Dr Hamill and the Soul of Neurology

I delivered these comments to 300 people at a testimonial dinner in honor of Dr. Robert Hamill, chairman of the neurology program at the University of Vermont, on Oct. 16, 2009. Both of the past presidents of the Vermont chapter of the American Parkinson Disease Association (I’m one of them) and the current president, Michael O’Connor, spoke, as did two of his colleagues, his long-time nurse, Jean Baker, the national APDA president, and Dr. Hamill’s three daughters.

Thank you, Michael, and especially to Jean Baker and the committee that assembled this wonderful event. It’s made all the more special because of the great man we are here to honor this evening.

We heard from Jean some perspective on Dr Hamill’s very impressive career. But the numbers and accomplishments, by themselves, cannot capture the spirit of the programs he has created. In working with clinical staff over the years, with Dr Boyd, and Jean, and watching Dr Hamill’s interactions with students and residents, I believe that what really distinguishes these programs are the humane values that distinguish Dr Hamill himself: a humble and sincere respect for the patient, a genuine concern for the well-being of each individual who enters his clinic, often with problems that ultimately cannot be solved.

As science advances and we learn more about Parkinson’s disease, we expand the arsenal of new drugs and approaches to treatment, but that makes individual case management far more complex. Patient care is no longer simply about handing out prescriptions for levodopa or anticholinergics.

Getting the treatment just right is a long, complex, and arduous process that is never finished; each case is different; success is often short-lived, elusive and fleeting; the relentless progress of the disease requires constant adjustment. Resources for excellent patient care are scarce these days. Burnout is a constant threat.

Yet, somehow, despite all the distractions and challenges, all the administrative headaches and teaching commitments, what ultimately matters is the well being of the individual patient, the whole patient. And it goes well beyond getting the meds right. With Dr Hamill, it’s much more than that.

Like many of you here, I was roped into the Vermont Parkinson’s community by the unsinkable Bruce Talbot, and my first experience of that community was at a Rock-A-Thon in Montpelier. I remember standing behind this fellow with white hair and a bow tie, waiting to buy a hamburger, and striking up a brief conversation. Nice guy, I thought. When I learned later who he was, I thought it was remarkable to see a doctor out in broad daylight, having a good time among a whole bunch of patients.

I encountered Dr Hamill more frequently as I became more active in APDA advocacy work, but I had not thought about consulting with him as a patient until my personal situation had became particularly desperate.

Through an unfortunate series of miscues and circumstances, I found myself six years ago at rock bottom. I had unwittingly become a poster boy for the side effects of a new drug called Mirapex. My cognition was deeply affected; even the simplest of tasks had become difficult. Even the simple act of reading a book had gone beyond my capability.

The consequences were shattering. The work I loved had become impossible for me to do. I had to give up my job, my career was over, humiliated, the future replaced by uncertainty and the sober reality of applying for Social Security and Medicare, wondering if I could see my then five-year-old through her adolescence. I was getting by, but just barely. It was a dreadful place to be in. The early onset of mid-life crisis didn’t help things much, either.

It was in this context that my dear wife suggested visiting Dr. Hamill for a second opinion. We went in hopeful, but completely at a loss as to how to proceed, scared by the progress of the disease and afraid of what the future might hold.

Our first meeting as patient and doctor was extraordinary. It was a late afternoon slot, but he was right on time. He walked in, shook our hands, looked us straight in the eyes and asked, “What would you like to get out of this meeting today?” We’d never been asked that by a doctor before. We stammered out a few words, and he said, “How about we do this, this and this?” We nodded our heads and sure enough, we got right down to business, and we did each of those things on his list.

Dr. Hamill then did something inconceivable to me: He wrote down his home phone number and told me to call him if I had any questions or problems with what we’d been through. He said he had to get going because his dog had been injured by a car and was having trouble walking. He was responsible for carrying the dog outside so it could do its business, and then he’d bring the dog back inside to the doggie bed. Because the dog was limited to his doggie bed, Doctor H said it had become part of his routine to read his New York Times with the dog, in the dog’s bed, so the dog wouldn’t be lonely. He turned and walked off with a smile, and Suzanne and I turned to each other and she said, I think we found the right doctor for you.

As we grew more familiar with each other, we grew to admire Dr Hamill’s curiosity, optimism, and authenticity. We always felt that we had his undivided attention, and the benefit of his searching intellect, always striving for improvement on our behalf.

Our office visits frequently started with Dr Hamill entering the exam room, stopping dead in his tracks, to marvel at our children, sweeping them up in his arms and marching off down the hall to show them off around the office, as if they were his own grandchildren.

An office visit with Dr Hamill often started with him stopping in to greet us, and to say he’d be back after his student or resident had a chance to do a workup. I can recall with delight the look on his face as I offered to screw around with the student: Maybe I could do a little Tourette’s thing and we see how they take it?

His curiosity and obvious joy in his work, his enthusiasm for teaching and learning was infectious. It reminded me of the Confucian ideal of the relationship between a teacher and student: that each supports the other by working as hard as they can in their respective roles. The teacher offers a gift, and the student expresses gratitude in return by using that gift every day. That, in turn, inspires the teacher, and that creates a virtuous cycle.

In this manner, we started the process of reclaiming my cognition, restoring my self esteem and self-confidence. We did great work together with open minds and a strong sense that we could always do better. The virtuous cycle that was initiated by Dr Hamill has paid off with results that are truly incredible. That relationship has served as a template for my dealings with other doctors and health professionals, and the outcome is almost inconceivable.

Slowly but surely, and with his steady encouragement, I can look back and say that these past five or six years have been among the best and happiest of my life. You’ve given me quite a gift, Dr Hamill: you salvaged my life, you rescued my family, you gave me a future that’s worth living for. Your brilliant intellect, kindness, humility, and wonderful sense of humor were the perfect prescription for this patient.

Multiply my experience by the hundreds of other patients you have served over the decades, and you will begin to sense the immense impact that one man can make in the world.