Like people from all walks of life, physicians themselves occasionally become ill. But when Albuquerque doctor Steven Hsi became seriously ill in 1995, he decided to document his illness and create a narrative of his experience, struggles and the sudden change in the role he faced as a doctor becoming a patient. His is a story that has become a spiritual lesson for those in the medical profession, as well as those faced with a life-changing disease.
In 2004, five years after his death, Hsi left the medical students at the University of New Mexico a glimpse into the future through the book he began to write when he was thrust to the other side of the doctor/patient relationship. The resulting memoir is a detailed examination of Hsi's declining health after learning of his terminal illness and the change in perspective he experienced as a patient.
Hsi first became ill in 1995. At first, doctors were convinced that he was suffering from the effects of a leaky aortic valve and performed surgery under that assumption. Hsi subsequently underwent two more surgeries; both for different diseases, and he was eventually diagnosed with a rare heart disease called Takayasu's aortitis, an inflammation of blood vessels and arteries.
Hsi's wife, Beth Corbin-Hsi, recalls how, following the diagnosis, her husband first came to realize that, as a physician, he had not been making truly human connections with patients. The night of his second surgery, she remembers, Hsi experienced a moment of clarity and self-recognition among the group of surgeons and residents who were preparing to operate on him.
“[Hsi's surgeon] was very perfunctory in his greeting and there was no warmth,” Corbin-Hsi said. “And here Steve was—he had already been through one open heart surgery and he knows there's a lot of risk in going through a second—and he just wanted to connect with somebody.”
Corbin-Hsi recalls that no one looked up from their notes or shoes, and that was when Hsi recognized himself in the crowd—he remembered being a resident and feeling tired like those in the room with him, and he knew he had not practiced a holistic method as a physician at that moment.
So Steven Hsi decided that he would document the rest of his life in a journal. From 1997 until two days before he died, Hsi wrote about everything that happened to him—all the procedures, emotions and various experiences he went through. Collaborating with a fellow patient and Albuquerque Journal columnist Jim Belshaw, Hsi began writing and compiling the journal entries that would eventually be titled Closing the Chart: A Dying Physician Examines Family, Faith and Medicine (University of New Mexico Press).
When Hsi died in 1999, Belshaw had only transcribed the intense interviews he had done with him, but there was no book. It was only later that Corbin-Hsi found her husband's journals and read them for the first time.
“I knew he was [keeping journals] but I didn't know how extensively, and, after he died [Belshaw and I] thought the project was dead.” Corbin-Hsi said. “He filled three notebooks with 58,000 words. When I found them, I took them to Jim immediately.”
Using the extensive journals and her own recollections where certain events or conversations hadn't been documented in writing or in the taped interviews, Corbin-Hsi and Belshaw finished the book, which, after some discussion between its authors, tells Hsi's compelling story in the first-person.
Closing the Chart was finally published last summer. And once it was released Belshaw and Corbin-Hsi embarked on a nationwide promotional campaign. One of the first places they spoke was at First Presbyterian Church in Albuquerque, where Hsi's family attended. When Edna Boyd, a member of First Presbyterian, read the book, she said she became inspired to get it out to those in the medical community right away.
“I couldn't put it down and read it in one sitting,” she said. “I felt that it was truly unique in that it gave the educated, yet compassionate, viewpoint of the doctor as patient.”
Boyd said the audience she felt the book was intended for was first-year medical students. So she set out on a promotional campaign of her own, providing every first-year medical student at the University of New Mexico with a copy of the book this past fall semester. Halfway into the semester, students were asked their opinion of the book and what they thought about the messages it contained pertaining to the treatment of patients as human beings rather than as “machines in for maintenance,” as Hsi wrote.
Armed with plenty of positive feedback from the students, Boyd later contacted the medical school at UNM and asked if she and the congregation at First Presbyterian could donate books to the first-year students. Dr. Craig Timm, associate dean for the Undergraduate Medical Association for the School of Medicine at UNM readily agreed, and decided to invite Belshaw and Corbin-Hsi to speak at the orientation of first-year medical students.
Students said they were impressed with the presentation and the book. Corbin-Hsi said she remembers crying while giving her presentation, and heartwarmingly recalls that when she looked up from her notes, the students were all crying with her.
Hsi's inspirational message made its way into the hearts and minds of the students in attendance, just as it was meant to. After Corbin-Hsi's presentation, the students instantly began to understand the importance of taking a holistic approach to doctor-patient relationships in their own lives.
“It took me aback that physicians don't think about those human aspects of how illness can effect people's lives,” Heather Oullette, first-year medical student, said after.
Oullette said she decided she wanted to go into medicine when she was young because of the strong women in her life. After reading Closing the Chart, Oullette said, she knew it was a wonderful tool for students who become so overwhelmed that they sometimes begin to dehumanize patients, mostly as a survival mechanism. She said the book has had a significant effect on UNM's medical school curriculum in that students are now being taught to deal with patients not just physically, but also emotionally.
“The school is really doing that,” Oullette said. “We're told that when we ask about pain, there are seven dimensions we need to ask about, and that we should ask seven, plus two. The first seven questions help diagnose the pain and the last two determine how the pain is affecting [patients'] lives.”
Shanna Combs had planned to be a ballerina until she found her calling in medicine. Now a first-year medical student at UNM, she said she found Dr. Hsi's book to be accurate, but also disheartening because of the truths it reveals about the medical institution's often clinical treatment of patients. She said the book made her think more deeply about her future as a doctor.
“Reading Dr. Hsi's book continued to emphasize my feelings of needing to maintain my humanity throughout my training and career as a physician,” she said.
Allison Greening said she wanted to go into medicine because she had struggled with illnesses in the past and wanted to help people like herself. She said she was shocked by the thought that one could be a physician of high caliber as Dr. Hsi and still forget about the human side of patients, and the insight the book gives into the patient mind makes it useful for all physicians.
“I think we worry about getting too close or being biased,” said Greening. “But the book reinforced that it's not only OK, but that you shouldn't be afraid to get close [to patients].”
Similarly, Matthew Smith related that he thought the book was good for everyone, especially first-year students like himself, and especially for practicing physicians. He said the speech by Corbin-Hsi really helped him to realize the story was not just a story; it was someone's life. Presently, he said, he feels like the medical school teaches the holistic approach to medicine in the first-year but fails to carry it through the entire course of study. He said he hopes the book will inspire more physicians and professors of medicine to teach such an approach to all students, no matter what level.
Boyd, along with members of First Presbyterian Church, raised more than $1,125, to purchase 75 books for first-year students last fall, and they are currently working on raising enough money to purchase books for the remaining students. Thus far, Boyd said there is $1,656 in the Steven Hsi Memorial Fund, and they've received a $1,000 check from the New Mexico Medical Society and the Greater Albuquerque Medical Association to help in their effort. She said she's confident they'll have enough money to provide copies of Closing the Chart to at least one more incoming class, and she's currently working on a church newsletter asking for another $600 for current second- and third-year students.
In the words of Dr. Steven Hsi, “If we are to be more than skilled, well-paid mechanics, we must ask these questions of our patients ... I have not seen nor heard nor felt things other patients have not seen and felt and heard before me. I bring only my perspective as a physician who looks at medicine differently now.”
As for Corbin-Hsi, she said she's hoping to get more national attention for the book because they have been selling so many locally. University of New Mexico Press plans to release a third edition of the book soon.