{"id":2555,"date":"2020-10-05T14:55:30","date_gmt":"2020-10-05T14:55:30","guid":{"rendered":"https:\/\/www.mc.vanderbilt.edu\/vanderbiltmedicine\/?p=2555"},"modified":"2021-08-11T19:35:30","modified_gmt":"2021-08-11T19:35:30","slug":"the-other-side-of-the-bed","status":"publish","type":"post","link":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/the-other-side-of-the-bed\/","title":{"rendered":"The Other Side of the Bed"},"content":{"rendered":"
\"\"<\/a>
Geoffrey Fleming, MD, and his wife, Amy Fleming, MD, are surrounded by their three daughters,
L-R, Hannah (19), Virginia (16), and Delaney (14). Photo by Anne Rayner.<\/figcaption><\/figure>\n

A month before his 49th birthday, Geoffrey Fleming, MD, had a biopsy of his liver to diagnose an unidentified metastatic disease that he already knew was \u201csomething bad.\u201d The next day, he jetted off to Scotland for a family golf trip, deferring the results of his procedure until his return.<\/p>\n

On Aug. 26, 2019, he got the news: he had a liver and bile duct tumor known as metastatic cholangiocarcinoma, a cancer that, when treated, offers an average survival of 12-18 months.<\/p>\n

As an Intensive Care Unit (ICU) provider at Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, the concept of terminal illness isn\u2019t new to Geoffrey, who has spent most of his career leading families through end-of-life conversations. He and his wife, Amy Fleming, MD, MScHPE, also a pediatrician at Children\u2019s Hospital and associate dean of Student Affairs for Vanderbilt University School of Medicine (VUSM), have been reminded each day throughout their careers that life can be fragile and fleeting through the sick children they\u2019ve had the privilege to treat.<\/p>\n

\u201cI know there are things worse than death \u2014 I\u2019ve seen them in the ICU,\u201d said Geoffrey. \u201cI am fortunate to have stood at the bed of many children who died, and they have taught me how to be brave. They taught me how to live well \u2014 how to find the joy in a bowl of ice cream \u2014 and how to die with dignity and acceptance.\u201d<\/p>\n

While the news was disheartening, Geoffrey found himself at peace knowing his life so far has been full of love and purpose. He, Amy and their three teenage daughters have been living as normally as possible, one day at a time, finding joy in the little moments such as sharing dinner, playing games and taking walks with their dogs.<\/p>\n

\u201cWe have a pretty tight-knit family anyway, but this has made me really thankful for our girls,\u201d said Amy. \u201cWe have really nice teenagers who still seem to like us and want to be around us, and I\u2019m so grateful for that. It has been tough with all of us quarantined in the house and trying to be extra careful to not be exposed to COVID-19 given Geoffrey\u2019s immunosuppression, but the fact that we all enjoy and want to be around each other is a gift.<\/p>\n

\u201cI think times like this make us all more appreciative of what we do have, and that\u2019s the way I have tried to stay focused.\u201d<\/p>\n

 <\/p>\n

A Chance Encounter<\/strong><\/p>\n

Amy and Geoffrey met during their first year of medical school at the University of Virginia in 1993. Geoffrey was a physical diagnosis partner of Amy\u2019s roommate, and the two belonged to the same tight-knit group of six friends who all sat in the back row of the auditorium.<\/p>\n

\u201cGeoffrey jokes that I paid attention and he didn\u2019t, but he did awfully well in medical school to say he didn\u2019t really pay attention,\u201d said Amy.<\/p>\n

Midway through their second year, Amy lost a close friend and realized Geoffrey was the only person in whom she wanted to confide. The two started dating and got married the weekend after their graduation.<\/p>\n

\u201cWe graduated, got married, went on a honeymoon and moved to a new state all in the span of about two weeks,\u201d said Amy.<\/p>\n

Amy and Geoffrey moved to five different states in their first 10 years of marriage before settling in Nashville to raise their children and begin their careers at Vanderbilt in 2007. Geoffrey was offered a faculty position at Children\u2019s Hospital that fulfilled his clinical and research interests in extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT), but it took some convincing and networking for Amy to agree to the move and find a role about which she could be passionate.<\/p>\n

Amy, who had always wanted to be a teacher and mentor, settled into a mentorship role for Gabbe College, one of VUSM\u2019s four advisory colleges.<\/p>\n

\u201cI remember interviewing for the college mentor role with the students here at Vanderbilt who said, \u2018We don\u2019t know you. Why should we give you this job?\u2019 And I said, \u2018I think I\u2019m going to be doing this job regardless of whether you give it to me, because this is the person I want to be,\u2019\u201d said Amy.<\/p>\n

\u201cWhen I went through medical school, I connected with my dean of students, and I really admired what he did. He would have students over to his house and got to know us individually, and I thought, \u2018I could do that someday. I could be welcoming and bring people into my home and show them what it\u2019s like to have a family and be a woman in medicine.\u2019 It\u2019s that reality that we sometimes lose when we\u2019re in the middle of our medical training.\u201d<\/p>\n

In 2014, she moved into her current role as associate dean for Medical Student Affairs, a position she considers her \u201cdream job\u201d because it allows her to focus on each individual student, their passions and how she can help them achieve their goals.<\/p>\n

\u201cThe thing I value most about my role is the ability to get to know my students and to be a mentor who connects them with other people in our community who will support them as they grow into the leaders in medicine they\u2019re going to be,\u201d said Amy. \u201cI love bringing people together. Our students are so excited and passionate about things. They get someone to work with as a mentor, and the mentors get someone who is excited and wants to help work on their projects or learn from them clinically. It\u2019s good for both sides.\u201d<\/p>\n

In addition to her advising role, Amy is responsible for VUSM\u2019s programs focused on student wellness, careers in medicine and academic coaching to help students \u201cbecome the best doctor they can be.\u201d<\/p>\n

She also spends 10% of her time seeing patients on the inpatient service in the Division of Hospital Medicine at Children\u2019s Hospital.<\/p>\n

\u201cI find energy in taking care of children, and I get some of that same energy from my students. The joy of being young, having the whole world in front of you, knowing that you can make a difference and having the energy and desire to do that keeps me energized. They keep me young,\u201d said Amy.<\/p>\n

 <\/p>\n

A New Perspective<\/strong><\/p>\n

As doctors, Amy and Geoffrey have learned a lot about what it means to show up for patients and their families, but being on the opposite side of the hospital bed due to Geoffrey\u2019s cancer diagnosis has given them a unique view of what makes exceptional care through the eyes of a patient.<\/p>\n

\u201cI think it makes you a better provider when you go through something like this because you see the experience from a different perspective. I\u2019m so grateful for the care that we get and for the colleagues who check on us, ask how we\u2019re doing and think to make sure that things are going the way they should,\u201d said Amy.<\/p>\n

\u201cI\u2019m also grateful that the things I see them doing are not different from what they do for other patients. They are giving us the same great care they give to everyone they encounter.\u201d<\/p>\n

Due to his immunosuppression, Geoffrey can no longer safely work with patients in the ICU, but being on the receiving side of care has brought him invaluable insight into the opportunities he feels he may have missed as a provider.<\/p>\n

He believes the role of a physician has changed from being the sole owner of information to being a knowledgeable guide who can help put information into the context of a patient\u2019s care. He likes the term \u201chealth care docent\u201d but realizes some might not agree with the analogy.<\/p>\n

\u201cAll the time, our patients bring us ideas about their care, whether it\u2019s information they\u2019ve found on Google or that somebody has given them. I used to live by this motto that said, \u2018My MD is better than your Google search.\u2019 But, in doing so, I missed an opportunity to partner with my patients,\u201d said Geoffrey.<\/p>\n

While such dubious web-touted \u201ctreatments\u201d as ionized water and specific diets may not cure cancer, Geoffrey now realizes how terrifying it can be as a patient to feel like one may be missing something that could potentially benefit their health.<\/p>\n

\u201cMy plea to my colleagues would be to do what my doctors did, which was sit with me while I asked these questions and walk me through what was plausible, what was not plausible, what could potentially help and what could potentially hurt,\u201d said Geoffrey.<\/p>\n

Another takeaway is the importance of establishing a connection with each patient, no matter the severity of their illness or how busy the provider\u2019s day may be. As an ICU physician, Geoffrey admits he often struggled with spending enough time connecting with patients who were less sick than others, forgetting that this may be the sickest that family has ever seen their child.<\/p>\n

As a patient, Geoffrey, with Amy by his side, spends most of his time in waiting rooms, anxiously looking forward to the moments with his care team. When those moments finally come, Geoffrey wants to know he\u2019s being seen.<\/p>\n

\u201cWhen I say \u2018seen,\u2019 I don\u2019t want them to see a 49-year-old \u2018cholangio\u2019 in room three. I want them to see Geoffrey, who is a father, a husband, an ICU physician, a golfer, someone who loves to play bluegrass bass and who is a bit of a prankster. I want to be seen as me,\u201d said Geoffrey.<\/p>\n

\u201cAs a provider, I have so often been afraid of becoming too emotionally connected to my patients or their families, because patients die. But, I\u2019ve realized my care team is very good at making a connection with me that doesn\u2019t require them to open the Pandora\u2019s box of their heart. They just remember that I\u2019m a golfer or ask us about our daughters, and it is so meaningful to me.\u201d<\/p>\n

 <\/p>\n

The Value of Community<\/strong><\/p>\n

While being on the other side of the hospital bed has allowed these lessons to crystalize, Geoffrey and Amy say the most important lessons they\u2019ve received have come through witnessing the dedication of their colleagues and students and through the privilege of treating sick and dying children.<\/p>\n

\u201cBetween the two of us, there are very few people across Vanderbilt that we don\u2019t know or haven\u2019t met. That is one of the greatest joys for us \u2014 we have built a huge network of colleagues that we\u2019ve done a whole variety of things with. Sometimes, we went to those colleagues asking for help, and sometimes they came to us. It has been a real privilege to get to work with so many people across the entire institution,\u201d said Geoffrey.<\/p>\n

Amy believes getting to know those colleagues as providers, co-workers and friends over the last 13 years has only doubled her confidence that she and Geoffrey will always have the support they need, regardless of what lies ahead.<\/p>\n

\u201cPeople always ask us what it is about Vanderbilt that we love, and my answer is that it feels like family to me,\u201d said Amy. \u201cThese are all colleagues, family and friends that I can rely on, and that becomes even more meaningful and important in a time like this. We have known 100% from the start that the support is there for us. There are so many hands outstretched to help us during this time, and that\u2019s a reflection of the community here.\u201d<\/p>\n

For now, Amy and Geoffrey are focused only on the present moment \u2014 something they believe their family has always excelled at due to occupations that have constantly reminded them of life\u2019s fragility.<\/p>\n

\u201cMy mantra through this has been, \u2018Love deeply, live passionately and demand meaning and purpose in your life.\u2019 That for me is the shorthand answer to \u2018How do you get to a place where you\u2019re 49 facing your mortality and are at peace with it?\u2019<\/p>\n

\u201cI want to be a grandfather, I want to see my children grow up, I want to see many years of life with Amy,\u201d said Geoffrey. \u201cI\u2019m sad about the idea of dying, but I certainly do not have any fear and anxiety.\u201d<\/p>\n

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