Tuesday, January 22, 2008

One final Jim training story. When we were fellows together at RIC in Chicago, the staff at RIC had a competition using pedometers. The staff was split into teams of 4, and the goal was to see which team would walk the most steps. Within a few weeks, it became apparent that Jim’s team was unbeatable. While a typical person might walk 5000 steps, and a motivated person might walk 10,000 steps, Jim was regularly clocking in over 30,000 steps. Jim walked constantly. We were reviewing MRIs, and Jim would walk and look at the MRIs overhead. We were observing injections, and Jim would walk in place in the fluoro suite. We would go to grab a bit for dinner, and Jim would eat while walking. He was far and away the most productive stepper, even more than a few of our colleagues who were training for the Chicago marathon. Even on the day of the marathon itself, while Jim didn’t have the most steps, it was close. You never wanted to compete with Jim if willpower was a limiting factor.

Jim the colleague.
Jim and I were fortunate enough to be part of a very special group of guys in residency. I say guys in the literal sense- through the magic of the residency match process, Kessler had 10 male residents. Early on, we realized that collectively we shared a pretty common set of goals. We had heard stories about how residency classes are often close with one another, but then when push came to shove, people would become competitive and the friendship would become compromised. Early on, we all collectively made a pact that no matter what else happened, friendship always came first. Jim embodied that ideology more than anyone else. For the next 3 years, the 10 of us studied together, vacationed together, skied together, went cycling together (to clarify- bicycles, not motor cycles), and grew together. From an educational experience, this was an incredible experience, as we collectively learned from one another. Clearly, the best teachers and the people I’ve learned the most from in my training were my fellow Kessler residents Class of 2006. When one of us learned a mnemonic for the different causes of myokymia, we all did. When one of us realized that a myokymic waveform sounded like the guitar rift from “One” by Metallica, we all did. When one of us came up with a way of classifying the 60 different causes of peripheral neuropathy, we all did.

As was always the case, though, Jim took the concept of selflessness to another level. When Jim and I were applying for fellowships, we traded notes with another. We were similar candidates, and there was the very real risk that by sharing information we might lose out on a fellowship that we desired. Again, before the process started, we made a pledge that friendship came first. As it worked out, that principle was put to the test. Jim and I both wanted to do a fellowship at RIC as our first choice, and we didn’t know whether they had 1 or 2 slots available. I was with Jim when I heard that I was going to be offered a slot. I am still blown away by Jim’s reaction. Eventually, it would turn out that Jim and I both went to RIC, but we didn’t know this at the time. In fact, my getting offered a slot at RIC dramatically reduced the chance that Jim was going to get his first choice fellowship. You would have never known that, though, from Jim’s reaction. His reaction was that of pure friendship- a warm congratulations and genuine excitement that things had worked out for me. I doubt that I would have been as magnanimous had the situation been reversed. Jim was different that way, though. It is a cliché to say when someone dies, but he was truly the single most selfless person I’ve ever known.

Jim, the academic and clinical colleague.
Of all the many ways that I will miss Jim, I think this is the domain that will be the hardest for me. Jim and I have trained together for so long and so closely with one another, I legitimately do not know where my clinical thought process ends and Jim’s begins. He was a great, great clinician- all the warmth and humanity he brought to his personal interactions, the emotional intelligence he brought to his friendships, the structure, organization, and logic he brought to his athletic training- it all culminated in him being one of the most brilliant, reflective, and original thinkers I’ve ever known. Ever since I started teaching residents, I tried to make it clear where my ideas came from- this is how I learned the ankle jerk from Pat Foye, this is how Paul Lento taught me the slump-sit exam, this is how Chris Plastaras taught me to test coronal plane strength, etc. Every day, every time I treat a patient, I think about all the gifted mentors who have taught me, and it is like they are part of my life everyday. Jim is at another level, though. I probably quote Jim at least once a day. Everything I know about practicing medicine, I know from learning with Jim. When we were studying for the boards together, we worked with one another from 5am until bedtime, usually around 10 pm. Every time we learned a new clinical pearl, we made sure the other one learned from the experience. Even this past year, as we embarked as attendings in different systems, we would talk several times a month, just bouncing cases off one another.

Jim the Physiatrist.
In the early drafts of Jim’s obituary that popped on the net this morning, they referred to Jim as a podiatrist from Kansas. This is fairly typical for physiatry- most people are not familiar with the specialty, and do not know exactly what a physiatrist does. At the annual AAPM&R mentor, our friend and mentor Joel Press gave a presidential address titled “Physiatry 2007: Who we are and where are we going?” JP has many messages in that address, but one thing I took away from the lecture was that on some level it doesn’t matter what you call yourself, it matters who you are and what you do. To me, a physiatrist is someone who can assess someone’s strengths, assess someone’s limitations, and inspire them through thought and action to better themselves to levels they had never seen before. Nobody has ever embodied that spirit more that Jim McLean. I’m going to miss him.”


Chris Pfeil said...

Gary - I have tears in my eyes reading your heartfelt memories of Jim. As you, I can't imagine Gary without Jim. It will always be Jim & Gary! Thank you for allowing us to read about your close relationship with Jim - your words are a beautiful remembrance of your friendship.
Chris Pfeil

Darshey said...

Gary- when I heard about Jim's passing my second thought was of you. I knew how much Jim was a part of your life and the thought of losing my own best friend is unthinkable. My best friend and I went out to dinner last night and cried for your loss and Jim's even bigger loss. Here was a guy that did everything the right way and has now been cut down in his prime. The Jim and Gary show will have more episodes...Jim is now the producer and you are the star!

Mary Beth Eggers RN, RIC said...

Gary-Your words brought tears and laughter...what a poignant recollection of your realtionship or shall I say relationships (5) with Jim.
Jim was a wonderful man and excellent doctor! I am honored to have known and worked with him!