After deciding in February 2007 that the American healthcare system was too much for my coronary arteries, I decided to retire. The business of medicine had become stressful to the point that the joy of being an Family Practice doc was being far outweighed by the non-medical issues which I was forced to deal with during the day…preauthorization, referrals, paperwork in duplicate, the threat of litigation, memos, and committee work (a committee usually being a group of individuals that individually can do nothing who get together to decide nothing can be done).

Having decided that the end of November would mark the end of my US medical career I was looking at doing medical research locally in Missoula or traveling to somewhere exotic such as Guam, New Zealand or Australia to do some locums work. As I look closer at them, these foreign options appeared to be more of the same….I would be replacing worn out docs or be working in locales that could not attract physicians due to the same issues that made me elect to leave clinical work….. Overworked, overstressed and underpaid.

Out of the blue in mid-July, I ran across an ad in one of my journals for a position of “hospitalist in a sports medicine facility in Qatar”. I am not sure why I followed up on that ad because being a hospitalist was not something in which I was interested. It may have been the mystique of the Middle East and the recent media aura around Qatar and Dubai regarding the rapid, elaborate, and large scale development that they were facing; or, it may have been the apparent (to a westerner) oxymoron of “sports medicine in Qatar”. At any rate, I sent an email to the recruiter and then spoke with the Medical director, Dr. Peter Fowler. It was apparent that there was no real job description for the “hospitalist” but it was a position that was required to meet accreditation standards. After my conversation with Peter, it sounded as if I could just about write my own job description as the organization was still very much in the organizational phase and it was not clear how a hospitalist was going to fit into the team of orthopedists, anesthesiologists, sports medicine specialists, podiatrists, physical therapists, and physiologists.

At any rate, our conversation went well and I was invited to interview on site. After agreeing to bring both Lisa and myself to Doha for the interview (in the spirit of marital harmony, I gave up by business class tickets so that we could both fly economy), we flew to Doha in the first week of August.

The trip was an eye opener.

Heathrow airport was our transfer point going from British Air to Qatar Airways for the final leg to Doha. The complacency and incompetence of the airport staff mixed with the rundown and shabby conditions of the facility changed what we hoped to be a nice three hour layover into a nearly three hour exercise in “line standing”. The excuse for the slow process was “security delays”. In reality, it was bureaucracy and socialized employment opportunity that kept only one of the three available screening stations open thereby putting a huge bottleneck in the stream of passengers changing terminals.

After that experience, getting on Tiger Lines freight express would have been a relief. Instead Qatar Airways was way beyond our expectations. The planes were new and roomy, the staff professional and pleasant, and the food that they frequently and graciously offered was edible. Economy class on Qatar Airways had better service than the first class service offered by any American airline. It was a pleasant and albeit short trip to Doha.

Arriving at Midnight and finding the temperature hanging at 105F was a bit of a shock. The real shock came the next morning when I went out for a walk at 0730 and was blanketed by the 114 degree 90 percent humid air.

Doha was an amazing place and it is home to about one fourth of the world’s high-rise cranes. We had a very fruitful visit and I was offered a position but they have to finish interviewing the other applicants before they can send me a contract. So, it will be “life on hold” (easy for me but hard on Lisa since she doesn’t do well with “grey”).

October 2

I got the contract via Email from Phillip Balmer the acting COO of Aspetar, the parent organization for Qatar Orthopedic and Sports Medicine Hospital (“Aspetar” means hospital in Arabic and it was chosen as a name for the parent organization since it sounds similar to “Aspire” which is the BIG sports academy that preceded us at the Sports City location). We went through a few rounds of negotiation via email and I got what I wanted and they got me….which is a deal no matter how much you pay. ;-)

December 3

It was a very fast two months. So many little details of which we must attend to, and so many good-byes. I have been repeated impressed by the number of patients who having learned that I will be leaving just stop by to say good-bye. I have realized after a few of these patients/friends have told me that they not only will miss me but are thankful because they owe their life to me. Those words are certainly not the ones that I would have used to describe the relationship that we had but I can see it from their point of view….a timely diagnosis of something potentially fatal and you do make a save. One of the main stressors from which I am escaping in my departure is the onus of malpractice. My several encounters with it have left me with significant PTSD and have taken a lot of the joy from my day to day practice. One of the quick takes that I got from these medico-legal encounters is that we don’t get any “good chips” for the saves we make as suggested by my patients. Instead, if we make a mistake or if some bottom feeding plaintiff attorney thinks we could have done better, we start at zero and go down on what “we owe”. Amazing as it is, all of the cases in which I have faced litigation have come from patients who I have cared for for nothing…either gratis care or Medicaid…..I am so tired of being a target when everything I do is with the best of intention and with a reasonable amount of medical acumen and too much empathy. My partner, Erik Kress, makes a tongue in cheek philosophical comparison….he says that every time that we see a patient we make a differential diagnosis. That means we list in our minds all of the things that a patient’s symptoms seem to mean but then we also make several other but in our minds less likely diagnosis. Even if we are 99 percent certain of the diagnosis, if we see 100 people (which is a full week of work), then we are going to make a wrong diagnosis once based on odds alone rather than just medical knowledge. With that perspective, it’s only a matter of time before we get nailed to the “malpractice cross”. My long time friend and mentor, Bob Stanchfield, who practiced in Shelby for nearly 40 years before he retired, told me that if you had never had a malpractice suit, it means that you have never practiced.

“How do you know that a Plaintiff attorney is being reckless with the truth?” His lips are moving.

Anyway, I know from past experiences that there will never be enough time for goodbyes. The days go by and with each one you shed some tears but in fair trade you take into your heart the memories of that person’s involvement in your life. I think that is what is meant by “Heaven” as we take our last goodbye from this life. Those memories we take with us and those that will live on in the hearts we have touched on our journey.

That being said, I have to comment on the emotions of having a grandson.

As we make plans, life throws us a few curves. Usually we use that term with a negative connotation but in my case it is highly positive. I was graced with my first grandson on August 10 and while this was somewhat of a surprise, the emotional impact was a huge positive event. While I hold newborns everyday in my office and get to cuddle them and hug them and love them to pieces, I had no clue how young Bridger would reach into my chest, grab my heart strings, and play “Home Sweet Home”. And the almost immediate father-daughter bond that occurred between his mother (beautiful and elegant Britta Stolle) was a welcome surprise as well. Lisa says after I spill the beans on my emotions over all of this that I am “such a marshmallow”.

Damn, getting out of Missoula is taking a long time and has about used up all of my philosophy…but I know having left my roots before that “they can take the man out of Montana but they can’t take the Montana out of the man”.

December 3

After a family gathering at the ranch over the weekend we stayed in an airport motel and had our last US pizza delivered while we watched “ 3:10 From Yuma”. My son Justin and his wife Dawn picked us up and took off with the F350 and the gooseneck after dropping us and the last of our stateside tears at the Missoula airport.

Getting hired by this outfit showed its benefits early….we get to fly business class. So in Denver we were moved up to first class on United for the trip to DC…which was held up because of threatened high winds in the DC Area. We planned on meeting my good buddy Walt (Captain Lost) Tingle and his bride (Out of Africa) Thea during our long layover in DC. Due to a hold up in getting out of Denver, our time is DC was cut to 90 minutes so we had a brief hug (all hugs with Thea are too brief) and a last American beer and got on our Qatar Airway flight to Doha. It became apparent quickly that Qatar Airways operates at a different level that any US airline. Business class emphasizes the “class” part of that definition. The accommodations and service were commendable.