Wednesday, October 20, 2004

dr. miller

I just got an e-mail from my Chiefs that Dr. Steve Miller is presumed dead, after the plane that he was taking en route to a medical conference crashed in Missouri this morning. I am beyond shock.

In fact, I don't even quite want to believe it. Right now, I'm reading over the news reports on CNN, kind of dazed, and see that there are still five passengers unaccounted for at the crash site. Five passengers. There were two survivors, after all. What if I write this, and we all start talking like he died, and he comes into Grand Rounds next week with a little bandage on his head like in the cartoons, smiling and telling us what a horrible misunderstanding it all was, and say in that that deadpan way of his, hey, I'm a pretty lucky guy, huh? That's the story I would like to believe. But I know it's not the truth.

Dr. Miller was the head of the Pediatric Emergency Room at our hospital, but more importantly for med students, he was the head of the third-year Pediatrics clerkship. He organized the curriculum, told us where to go and what to do, and above all, talked to us about a number of topics both Pediatric and professional. And oh, could that man talk. Sometimes, at 6:30pm on a Friday afternoon in that stiflingly hot lecture room with no windows, we really felt like he was earning his money.

When I first met Dr. Miller my first year of med school, he was the preceptor of my Clinical Practice small group, and I thought he was just about the greatest doctor I'd ever met. So sensitive, so patient, so funny. And so absolutely committed to med student education. We could just listen to him talk for hours. We did listen to him talk for hours. And we learned. He was one of my composite ideal doctors, one of the doctors like Dr. Garvey who I met early on in my medical career and idolized them all "Single White Female," biting their style. Even to this day, I find pieces of Dr. Miller falling out of me, in the way that I approach patients or talk to parents.

Dr. Miller had a way of teaching that was insidiously appropriate for his audience. He taught med students, so his method for teaching was repetition. I've known Dr. Miller for--what, five and a half years now?--and I must have heard him give the same handful of lecture at least seven or eight times. He would just go over it and go over it and go OVER it. I used to joke that it was like he popped a tape in. Initiate Miller Lecture 501B: "Professional Decorum" And then the tape would play. He would always say that he wanted certain approaches and behaviors ingrained in the very fiber of our being, like an automatism, and that's why he would repeat things so many times. So we would learn it good.

And hot damn, it worked. Just a month ago, I had to call a parent at home because their sick child was very unstable, to the point that we thought she might die sooner rather than later, and we wanted those parents to get in now. It was not a comfortable conversation to have over the phone, honestly not an exchange that I'd ever had to have before, so I wasn't quite sure how to approach it. The funny thing is, the second I started talking, it was like I popped in Miller Lecture 423G: "Delivering Bad News" and suddenly I was calm as could be. I told the parents that their child was very ill ("Set them up for the news."). I told them that right now, her blood pressure was dropping despite the medicines we were giving her ("Try to avoid jargon"), that this was a life or death situation ("Don't be afraid to use the 'D' word, they need to hear it to understand") and that and despite all our best efforts, their child might die ("Say the 'D' word again, in case they didn't hear it the first time"). It was so strange in that moment, like having a little Dr. Miller on my shoulder, feeding me my lines. Strange, and comforting.

Many of us, students and residents both, felt that he worked too hard. He was like some mysterious holdover from the workaholic 1980's, just completely overextended. There wasn't a med school committee he wasn't some way involved in, not a single residency meeting about the medical student education he didn't run or help organize. Sometimes we got impatient with him because he was so busy--he was always off to his next meeting, it seemed. You could catch him for five minutes here or three minutes there, but there was always more to do, always somewhere to be. Why couldn't he just slow down? Do a little less? Now I understand. The man had a lot of life works to accomplish. He just didn't, in the end, have a lot of time.

Thank you, Dr. Miller. We'll miss you.

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