Saying Goodbye to the Marshfield Clinic...

Today was a sad day. In fact, it has been a sad several months...ever since I announced to my colleagues, staff and patients that I was leaving the Clinic to take an academic position at University at Buffalo (UB), The State University of New York.

There were lots of tears during office visits, some outright bawling and some quiet moist eyes and wet cheeks as precious patients strove to maintain their dignity but could not stop the tears. There was a lot of gratitude and tributes in person, on Facebook, through email and in touching cards, often accompanied by a thoughtful gift, sometimes a photograph, sometimes candy, sometimes a momento.

If you're a primary care provider and you feel unappreciated or feel that the care you give matters little to your patients, that you're just another warm body, PCP, 'doc-in-the-box' or whatever, try leaving and see what happens.

I found it interesting that as one patient posted a picture of me standing next to her daughter during a clinic visit, on Facebook, there were loads of replies, comments, likes and hearts. So much for HIPAA, as my patients 'outed' themselves and me as their provider. Of course, due to HIPPA, I could not reply or acknowledge their posts or comments.

I have spent 12 years at the Marshfield Clinic in Marshfield, WI. I came here as a fresh MD, moving here with my worldly possessions in a sedan I called Jenny (because the letters on the license plate were JNY). I came as a single man and set up my Spartan existence in an apartment complex. I am leaving married, with a daughter, and 2 Penske trucks full of possessions.

I came to be an intern at the Marshfield Clinic in the Combined Internal Medicine & Pediatrics program. I had yet to get a license to practice medicine (only given in the United States after one year of internship). I am leaving after being a physician for over a decade, now double boarded -- in Internal Medicine and in Pediatrics, to be an Associate Professor at UB. Life has changed!

Between these two two bookends, a lot of life has happened.

I was privileged to be invited to become the camp doctor for Camp Angel -- a summer and winter camp held for children between 8 and 12, touched by cancer through a loved one. I've had many laughs and tears at the camp and been privileged to be a part of many stories.

I still remember a retiring pediatrician trying to get me to take on adults with cystic fibrosis as patients. Little did I know what a big part of my life and my heart this would become. Our little practice of 3-4 patients has grown to 30 and I've accompanied patients through their diagnosis, treatment and sometimes inevitable and untimely death. There are many ghosts that come to me when I'm alone and pensive. Caring for these precious young people (and some not-so-young) has brought me joy, tears, heartache and heartbreak. Yet, I would not trade it for anything. I've made friends or colleagues as we have battled CF together.

They say that you can measure the passage of time by watching a child grow. As I said my goodbyes, I hugged (and was hugged by) children whose newborn exams I had done in my office. We reminisced about the close misses, the severe illnesses and hospitalization and the celebrations of milestones. I have a precious picture of a young lady who came to me as a single early twenties and brought to my practice in time, her husband and then 2 children. I still remember going through the take-out window at Pizza Hut every Friday (my tradition when I was single) and being greeted cheerfully by her as she handed me my order. One day I asked her if she had a doctor and she said, 'No'. That was how she came to my practice.

I reminisced with one shy pre-teen about how she cried bitterly during every exam in her first two years of life. We laughed at this as I examined her for the last time.

I cried with a patient as we visited his wife in a memory care center, where his wife was now committed due to dementia. They had come to me as a couple who bantered constantly in the office, each other's best friend. During the years, I shared their grief as I diagnosed their oldest daughter with inoperable brain cancer, then watched her decline and die. It bonded us together.

So, here's the thing: