David's Practice

After completing his cardiology fellowship at Henry Ford Hospital, David Barnett, his wife, and child moved back to Toledo, Ohio. Both Sue’s and his parents still resided there. David was offered an attractive position as an invasive cardiologist at the Toledo Clinic, a large, incorporated group of medical specialists. He would be the third member of the cardiology group. In July, 1991, at he age of thirty-one, Dr. Barnett started his new career.

His two senior partners, having been there a number of years, had developed a huge practice comprised of hospital inpatients and office outpatients. They were undermanned and swamped with work. David was welcomed with open arms. 

Dr. Barnett jumped in with both feet and soon had a sizeable, thriving practice. He was well respected by his colleagues, both his partners and other sub-specialists.

Office staff and hospital personnel quickly developed high respect for Barnett’s abilities. They enjoyed his humor and pragmatic demeanor. David later learned, through conversation with his senior partner, that the director of the cardiology department at Ford Hospital had described him as the best cardiology fellow he had ever trained.

Despite these accolades, he remained humble and cautious in his approach to medicine. Having known many arrogant medical residents and cardiology fellows who were cut down to size and put in their place following a misdiagnosis or disastrous outcome; David was careful in his approach to medicine.

His popularity and capabilities were an odd contradiction to his insecurity as a physician. A deep internal anxiety induced him to compulsively check and re-check patient therapy plans. He obsessively reconsidered every move regarding patient diagnosis and treatment--strongly adhering to the physician’s motto to do no harm.

This was time consuming, and for the most part, unnecessary. David recognized his compulsive approach to medicine as self-defeating behavior that interfered with his family’s well being. They suffered from his absence.

During Barnett's training at Ford Hospital, Susan and he had a child. Their four-year-old daughter, Elizabeth, was the delight of their life: precocious, cute as a button, clever as could be. Their son, Paul, intelligent and all boy, was born in the fall of Barnett’s first year of practice. A daughter, Marilyn, would follow in two years.

Eight months after joining the Toledo Clinic, Dr. Barnett suffered an emotional set back when one of his patients died from an unusual cardiac condition. In reality, the patient’s death was not David’s fault, but due to his insecure nature, he blamed himself. He was plagued by depression and guilt for many weeks. Fortunately, over time, as he gained more experience, his self-doubt slowly healed. Over the ensuing years he matured into a confident, efficient cardiologist, who maintained high practice standards.

David had an uncanny knack for making difficult diagnoses. His clinical acumen and bedside skills were superlative, and he prided himself on using his stethoscope and intelligence, rather than expensive testing, to make a diagnosis. His partners were pleased to have him as a member of their group. Cardiologists across the country were being criticized for excessive utilization. David’s group did its best to limit expense--being gratified with their ability to maintain low test utilization. The group was recognized by insurers for their cost-conscious approach, especially when compared to other cardiologists in the community. 

Dr. Raymando Tamayo, for example, was notorious for his inordinate, unnecessary, potentially harmful and incredibly expensive use of cardiology tests. His referring physicians were frequently disturbed by the plethora of expensive  studies to which Tamayo subjected their patients--their anger compounded by the large number of normal test results, an indication that most of these evaluations were never indicated in the first place.

Consequently, over the years, Tamayo’s referral base dwindled, along with his patient population. To compensate, Ray resorted to distasteful advertising on billboards, phone book covers, and radio programs.

He became the laughing stock of the medical community, but didn’t care. Through years of practice, Tamayo’s ego had hardened enough to withstand virtually any criticism: derision from other professionals, anger and disgust from abused patients, even widespread snickers and jokes about his lousy patient care and blatant greed. At David’s office, if a physician were thought to have done an unnecessary test he was jokingly said to have “Pulled a Tamayo.” For Ray Tamayo, money came first, vacation time second, patient care a distant third.

Three years into his career, Dr. Barnett was routinely working twelve to fourteen hours a day. The toll on Susan was mounting. In addition, fatigue caused by his abusive work schedule compromised his ability to remain sober. In the evening, after an arduous day, he would obsess over having a drink or two at home.

Near nightly drinking soon became his norm, only abstaining, with difficulty, every third day and weekend when he was on call at the hospital. Susan loved David, but hated having their brief time together ruined by his intoxication. He was usually so exhausted that after a couple of drinks he would fall asleep, not helping her with childcare and routine chores around the house. 

His ever growing patient load added more and more work to his day. Within another year he was struggling through eighty to one-hundred hour weeks, often going to his office on his weekend-off to catch up on paper-work and test dictation. His relationship with Susan was on a downhill spiral.

Through it all, through all his years of work, saving lives and depriving his family of his presence, he continued to drink. David's urge to soothe his fatigue with alcohol was uncontrollable. 

He often arrived home as late as eleven or midnight, missing nearly all family meals and many gatherings with relatives. As his oppressive schedule advanced, so did his alcohol use. He wondered what his partners would think if they knew their junior associate was a frequent drinker. Dr. Barnett would carefully abstain in the presence of other physicians, when attending medical social events or hospital functions. Drinking at home was his secret—a secret he kept from colleagues, and most importantly, his father.

David never drank in front of his parents. His reasons were twofold: not wanting to hear his father’s criticism, and not wanting either of his parents to worry. Susan saw this as her husband’s concern for the well being of his parents, over that of his family. It compounded her anger. She considered blowing the whistle on David by telling his father, asking him to intervene. Not wanting to destroy the last bit of trust shared with her husband, she held back on calling, but kept it in mind as an option for the future.

Barnett used long work hours to justify his drinking, despite knowing of many doctors who worked just as hard without using alcohol for relief. His guilt and shame grew as his drinking increased, occasionally having one or two when on call, which eventually escalated to a nightly event. Being on call was no longer a deterrent.

Despite this, David's' popularity and prestige in the medical community remained solid, as did adoration from his patients. His esteemed reputation only amplified his guilt and remorse. David’s self-respect and sense of integrity deteriorated as shame over his secret grew.

The Barnett’s were wealthy. Their children attended private school and David took his family on many expensive, exotic vacations. He knew private school and vacations were no substitute for an attentive father and husband, but he was stuck. His career was what it was. He couldn’t change that.

Susan’s tolerance approached the breaking point as the children became more distant from their father. What David knew to be the most important thing in his life, his family and their love, was fading away.

In response to her husband’s absence, Susan resolved to find a career of her own. This conflicted with her dedication to her children and her refusal to use daycare facilities. She abhorred the thought of her children becoming latchkey kids. As an alternative, she decided to work out of her home as an interior designer. Part of that plan entailed a new house to be designed and lavishly furnished by Sue as a showcase for her decorating talents.

The home she envisioned, and its furnishings, would be expensive. If her husband could not fulfill her life with the attention she craved, she would try to find happiness from the wealth his career created. David, willing to do anything to improve his marriage, readily agreed to the construction of a new home. As Susan’s plans grew, so did the size of the house. What started out as a fairly modest, three to four-hundred-thousand dollar home, turned into an extravagant, seven-thousand square foot monster, with a million dollar price tag.

Despite that, Barnett, committed to pleasing his wife and keeping his family intact, never said a word. He never complained about design changes made by Susan, and willingly agreed to nearly any construction costs. The mounting expense and anticipated mortgage only compounded David’s travails, demanding that he continue working long and hard to satisfy new financial obligations. As his fatigue increased, so did his drinking. 

Near the end, Susan and David became sadly aware that a house is just a house, money is just money, and neither can replace love. They were caught in a heartbreaking dilemma with no solution in sight. David saw his life racing toward a head on collision with divorce. In desperation, he did his best to reduce his work schedule and spend more time with his wife and children.

Dr. David Barnett had practiced cardiology for slightly less than six years. Over that relatively short time, his career had taken a severe toll on his family. Attempts at working fewer hours were seen by his wife as too little, too late. Before long, the foundation of his marriage would crack, and David’s life would come tumbling down.