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Special Mentors in My Life: the Path to Geriatrics and Dementia Care - Page 5

that I could use the 500 pounds for a repeat visit to Israel to do in essence part of my internship in obstetrics and gynecology, my plan began to solidify. I would do my first 6 months of post-graduate training as a house-officer under the supervision of Dr. Walker the internist-humanist who had moved to Aberdeen where he agreed to take me on, and then I would return to Israel, a visit I looked to with great anticipation.

Dr. Walker in Aberdeen had a profound effect on my approach to medicine, but also to all the people with whom he came into contact. It was from his modeling and style that I realized the importance of acknowledging and asking the opinion of nurses with whom we were doing rounds, a practice that I integrated into my style of practice after witnessing its positive impact on the staff during that six month period. He deferred at times to the opinion of the head nurse and always sought the input and opinions of the house officers with whom he did rounds, sometimes writing in the chart that a certain idea or suggestion came from one of us—something I had never witnessed before from a staff physician. He could be critical in a very instructive way, but when he praised me for something I did he gave me such a lift and that too became part of my practice-style when I entered into the role of a medical teacher and mentor.

As I came closer to my career choice I had the various influences of rotations, specialties and probably most important the mentors in my life. As it turned out when I ended up settling in Toronto, rather than pursuing a career in nuclear medicine which I had come for, but soon found that the lack of patient contact made it not particularly attractive for me. It was then the influence of two wonderful physicians in Toronto that pointed me in the direction of geriatrics: the first was Dr. Abe Rapoport, an internist and kidney specialist that I had met and gave a lift to in Jerusalem just prior to my move to Toronto, ostensibly to learn nuclear medicine and bring it back to Israel where it had not yet been developed in any substantive way. While driving him back from Hadassah Hospital where he had given a seminar that I attended to the centre of Jerusalem I mentioned that I was going to spend a couple of years in Toronto. He said, “If I can help you when you are there, please feel free to contact me.”

After a number of months doing nuclear medicine it became clear to me that it was not a specialty suited to my medical interests and personality, I did seek out the advice of Dr. Rapoport. After I told him about myself he suggested I look into Geriatrics and contact the people at Baycrest while at the same time pursuing a chief residency position that I became aware or at Mt. Sinai Hospital. When he mentioned geriatrics as something that might satisfy my desire to continue in a broad based specialty in internal medicine and not focus on just one organ system or realm of diseases (such a specialty in infectious disease might provide) I conjured up recollections of the wonderful geriatric unit in Dundee where among other things the staff physicians were among the best in the medical school and the patients were delightful—often referred to with endearment as auld wifies.

I followed up with a visit to Baycrest and when I was offered the position of chief resident at Mt. Sinai Hospital with which Baycrest was affiliated I requested of my second wonderful mentor, Dr. Barney Berris, the head of the department with whom I would be working if I could do the Baycrest consultations who were at Mt. Sinai while I was working for him. He agreed and besides being a mentor in terms of gentleness, clinical brilliance, and warmth he helped me formulate my career in geriatrics which when I passed my Royal College examinations that fall, resulted in him and another mentor, Dr. Henry Himel, the chief of medicine at Baycrest offering me a conjoint position which I accepted—thus determining my career path.

For many years my roles and path of academic development moved in a very satisfying direction with areas of great satisfaction in many domains especially in teaching and writing. I had always had an interest in writing, but with my academic roles the opportunities grew and I was able to undertake initially academic articles and then in 1981 my first book was published, Old Enough to Feel Better: A Medical Guide for Seniors. With it a new aspect of my career was launched that of author and over the years since that time a number of other books in addition to articles for the professional and lay press where the objects of my writing interests, all of which reflected my experiences in medicine and the care of the elderly.

As the various challenges of geriatric medicine began to coalesce in my practice I became increasing interested in the ethical aspects of eldercare which resulted in my completing a masters in ethics which was soon followed by an interest and the incorporation into my clinical and administrative practice palliative and end-life care—with all these threads of these special interests intersecting in a very meaningful way.

This eventually resulted in the focus of my clinical care, ethical deliberations, writings and teaching to become increasingly focused on dementia, especially the later stages where special aspects of care and caring come into play and where ethical conundrums become very common. The culmination of these influences has been my most recent book, Late Stage Dementia: Combining Compassion, Comfort and Care. The result has been a dramatic shift in my approach to my clinical ambulatory practice and focus on my teaching of trainees who accompany me in the clinic and my role helping those in our palliative care unit understand the special challenges of caring for those with non-malignant disease especially those with dementia, an increasing challenge in the long-term care system.

I have been very fortunate along the path of my career to have had many teachers and mentors who have inspired, guided and influenced me on the path that finally became my own and now gives me the opportunity to do the same for my students and medical trainees. It goes back to one of the tenets of the teaching of medicine, that one has the duty to learn and then the duty to teach so that the continuity of the wonderful art and science of medicine is assured for the future.

Dr. Michael Gordon is currently medical program director of Palliative Care at Baycrest, co-director of their ethics program and a professor of Medicine at the University of Toronto. He is a prolific writer with his latest book Late-Stage Dementia: Promoting Comfort, Compassion, and Care and previous two books being Moments that Matter: Cases in Ethical Eldercare followed shortly on his memoir: Brooklyn Beginnings-A Geriatrician’s Odyssey. For more information log on to www.drmichaelgordon.com