I recently read Kara Wada’s September 7, 2026, KevinMD essay asking a simple but profound question: Who holds the telescope? Her article resonated with me immediately because I know the answer.
When my wife Kathy was dying, nobody did.
Kathy was not the victim of one catastrophic mistake. There was no single dramatic error that changed the course of her illness. What I witnessed instead was something more common and, in many ways, more dangerous: the gradual fragmentation of responsibility. Every specialist managed a piece of her. Nobody owned the whole picture.
As a developmental pediatrician, I spent my career connecting dots. My patients rarely fit neatly into a single diagnostic box. Development, behavior, cognition, family dynamics, school performance, neurological function, and medical illness all interacted. The job required seeing patterns that crossed disciplines and recognizing that the most important answers often lived between specialties rather than within them.
Real physician voices, twice a week
Free, and one click to unsubscribe.
I assumed adult medicine worked the same way. I was wrong.
Over the final months of Kathy’s life, she accumulated specialists the way many chronically ill patients do. Vascular surgeons managed her peripheral vascular disease. Nephrologists managed dialysis. Cardiologists managed heart failure and coronary disease. Podiatrists managed wounds. Infectious disease specialists managed infections. Pulmonologists addressed respiratory complications.
Each physician possessed expertise I respected. But expertise is not the same thing as integration.
In April 2024, Kathy developed gangrene of her right great toe. Disagreements among specialists about the best vascular approach led to delays and indecision. Eventually, her toe was amputated in hopes that sufficient blood flow remained for healing.
At the same time, testing revealed worsening heart function with an ejection fraction of 30 to 35 percent. She underwent emergency coronary intervention and stent placement.
Weeks later, a seemingly minor fall revealed something far more serious. Laboratory studies exposed sepsis. The source proved to be an internal jugular dialysis catheter that had remained in place for more than a year. Cultures grew MRSA. Further evaluation suggested endocarditis.
One complication led to another. Then another. Then another.
As her condition deteriorated, I repeatedly asked physicians to communicate directly with one another. I was not looking for miracles. I was looking for synthesis. Who was stepping back to ask how heart failure, dialysis dependence, vascular disease, chronic infection, malnutrition, immobility, and declining functional status fit together? Who was looking through the telescope?
I never found an answer.
The health care system excels at specialization. Specialists save lives every day. The solution to fragmented care is not less expertise.
The problem is that specialization has become a substitute for ownership. Each physician may feel responsible for a disease, an organ system, or a procedure. Yet no one may feel responsible for the person experiencing all of them simultaneously.
As Kathy’s illness progressed, new failures emerged. Pressure ulcers went unrecognized or undocumented during one hospitalization. Nutritional interventions were repeatedly delayed. Critical consultations often required persistent advocacy by family members. Information existed throughout the medical record, but information alone does not create understanding.
A chart is not a narrative. Data is not synthesis. Electronic medical records can store enormous amounts of information while simultaneously obscuring the patient underneath it.
Eventually, my son and I became the coordinators of her care. We tracked events, relayed information, questioned discrepancies, monitored treatments, and connected timelines. In other words, we inherited the telescope.
This is precisely the phenomenon Dr. Wada describes. When no clinician has the time, authority, or incentive to integrate care, that responsibility does not disappear. It falls to the patient and family.
The irony is that patients and families are often the least equipped to carry it. They lack access to the entire record. They cannot order consultations. They cannot convene multidisciplinary discussions. They possess responsibility without authority. Yet they become the only people trying to see the whole picture.
As physicians, we often speak about the importance of communication. But communication is not merely exchanging information. It requires someone willing to assume responsibility for integration.
Someone has to ask:
- What are we missing?
- How do all these pieces fit together?
- What is happening to this patient as a whole?
Those questions are becoming harder to answer in a health care system increasingly organized around productivity, documentation, procedures, and subspecialization. Thinking remains medicine’s most essential task. Yet it is often the least visible and least rewarded.
My wife’s death was not simply the result of multiple complex illnesses. It was also the experience of watching a system divide a human being into smaller and smaller clinical fragments.
Every fragment had an owner. The person did not.
Kathy died on July 5, 2024. I have spent much of the time since then asking myself what could have been done differently. Some of her illnesses were severe. Some outcomes may have been unavoidable.
But one question continues to haunt me. How many patients are lost not because nobody cared, but because the person connecting the dots had no authority to act on what they saw?
In Kathy’s case, someone was trying to hold the telescope. I was.
As a developmental pediatrician, my professional life had been devoted to integrating information that others viewed separately. I was trained to look for relationships among medical, developmental, behavioral, educational, and family factors. Connecting dots was not a hobby. It was my specialty.
Yet inside the hospital, my expertise became invisible. I was no longer seen as a physician who understood complex systems of care. I was seen as “the husband.” Every attempt to encourage communication among specialists, every effort to reconcile conflicting recommendations, every question about the larger picture was filtered through that lens.
The irony was painful. The skill that had defined my professional career was exactly the skill Kathy needed most. Yet when I tried to exercise it, my concerns were often interpreted as interference rather than advocacy. I spent an entire career identifying complex patterns across disciplines, and when my wife needed that exact skill, I was dismissed as an emotional family member.
I was not asking physicians to surrender their expertise. I was asking them to talk to one another.
Dr. Wada asks who holds the telescope. My answer is both simple and troubling. When my wife was dying, it was carried by a very sick patient, her son, and her husband.
When did medicine become so specialized that it stopped listening to the people trying to assemble the whole story? That is not how medicine is supposed to work.
Ronald L. Lindsay is a retired developmental-behavioral pediatrician whose career spanned military medicine, academic leadership, and national advocacy for dignity-centered neurodevelopmental care. His NIH-funded work with the RUPP Autism Network helped define evidence-based approaches to autism and related developmental disorders.
He directed the LEND Program at The Ohio State University and founded JBLM CARES, a $10 million autism resource center for military families. His writing spans clinical scholarship and long-form fiction. He is the author of The Mercy Directive and the six-novel Cassandra series, a completed political and medical fiction saga tracing the rise of the Cassandra system from its origins to its national and international legacy. His forthcoming memoir, The Quiet Architect, examines how conscience and structure collide in modern medicine.
He shares updates on LinkedIn.
