A Heart to Serve

by Bill Frist

  I reported for Surgical Clinic that Thursday and immediately went to Room 3 of the old Clinics Building, built in 1907 at the end of Fruit Street, just cattycorner to the White Building’s front entrance. Patients checked in at the front desk and were triaged to the appropriate room, where the initial evaluation was conducted by an intern, before a more advanced resident provided treatment. The White surgical service was run entirely by residents, with a sixth-year chief resident shouldering the ultimate responsibility. I was at the bottom of the chain, no longer a medical student, yet still just an intern.

  About halfway through the otherwise routine morning, I grabbed another chart on the door and entered a room to find a young woman, twenty-some years old, who had scheduled an elective visit. As I gathered information regarding her chief complaint and past medical history, and while waiting for the resident in charge, our casual conversation led to the realization that we were both misplaced southerners. She was from Texas and I from Tennessee. Both of us were spending a transient period of time in Boston, for me to further my fledgling career, and for her to see the world. Over those few minutes we shared the excitement of living in such a vibrant town as Boston, although both of us confided we were overwhelmed by the more reserved and at times brusque nature of Bostonians compared to the more open and friendly attitudes that we were used to growing up in the South. I was intrigued. I didn’t run into many warm, engaging out-of-towners (especially southerners) in the resident-run surgical wards of MGH, and I was enjoying this chance encounter. In the course of our friendly yet businesslike conversation, I learned that she had visited the clinic because, having recently been transferred to Boston as an American Airlines flight attendant, she did not yet have a doctor in the area.

  Although I’d usually see nearly thirty patients a day in the clinic—and interacted with scores of new patients, visitors, and staff from all walks of life every day—by the end of that fifteen-minute conversation, I knew there was something special about this woman.

  But I had a line of patients waiting to be seen in the clinic. As the attractive young woman was about to leave, I told her that her test results would be back in a week and that I would call her if there were any abnormalities. I scribbled two telephone numbers on a prescription pad—the hospital number through which I could be paged and, if I was not on call, the only other way I could be reached, my home number. On the way out the door I handed her the paper and said, “If you have any more questions, let me know. You can reach me twenty-four hours a day through one of these two numbers.” She thanked me and smiled as we said good-bye.

  I was on call the next weekend, but my brother Tommy and his wife, Trisha, had come to Boston and were staying with me in my small apartment (so sparsely appointed that whenever I had guests, I slept on an extra mattress on the floor in the living room). Tommy was going to complete his seventeenth marathon, this time running the time-honored Boston Marathon on Patriot’s Day. (Last month he had a knee replacement which, as with his previous hip replacement, had nothing to do with his obsession to stay fit with running—or so the older big brother tells his forever naïve little brother!) I had traded call times so I could visit with Tommy and Trish Saturday night. I finished my rounds at the hospital and made it back to the apartment by about 10:00 P.M. Trisha was still awake, but Tommy had already gone to sleep, having loaded up on pasta in preparation for the twenty-six-mile run two days later.

  I had no sooner come in the door, when Trisha said, “You had a phone call. It was a patient named Karyn, asking for Dr. Frist, but it didn’t sound like it concerned a medical problem.”

  I was immediately intrigued. “Did she leave a number?” I asked.

  “No, she didn’t,” Trisha replied, eyeing me with a hint of a smile. “But she seems like the nicest girl. She didn’t sound like she was from here.”

  “What about her last name?”

  “She didn’t say,” Trisha replied.

  Now my curiosity was really stirred. Throughout the night, I kept trying to recall Karyn’s last name. How in the world was I going to get in touch with her? While all this was going on, I began to remember her big, expressive eyes, the quick smile, her down-to-earth, yet subtly sophisticated southern charm, our conversation about being “misplaced southerners.” Now I knew I had to get in touch with her; an urging inside told me that it was important that I call her back…and for some reason, I felt that this connection could not wait until the following week.

  I became a man on a mission. At five the next morning, I hurried back down Beacon Hill and into the Clinics Building, where I found the stack of notes from my previous week’s clinic visit. I ran my finger through the log of patients I’d seen that week. What was her last name? Page after page, entry after entry, I searched. Growing anxious, I began to worry that I might not find it. Then what?

  Finally, it was there! Karyn McLaughlin, age twenty-five, Lubbock, Texas. Routine visit. And, on the next line, thank goodness—a telephone number.

  My interest must have been strong or I would not have been rummaging around a closed clinic to find patient records before the sun had come up. Should I call her back or wait for her to call me again? I wondered. And why had she called in the first place?

  I waited until that night, but when I hadn’t heard from her, I dialed Karyn’s number. She answered the phone and after perfunctory pleasantries, I asked her if she was experiencing some sort of medical problem.

  Karyn replied, “Dr. Frist, I wasn’t calling about a medical problem.” She explained that she’d been calling for a friend who’d been in town for the weekend, wondering about the advantages and disadvantages of his doing a cardiology residency in Boston. She wanted to put us in touch. Then our conversation wandered to other subjects. She asked why I had come to Boston to do my surgical training. After all, she’d heard all her life that Texas, not Boston, had the best medical centers in the world! And for some reason, we talked at length about the importance of family, a topic we first broached that night but have shared for a lifetime.

  Near the conclusion of the conversation, I took a chance and asked, “Do you think we will see each other again?”

  “I don’t know,” Karyn replied.

  “We could get together for a cup of coffee…we don’t need to make a big deal about it.”

  Karyn later confessed that she thought, based on our brief conversations, I was likely too cheap to spend the money for a decent lunch or dinner, so she hedged in answering. But something else had begun to click—something beyond a first phone call, following a happenstance meeting in a professional setting. Nevertheless, we left the call saying we’d talk later in the week.

  A couple of days went by and we reconnected: She’d pass on to her friend my thoughts about coming to Boston for the residency, and then maybe we could get together and talk further about it in person. I explained that due to my call schedule, it would be best just to meet for a drink and not have dinner. I sheepishly told her that I rarely went out to dinner during my residency, because all too often, I’d fall asleep at the table, right in the middle of the meal.

  Karyn laughed, and we decided to go to Warren Tavern, a historic old restaurant in Charlestown—the nicest place that I knew to have a drink, without buying dinner.

  I met Karyn that next Friday evening at her apartment on Columbus Avenue, in South Boston, an enviable place to live today but at the time in its earliest stages of rehabilitation and not the safest part of Boston for a young woman to be living. When she opened the door, wearing a khaki-colored dress that highlighted her sunburned face, her beauty struck me.

  We talked and laughed and time seemed to stand still. Karyn chided me once again for being cheap, first for not buying her dinner and second for having suggested that we walk to the Warren Tavern to save cab fare. Actually, I can’t remember whether we walked, took a cab, hitchhiked, or rode on a magic carpet. What I do recall is that I was enthralled with Karyn’s bright-eyed, contagious, easygoing personality and her ric
h love for life.

  The minutes grew into a full-blown dinner and several hours of conversation as we got to know each other. I was mesmerized by the soft southern lilt in Karyn’s voice, as I learned more about the special education teacher with deep Texas roots, who had graduated from Texas Christian University, and was now taking time to explore the world.

  Over the next several months, we talked regularly and met casually whenever we could, trying to squeeze time into our busy schedules. Karyn’s flight schedule and my intense program at Mass General did not always mesh well, so we simply enjoyed whatever fleeting moments we could spend together. Often Karyn would be out of town three or four nights a week, and I had my intern routine of thirty-six hours on, followed by twelve hours off. Consequently, Karyn and I didn’t develop the usual type of relationship, in which a couple sees each other often, sometimes every day or evening. We rarely went out to dinner and didn’t have “dates” in the traditional sense. We enjoyed each other’s company, spent a lot of time talking about our values and what was important to us in life.

  Much of our getting to know each other happened when I was on the emergency-room rotation; the schedule then was twenty-four hours straight on call and then twenty-four off. On the days that I was off and Karyn was in town, I’d sleep for five hours, then meet her for lunch at the T.G.I. Friday’s restaurant over on Newbury Street. We’d order ice cream drinks like the banana split or strawberry shortcake to wash down nachos or potato skins.

  Our evening at Warren Tavern was on April 29. During the month of May, our talks grew more intense; they were more focused than those generally held between two people just getting to know each other. They were especially focused on my part. It wasn’t that I was such a good communicator. No, it was because I was under a time line that I had not shared with Karyn.

  Although I didn’t consciously discuss it with Karyn in those early days, I was questioning and probing whether my personal life was really on the right track. I’d previously set out pursuing a destiny that I had recently begun to question. Amazingly, through all those early conversations with this woman I’d only just met, I confided in her everything important to me—all except one thing, probably the most important thing at that time. Something to this day I regret not being more open about sooner, with all parties concerned.

  While Karyn continued to date others and our relationship was casual, still brand-new and evolving, and limited by the realities of two careers that so often took us in different directions, the one thing that Karyn did not know was that back in Nashville, wedding plans were on a collision course with the calendar—my wedding plans! I hadn’t mentioned to Karyn that I was engaged.

  I beat myself up in my thoughts. Karyn and I had shared so many conversations over the previous month about substantive and personal issues. Why couldn’t I tell her about my engagement? And as the deadline drew closer, the intensity of my dilemma—and my sense of guilt and anguish—continued to grow.

  Six days before the planned wedding, I finished a forty-eight-hour shift in the emergency room. I left the hospital immediately after rounds, went to the airport still dressed in my white toad skins, and boarded the plane for the long, painful ride home. I’d decided to announce to both my parents and my fiancée’s parents that “we” had decided not to get married. That things weren’t right, and I did not know exactly why. That we were going to have to call everything off, even though we had already received hundreds of gifts and dozens of people would start flying into town within a few days.

  I went straight home and in the kitchen explained to Mother what I had to do. Sensing my anguish, she was totally supportive, without hesitation. I called Dad, who also never hedged in his support, and then went to have the most difficult and painful conversations of my life—with my fiancée’s parents, and then later that night, in the same room with all the wedding gifts, with my fiancée.

  We called off the wedding and notified our friends as best we could. I flew back to Boston immediately, devastated and feeling lower than I’d ever felt. My spirit was blunted and a huge cloud hung over me. My life had gone pretty well, with the exception of the motorcycle accident, up until then. Now it had been upended for reasons I didn’t understand. I’d made a decision and acted on it. Sure, I could lose myself in my waking hours to my harried work in surgical training. And there was some consolation that I had made the right decision—but I will always regret not waking up to the reality sooner, so as to cause less pain to my fiancée, to me, to our families, and to our many friends.

  The breakup was heart-wrenching for both of us. It was difficult, embarrassing, and painful, but it was also the right decision. Life is no fairy tale. Things don’t always turn out as one anticipates, and things are almost never as perfect as they might seem. Loss of a relationship, like death, is always difficult to endure, and some decisions leave prolonged pain and scars that not even time can heal. I learned, though, just how imperative it is to be true to oneself, to be true in one’s relationships, and the importance of never letting work or anything else take precedence over a relationship.

  I also realized that slowly but surely, almost imperceptibly, Karyn and I had been falling in love. About a month after my Nashville trip, we were at a party with a lot of the people who worked together at MGH. One of my senior surgical residents was so impressed with the warm and charming Karyn that he gushed, “Oh, so you are the woman Bill is going to marry!”

  “Well, we’ve been seeing each other,” Karyn said demurely, “but nobody has mentioned anything about marriage.”

  “Oh, I see,” the resident replied. “I must have misunderstood. I thought the wedding date had already been set.”

  Karyn smiled and politely answered, still not knowing I had been engaged, “No, of course not, we are just getting to know each other.”

  Shortly thereafter, I told Karyn the full story about my engagement. When Karyn discovered that I had been less than forthcoming, she was furious with me and made it clear how disappointed she was. More than anything, she was hurt. We had talked about so many matters, yet I had not confided something as intimate as an engagement!

  I feared that I had lost her, but I was not about to give up. I called her repeatedly. I’d venture to Columbus Avenue, hoping to “bump into her” when I knew she would likely be returning from a trip. When she finally accepted my phone calls and agreed to see me, I tried to explain to her (not all that convincingly, I’m afraid) that I had not willingly tried to deceive her. I explained that though we had known each other for only five or six weeks, our conversations had led me to a greater understanding of myself. We had become great friends and had fallen in love, and our hearts had melded together. The swirl of our schedules and the intensity of my residency program no doubt contributed to the blur in which we had developed our relationship.

  Slowly I worked to rebuild Karyn’s trust. She continued to date others over the summer, but eventually we began seeing each other regularly. The better I got to know Karyn, the more I realized that she was the perfect counterpart for me and that we could grow together and build a family over a lifetime. I loved her and I wanted her to love me; it didn’t take me long to realize I wanted to spend my life with her. Bright, articulate, fun, loving, and kind, with a deep faith in God, she would be an inspiring spouse and a marvelous mother to our children.

  Karyn wasn’t so sure. Aware that my family members had all known my fiancée for years, Karyn worried that they might feel some sort of resentment toward her. I knew that my family would do nothing of the sort.

  At long last, we planned a trip to Nashville so she could meet the Frist clan. I returned to Nashville a couple of days before Karyn. The night of her arrival, I drove Dad’s old, black Chevrolet out to the airport to pick her up. During the drive back to my house, knowing that Karyn was already nervous, I told her that all my brothers and sisters and their spouses and children would be at our family home on Bowling Avenue to meet her and “pass judgment.” I teasingly instru
cted as we were driving home, “Definitely don’t sit down when you walk into the living room, because everyone has a specified chair where they always sit.” I continued to jangle Karyn’s nerves by describing my family as sedate, highbrow, sophisticated, and extremely formal—all about as far from the truth as you can get.

  I maintained the façade right up to the point we arrived at the Bowling house. As I turned into the driveway, the black night was suddenly illuminated by the glaring, bright headlights of four cars parked in front of the house, all pointed directly at us. Horns started honking, and we saw a huge hand-painted banner draped across the front of the house, reading, “Welcome home, Karyn! We love you!” We later discovered that many of the grandchildren had scrawled notes of welcome to Karyn and had drawn pictures for her on the banner. Little Bobby, for example, drew an airplane, a perfect choice for us.

  All my nieces and nephews, from three years to ten, came running out from behind the bushes to open the car door, nearly hugging Karyn to death before we ever made it to the front door. It was a fabulous homecoming, far from the formal reception I’d described. The ice broke and melted away immediately, as my family welcomed her. Still not sure what to make of all the celebration in light of my highly exaggerated dissertation on what to expect, Karyn was even more disconcerted by what followed.

  The whole family poured into the living room, filling every available seat, and some of the grandchildren huddled on the floor, admiringly looking up at Karyn as we sat on the couch. All eyes focused on Karyn. The little girls especially loved her long eyelashes and her beautiful eyes. Everyone asked questions of Karyn, one at a time, as we went from person to person around the room.