The world got a little darker last month when Dr. Vijay Patel passed away unexpectedly at the age of 48. We had known each other since 2010, and he’d been my physician since 2012. He was closer to others than me, but I still thought of him as my friend.
That speaks as much to his quality as a physician as it does to us chatting at dinner parties. He was so genuinely interested that it was easy to feel camaraderie with him. Last year, I felt a sudden chest pain at the gym a few months after quitting my job to start my own company. Once they’d confirmed it wasn’t ER-worthy, his staff worked me in for a next-day appointment. He walked into the exam room and demanded,
“Do you know what I said when they told me about this? ‘What was he thinking?!’ — If you get taken out, who is going to run your business?”
Sheepishly, I had not thought of my startup before attempting the heavy lift which caused the strain. He went on to underscore his point by explaining that he’d given up downhill skiing when he started his practice. As the only physician, if he blew out his knee and couldn’t walk between exam rooms, then they couldn’t see patients.
So, he was my friend. And maybe he was everyone’s friend, too — He has been remembered as a ‘country physician in the big city,’
As evocative as that is, he was something else, too: Vijay was a Hacker.
That word might make you think of Mr. Robot, but I’m actually thinking of a broader definition, one known primarily in the computer programming world. Eric Raymond’s Jargon File defines a hacker as, in part:
A person who delights in having an intimate understanding of the internal workings of a system… One who enjoys the intellectual challenge of creatively overcoming or circumventing limitations.
Family Medicine is an underrated, complex field; a long game played to avoid negative outcomes 5, 10, or 20 years from now. And it’s played on the field of American health insurance where the system focuses more on extracting money than on promoting wellness.
Dr. Patel took pride in mastering the game and finding clever solutions. You’d bring him a thorny problem and he’d get a glint in his eye: The delight of someone who recognizes a gnarly problem and has just thought of a clever solution. The X-ray says your shoulder’s not separated, so you can take some ibuprofen and wait or… (glint) we could try some shots right now. You want to quit your job and start a company? (glint) Here’s how we can stockpile your meds before you lose your insurance.
But it wasn’t the camaraderie or the clever hacks that made him truly great. It was his insight.
Last fall, I was going in for bloodwork and badly wanted his advice. My girlfriend (who is also a physician) had moved to her family farm in Tennessee and wanted me to follow. It would be a huge change and I didn’t want to move or to lose her.
Appointments like that are usually just 15 minutes, so my expectation was that he’d give me ten minutes of chart review, five minutes of advice and be out the door. Instead, he sat down and we discussed my problem for what must have been forty-five minutes or more. I kept saying, “I don’t want to keep you,” and he kept telling me not to worry about it. He told me about meeting and dating the woman who would become his wife, Tove. How he couldn’t live without her and how they’d moved repeatedly over the years to make each other happy. It was like I could breathe again when he said:
“If you want to be with [her], then you need to be prepared for compromise, OK? [She’s] worked too long not to realize [her] goals …But that doesn’t mean she just gets to have her way forever—She needs to be prepared to compromise, too. Giving up what you want for a little while is fine, but giving it up forever will leave you embittered,”
I still can’t believe he’s gone.
The last time I saw him we talked about The Martian. We had run into each other at the theatre opening weekend and shared the traditional ‘post-movie conversation’ with a mutual friend. He was envious that I had caught a detail about the density of Mars’ atmosphere which he had missed.
“…because it’s what I do, you know? I know all the details so that I can manage the risk for everyone,”
We talked about the business, my girlfriend, and the farm. We made a plan for him to remain my doctor after the move. Almost as an afterthought, he pulled up my bloodwork on his iPad, and warned me about the dangers of high cholesterol. This was not my first warning, so he added detailed statistics about my risk of heart disease. That was, after all, what he did. I promised to clean up my diet and return with better numbers. Then he asked, in his customary fashion, “Anything else?”
Yeah, you know, one last thing:
Goodbye, Friend. We will miss you.