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Join David Alfery, a cardiac anesthesiologist and author of Saving Grace: What Patients Teach Their Doctors about Life, Death, and the Balance in Between. David recounts a transformative moment from his medical mission trip to Nicaragua, where he cradled an infant named Jose with a cleft lip and palate. We explore the emotions, the mother’s heartfelt gesture, and the profound impact of this experience. Don’t miss this inspiring discussion on the connections between doctors, patients, and life’s important lessons.

David Alfery is a cardiac anesthesiologist.

He discusses his book, Saving Grace: What Patients Teach Their Doctors about Life, Death, and the Balance in Between.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back David Alfery. He’s a cardiac anesthesiologist, and he’s the author of Saving Grace: What Patients Teach Their Doctors about Life, Death, and the Balance in Between. David, welcome back to the show.

David Alfery: Thank you so much. Thanks for having me back.

Kevin Pho: We’ll get into your book and the story in your most recent KevinMD excerpt in a little bit, but just for those who didn’t listen to our first episode together, briefly share your story and journey.

David Alfery: Yeah, I had a 36-year career as a cardiac anesthesiologist, and when I finished it, for some reason I had a desire to talk about what life in anesthesia was about. In a way, I think I wanted to tell my wife and kids where I went for 36 years. And so I wrote a book that was a little bit about my life in anesthesia, a good bit about what we do in our profession, which, it turned out, nobody had ever written about before, and then a lot about what the patients really taught me from all those years of practice.

Kevin Pho: Now, as you reflect on your decades-long career in anesthesia, what are some misperceptions about the field that you’d like to clear up with the audience?

David Alfery: Well, you know, what we’re seeing on TV and in movies is this sort of nameless, faceless entity on the other side of the ether screen, and when there’s a crisis in the OR, the surgeon is barking orders as to what we should be doing. In fact, it’s really just the other way around. Other than bleeding, if there’s a real crisis in the OR, the surgeons generally step back and just sort of hope that we can get the patient resuscitated. So it’s really a situation of egalitarianism in the OR, where everybody has a role to play. The idea of the captain of the ship being the surgeon is really antiquated. It’s a specialty where really the very best and the brightest have gone into it for the last 20 years.

Kevin Pho: All right, so let’s talk about your book. It’s titled Saving Grace: What Patients Teach Their Doctors about Life, Death, and the Balance in Between. Your latest KevinMD excerpt talks about your mission trip to Nicaragua. Tell us this story.

David Alfery: Yeah, I was fortunate in that I went on a number of medical missions, usually with a group called Operation Smile, and they operated on little kids with cleft lips and palates. As one of my partners told me one day in the Nashville airport, when we were heading down to Bolivia, he turned to me and said, “You know, David, it’s an hour and a half of our life. It’s the rest of their life.” So these are really incredibly rewarding experiences.

I was in Nicaragua, and on every mission, we started with the smallest and the youngest patients first. I was an adult cardiac anesthesiologist, so I was way out of my comfort zone, and I had as my first patient a little guy who was about a year old, and he only weighed maybe 9 or 10 kilos. He was very small, and of course I’m scared to death to put this small child to sleep. He’s got a cleft lip and a cleft palate, and his mother was one of the indigenous people from Nicaragua. She didn’t speak any English, and she appeared to be a child herself, maybe 18 or 19 years old.

I looked at the folder, which is basically the patient’s chart, and it had one single sheet of paper inside, written in Spanish, and on the outside there was a Post-it note that said where the child had come from. It said, “Two days. First day, canoe. Second day, bus.” And you realize that she had taken this incredible trip to get to the hospital, not even knowing if her son would be operated on.

When he got through the screening process, now it’s the following Monday, she handed her child to me. She had no way to thank me, but she just grabbed me by the neck and pulled me down, and she kissed me on the cheek and held me there for a second, and then she let me go. She had just one little tear running down her face. It’s just an image that I will never, ever forget. I’ve never had such a wonderful thank you from a patient.

Kevin Pho: So as you were going through this experience and that teenage mother was thanking you, what was going through your mind at that time?

David Alfery: Well, it was the same feeling that I had over and over in my practice life, and that was what a privilege it was to take care of patients. The idea that here’s a mother who sees really a terrible life ahead for her infant, and this kid’s going to have a normal life, and that I’m able to participate in that, it just doesn’t get any better than that. That was really one of the themes of the book, and I’m sure you understand this, what a privilege it is that we have when patients put their trust in us.

Kevin Pho: Sometimes we have so many obstacles that distract us from this privilege, right? There are so many negative things that you read about in medicine, about burnout and moral injury and all the interference that separates us from patients. So how do you keep this goal in mind? How do you remind yourself about the true values of why you went into medicine?

David Alfery: Yeah, you know, what you say is so accurate. Burnout is such a problem. I had a little bit of an advantage being an anesthesiologist, and I didn’t have to put up with a lot of the bureaucracy, the paperwork, getting pre-approvals, and all this other kind of stuff. But when I took care of patients, I tried to filter out the noise of the hospital, the system, and everything else, and just focus on this one-on-one interaction with the patient, and realize that no matter what else was going on out there that was trying to interfere with this relationship, I still had that relationship. It’s one patient and one doctor, and that sort of human bond, that shared humanity that we have when we’re interacting with each other. So I just tried to focus on each patient individually and on what a privilege it was for me to be entrusted with their care.

Kevin Pho: So you’ve been on medical mission trips, of course. How did these experiences change you?

David Alfery: Oh, gosh, it just changed my entire perspective on life. I think I was like many physicians. I’d worked hard, and I had the nice car, I had the nice house, and I took nice vacations. In a way, I think I sort of took it for granted: Well, I was entitled to this. I really worked hard for this. But I went to these other countries and saw that other people were working just as hard, and just because of their circumstances, they had almost nothing. And so it gave me a real sense of gratitude for what I did have and changed my perspective in terms of what I should be expecting, and the things that bothered me in the past bothered me a whole lot less.

There were times I went to bed in the hospital on OB call, and it might be one in the morning, and I’m anxious, and I’ve worked for 18 hours or whatever it is and am trying to get a couple of hours of sleep, and I would consciously think, “Well, you know, you could be in Romania.” I had a memorable week on a mission trip in Romania. So it really helped put things in perspective.

Kevin Pho: Let’s talk about the decision point for you making those medical mission trips. Like you said, you had a thriving practice, you had a nice life. What was the decision point that led you to do these medical missions?

David Alfery: You know, I’m not exactly sure, other than a little voice inside. I had seen other physicians and nurses go off on medical missions, and I noticed that when they went on one, they always went on another and then another. I felt like, “Gosh, you know, I really need to do this.” And as each year went by, I sort of made my own excuses: Well, the kids are too small. Well, I’m working too hard; I need that week off.

And then there was a notice up in the anesthesia office that said, “Need an anesthesiologist for a trip to the Caribbean,” and I thought, “You know what? You’re done making excuses.” I signed up for it, and after that, my whole life was different in terms of the vista that opened up for me.

Yeah, for any readers or watchers out there who have an opportunity to go on a medical mission, I can’t stress enough how rewarding it is. You get back so much more than you give.

Kevin Pho: How many medical missions do you think you’ve done?

David Alfery: I think I did seven or eight of them, something like that. And one of my regrets was that I waited too long. I really waited until I was well into my 40s, probably my late 40s, and it’s sort of a young man’s and a young woman’s sport, because it’s a pretty grueling week, at least on the missions that I went on.

Kevin Pho: So that story is from your book, of course, Saving Grace: What Patients Teach Their Doctors about Life, Death, and the Balance in Between. Now tell us some of the other key messages that you want readers to come away with after reading your book.

David Alfery: Well, one of the things, and I have found this in feedback from Amazon reviews, is that people will realize that your doctor is really just the way you are. Many of the readers that left reviews said, “You know, I’ve always put doctors on a pedestal, and they’ve always been sort of unapproachable. They’re living in this Neverland.” And they said, “I was surprised at seeing how human you all are. You have the same fears that we have, you have the same anxieties that we have, the same desires that we have.” So I think, first of all, there’s the fact that we have this shared humanity and so much in common.

And I think the other thing is that our lives race by us, and the fact is that they’re all going to come to the same end. As I say in the epilogue, there’s a poet, Heartsill Wilson, who talks about how the way you spend today is important, because you’re spending a day of your life for that day. And as I say, that’s a high price we’re paying for that day. We’d better live it as though our life depends on it and make those days count. Man, life goes by quickly, and every day is an opportunity to make the world a better place.

Kevin Pho: So you mentioned the words “shared humanity,” right? And you share these stories in order to let patients know that, hey, doctors are human too. So why is it important for patients to know that?

David Alfery: Well, I think so much of the care of a patient is built upon trust. We’re trusting that the patient is telling us the whole story, the whole truth, and not leaving anything out. And I think that patients have to understand that we’re trustworthy, that we’re just like them. If we’re going to have this relationship, this unbelievable bond that we form with our patients, knowing who we are and what we’re all about is really important, that we are the same. And in fact, there’s one team here, and we’re playing for one goal, and that’s the betterment of the patient.

Kevin Pho: So you talked about the reaction from Amazon readers and patients. What about the reactions from your colleagues in the medical profession? What were their reactions when you shared these stories in your book?

David Alfery: They were really gratifying. Nurses and physicians contacted me and said, “You know, I’ve never seen a more accurate depiction of what it is to be in medicine,” whether it’s in the OR or just interacting with patients. And interestingly, the people who worked in acute critical care medicine separated out from the cognitive specialties.

I had always said that I went through my practice with a little baseline anxiety, this little white noise of anxiety that something was going to happen and I wouldn’t be able to handle it. And I thought, “Well, I’m probably the only guy who ever felt that way. That was just unique to me.” And I’ve had so many people contact me and say, “It’s exactly the way I felt.” I had no idea that that’s sort of common to people who are in the specialties where you might have to make a critical decision in a matter of seconds. So I didn’t feel quite so lonely when they contacted me with that.

Kevin Pho: Now, for those clinicians who are listening to this and they’re on the fence about sharing their experiences and sharing their stories, what kind of message do you have for them?

David Alfery: It was far more rewarding than I realized it would be, going back and visiting these episodes, although some of them were painful to visit. As physicians, we all have experiences, and we put them in a little box, but that box is always there. When you open that box, a lot of those emotions that you felt at that time, and it might be 40 years ago, those emotions come back to you, and that can be a little painful, but it can be a little cathartic as well. Reliving a lot of these stories and these episodes really reinforced to me the lessons that I had learned in life, and it was really a rich and rewarding experience.

So for the listeners, maybe the way to start is to write an episode down, or write something from their heart, and submit it to you. You’ve got so many great things that you publish on your site. It’s a nice venue for them to enter into this realm. I just want to really encourage people to go ahead and express themselves. It’s really fulfilling.

Kevin Pho: The book is called Saving Grace: What Patients Teach Their Doctors about Life, Death, and the Balance in Between. David, tell us some of the take-home messages that you want to leave with the KevinMD audience.

David Alfery: I think that the take-home message is that we are all alike. We all have the same fears, dreams, and aspirations. We’re all in this together, with that shared humanity. We have the same characteristics and the same emotions, and hopefully a book like this will bring out the fact that we’re not here forever, and to make every day count.

Kevin Pho: Thank you so much for sharing your time and insight. Thanks again for being on the show.

David Alfery: Thank you.