Guest Editorial

Death of a Colleague: How Do You Replace a Legend?

December 05, 2017 04:36 pm Jay Lee, M.D., M.P.H.

It was early on a September morning in San Antonio, the first day of the 2017 AAFP Congress of Delegates, when my mobile phone buzzed. The call was coming from California, where it was even earlier.  

[Jay Lee, M.D., M.P.H.]

Jay Lee, M.D., M.P.H.

Calls received before sunrise rarely bring good news. This call was no exception.

My boss was calling to let me know that Theresa Brehove, M.D., one of our clinic site leads and a fellow family physician, had been hospitalized overnight because of a brain hemorrhage. She died several days later surrounded by her loving family.

As physicians, guiding our patients and their families toward the end of life is part of our work. We receive training on how to communicate and provide the support our patients need. We do not, however, receive training on what to do or say when our colleagues die.

Terri's sudden, tragic death at age 58 was shocking and devastating for our patients and staff alike. Before becoming a site lead, she was the longtime director of our homeless health care program, developing a model for other clinics across the country. She was so well respected at Venice Family Clinic that "What would Terri do?" became a common refrain when difficult choices needed to be made.

Now, I find myself in just such a position. As chief medical officer, I am responsible for recruiting and managing a medical staff that serves more than 26,000 patients at a federally qualified health center with 12 sites. The question is, how do you replace a legend?

The easiest path would have been to hire a locum physician and plug someone into our schedule. That would have filled a void and bought us some time as we search for a new physician. But that short-term solution wouldn't have been good for anyone in the long run. Terri had devoted her professional life to our patients for two decades at the clinic and had mentored dozens of staff members along the way. She and they deserved more.

Theresa Brehove, M.D.

As I pondered her legacy, I remembered guidance that family medicine pioneer Gayle Stephens, M.D., shared about the essence of our work as family physicians during a keynote speech at an AAFP leadership conference. To paraphrase, he reminded the audience that a physician's fundamental moral obligation to patients is to be there and to give a damn (neither of which can be faked, by the way).

So that's what I did. I doubled the number of my patient care sessions and moved myself closer to the work. In the process, I had the opportunity to personally assure Terri's patients that our clinic family is committed to continuing her work and making their health primary. I also got to know our staff more personally and provide some stability at a time of uncertainty. I let everyone know that when the time is right, we will hire someone to continue Terri's work with the same commitment and caring she modeled. And for the moment, we are all working together toward that future.

It has been about three months since Terri died, and I'm still struck by how inadequate one can feel stepping into someone else's shoes. And it doesn't really matter what title, experience or ego you might have. It's hard.

I won't forget the first day I filled in for Terri. I worked with her medical assistant, and every patient we saw together brought tears to our eyes. It was a raw and emotional day.

One of Terri's longtime patients recently came to see me. When he started seeing Terri, he was in his 40s, homeless, and struggling with addiction and an undiagnosed psychiatric condition. Today, he is in his 60s, housed, off drugs and well-managed with medications. That's a testament to the value of the long-term relationship this patient had with Terri, his family physician.

But there is more to it than continuity. Terri had a magical ability to make people who felt ignored by society feel cared for. This particular patient told me he needed a new doctor because, "One of the things Dr. Brehove taught me was that I'm worth taking care of."

A little more than a year ago, I shed tears in visit after visit on my last day at my old job, saying farewells to many of my longtime patients. Now, I shed tears as my new patients deal with the loss of their longtime physician.

We are in the process of hiring someone to continue Terri's work. To be clear, this isn't a national plea for CVs. Rather, this is a reminder that when times get tough, physician leaders need to be there and give a damn. There is power in vulnerability. It's not often easy to show our vulnerabilities, but I've learned that it's OK not to know all the answers. Sometimes answers will present themselves if we take the time to be present and listen.

That is what Terri would have done.

Jay Lee, M.D., M.P.H., is the chief medical officer of Venice Family Clinic in Venice, Calif. You can follow him on Twitter @familydocwonk(