Sharon Scott, M.D.: Fearless Compassion

Sharon Scott, M.D.

Her mother delivered a fourth child, a boy. Melvin seemed perfectly normal at birth, and everyone was happy as his early development progressed as expected. He crawled, and he learned to sit. But at six months of age he began to have minor seizures followed by repeated violent convulsions. While the family watched, Melvin lost motor control, lost the ability to sit; his behavior steadily deteriorated. As a result of the unnamed neurological disorder he failed to develop. He was unable to feed himself, unable to walk, unable to gesture, unable to speak; he could not communicate at all.

The neurologist in Montreal, ten hours away, told her mother that while all of her children will have worries and stresses in life, “this child will always be happy in his own world.” Those generous healing words stuck with, and sustained, the family.

Of Melvin’s three siblings, the eldest, by virtue of her position in the family, stepped in to help her mother take care of him. Untrained in medicine, and living in a small town far north of Montreal, her mother was forced to teach herself nursing and doctoring to care for her fragile son. As she lovingly treated him, her daughter watched closely. 

Dr. Sharon Scott is that daughter and sister whose childhood was not what one would have expected, and who "got up at six o'clock in the morning and took great pride in helping Mum with Melvin, and got two hours of housework done before going to school." She noted that her younger siblings, Gary and Lynn, played their roles as well, and Dr. Scott remains close to them.

Noranda Copper Mine, Murdochville
(c/o Bob Anderson)

In Murdochville, a far-eastern Quebec copper-mining town of 4,000 then, the frigid winters lasted until April. Not everybody went to university then, and “nobody” (yes, really, nobody) went on to study medicine. While her mother raised the family her father “worked from morning to night.”  He was “driven and highly-motivated, and taught himself everything. He built a construction company, and did very well," Dr. Scott said, with obvious respect.

She did well enough, herself, in school, and enjoyed sports and student council, but had “trepidation” about going to college, about leaving her family, leaving her mother and her brother. She was attached to him. Choices. What to do? 

Dr. Scott noted that “in the early 1970s women were teachers or nurses.”  She applied to nursing school at John Abbott College in Montreal. She went there, and graduated. ”This totally changed me," she said, as she, for the first time, “became interested in studying and learning.”

The new Manitouwadge Hospital

She was now 21, and good local nursing jobs were hard to come by. She moved to another small mining town, this time north of Lake Superior in northern Ontario. She worked and learned at the tiny Manitouwadge General Hospital. When on night shift there were no doctors around and she was the only nurse in the hospital as she and an aide were on their own.  Reflecting on that experience, she said, "Looking at the moon as I drove to work, I would pray to God that the night would go well. I was utterly terrified. I wondered if I had the skills to take care of the patients by myself.” 

At night she managed deliveries by herself. She watched babies die with SIDS. She administered CPR. Some patients lived, and some died. She washed the bodies of the deceased, dressed them in burial shrouds, and placed the “toe tags,” before slowly sliding the morgue drawers closed. At times, she was “absolutely petrified.” 

When she later on accepted the position as public health nurse (a job for which she, of course, had not been specifically trained) she had to travel to the nearby “Indian reservation,” and she needed an armed police escort; there was a lot of abuse in this poor under-served native community, she explained, and it  could be dangerous.

As I heard these words, I wondered, “Who would choose to continue to do nursing under those conditions?” Her calm reply: ”You did what you had to do.” Yes, you did what you had to do.

But she needed to know more, and she dreamed of getting a university degree. So she took a few correspondence courses before moving to Hamilton, Ontario, to attend McMaster University for a B.S. in nursing. While there, she studied International Health with Dr. Susan Smith (“an amazing woman”). She enjoyed the difficult work and was encouraged to do an elective rotation at Aga-Khan University (in partnership with McMaster) in Karachi, Pakistan.

Headline from Islamabad Newspaper 

Dr. Scott was getting ready to leave for Pakistan when President Zia Ul-Haq’s plane crashed under "suspicious circumstances" (on August 17, 1988). She went anyway. She was 30. Her parents were strong, and they encouraged her “to explore the world.”
(Landing in Karachi, she was shocked to see armed soldiers on the tarmac, their  Kalashnikovs ready for firing. Flashback to words of wisdom before her departure: “If shelling has started, and you are on the tarmac, lie down and pretend you are dead.”) 

And now, in 2018, would she provide the same encouragement to her 13-year-old daughter Lily, the daughter for whom she had waited so long? Without hesitating a second, Dr. Scott, now in the role of the protective mother, said, ”I tell you, it would not be the same."

Back to 1988. So the plane arrived safely in Karachi, and “it's wild.” Millions of people, rickshaws, wandering animals, more people, teeming with people, and...lumbering elephants. It's hot, dirty, smelly. Overwhelming. “You can feel it in the back of your throat,” she said, as she briefly relived the experience. The smell of open sewers, the swarming mosquitoes, and human waste. “It burns." Did she turn and run? Did she seek safety? Why, of course not! Sharon dug in. 

Aga-Khan University Hospital 

She stayed at the residences at the Aga-Khan University where there were “lots of (American and Canadian) expats,” including professors from McMaster that she knew fairly well. And the intrepid student-nurse adapted quickly. For her research project she looked into the nutritional status of the local pregnant women. Unfortunately, there were a lot of superstitions and rigid customs about what foods could be eaten, and which could not. As a result, “there was a huge problem with malnutrition.”

She went around with an Urdu interpreter, and had to wear proper traditional dress (a long tunic) and a head-covering. She said, “We would ride ‘shotgun’ in the van to the outlying villages, and there was always killing.”  

“That must have been terrifying,” I noted. 

She replied, “Just doing what I’m doing.” As if there is no danger at all, or that the obvious danger must be pushed into the background to get the needed-work done.

“It was a time for the first free elections in Pakistan but ‘free elections’ in Karachi meant that they had army tanks sitting outside the polling booths telling people what they could or couldn’t do,” she told me.

She did the maternal nutrition research for two months and she “really liked it.” The professors liked her, too (she received a national Canadian award for the work), and they asked her to come back and join the joint faculty. She quickly accepted, and on her return to Pakistan after receiving her degree she taught public health.

She realized, however, that she was still doing “a lot on the fly” and that she “would really like to have skills” to take care of her patients better. She “would love” to study medicine in more depth. How? She discovered that in Karachi she could  go into a “little shop” or “tiny cafe” and purchase illegal photocopies of standard American medical textbooks “for a dollar or two.”  

For ten dollars, the future Dr. Scott could collect all the books she needed to study medicine. “What a great thing!” she thought. She could, like her father, teach herself anything. So...medicine it was.

Let’s go back to 1986, before Pakistan. She was cajoled by friends to take a much-needed vacation break on her own, and she picked a family resort in the Caribbean. On the first day they sat her at a table with a gentle man and his two adult daughters.

The famous St. Lucia Pitons

"Hello, I’m John Mathai from York, Pennsylvania, and I’m a heart surgeon,” he opened.

"Well, I am Sharon Scott, and I’m a nurse from Toronto," she replied.

Reflecting on this now, she noted, “This is such a cheesy story.” Anyway, they spent a lot of time together that week, and got to know each other. At one of the last dinners they came down the steps together and the official resort photographer took a picture of them under a trestle of flowers. She thought, “This is what people do when they get married."  Perhaps this same fleeting image occurred to the recently-divorced Dr. Mathai (not so fast buddy boy...) and before leaving for home he gave her a copy of that photo with his office phone number written on the back. 

They reconnected later, and he visited her in Toronto “once or twice,” but it was not the right time for a serious relationship.

Nurse Scott went off to Pakistan and did her thing for a year. She shared a flat with Tina, a Fulbright scholar, and related her story about the humble man she met a few years before. Tina, noticing her interest, said, “Why don’t you call him?” Sharon got up her courage, and called. Dr. Mathai quickly rearranged his schedule so he could meet her in Toronto on her return.

Afghan Girl
(c/o "National Geographic")

But just before leaving Pakistan she and two of her women-friends flew to Islamabad and hired a driver to trek up to the Afghan border since (get this) “the Afghan war with Russia was over.” At the border they met the security guards. Dr. Scott and her comrades wore the full burqa covering and (hold onto your seats) they learned to shoot the previously-mentioned Kalashnikov (aka the AK47). Dr. Scott noted that despite the seeming hopelessness of their situation, the inner beauty of the Afghan people was striking, and she is unable to forget the look in the eyes of the lovely shepherdesses.   

After this she returned to Toronto for her dreaded medical school interview at the super-competitive McMaster (4,000 applicants for 100 spots) and Dr. Mathai met her there (in Toronto, not at the actual interview). Though the prospective medical student had not seen him in three years it was as if they had been together the day before. She decided that if she did not get into medical school she would go back to Karachi and continue with her life there without him, but if she did, they could see each other.

She was accepted, of course, in 1989, and medical school itself “was easy, and it was fun” and she went “straight through” and graduated in 1992. During the three years of study she and Dr. Mathai met either in Toronto or York every other weekend, and they decided to stay together. That worn photo of them under the trestle of flowers was displayed at their wedding and read, “The Island of St. Lucia, the summer of '86;” someone knew something we did not.” 

Her direction in medicine? Dr. Scott’s experience taught her that it was critical to treat “the whole patient,” and she applied to internal medicine programs, including the coveted Johns Hopkins. She was accepted there, but (are you ready for this?) she turned them down in favor of the community-based York Hospital residency. She felt that there were “excellent teachers” in York and that it was a “strong program.” She did not want to travel back and forth to Baltimore and she “didn’t need the paper” from a prestigious institution to let her know who she was. She felt “very proud and privileged” to be a physician.

At York she completed the three-year program in 1995 as Chief Resident. She then practiced and taught general internal medicine, both inpatient and outpatient, through the Internal Medicine program for 15 years. Dr. Scott has spent the last eight years as a hospitalist, and was recently appointed as the Site-Director for the Academic Hospitalists with WellSpan. She focuses exclusively on the inpatient service, and the task of teaching the art of medicine to students and residents. 

Sir William Osler c. 1912

Her own most important mentor? The nearly-legendary Dr. Wolfe Blotzer. She noted that he was the former program director (her director) who, like Sir William Osler (another Canadian, by the way), was “a master of medical knowledge” and the consummate clinician.  He shared his knowledge with Dr. Scott, and shared her love of medical quotes. Quotes such as Osler’s: “To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all" (Osler, p. 210).

The nurse-doctor, student-turned-teacher, tries to pass on to her own students what she learned working alongside Dr. Blotzer, and what she had learned from her patients. She models close compassionate listening to arrive at a correct diagnosis and, more importantly, to understand the patient’s full needs. Listen carefully, and the patients will tell you the diagnosis (there's Osler, again); listen, and they will tell you what they need.  

She sees that while the students and residents can use phone apps expertly to find information in seconds, they often struggle with the interactive and communication skills. To help them (especially, with difficult patients) she employs role-playing before asking them to enter the patient’s room for that ever-critical history-taking and confirmatory physical exam. 

"The Lost Art of Healing":

Dr. Scott strives to engage her patients on a level field as she and they work things out together. The effective physician, in addition to mastering the science of medicine and the knowing the limits of diagnostic testing, must get to understand her patient’s full range of needs, the physical, emotional, and social. She must know where the patient wants to go from where they are, and how that journey may affect her loved ones. Dr. Scott says, “Let’s work together. How we can help you?”

Cardiologist Dr. Bernard Lown writes, “If there is a partnership in medicine, the senior partner has to be the patient, who must not be deflected from having the decisive word” (Lown, p. 77).

For her efforts with students, Dr. Scott felt honored this year when she went to Philadelphia to receive Drexel University’s “Dean’s Special Award for Teaching” at the medical school graduation ceremony.  

(Although her career goal was always to pursue studies at a higher level, as she certainly has, her dream was to have a child. Lily Scott Mathai, her daughter, is that dream, who “came home” from Guatemala at the age of three-and-a-half.  Simple words cannot convey the depth of Dr. Scott’s gratitude for that “gift from above.” Family, you see, means everything.)

A true clinician, in the words of the renowned Dr. Philip Tumulty, of Hopkins, is “one whose prime function is to manage a sick person with the purpose of alleviating most effectively the total impact of the illness upon that person” (Tumulty, 1970).   

To that, Dr. Scott adds that she hopes “to give people the strength and the resources that they need to help themselves.” She strives to treat them “with respect and humility,” just as she would want done for her own family. While this is not be something you can teach through a lecture, it is something you can model, and is something that others can seek to emulate. 

Dr. Scott watched her mother care for Melvin. She watched her father teach himself what he needed to know to support his family. She watched her physician-mentors. She watched and learned. The next generation watches her.

"In these days of aggressive self-assertion, 

when the stress of competition is so keen

 and the desire to make the most of oneself so universal,

 it may seem old-fashioned to preach the necessity of the virtue

 of humility for its own sake,

 and for the sake of what it brings,
and that a due humility should take the place of honor...
amongst the influences which make for a good student, and a good physician."

Sir William Osler, to medical students at the University of Minnesota, 1892 (Osler, p.38)

References:

1.  Lown, Bernard, M.D. The Lost Art of Healing: Practicing Compassion in Medicine.  Ballantine Books. New York 1996. (Recommended reading.)

2.  Osler, Sir William. Aequanimitas: With other Addresses to Medical Students, Nurses and Practitioners of Medicine. P. Blakiston's Son & Co. Inc. Philadelphia, 1932.

3. Tumulty, Philip, M.D. "What Is a Clinician and What Does He Do?" NEJM 1970; 283: 20-24. (Essential.)