My colleague is dying. He's not just a colleague; he's a dear friend as well, even though I don't often see him outside of work. At least I didn't until he was too sick to come in to the office. Now I visit him every weekend. I always take him something yummy to eat because his appetite is failing, along with his breathing and his strength.
Pepe recently began in-home hospice care. The other day (nicely paraphrasing Francis W. Peabody1) he said to me, “You know, Ellen, I think the secret to hospice care is that they love the patients.” As I've spent time with Pepe in recent weeks, I have been reminded of the importance of this principle.
We exhort parents who wish to raise loving and generous children to act lovingly and generously toward them. Similarly, modeling caring behavior for our students is one of the most potent ways to encourage them to act that way toward their patients.2
Medical education has undoubtedly evolved since I was a student, but I suspect much of the boot-camp atmosphere remains. Although I have many positive memories from the time and remember some wonderful mentors, I do not recall an atmosphere of warmth and caring at school. Nor was I ever hugged by a superior. If I received love from my medical school teachers, it was usually of the tough variety.
I have found PA education, at least at my program, to be different. We look for caring attributes in our applicants (among other things, volunteerism is an admissions criterion), and, once they are admitted, we stress the importance of community involvement and personal responsibility. Unprofessional behavior is treated more harshly than just about any other infraction. And we hug our students, both when we “coat” them at the white-coat ceremony and again when they graduate (and occasionally in between). Beyond the hugs, the professionalism, and the social responsibility, I believe we project a sense of caring toward the students, toward patients, and toward each other.
I'm not the only one who visits Pepe. Other coworkers stop by regularly, bringing soup and office gossip. But the one who visits most often is our program director, who stops by every morning and makes Pepe oatmeal before driving in to work.
My first memory of Pepe dates back to more than 20 years ago. As a newly minted internist, fresh from residency, my first job included teaching responsibilities in the PA program, and I had been invited to the program's holiday party. I pulled into the driveway of the unfamiliar house and sat in the car for a moment, trying to banish my congenital shyness before marching into a sea of barely known faces. Suddenly an infectiously warm smile bloomed in my car window. “Hello, Dr. Feld. I am Pepe Barcega, and I'm so happy to meet you!” he said. Then he opened my car door and walked me into the party.
In loving memory of
Jose “Pepe” Barcega, MHS, PA-C
January 20, 1950—September 26, 2015
1. Peabody FW. The care of the patient. JAMA
2. Weissmann PF, Branch WT, Gracey CF, et al. Role modeling humanistic behavior: learning bedside manner from the experts. Acad