Poonam Agarwal, CRNP: She is Finding Her Way

Poonam Agarwal CRNP

It was bright and sunny–the deep blue sky was cloudless. It was her second week at NYU in Lower Manhattan. Having left the protective cocoon of her hometown in South Central Pennsylvania, Poonam wanted to be part of the city she had often visited with her parents. She did not want to be isolated on a college campus. 

Her freshman chemistry class ended early, and there was time to enjoy the warm weather that Tuesday morning. But as she was leaving the building and heading toward her dorm near Washington Park, only two blocks away, she heard a kid yelling, “A plane ran into the Twin Towers!” She looked around and saw that people were sitting on the ground, crying into their phones. She didn’t know what to think. 

The TV was on when she got back to her room, and she saw that, she said, “This was real.” Her neighbor’s suite had a shocking head-on view of the Towers, directly confirming the horror of the day.  When Poonam and her classmates went out to the street again, it was, she said, “surreal.” Looking toward the billowing smoke from massive burning structures, she realized that she was seeing people who had leapt from the suffocating buildings and that they were falling through the air to their deaths. 

After a while, the father of one of her classmates came to the dorm in a daze, “covered in dust and dirt,” dragging his jacket behind him, looking “like a homeless person.”  He banged on his daughter’s door: “Let me in!” The situation was terrifyingly grim. 

Stunned New Yorkers on 9/11/01 (Credit: Mario Tama)

Poonam and her stunned colleagues didn’t know what to do. They wanted to help. Could they, for instance, donate blood? No, they didn’t have the required donor cards needed for emergency situations. Where to turn?

Poonam called her aunt, who lived in the city, and she was safe. She called her mom. She talked with her father, the trauma surgeon Nikhilesh Agarwal, who offered help. Though in New York for only a few weeks, she felt connected to the city under attack and didn’t want to leave. The following day, as she walked down the middle of Sixth Avenue, she said, “It was like a dead city, a ghost town.”  But “you felt part of something,” and “one with the city.” 

Looking back nearly twenty-five years later, Poonam feels “honored” to have been there in 2001. But she is unable to watch the anniversary programs. She doesn’t like the fact that a “giant grave-site,” a sacred place, has been turned into just another casual tourist destination to be checked off.  

(One of her father’s close colleagues, the heart surgeon Dr. John Mathai, lost his brother that day. The 49-year-old Joseph “Minoo” Mathai was attending an important tech conference on the 107th floor of the North Tower of the World Trade Center when the first plane struck. Years later, Poonam searched for, and found, his name inscribed on the bronze parapet surrounding the deep, unfilled reflecting pools precisely where the iconic Towers once stood.)

9/11 Memorial Reflecting Pool (Credit: Marley White)

Poonam said that 9/11 made it “extra hard to focus on her classwork in college as she was “struggling” with finding “purpose.” She engaged in deep “self-reflecting at the time.”  And she believes that the experience probably affected her later career path.

As the daughter of a physician-father (who never thought of his practice as “work”) and an ICU nurse-mother, Poonam entered NYU, in her words, “as a medical student wanna be.” But she didn’t start college as a premed; she was a Liberal Arts major. 

Biology was her favorite subject at Country Day School in York, and she was quite discouraged when she got a C on her first college exam in that discipline.  The large Freshman classes were taught by a team of professors with different styles, and “shy and introverted” Poonam, accustomed to the intimacy of a small private school, was in culture shock. 

For that formative first semester (after dropping calculus following the first class), she did better in chemistry and did okay in the required writing course (though Poonam said that her much-older half-sister was “the writer” in the family). As the goal of being a physician slowly faded, and she had enjoyed an economics course, when it was time to declare a specific major, she innocently picked economics.  

She recalled that in the early 2000s, healthcare public policy was a topical issue. She could combine her interest in medicine with her studies in economics. So, as a student, she got a job in the planning department of the prestigious NYU Wagner Graduate School of Public Service. Within the health policy division, she worked with spreadsheets, set up events for the bigwig donors in the city, and made labels.   It wasn't fulfilling.

Still undecided about what to do, Poonam took a summer semester job at Time Warner Publishing. She was part of an all-female department of sales and marketing. One of the highlights was meeting humorist David Sedaris, who signed his new book (probably Dress Your Family in Corduroy and Denim, but she couldn’t recall) for her. While there, she witnessed the “glass ceiling” preventing women from moving into the highest management positions. And by the end of the summer, she sensed that all women working together may sometimes hurt themselves; she didn’t want to be part of that.

View of Columbus Circle and Central Park
from the Time Warner Center (Credit: enclos)

As her wise father had already planted the idea of a nursing career, where she would have plenty of options to choose from for a career, Poonam decided to stay at NYU, at the Rory Meyers College of Nursing (a very competitive school), for a nursing degree. She wanted to stay in the wounded city that, after four years, had become part of her. She could have done the accelerated program, but as she desired to be a New Yorker as long as possible, she took the “extended route.” 

She enjoyed nursing school, did well, and as she finished the two years of study, she looked for a job near home, near her parents. She applied for a plum job in the cardiac ICU at the University of Maryland (the same institution where her father had done his advanced training in trauma care). When it was offered to her, she said that she “couldn’t turn it down.”

Poonam accepted the position. She told me that she greatly enjoyed working with such a “unique group” of people on the night shift, as they took care of “really sick patients.”  She didn’t feel that it was “work.”  She was happy there.

Nurses in the Critical Care Resuscitation Unit
at the University of Maryland (Credit: UM) 

Unfortunately, she hurt her back (as nurses often do) during "the first year or two," and she eventually had to negotiate the unfriendly Worker’s Compensation system. As the nagging lower back pain continued, Poonam felt that she could not function as an ICU nurse forever, and after four rewarding years at the busy downtown Baltimore university, she searched for less physically demanding (but still fulfilling) work.

What was the next step? What does a former ICU nurse do next to keep the adrenaline rush she was used to?  Poonam quickly rejected the idea of becoming a Nurse Practitioner, seeing routine patients and sending in prescriptions for their medicines. She wanted to utilize the skills she developed in the ICU.  Skills such as monitoring and treating dangerous blood pressure fluctuations and potentially fatal heart rhythms. It seemed that working in the OR as a nurse anesthetist might be ideal, being, in her words, “what an ICU nurse does.”

She was accepted to the York College and the University of Maryland programs; she decided on York. So she moved back home and lived with her parents. At first, she was happy with things, and she really liked the didactic material. But as time passed, and she got into the clinical work, she became increasingly uncomfortable with the brusque, sometimes military style of teaching (a simulated intubation went especially poorly). After taking some time off to think, and a trip to India for her cousin’s wedding, Poonam reluctantly resumed her studies

York College of Pennsylvania (Credit: York Dispatch)

But with only two semesters to go, she was so unhappy that she was compelled to withdraw from the program altogether. It was a difficult (and costly) decision. As a perfectionist, she felt like a failure, but her concerned parents were supportive. (We do want our children to be happy.)

Poonam could not return to bedside nursing, risking recurring back troubles. So, in 2015, she took a telemedicine ICU job with the University of Maryland Health System. Intently watching a bank of computer screens, the nurses covered eleven small outlying hospitals that did not have an in-house intensivist at night. 

This sedentary job allowed Poonam to pursue a Master of Science in Nursing at York College, after which she could be certified as a Nurse Practitioner. As she worked nights in Maryland, she studied diligently in Pennsylvania during the day. Her declared focus was geriatric primary care, and she especially enjoyed her rotations in orthopedics and palliative care. After completing the rigorous two-year program in 2018, she took a job with Orthopaedic and Spine Specialists (OSS) inYork. 

After a while, working at OSS was not her thing, and she began to dread Mondays. So, in June of 2020, as COVID-19 was impacting the community terribly and the ICUs were full, Poonam took a position in the other area she had been drawn to, given some of her experiences of critical illness and death and dying in the ICU, palliative care.  

This comprehensive, holistic, patient-centered consultative service is designed to help individuals and families navigate chronic progressive illness. It can be employed at any stage; it is not to be confused with end-of-life hospice care, though it does deal with issues surrounding death. The local UPMC program, based in Harrisburg, involves working at seven central Pennsylvania sites. 

Elements of palliative care (Credit: SSMHealth)

As of late 2025 (the time of our interview), Poonam had been doing palliative care for more than five years. She has learned much. Among other insights, she has seen that chronic illness and death “will either bring a family together or tear it apart.” 

Her words reminded me of something I was told many years ago by a woman working in oncology (I believe she was a seasoned nurse, but I’m not certain). She said that, in her experience, fifty percent of people can handle illness and dying in their loved ones and can be present and compassionate. The remaining fifty percent, for whatever reason, simply cannot. It seems to be built into their nature. 

Poonam has seen this dichotomy of reactions even in her own family, as her dying mother was hospitalized five times in 2023 and was eventually transitioned to hospice.  But Poonam, as a palliative care nurse, knew the importance of being there for her mother (and her father). 

Despite the demands of her own work, her family was her priority at that difficult time, and she took the necessary time off to be with them. However, the absences strained her position with UPMC, though she couldn’t be in two places at the same time. She was conflicted, and even thought about resigning, but things eventually worked out. Her mother passed away peacefully in December 2024 with the loving end-of-life support from her husband and her two daughters.

Poonam is optimistic that the quality of such care (including sufficient education for all involved parties) can be improved, especially if the palliative care team (and it requires a team) is engaged earlier in the disease process instead of often waiting until nearly the end. And one might even consider changing the name of the service altogether to just “supportive care,” to reflect the real goal of better management of advanced disease while avoiding the often dark "hospice" specter of “giving up.” 

Poonam had been making the rushed and harried commute to Harrisburg from York, but she was subsequently transferred to Hanover, making her life a bit easier. While things are not fully in place yet, she’s working on developing a program for patients with late-stage heart failure. She told me that barriers to effective communication, both among the medical staff and with (and within) the families, remain, and are real challenges. In her frustrated words: “We all just need to talk to each other!”  

And when the clinical situation requires urgent critical input, those responsible for making decisions must be readily available (she had found that they are too often not). 

This reminded Poonam of a recurring scene from her childhood: As a trauma surgeon, her father usually took his “beeper” or pager with him everywhere. But if he was outside working on the lawn, he left it in the house.  When it beeped, when it summoned him, Poonam would quickly rush out to find her father to let him know that he was needed.  Her mother’s illness taught her a lot about the painful process of dying. He father’s dedication taught her something else. She carries both lessons with her as she waits to be needed.

Suggested Readings:

1. Boston University Staff. "How 9/11 Changed the World: BU faculty reflect on how that day's events have reshaped our lives over the last 20 years." BU Today, September 8, 2021. ("The fires of 9/11 continue to burn.")

2. Brown, Deborah X, RN, BSN. "Nurses and Preventable Back Injuries."  American Journal of Critical Care, September 2003, Volume 12, No. 5, p. 400-401. ("Disabling back injury and back pain affect 38% of nursing staff." The author recommends the use of a dedicated "lift team" for all total body transfers," to prevent potentially career-ending injuries.)

3. Strand, Jacob, MD, Mihir Kamdar, MD, and Elise Cary, MD. "Top 10 Things Palliative Care Clinicians Wished Everyone Knew About Palliative Care. Mayo Clin Proc.  August 2013; 88(8): 859-865. (#2: "Palliative care is appropriate at any stage of serious illness.")

By Anita Cherry 1/14/26

Odd cloud formation at Reservoir Park (Photo by SC)

Volume 1

Volume 2

Two volumes of collected stories are available in print.

Dr. Samuel Laucks: It's a Wonderful Life

I met Dr. Sam Laucks at the visitation before Dr. Eamonn Boyle’s funeral last summer. Some time later, my husband suggested that Sam might tell us his story. 

As the regular readers know, in some of these stories, the protagonists have escaped from suffocating Fascist or Communist totalitarian regimes or from frightening civil wars and widespread famine. In others, young men and women have left their families behind and traveled halfway around the world in search of more education and work. 

Dr. Laucks

In some, the trainees repeatedly faced hurtful, subtle, or even frankly blatant racial prejudice and hatred. In a few stories, the doctors suddenly became patients themselves, developing acute life-threatening illness requiring a helicopter trip to a university center or a swift gurney ride to the OR for extensive brain surgery. And so on. This story is not one of them.

In fact, quiet Dr. Laucks wondered how he got to be, in his words, “so unbelievably lucky.” 

Sam started out by telling me that he was “a local guy.”  He was born at York Hospital in the mid-1950s. He was delivered, he knew, by Dr. Robert Farkas. In the US, the cost of the delivery and five-day hospital stay would have been less than $200 (about $1800 in today’s money) compared to about $20,000 today. (Times have changed, noted Sam–his daughter couldn’t recall the names of the obstetricians who delivered her two children just a few years ago, and she didn’t think that was unusual.)

Family and Early Life

His family has deep roots in York County, and he grew up about five minutes from the hospital. Sam said that he had a “very good childhood” and “supportive parents.”  His attorney-father and his college-educated mother were both active in civic affairs. He considers himself fortunate to have grown up in these circumstances. 

Early on at York Suburban High School (frequently rated top in the county), he knew he wanted to go into medicine, so he spent the last two years there trying to think about how to make this happen. 

He is sure that several of his teachers paved the way for his success in college. At the top of the short list was his calculus teacher, Janis Snell. He recalled that she was very demanding and strict.  Since math was never really Sam’s subject, and he was in a college-level class, he got a C–the only C he received in either junior or senior high. 

But when he went to Ursinus College outside of Philadelphia (his father’s alma mater) as a premed Biology major, and most of his classmates struggled terribly in calculus, he breezed through with an A, and tutored his less well-prepared buddies. 

Ursinus College Campus (Credit: Ursinus College)

Sam also credits his high school biology teacher (for two years), Scotty Bickelman, for teaching him “how scientists are supposed to think,” and “how science works.” In the broad liberal arts tradition, he was taught how to think, not what to think. He was taught to think critically.

Medical School

Following Ursinus, he went to Thomas Jefferson Medical College. Though this originally wasn’t his first choice, it turned out to be the right place for him as the focus of the school was on the practical matters of actually being a physician, not a doctor who did research. He lived in Center City Philadelphia, and “it was fun.” And it was through his formative surgical rotation at the Catholic Mercy Fitzgerald Hospital in Darby (now affiliated with Drexel) that Sam met his wife, Jeanne, a nurse. 

Mercy Fitzgerald Hospital in Darby (Credit: Delco.Today)

Through medical school, he thought about doing general internal medicine or general surgery. He eventually chose the latter. When he graduated in 1981, after the urging of York surgeons Dr. Robert Davis and Dr. Thomas Bauer (who knew him through his volunteer work at the hospital), and after seeing for himself that all of the surgical residents in the nearby (academic) Penn State Hershey program looked unhappy, he returned home for his five-year surgical residency at the (clinically-oriented) large community hospital. 

Residency and Fellowship

York Hospital had just hired its first full-time program director of their surgical residency, the trauma surgeon Dr. Nikhilesh Agarwal. In the beginning, the training followed what might be considered the “apprenticeship” model.  In this, one or more residents worked with a single attending surgeon for a while and dealt with a variety of cases as they came along. For example, there might be a few simple inguinal hernias followed by a routine, uncomplicated appendectomy, but the next patient could need the complex, lengthy so-called Whipple procedure for pancreatic cancer.

This “real life” experience eventually gave way to a schedule whereby trainees started with the easy stuff consistent with their new skills and gradually learned the advanced techniques for progressively more demanding procedures. 

Dr. Laucks said that each approach to learning his craft has strengths and weaknesses, and he would not choose one over the other.

By his third or fourth year, one of the senior residents who was two years ahead of him mentioned the idea of specializing in the new field of dedicated colorectal surgery. Sam liked the concept and followed his colleague’s advice (and track) and did a one-year fellowship at the long-standing and well-regarded Ferguson Clinic in Grand Rapids, Michigan. 

View of Grand Rapids, Michigan (Credit: HBMAGAZINE)

Practice

He wanted to have a specialty, but didn’t want to give up general surgery, so when he came back to York, he joined William Shue’s solo general surgery practice. Having already worked with him as a resident, Sam thought very highly of Dr. Shue “as a surgeon and as a person.” Bill, noted Sam, cared about his patients, knew his own limitations, and had (that rare attribute of) “common sense.” His surgical outcomes were excellent, and he was “kind and generous.” The partnership worked out “wonderfully well,” noted Sam.

Dr. Shue

In time, Dr. Shue retired, and additional surgeons, including Dr. Tom Scott, Dr. Paul Sipe, Dr. Dan Henriksen, and Dr. Heather Thieme, joined the group. And as the business of American medicine evolved, the private group was folded into the large regional WellSpan Health System. There was always an easy camaraderie among the physicians in the group, and Dr. Laucks said that “over three generations,” nobody left the practice because they couldn’t get along. They all agreed on the important things. (Heather eventually left, but the reason was external.)

The members of the group all settled into their niche of what they liked to do and what they did best. Dr. Laucks told me that he was “not a natural when it came to being a technician.”  He soon recognized the critical importance of good judgment when it came to making decisions about surgery. As he said, “Not everybody needs an operation.” And the longer he was in practice, the more patients he turned down for surgery. He took the classic “First, Do No Harm” dictum very seriously.

Colorectal Cancer

As Dr. Laucks spent about two-thirds of his practice doing colorectal surgery (not counting colonoscopies), we talked a bit about colon cancer and the fact that while this has been mostly a disease of older age, it is now being diagnosed in younger people.

Colorectal cancer (CRC) is the third or fourth most commonly diagnosed cancer and the second most common cause of cancer-related death. About 10% are related to specific underlying genetic factors, while 90% are not, and are sporadic, and almost certainly related to environment and diet. It has been said that more than one-half of all cases and deaths are attributable to modifiable risk factors, such as smoking, an unhealthy diet, high alcohol consumption, physical inactivity, and excess body weight.

Risk Factors for Early-Onset Colorectal Cancer (Credit: Loyola Medicine)

Dr. Laucks told me that most (but not all) CRCs begin as benign polyps, and that their evolution to malignancy may often take about eight years. If polyps are found and removed early on, the risk of CRC goes down considerably (but not, unfortunately, to zero). 

Regular screening is important, and it now seems that this should begin at age 45 instead of 50.  Dr. Laucks still believes that routine colonoscopy (especially by an experienced, well-trained endoscopist) remains the best screening tool and is the gold standard. Not only are suspicious lesions identified, they are removed, and cancer is prevented. The at-home stool sample tests (including the FIT and Cologuard immunologic tests) are quite good and are getting better, but a colonoscopy is still needed if there are “positive” results (including those that are “false-positive”). 

Screening imaging (including a tiny swallowed camera that slowly makes its way down the long tube that is the GI tract) is getting better at finding suspicious lesions. But, again, the expert endoscopist is needed to biopsy or remove the growths.  

Since most CRCs grow slowly, being able to pick them up early, before they have spread, usually results in a cure.  Because symptoms of the developing cancer are often lacking or nonspecific, regular screening is highly recommended. 

You may ask, “Am I at risk for colorectal cancer?” I have read that one in fifteen men and one in eighteen women in the U.S. will be diagnosed with bowel cancer in their lifetime. The risk factors are complex and, as mentioned, include age, genetics, diet, and unclear environmental exposures. Suffice it to say that if you have a colon or a rectum, you are at risk.

Changes in Surgery

At this point, it should be noted that Sam’s practice of general surgery changed quite a bit over the decades. As a result of the remarkable advances in diagnostic imaging, his hard-won clinical skills of obtaining an accurate history and carefully examining the “acute abdomen” with his eyes, his ears, and his hands to determine if the belly needed to be opened have been made less relevant and nearly obsolete by CT and MRI (especially with the help of AI). Dr. Laucks freely admitted that “imaging is frequently better than the clinical exam.”  But he agreed that the personal exam by the surgeon supplies important intangible benefits for the anxious patient that cannot be measured.

Sam also noted that minimally invasive surgical techniques developed during his career, including laparoscopic and so-called robotic surgery, reduced postoperative pain and recovery times for patients. The first laparoscopic colectomies were performed in 1991, and robotic surgery of the colon using the da Vinci device (overcoming some of the intrinsic limitations of laparoscopy) was initially reported in 2001.   

Da Vinci Robotic-Assisted Surgery (Credit: Glasgow Colorectal Centre)

Retirement from Surgery

Dr. Laucks retired from the practice of surgery nine years ago, at age 62, three years after his group, White Rose Surgical Associates, was folded into WellSpan Health. By then, he had already cut back his hours and his on-call responsibilities.  Since then, he has been employed part-time at several WellSpan wound centers. He appreciates the expertise and support of the wound Care nurses whose hard work makes his job easy. 

He and his wife give their daughter’s two young children their “full attention” three days a week. And, staying busy, Sam does an “array of little things.” He plays the French horn in several local bands, and he (like his father) joined the ancient Freemasons fraternal organization, where he enjoys the diversity of meeting people from all walks of life and different religious and political perspectives. 

He said that he regularly reads The York Daily Record, The Washington Post, and The New York Times. He is saddened by the fact that widespread “bias and prejudice” are still very much with us, and not relegated to the distant past. He wondered why we don’t learn from history.

And, curiously, remarkably lucky Dr. Samuel Laucks, a semi-retired colorectal surgeon whose life story so far contains no major obstacles or mishaps or wrong turns, confesses that he is sometimes prone to complain “about the minor nuisances in life.” He even admits that while his benign grumbling is a bad habit, it can sometimes be (tongue-in-cheek) one of his “favorite pastimes.”  Nevertheless, he noted, with true sincerity, that he is “grateful to have been so abundantly blessed with a wonderful family, wonderful friends, wonderful colleagues, and with a fulfilling personal life and a successful professional career.” No drama required. 

Suggested Readings:

1. Cope, Zachary (revised by William Silen). Cope's Early Diagnosis of the Acute Abdomen, 21st Edition. Oxford. Oxford University Press, 2005. (Still essential reading, focusing on the history and physical examination of the patient with acute abdominal pain, but going beyond that.)  

2. Pitiakoudis, Michail et al. "Artificial Intelligence in Colorectal Cancer Screening, Diagnosis and Treatment. A New Era." Current Oncology, 2021, 28, 1581–1607. (An in-depth article that I could not understand at all, whose conclusion is: "Computer-aided systems can provide physicians with assistance in detecting and diagnosing precancerous lesions or early-stage CRC. Several novel algorithms have shown promising results for the accurate detection and characterization of suspected lesions.") 

3. Rex, Douglas et al. "Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer." American Journal of Gastrenterology, 2017 July; 112(7), 10161030.  ("The first-tier tests are colonoscopy every 10 years and annual fecal immunochemical tests." Colonoscopy is offered first, and FIT should be offered to patients who decline colonoscopy.)     

4. Zhang, Jiaxin et al."Colonoscopic screening is associated with reduced colorectal cancer incidence and mortality: a systematic review and meta-analysis." Journal of Cancer 2020; 11(20); 5953-5957. (Colonoscopy was associated with a 52% reduction in the incidence of CRC and a 62% reduction in mortality.)

By Anita Cherry 12/20/25

Two Tulips (stained glass by Anita)

Volume 1

Volume 2

Two print volumes of collected stories are now available.

Dr. Andrews-Murray: "Better is better."

Gayle

Dr. Gayle Andrews-Murray’s grandparents were Christian immigrants from Zahlé, Syria. Her grandmother was pregnant and had two toddlers with her when she boarded a ship heading to Vancouver to be with her family. She left a daughter in Syria to be cared for by her grandparents; the plan was to send for her later. Sadly, her grandmother’s two young boys and the baby (also male) died during the long and difficult voyage across several oceans and were buried at sea. While in British Columbia, she had four more children, all girls. 

Gayle’s grandmother died young, possibly from a gynecologic cancer, and six months after her passing, her grandfather died suddenly while running for a bus. The four girls were now orphans. They were sent to live with an uncle and his son. When old enough, one of the girls, destined to be Gayle’s future mother, joined the Canadian Air Force. 

The young girl was in El Paso visiting a friend from her military experience when she went on a blind date with a soldier from Fort Bliss. Wasting no time, the two were married two weeks later. They were together for fifty years before Gayle’s mother passed away with ovarian cancer. Her father (as of 2025) is 97 and is stubbornly still living by himself in Las Cruces, New Mexico; Gayle and her husband, Dr. Richard Murray, visit him often. While there, they sometimes enjoy a hike in the mountains.

Organ Mountains, Las Cruces, New Mexico (Credit: Loree Johnson)

(Her father lied about his age when he joined the Army at 17, and fought in Japan and twice in Korea, so Gayle is not quite sure how old he really is.)

Gayle’s father came from a family of twelve, nearly all boys. They lived on a farm in Oklahoma. Life wasn't easy. His mother had married at thirteen and had her first child at sixteen. Her first husband died in the 1918 flu pandemic, the second died in a tractor accident, and the third became Gayle’s paternal grandfather. 

Growing up in Texas, Gayle (she now knows) was a so-called FLK, the pediatrician’s affectionate acronym for a funny-looking kid, a child whose physical appearance suggests genetic health issues. Gayle had, in her words, “skinny, flat, and long feet,” and it was difficult for her mother to find shoes that fit her daughter properly. And, as a child, “the girl with the skinny legs” was often sickly and anemic. There was no medical explanation for this at the time, and satisfying answers wouldn’t be found until many years later (as we will see). Nonetheless, she had to adapt, to cope, without knowing why she had so many physical problems. She said that she read “the encyclopedias” in her search for answers and that this quest fueled her academic interests.

(Days after the interview, as I was “in the flow” listening intently to the recording, I was interrupted by a text from Gayle. Deeply absorbed in the engaging activity, I did not want to stop, but I paused to read the message. It turned out that the little girl who was left behind in Syria became a Catholic nun. She petitioned the Pope to allow her to travel to Canada and the U.S. to meet the family she never had the chance to know. Her petition was granted, and while here, she stayed with Gayle’s family for six weeks. After this, the family received letters from her–handwritten in Arabic and translated first into French and then English–for some years.)

Back to Gayle’s story. In college, she walked into a ballet class. It looked interesting, but it was full. The teacher asked her to jump as high as she could. She did that and showed her flexibility. The teacher quickly said, “Okay, you’re in.” Gayle said that, in her mind, she was just “extremely limber.”

When she was the first in her family to graduate from college, she wanted, she said, “to help people,” but she wasn’t sure what she would do to accomplish that. She had not actively thought about going into medicine until a medical school opened in Ciudad Juárez just across the Rio Grande in the state of Chihuahua, Mexico. Hearing about this, Gayle innocently thought to herself: “Huh! Maybe I’ll do that!”

Ciudad Juárez (Credit: world wonders)

So she went to the Universidad Autonoma de Ciudad Juárez and learned human anatomy and physiology and other subjects–in Spanish. She enjoyed studying there for a year and a half before she decided to transfer to an American school for her medical degree--in English. 

So she applied to several U.S. medical schools. She was accepted to Chicago Medical School, but she felt that she “couldn’t do” the windy, cold weather of the Upper Midwest after having been adapted to the hot desert of El Paso. When she got into Medical College of Pennsylvania (MCP)--formerly Women’s Medical College of Pennsylvania until becoming co-ed in 1970, when it first accepted a few men–she thought: “Maybe I could do Philly.”

MCP (founded by Quaker men in 1850 as the first medical school in the world for women) it would be. By the time Dr. Andrews-Murray graduated four years later (in 1983), the gender split at the school was 60/40 in favor of women. When it was time to pick a residency, she chose to stay at the college. It turned out to be a good decision. You see, as an intern in the internal medicine program, one of her supervising residents was Dr. Richard Murray. He had been dating her girlfriend, and when she left MCP after graduation, Gayle, in her words, “moved in.” (Rich, as we have seen in a previous story in the series, remembers things differently.)

MCP class of 1891 (Credit: vintage everyday)

After MCP, Rich went to the University of Maryland for his fellowship training in Pulmonary and Critical Care. By then, he and Gayle were engaged, so she joined him there. While she was in medical school, she had been greatly influenced by the renowned diagnostician and endocrinologist at MCP and the Philadelphia VA, Dr. Francis Sterling (1934-2015).  Partly as a result ot this, Gayle decided to do a fellowship in Endocrinology, Diabetes, and Metabolism under Dr. Thomas Connor in Baltimore.

During her training, she met endocrinologist Dr. Francine Camitta. Dr. Camitta had also been a Fellow at the University of Maryland with Dr. Connor and was practicing in York. She often came back to Baltimore to present interesting cases to her former (and, as we will learn, future) colleagues. 

While Gayle and Rich were in Baltimore, “two boys came along,” she said. But having children did not come easily. Early on in the marriage, when conception did not happen, she saw a fertility specialist. She was diagnosed with extensive endometriosis; seven hours of delicate surgery allowed her to conceive. But with the first pregnancy, she had pre-term labor and was in the hospital for two months. She spent a week in the hospital waiting for her second son, but only needed medication to successfully carry the third. 

While doing her three-year fellowship and raising two sons, Rich was in private practice and an attending physician at the university in downtown Baltimore. The family moved from an apartment outside the beltway to the city near the old Memorial Stadium. But as the neighborhood became progressively more dangerous, Gayle knew they had to move. 

Memorial Stadium (Credit: Historic American Buildings Survey)

Dr. Camitta offered Gayle the option of practicing with her in (much safer) York. Gayle liked the idea and convinced her husband to consider leaving Baltimore and heading north. After a bit of coaxing, he agreed and joined the staff at York Hospital to develop a Critical Care program. He was very busy, had no real coverage, and, according to Gayle, “worked hard all the time.”   

(Many times, sitting across from Gayle as she told me her story, the connection was easy and open, and I momentarily forgot that she was a doctor.)

Frannie and Gayle were able to do private practice endocrinology and diabetes medicine together for a while, but as it became “harder to pay the bills” (without a lucrative “procedure” to supplement the office fees), they joined the nascent WellSpan Medical Group as the first subspecialty practice under contract. (The hospital needed to have an endocrinologist on staff to have an accredited Internal Medicine residency.).  

Dr. John Bobin

In time, Gayle’s third son came along, and she took time off for a few years to attend to her young family. When she returned to practice, she wanted to be able to work part-time with endocrinologist Dr. Bruce Williams (Frannie had retired by then), but there was no part-time position available.  What would she do? She was relieved when Dr. John Bobin offered her work with his primary practice internal medicine group (with Dr. Leon Gibble and Dr. Chris Due). She could work part-time as a general internist, she said, and “do endocrinology on the side.” Dr. Bobin was, in her words, “a great mentor” as she delved into doing primary care for the first time. 

After Dr. Bobin left the practice for a fellowship in cardiology, Gayle moved on. By then, she was able to go part-time with WellSpan, mostly taking care of complex patients with diabetes.   

She took a hiatus from practice in 2006 when there were twelve surgeries in the family. Dr. Andrews-Murray said she used this time “to take care of everybody” and herself.  When she was ready to return to medical practice, Dr. Oscar Murillo, who had formed a multispecialty group in Hanover, recruited her to be their endocrinologist. He was “a wonderful mentor and wonderful to all his patients,” said Gayle. 

And by this time in her career, Gayle had developed an interest in reversing or even preventing diabetes rather than treating the late (and mostly unfixable) complications. She said that studies were being reported showing that early treatment with comprehensive lifestyle changes and substantial weight loss could allow the metabolic disorder to regress or disappear altogether. 

Dr. Oscar Murillo

Dr. Andrews-Murray was able to obtain a grant from a pharmaceutical company to enroll suitable patients in a program to attempt just that. Working in this “metabolic wellness center,” as she called it, she was assisted by a capable Ph.D. Nurse Practitioner. Gayle greatly enjoyed this and said that it was the most fulfilling time for her. All of the patients were motivated employees of the (self-insured) Hanover Hospital Group, and the team was often successful in getting patients to change their eating patterns and lose ten percent or more of their body weight. With this, their lab numbers and their overall health improved. Gayle did this for three years, but the program closed when the grant money dried up. 

As an example of the approach to promoting healthy habits through understanding, Gayle pointed out that “a carb is not a carb.” There are simple and complex carbohydrates, and the metabolic effects of each are different and vary according to what they are eaten with, what time of day they are consumed, and what you do after eating. 

The glycemic index (introduced in 1981 and rating the effects of carbohydrates on a scale from 0 to 100) is a measurement of how quickly blood glucose rises after a specific food is eaten. If the index is high, the blood sugar rises very quickly. This is met by a vigorous outpouring of insulin from the pancreas to bring the (damaging) excessive glucose down and store it (for later use). But the blood glucose can then fall too low, resulting in counter-regulatory hormone release (including cortisol and adrenaline) with intense hunger (for more carbs) and fatigue about two hours after the meal. More carbohydrates are consumed, and the cycle continues. 

To avoid the harmful spikes in blood glucose and high levels of insulin that follow a carb-laden breakfast, and that contribute to the development of insulin resistance leading to (among other maladies) diabetes, the metabolic syndrome, fatty liver, and cardiovascular disease. Dr. Andrews-Murray firmly recommends a routine of “no carbs before noon.” And she told me (hang on…) that “cold cereal in the morning is the worst time and the worst food you can eat.”  If you must have it, she said, “eat it at lunch or dinner,” (when the body deals with nutrients differently, in accordance with the intrinsic circadian rhythm characteristic of all life on Earth).

 Idealized blood glucose curves for foods with
different glycemic indices (Credit: marleydrug.com)

And always choose minimally processed cereals made with whole grains and with little or no added sugar. Pairing the carbs with protein or fat can also even out the rise in glucose. Healthy eating should become a positive habit, a routine — ideally, one started in early childhood. But Dr. Andrews-Murray noted that, as a beginning, simply changing a patient’s breakfast regimen can result in clinically meaningful weight loss. As she says, “better is better.” 

(Taking a walk or doing a few squats or calf-raises, or going to the gym after a good breakfast of bacon and eggs, also helps smooth out unhelpful metabolic fluctuations.)

As Dr. Andrews-Murray took care of patients in Dr. Murillo’s clinic in Hanover, everybody in the small cohesive group (all of the patients were employees of the hospital) had “a  wonderful time.” She was, noted her husband, “excited” about how well her patients were doing. But after the grant money ran out and the hospital was acquired by UPMC (the huge healthcare system based in Pittsburgh), Dr. Andrews, she said, “had to move on.” Reflecting, she felt that this project was the “apex” of her career in medicine. 

So Gayle retired from practice in 2017. And in 2025, eight years later, her careful scientific approach to treating and maybe preventing diabetes and its complications has become mainstream. She noted that it was discussed on "60 Minutes" (in October) when Dr. Peter Attia, best-selling author of Outlive, was interviewed about his comprehensive program for preventing or delaying many of the infirmities of old age. 

Dr. Andrews-Murray lamented that many of the antidiabetic medicines she prescribed for her patients had troublesome side effects and did nothing to reverse the disease. She said that drugs like Ozempic (FDA-approved for type 2 diabetes in December 2017) are “very, very effective” and she would have “loved to have been able to use them” in her wellness clinic. However, she has some concerns about the adverse effects of these GLP-1 receptor agonists. Many patients experience nausea and vomiting with delayed emptying of the stomach. There may be significant muscle and bone loss, and there is the risk of nutritional deficiencies.  And, rarely, some patients have had dangerous inflammation of the pancreas or ischemic optic neuropathy with potential blindness. 

As noted above, Dr. Andrews-Murray had taken some time away from practice partly for her own health issues. As she was seeing Dr. Peter Rowe at the Johns Hopkins Ehlers-Danlos Syndrome (EDS) Clinic, and (among other things) showed him that she could touch her thumb to her forearm, he definitively diagnosed her as being on the hypermobility syndrome spectrum. Her findings were subtle and were easily overlooked by physicians for years (not uncommon in this hereditary but variable condition). 

Classic simple example of hypermobility
(Credit Franklin Cardiovascular Associates, PA)

The validation that her many physical complaints through the years could be understood as due to a named disease and were not, as some claimed, just in her head, and the result of stress, provided her with the hope that there might be treatment. And simply knowing the diagnosis was remarkably reassuring and empowering.  (EDS has been discussed in Dr. Mark Lavallee’s story earlier in this series about doctors, and this is worth reading.) 

So, many of the problems Gayle has dealt with, including the allergy-like mast cell activation syndrome, inflammatory rheumatoid arthritis, the anemia and neuropathy of B12 deficiency, an underactive thyroid, areas of hair loss, and maybe even the extensive endometriosis that resulted in infertility, can be traced to her faulty hereditary disorder of connective tissue. 

Though she was often tired of going to doctors in the past, and missed many visits, she is on top of things now and has willingly gone for screening tests to identify small problems (such as minor aneurysms) before they become big ones.

But EDS and its complications would not be the only health issues Dr. Andrews-Murray has had to endure. After she and her pulmonary specialist husband attended a medical meeting and sat around a table with his weary colleagues, everyone (are you ready for this?) developed COVID-19. Everyone. She responded to Paxlovid at first, but relapsed and was even sicker. She then developed a post-COVID syndrome (sometimes called long COVID) with prolonged cognitive and speech trouble. And fatigue. (The precise cause--or causes--of this remain unknown, but autoimmunity is suspected to play a major role.) 

Gayle needed eight months of cognitive therapy and physical therapy, and eventually did well. But she still copes with intermittent brain fog and mental fatigue. And when she had a second bout of COVID after flying out west to see her father, her rheumatoid arthritis flared up. 

On a lighter note, Gayle’s three sons, without specific encouragement from Gayle or Rich, chose to go into medicine. One of them is in a serious relationship with a woman physician. So, at some point in the future, there might be six doctors in the family. Maybe even more. Who knows? 

To close, an interesting connection across time and space:

One of Gayle’s close colleagues when she was with WellSpan was Dr. Rita El-Hajj. Rita is from Beirut and now practices endocrinology in Wynnwood, just outside of Philly. Her parents were visiting from Lebanon, and Gayle and Rich were invited to meet them. They said they were from Zahlé — the very same city where Gayle’s ancestors had lived when it was still part of Syria. Rita’s parents knew Gayle’s family and told her there was a statue of Gayle’s great-great-grandfather there — he was a doctor. 

Suggested Readings:

1. Attia, Peter M.D., with Bill Gifford. Outlive: The Science & Art of Longevity. New York: Random House, 2023. (An in-depth plea and detailed outline for what he calls Medicine 3.0, the idea that chronic illness can and should be prevented rather than treated. A big book of 470 pages, but essential reading.)

2. Duhigg, Charles. The Power of Habit: Why We Do What We Do in Life and Business. New York: Random House, 2012. (Recommended by Gayle after our interview. Quoting William James, Duhigg wrote: "Habits are what allow us to 'do a thing with difficulty the first time, but soon do it...with hardly any consciousness at all.'" p. 273)

3. Hideaki Oike, Katsutaka Oishi, and Masuko Kobori. "Nutrients, Clock Genes, and Chrononutrition. "Curr Nutr Rep (2014) 3:204–212. ("Because the circadian system organizes whole energy homeostasis, including food intake, fat accumulation, and caloric expenditure, the disruption of circadian clocks leads to metabolic disorders." p. 204)

  

By Anita Cherry 11/14/25

"POTS" by Anita, charcoal on paper, Baltimore, 1983

                                             

Volume 1

Volume 2

Two printed volumes of collected stories are available.

Dr. David Gilbert: Cardiologist On His Own

 

Dr. David Gilbert

On an early morning drive to one of our favorite hiking spots, we saw a large roadside billboard announcing Dr. David Gilbert’s private cardiology and vascular practice. My husband knew Dr. Gilbert, but was unaware of this new venture. Would he want to give us his story? Maybe. 

After we passed the smiling image of him again, we contacted him to ask. “Sure,” he quickly said. So we sent him the address of the website containing more than fifty prior doctors’ stories. 

A few weeks later, not having read any of the narratives (he was busy, he said), Dr. Gilbert showed up for the interview. Despite not knowing what to expect, what others had said, and what was written about them, he seemed relaxed and confident.

David said that he was born and raised in a “lower middle class” community in blue-collar Dundalk, Maryland, a planned close suburb of Baltimore. Nearly all the men (and many of the women) worked for giant Bethlehem Steel. The work could be dangerous, but it was steady. 

Worker near blast furnace at Bethlehem Steel,
Sparrows Point, 1951
(Credit: HumansAreMetal)

His Parents and the Family

Dr. Gilbert said that his parents were from “broken homes.”  His dad’s father “ran off” early, and his dad’s mother spent 14 years (yes, years) in a TB sanatorium. So his father was “passed around among family members,” and he was only 16 when he and David’s mother (then 15) were married.

They had six children, three boys and three girls. So, at one point, eight people lived in a house of about 2,000 square feet with one (that’s one, as in uno) bathroom. As his father worked in the steel mill, his mother took a job as a (stern) school crossing guard in the inner city. 

David said that his parents “were great.” His mother was “tough” but good, while his father, his “hero,” was simply “a good, good human being.” Dr. Gilbert told me that he appreciates the many invaluable lessons he picked up from the hard-working individuals of his childhood environment. There could be, he noted, profound wisdom about life without the need for a formal education.  If the family was on the poor side, he didn’t feel that at all.

As a kid, he was, in his words, “preoccupied with sports.” In football, he was one of the best players (as he quarterbacked for bad teams), but baseball was his true “passion,” and he admitted that he was a pretty good all-around ball player. As he was preparing to graduate from Dundalk High School, he didn’t know what he wanted to do, “to avoid getting into trouble.” You see, nobody at his school, including the so-called guidance counsellor, talked to him about college. You might take that route for sports, but never for pure academics. So David was slightly adrift.

Dundalk High interior (Credit: David Robert Crews)

The Navy

Since he enjoyed being challenged physically, six months after graduating, at the age of 18, he joined the Navy.  He wanted to be a special-ops, highly-trained Navy SEAL. In his (adolescent) mind, “knocking off third-world dictators wouldn’t be a bad job.”

(Credit: med.navy.mil)

He heard that one of the best ways to improve your chances of getting into the SEAL program was to start as a Navy Corpsman, where he would learn how to provide medical care for Naval and Marine personnel. The job required academic and physical skills, and he went for it. As a Corpsman, David moved around, and when he was assigned to the Great Lakes Naval Hospital in Illinois, he worked in an ICU.  It was here that he “fell in love with medicine.”  He saw firsthand that you could take somebody who was at the brink of death and return them to a good life. He wanted to be a doctor like that.

(What about his dream of being a SEAL? Well, nobody had bothered to tell David that he needed to have perfect 20/20 vision to qualify for the program; his eyesight was 20/200. Enough said.) 

So, as he fulfilled his Naval obligations around the country (sometimes moonlighting as a respiratory therapist), he took enough college courses to allow him to apply to medical school without having an undergraduate degree. (He had plenty of  credits, just not enough of the ones that York College, where he took his final courses, accepted for a degree.)

Medical School at PCOM and Early Practice

At this point, Dr. Gilbert noted, by the way, that his brother Tom, ten years older than him, and “a tremendous brother” who always tried “to do the right thing,” was an osteopathic ER physician. So when it was David’s turn to go to medical school, he followed his brother’s example and attended the Philadelphia College of Osteopathic Medicine (PCOM) on City Avenue, just off the always-busy Schuylkill Expressway. 

Mid-1990s campus overhaul of PCOM (Credit: PCOM)

Because of his years in the Navy, he entered medical school at 28. As an older, motivated student, he was “incredibly dedicated” to his studies. He had an “overwhelming fear of failure,” but he did well and graduated in 1998 at 32. Dave then did a three-year medical residency at Memorial Osteopathic Hospital in York. 

While in training, he wanted to specialize in cardiology, but by 35, he was “out of gas” and (in his words) “tired of being poor.” So he put aside his lofty ambition and joined a group private practice in York, Internal Medicine Consultants. The practice was busy, and he did inpatient and outpatient work for seven years. During this time, he met his wife, Tiffany (more on her later).

Time for a Heart and Vascular Fellowship

And by age 42, Dr. Gilbert was reenergized enough to look for a cardiology fellowship. By then, he had developed a special interest in peripheral vascular work.  He had taken care of amputees whose legs might have been salvaged with skilled intervention that was not readily available in York. He wanted to change that.

He was offered a position at the Deborah Heart and Lung Center in New Jersey. He was aware that they focused on peripheral vascular disease as well as heart disease, and he liked that, as he could bring back something of value to the region, should he stay. For more than three years, he commuted more than two hours each way daily in order to be with his family. He felt that being an older “non-traditional student“ was a benefit.  (Deborah was founded in 1922 as a small TB sanatorium to allow patients--regardless of their ability to pay--to get away from New York City for the healing fresh air of New Jersey.)

Philanthropist Dora Moness Shapiro founded Deborah in 1922
(Credit: Deborah Heart and Lung Center)

Dr. Gilbert spent about a third of his clinical time doing peripheral vascular work. His world-renowned mentors in this area included Richard Kovach, M.D., and Jon George, M.D., both of whom, according to Dr. Gilbert, are “tremendous critical thinkers.”

Time for a bit on peripheral vascular medicine, impaired circulation in the legs:  

Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis. Modifiable risk factors, including cigarette smoking, dyslipidemia, diabetes, poor diet quality, obesity, and physical inactivity, (and these), along with underlying genetic factors contribute to lower extremity atherosclerosis. Patients with PAD often have coexistent coronary or cerebrovascular (disease), and (an) increased likelihood of major adverse cardiovascular events, including myocardial infarction, stroke, and cardiovascular death,” (Bonaca, p. 1868).

And:

While LDL-lowering statins are not for everybody, there is underuse of statin therapy in patients with PAD. These medicines have “demonstrated a strong, intensity-dependent effect on amputation and mortality.. (and) cardiologists, primary care physicians, insurers, and other care providers need to do a better job in helping both our colleagues and our patients understand the importance of these medications in preserving both life and limb,” (Aday, p. 1449).

Back to the story:

Dr. Gilbert and his wife considered going south after he would complete his training in the Mid-Atlantic, but as he was a bit into his fourth year at Deborah (the year of interventional work), he received an unexpected call from the small Hanover Hospital, thirty miles west of York. They wanted to develop a cardiac program.

Developing a Cardiac Program

Staying in the area where his wife’s parents lived would foster close extended-family ties, and this appealed to Dr. Gilbert and Tiffany. So he accepted the challenge to build something for the community. Since this was not to be an interventional program, David chose not to finish his fourth year at Deborah. 

Dr. Bridenbaugh

In 2011, about 12-18 months into the new Hanover venture, things were going well, and the administrators changed their minds; they now wanted to offer full interventional services. Obliging, Dr. Gilbert returned to New Jersey to finish the fourth year of his fellowship.  And in 2013 or 2014 (David couldn’t recall the exact date), having racked up lots of miles commuting while listening to cardiology tapes, Dr. Gilbert and local cardiologists Dr. Larry Freer and Dr. Alan Bridenbaugh joined to provide their patients with some of the latest technical advances in heart and vascular care. Acutely ill patients no longer had to wait to be transferred to a large medical center to receive life-saving and heart muscle-preserving stents.

The interventional program quickly became successful, and they expanded from three physicians and a nurse practitioner to a professional staff of 21. They went from doing 100 cases a year to 1600 yearly, all while trying, in David’s words, “to do everything with an ethical and moral perspective.” The aim was to do things “for the right reason and in the right way,” and “not just to do cases and make money.”  

In 2016, Dr. Gilbert, having lost two young patients to acute pulmonary embolism (PE), added another type of procedure to what he had to offer: he learned to remove the deadly, thick blood clots from the lungs that were severely compromised by PE. And, turning to the usual source of the clots, a deep vein thrombosis (DVT) in the legs, he learned to pull them out to prevent the troublesome late complications (swelling, pain, tiredness, and skin changes leading to poorly-healing sores, or ulcers) that were not avoided with use of anticoagulants alone (the standard approach).

When UPMC/Pinnacle took over the Hanover Hospital and Memorial Hospital in York as the Pittsburgh-based health system expanded into the York area, Dr. Gilbert became the Medical Director for both cardiac programs. He was busy. But, after a while, he became, he said, “disenchanted with corporate medicine.”  While he had a lot of responsibility, he had virtually “no say” (when it came to institutional decisions). 

UPMC Memorial (Credit: jeffreytotaro 2019)

Disallusioned 

He was asked to do things (such as to recruit a heart surgeon), but was not invited to the meetings where the final decisions were made (e.g., there would be no surgery). He tried, but could never meet with anybody at all. He saw that the (Pittsburgh) people in charge didn’t understand the nature of the small community they had stepped into. In time, it was too much for Dr. Gilbert to accept. He was paid handsomely, but money was not enough to ease his conscience. He was 58 and could just walk away from medicine altogether, but “it didn’t feel right” to do that. 

(Confirming his suspicions about the administrators and their relationship to the practicing physicians, they made no effort at all to retain him after he told them he was bowing out. You see, he was, he felt, just “a replaceable cog” in a vast impersonal machine.

A scene from Modern Times (1936) (Credit: Roy Export SAS)

So David decided to do the nearly unthinkable in the current climate and start a private practice. He knew how things worked, and he had built a full program before, but this would be his own, and he could adhere to his strong ideals of being, as he said, “a devout Christian.”

He chose to practice medicine in such a way that he would have peace of mind. He realized that he would have a substantial cut in  income at first, but Dr. Gilbert said that he doesn’t lose sleep over money or anything.” He said that money itself is meaningless to him (as long as he doesn’t repeat the time in his twenties when his electricity was shut off).

Return to Private Practice

But building a modern (and viable) medical practice while being hemmed in on all sides by corporate healthcare giants with loads of cash would be a real challenge. After serving the York and Hanover areas for years, people knew of him and his work, but he was aware that word of mouth alone wouldn’t assure success. He had to create a reliable referral base. 

Dr. Green

As he provided the advanced heart and vascular services, he would not be alone. Dr. Gilbert has brought on a respected podiatrist (as peripheral vascular problems usually show up in the feet first), an older but energetic and wise general surgeon, John Green, D.O., to do wound care (as poorly-vascularized tissues heal very slowly), and a seasoned nurse practitioner (filling the somewhat surprising need for additional primary care services).  Dave tried to convince a graduating resident to join him, but the wary resident chose the system instead, the seemingly safer option.

This brings us to a special integral part of his team, his wife Tiffany, who runs the practice. She has a doctorate in Natural Medicine, focusing on traditional herbal and nutritional remedies, manual therapies, and homeopathy. She follows a holistic (i.e., a mind-body-spirit) approach. Dr. David Gilbert, trained in osteopathic as well as allopathic medicine, also believes strongly in the importance of caring for the whole patient, not just their individual parts.  

He said that in his practice, his “security is rooted in doing the right thing.” And he said that  he needs to know that he did what he could, and that he “made a measurable difference in the world.” As noted, Dr. Gilbert was disillusioned as he saw up close that the prime motive of corporate medicine appeared to be financial profit, so the decision to break away from that model wasn’t totally unexpected. 

Moral Injury

It has been claimed that physicians leave medicine altogether, or change jobs (looking for something less stressful), because they are “burned out.”  It is said that they are mentally and emotionally exhausted by the workload and that they need to learn how to cope better, that they are just not strong enough, not resilient enough. It has been suggested that the stressed-out doctors should do yoga, or meditate, or splash on some lavender oil to cope better. Maybe what is needed is a Chief Wellness Officer. But brief research told me something else. 

The real problem, according to psychiatrist Wendy Dean and others (writing in 2019, before the Covid-19 pandemic), is that our healthcare system creates moral injury. Accordingly, she notes: 

Moral injury occurs when we perpetrate, bear witness to, or fail to prevent an act that transgresses our deeply held moral beliefs. In the health care context, that deeply held moral belief is the oath each of us took when embarking on our paths as health care providers: Put the needs of patients first. That oath is the lynchpin of our working lives and our guiding principle when searching for the right course of action. But as clinicians, we are increasingly forced to consider the demands of other stakeholders— the electronic medical record (EMR), the insurers, the hospital, the health care system, even our own financial security—before the needs of our patients. Every time we are forced to make a decision that contravenes our patients’ best interests, we feel a sting of moral injustice. Over time, these repetitive insults amass into moral injury. (Dean, p. 400) 

As Dr. Gilbert, I believe, sensed that creeping moral injury, he did something about it. He bemoans the current general societal “lack of empathy for our fellow human beings.”  And he believes strongly that there is “not as much compassion as there used to be.” (Recall that empathy is feeling what others feel, and compassion is that, plus taking action to relieve their suffering.) He reminds his three sons to think of others before they think of themselves, and that they are the least important people in the room. David has “complete disdain for selfishness.”

Back to Family

When he’s not doing for others, how does he spend his free time?  He doesn’t play golf, or fiddle with cars, or play video games, or whatever. He simply said he “hangs out with family.”  David and Tiffany’s first son (Carson, currently a junior at Liberty University) was adopted from Guatemala. His adoption was followed (of course!) by “natural” (fraternal) twin brothers (Grant, an ice-hockey athlete, and Tate, an aspiring actor). Dr. Gilbert revels in watching them mature. Family is very important, and he credits his capable wife for how well the boys have turned out (though I think he has had something to do with it).

And just to remind us that life is short and should be savored, when my husband and I went back to our hiking spot recently, the billboard sign for Dr. Gilbert’s medical practice was replaced by one for a new local family-run funeral home.

References:

1. Aday, Aaron W., MD, and Everett, Brendan M., MD. "Statins in Peripheral Artery Disease: What Are We Waiting For?" Circulation. 2018;137:1447–1449.

2. Bonaca, Marc P., Hamburg, Naomi M., Creager, Mark A. "Contemporary Medical Management of Peripheral Artery Disease." Circulation Research. 2021;128:1868–1884. 

3. Dean, Wendy, MD, Talbot, Simon, MD, and Dean, Austin. "Reframing Clinician Distress: Moral Injury, Not Burnout." Federal Practitioner, September 2019.

4. Trzeciak, Stephen and Mazzarelli, Anthony. Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference.Studer Group. LLC. Pensacola, Florida, 2019.  Exhaustive compendium of scientific and observational studies making a strongly reasoned argument that compassion for others always benefits the giver as well as the receiver. (But awareness of that mystery is ancient knowledge that has to be continually rediscovered.) 

By Anita Cherry 8/17/25

Ballet Class at the Downtown York JCC
(Chalk sketch by Anita, 1986)

(The first collection of these stories is available in book form:  York Doctors: Their Stories Vol. 1)