husband, he was a son. He was a Black man and he was sick as hell.

Joe had this thing called Stevens-Johnson syndrome, which essentially is a hypersensitivity or allergic reaction that you can treat if you know what the person is hypersensitive to. We were treating him for this skin reaction.

Stevens-Johnson syndrome is difficult to watch because it causes these boils and the skin dies, and it's very painful for the patient. We were treating him and Joe wasn't getting better. The problem was that Joe would slip in and out of consciousness.

Joe was in his thirties; he was a young man. In talking with the senior physicians on the floor, we decided that we need to see if something else was going on because this skin reaction should not cause him to lose consciousness.

We decided we were going to do a CAT scan examination of this brain. The rule is that when a sick patient has to go across the hospital to radiology, that patient is accompanied by a physician. As a senior resident, it was my job to send somebody and I could have sent an intern.

But I chose to go. I think now that the reason I chose to go was, well, I don't think you choose the newest member of the team who knows the least to take care of the patient that needs the most. I asked the interns to stay on the floor, watch the other patients, and I went with Joe to radiology.

When we got to radiology Joe's breathing changed; his breathing was that kind of breathing that you see when people are about to die. It came on suddenly and it shocked me. I got scared.

When somebody can't breathe you can call out for help. Scared as I was, I called for help I called the code and when that code goes over the loudspeakers people rush from all over the place. They come with tubes to put in people's mouths, they come with medicine and everybody tries to help the patient. Joe was inside of the CT scan machine when all this went down. We had to pull him out of the machine.  I came in and I was pushing on his chest. We did everything to keep him alive, but we failed, and Joe died right in front of me.

[pause]

That was horrible. Knowing that he was dead, I knew I had to start telling people. So first I called David and I said, “David, I need your help. As soon as you get out of the clinic, please come back. We lost a patient.” I called our supervising physician Rita, said the same thing, and then I went upstairs to tell his family. I told them, and they were very sad. They cried. They were grateful that we tried to help.

And then I left because I was called away. But I felt horrible. I felt like I had completely failed Joe.

Now, a little bit about me. I decided to go to residency in the Bronx because the Bronx was a very diverse place. The Bronx at the time had 1.4 million people, and I swear 1.3 million of those people were Puerto Rican like me, or Black, or both. And I knew from personal experience, although I didn't have the words, that a lot of people, due to their appearance, got substandard care.

Back then, we didn't call them health disparities because there was no ... there was no scientific language around it, but it was a personal experience. But I knew that if I could be a physician in a place like that, I could make a difference. And it was part of my promise when I chose family medicine that I was going to work in that population to make healthcare outcomes better. Yet here I was with a Black patient who likely had terrible treatment before he came to see us, and I failed him.

Rita came just a few minutes after David came. And instead of coming to talk to us, she went straight to the family and expressed her grief and her condolences. After talking to the family, she came to talk to me.

She told me a couple of things that I still remember today. She said, “This is a horrible thing. And I'm sorry that you had to live through it, but this is part of your job. And whether you go over it in your head a million times to find out what you did wrong or what you could have done better, it's not going to matter, because it's not going to change the outcome.” And she also said, “I want you to be sure that when you leave here, that you know that this wasn't your fault.”

I said, “Yeah, yeah, yeah, I know.” I didn't know. I didn't believe her, and I left. The next few weeks were very difficult for me. I couldn't focus. Now, part of that is because I have ADD …

But the other part of it is that I was grieving, and I became frightened to do my job. And, as a physician, you must do things to have some risk. Even when you stick a needle in somebody's vein to take blood, that has risks.

And I didn't want to do anything because I was so scared, I was going to hurt somebody, it was affecting my performance. My residency program director, Dr. Gorski, called me into her office and said, “We need to talk. I can see you're having a rough time. I have an assignment for you.” I'm like, “I hate homework, but if you have something that'll help, I'll do it.” She said, “Here's an address and a time and a date, and I want you to go to Joe's funeral.”

How's that going to help? I thought. I said, “I'll do it if you think it'll help.” I was scared. I felt responsible for this man's death and I thought, “My goodness, if I show up at that place, they're going to be furious. How could I, how dare I, show up in their moment of grief?”

I called David and I said, “David, I have an assignment. I need you to come with me.” And he did. I was a little worried about it because, you know, David was White. I was Puerto Rican and we're going to Harlem. My father used to tell wonderful stories about his time in Harlem, so I wasn't scared for me

I process things by talking, so I talked to David a lot on the way down there. And I expressed my concerns because I felt so guilty about this.  We finally got to the church and we went in and people were looking at us and we introduced ourselves as Joe's physicians and we expressed our deep sympathies and condolences for their loss. People looked at us, and I was expecting to hear that they were unhappy with us, but every single person in that room came up to us and gave us a hug and they embraced us. They were astonished! They told us they had never ever seen anything like that! That a physician would go to somebody's funeral.

Near the end of the service, the person who was directing asked David and I to speak. I have no idea what I said but I remember how I felt. That long subway ride home I was telling David all this stuff and how wonderful it was and how magnificent Joe's family was and I can't believe how relieved I was. That changed my career. I felt responsible for Joe's death and I didn't want to go to the funeral but it changed me. Now when I have a patient that dies in my care whether I'm there when they die or whether I hear about through email, if I know what the funeral is I go. I go because I have this fantasy that I am going to comfort the family of my deceased patient. Yet almost uniformly the person who gets comforted is me.

Now I knew a long time ago that when I took this career on that I wanted to do good things for patients. I knew that when I had an opportunity to do something unusually good for patients I should jump at that opportunity. Before Joe, I knew it here [in my head] but after Joe those words were engraved on my heart. Thank you.