Chapter 04: A New Residency Program and Thoughts on Challenging the Status Quo

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Chapter 04: A New Residency Program and Thoughts on Challenging the Status Quo

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In this chapter, Dr. Ewer explains why he left his job with Princess Cruises returning to his medical education with a Senior Residency at Pawtucket Memorial Hospital at Pawtucket, Rhode Island, where he also served as chief resident (1974-1975). To demonstrate his belief in questioning the status quo and conventional ways of operating, he tells an anecdote about a choosing a controversial and unorthodox stress test he applied to assess cyanosis in his own son. He goes on to talk about the importance of assessing how much of medical treatment actually benefits the patient.

Identifier

EwerMS_01_20180524_C04

Publication Date

5-24-2018

City

Houston, Texas

Topics Covered

Professional Path; Evolution of Career; Professional Practice; The Professional at Work; Character, Values, Beliefs, Talents; Discovery, Creativity and Innovation; Faith, Values, Beliefs; Personal Background; Professional Path; Funny Stories; Personal Background

Transcript

Tacey A. Rosolowski, PhD:

So was this before or after you left work on the ship?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

I left work on the ship... The ship was sold. Princess Cruises, I don’t know whether it was sold; it was taken over by Pacific & Orient, or whatever, P&O, anyway, took it over. And they then had a British crew. And so I scouted around to try to finish my residency, and the promises of Norfolk General not to badmouth me were not true, and I had some problems reintegrating. And so I wound up in Pawtucket at a small hospital.

Tacey A. Rosolowski, PhD:

The Memorial Hospital.

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Pawtucket Memorial Hospital. And shortly thereafter, my child was born, Steven. Was born in June of ’74, and I started in June of ’74. And the firing there was only one doctor that fired me.

Tacey A. Rosolowski, PhD:

Firing at...?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

He said, “I will not take care of you, your family, or your child.”

Tacey A. Rosolowski, PhD:

Oh. So you got fired from Pawtucket, too?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

No, I didn’t get fired from the hospital, only by the one doctor. But that’s a wonderful story.

Tacey A. Rosolowski, PhD:

It is a—yeah, tell!

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Are you ready for the story?

Tacey A. Rosolowski, PhD:

Oh, yeah, I’m ready! I’m just like, okay, I want to make sure we know where we are chronologically here.

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Chronologically, okay.

Tacey A. Rosolowski, PhD:

So you went to Pawtucket, let me just say, in 1974, senior residency. Okay, so we’re in ’74. So tell me the story.

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Jane goes into labor. Most of her pregnancy was on the ship. The captain said, “Oh, I’m going to come down for the delivery. I want to watch the delivery.” And Jane said not just no, hell no, got off the ship, (laughter) and went to where we were going to work. And so we have this wonderful little child, Steven, and we’re about ready to go home from the hospital, and the doctor comes in, very, very sheepishly, and says, “Both of you sit down,” and starts to tell us that Steven has a heart murmur. And he thinks it’s a ductus, patent ductus, “But we’re not sure, but Jane, you’re a nurse; would you watch him for cyanosis?” And Jane goes crazy. Firstborn child, now there’s a problem with it. And she’s there with a stopwatch in one hand, stethoscope in one hand, and this poor little baby never gets a chance to do anything, never gets a chance to sleep.

Tacey A. Rosolowski, PhD:

Now, how many days after the birth was all of this?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Well, this was three days, four days.

Tacey A. Rosolowski, PhD:

Wow, wow, little, tiny creature.

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Little, tiny, tiny creature. Are you ready for the story?

Tacey A. Rosolowski, PhD:

Yeah.

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

And I said, “Enough is enough. We’re going for a ride.” So I take this little boy to the airport, and I put him in an airplane, and I take the airplane right over Logan Airport in Boston, at 10,500 feet, which is as high as you’re allowed to go without supplemental oxygen. We undress him. I open the window of the airplane and make it cold. Even in June over Boston, at 10,000 feet it’s cold. And then I slapped his foot, and he goes... (imitates baby crying) Screams, and his big toe turns purple. And I said, “That’s what it takes to make him cyanotic. Now can we land?” “Yes, we can land.” So we fly back down to Rhode Island. I call the pediatrician, and I said, “Oh, I gave Steven his stress test.” (laughter) And he says, “Oh, you carried him while you were walking on the treadmill! How cute?” And I said, “No, no, no, there’s nothing wrong with him. He’s fine.” “You did what?” I said, “No, we gave him a stress test.” “What did you do to that little baby?” And I told him. And he said, “You get right in here.” Looked at Steven, and Steven, of course, was fine. Put a stethoscope on his chest. There’s no more murmur. I said, “Yeah, the hypoxia up there at 10,000 feet probably closed the ductus. We’re fine.” “I’m calling Child Protective Services. How could you ever endanger this child this way? Don’t ever let me take care of you or anybody. You are crazy.” And that was the story of Steven. He’s fine. Okay, he’s 44 years old. No more murmurs. No more problems.

Tacey A. Rosolowski, PhD:

So what made you do that? Take him for a ride on a plane?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Stress test. I mean, this was the logical thing to do to stress the child, to prove to its mother that this child is fine, the doctor’s crazy. But this is the personality of somebody who’s been here trying to do maybe the outrageous, and getting some of it actually done.

Tacey A. Rosolowski, PhD:

Trying to do the outrageous, and getting some of it actually done. I like that.

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

And some of it became models, although they were very controversial.

Tacey A. Rosolowski, PhD:

Now, were there other previous incidents before the stress test with little Steven that you had kind of taken that approach of the outrageous route?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

I mean, I was vocal. I remember... I remember in one of my obstetric rotations saying, “There’s something so different here than what I saw in Switzerland. Here, most women are induced. And why are we inducing everybody? And why are we inducing them at 4:00 in the morning?” He said, “Well, that’s just the way we do it.” And I said, “Well, what’s wrong with nature?” But questioning the status quo. And, of course, as time has gone on we’ve realized that we probably were inducing way more people than we needed to. And this type of questioning kind of got me very much involved in where are we going with medicine, and to what extent is—how much of what we do is good? And obviously lots, but maybe there are some things that we do that we need to rethink. And how do we rethink them? And what’s the right way to rethink them? But questioning the obstetrician who made a great deal of money inducing a lot of people was probably not the way to endear me to and ingratiate me to his... Anyway, so be it. But there’s always been this type of—I’m a contrarian, maybe, at some point. The institution needed a contrarian at times. So—

Tacey A. Rosolowski, PhD:

And it doesn’t always make you popular, that’s for sure.

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Chapter 04: A New Residency Program and Thoughts on Challenging the Status Quo

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