R. Eric Mathews, M.D., Internist and Avid Tennis Player: Always change a losing game.

 

Dr. R. E. Mathews

Dr. Eric Mathews was born in Baltimore in the late 1950s. His father was a mechanical engineer employed by the government and his mom worked as a secretary. They were both introverted. They had no social contacts outside of work and “lived like hermits.” There was no public entertainment for the family, very rare vacations, and almost no church attendance. During the hot and humid summers, the air conditioner remained unused. They were isolated as they lived “in the sticks.” Why would people choose to live this way? 

Eric explained that the constricted lifestyle of his parents was based on a suffocating frugality, the urge to “save every penny.” With a touch of irony, he said that “it was an interesting childhood.” For example, he recalled that his father handed him a pail full of bent nails and Eric’s job was to straighten them so they could be used again.   

Unlike them, athletic Eric was a “pretty outgoing kid.”  Until the fifth grade, that is, when his front teeth were knocked out during a basketball game. It was “a formative moment.” As he was ridiculed and called “snaggle tooth” he became uncomfortable in social situations and turned inward. This went on for a good while. 

High School

By the time of the unfortunate dental mishap, the family had moved from their rural spot to more populous Timonium in Baltimore County, buying the house with cash. Eric attended Dulaney High School where he “didn’t try very hard” at first, as he would rather concentrate on basketball and tennis. (His tennis partner was voted class clown; Eric “came in second.”)

Artist's rendering of Dulaney High (Credit: designcollective.com)

But in his senior year, when he took a class in medical biology “something went off.” He knew at that exact moment that he wanted to be a doctor. Maybe a pediatrician, he thought. He quickly became “pretty nerdy” and subscribed to (get this)  the “Morbidity and Mortality Weekly Report” sent from the CDC (it was free). He “gobbled up all the medical stuff” he could.  His parents approved of this change in their son’s interests.

For his senior biology project on artificial parthenogenesis (triggered reproduction without sex; no male of the species is required) in sea urchins he “made up most of the data.” You see, he was mad at the teacher for withholding an A for his work despite an 89.9 average for half of the year. 

College and Medical School

After high school, Eric went to college at the University of Maryland Baltimore County campus (UMBC). It was so cheap  ($649 a year)  that he could pay the tuition by giving tennis lessons. And, saving money, he could live at home and commute. Eric did well academically, but still thought of himself mostly “as a jock.” 

Retrieiver Tennis Complex at UMBC (Credit: UMBC)

Yes, Dr. Mathews admitted that he “was always kind of a maverick” and has had trouble with authority figures, including his father. One day, his dad, who was paid by the hour, told him to spend four hours to till a quarter of their vegetable garden. After Eric finished the entire plot in two his father sent him back for another two. This didn’t make sense to an independent industrious child.

Eric played #1 on the tennis team through college. And as a senior, he was “Academic Athlete of the Year.” Though he didn’t join the premed society (he didn’t fit in) he worked toward his goal of becoming a physician and he gained acceptance to the (relatively inexpensive) University of Maryland Medical School. Again, he could minimize costs by living at home and commuting. 

Famous Davidge Hall at the University of Maryland
Medical School(Credit: Acroterion)

While there, he still enjoyed playing basketball and kept up his (quite accomplished) tennis skills (in the late 1980s he hit with Jenni Goodling and Laura Glitz, both of whom competed at the Wimbledon Championships). He didn’t find medical school “that hard,” as he “really liked it,” and studied from morning to night and on weekends. 

During his training, as he thought about his future, he crossed off surgery (his hands weren’t steady enough) and OB/GYN (it had no appeal). He briefly considered doing pediatrics (but that was too tricky). As he discovered that “thinking about things” was what he liked most, he decided to do internal medicine.  Where would he go for that?

Residency

Eric had dated a medical student from York (a straight shot 40 miles north of Timonium) who was a year ahead of him, and he took a few outside rotations at the York Hospital. His experience was so positive that he chose to return to York in 1985 for his three-year residency. 

From Timonium to York (From Google; where else?)

He enjoyed working with his thoughtful and dedicated attending physicians (he specifically mentioned Drs. Jack Kline, Jay Nicholson, and John Carson). He became close with his fellow residents, especially Bob Clinton, Eric’s Best Man at his wedding.  (Bob, an oncologist, sadly passed away suddenly at 49.)

Dr. Mathews moonlighted in the ER during his residency. He greatly enjoyed the work and took a job there after he completed his internal medicine training.  (You didn’t need to have done an ER residency back then to man the ER;  in fact, emergency medicine wasn’t even recognized as a specialty until 1979).   

Lisa Enters the Picture

And yet, the ER wasn’t quite enough for Dr. Mathews who “wanted to be a real doctor.” While he was looking into joining a practice in Lewes, Delaware, where he could work and still play a lot of tennis, fate stepped in. Or, shall we say, it was a girl.

Eric and a buddy went to a local nightclub, Zakies.  As they were coming in, he spotted a pretty girl on her way out. He managed to say something to her like: “I think I just fell in love with you.” She continued on her way.

Dr. Mathews was back at the same hang-out a month later, as was the girl. He spotted her, eventually walked over, and they “talked for a few hours.” She was in the medical field (as a radiation therapy tech) and she enjoyed sports (she played, of all things, both tennis and basketball).  Eric quickly knew that “she’s the one.” 

After their first date, the girl, on the other hand, wasn’t quite so sure; she heard (from her hospital sources) that he had a “reputation.” But her kind boss, radiation oncologist Dr. Greg Fortier, convinced her to agree to a second date. She did, and Eric and Lisa were married one year later (in 1990).

After the Residency

The relationship kept Dr. Mathews from moving away for the Delaware job. Instead, he decided to join Dr. Barb Shute in the Hanover Hospital ER. He worked nicely with her until 1993. By then, he and his wife Lisa had two sons (they would later have one more) and as he needed to provide for the growing family he took a better-paying position at a Level 2 ER in Indiana, Pennsylvania (birthplace of actor Jimmy Stewart). In the middle of nowhere, there was little backup for a cerebral internist with a deft backhand, but almost no surgical skills.  

Main Street in Indiana, PA (Credit: Wikimedia)

At the time, Dr. Mathews also manned a very busy urgent care unit (seeing 65 patients a day) in addition to shift work in the ER. He did all of this for a year,  but there was a nagging sense that he wasn’t fully qualified for the job (especially as many acute emergency patients were simply flown to a tertiary care center).

When a car carrying a family of five was hit by a coal truck he decided it was time to make another move. He left Indiana and returned to Hanover in 1994 to do internal medicine with Dr. Hy DePamphilis (though they each had their own patients). Dr. Mathews had a full office load, took care of patients in the hospital (as one of only four internists on staff), made nursing home visits, and did house calls. He was very very busy.

The Stress Gets to Him 

And by 2001 he was “pretty stressed out.” He was “always worrying about something” concerning his patients as he was essentially “on call 24/7.”  Eric developed more and more trouble sleeping as his mind was constantly going, and after “two weeks without sleep” no matter how he tried, he turned to sleeping pills.  

He began using the benzodiazepine Restoril regularly. It helped at first, but he soon needed increasingly higher doses. This went on for some time, and as Dr. Mathews continued to have painful insomnia despite that, he began taking Ambien (not a benzodiazepine, but still potentially addictive). He eventually overused this as well, and when he abruptly ran out of pills he had a withdrawal seizure. 

He got some help but continued to have sleep issues. He tried to solve the problem with a wide variety of non-addicting non-controlled medicines. But to no avail. And after a second seizure (this time a direct result of high-dose medication, not withdrawal), and a painful family intervention, he finally got the help he needed through the Pennsylvania Physicians Health Program (PHP).

The PHP is designed to rehabilitate (literally, "to make fit again") physicians with substance abuse, mental health, and/or behavioral concerns. Dr. Mathews willingly took part in the residential program and “came back a different person.” He told me that it was “life-changing.” He had always felt that “someone” was looking after him, and this experience cemented, solidified, that notion. After that, he no longer had sleep problems, and has no interest in taking pills. 

After Rehab

Thus, Eric was able to return to his patients. After staff members had left, his wife stepped in and helped run things. It “was fun” and “more profitable,” he said. For years, he had a stable “closed” practice of people he cared deeply about (and who cared about him), and he was content. 

But, in time, the use of a government-sanctioned electronic health record (EHR) was being pushed on physicians. The high cost of implementing one for a small office such as Eric’s seemed unreasonable, despite the incentives. So, after two decades in private practice, cost-conscious Dr. Mathews decided to give in to economic pressure and join a regional health system. 

Busy screens that demand attention (Credit: Britannica)

They took over his practice with about 6,000 patients who were his “buddies.” One of the rules was that you could not work with your spouse, so Lisa had to go. And Eric had to learn to use a clunky and buggy EHR system in a day or two.  

Flummoxed by the computer, Dr. Mathews relied on his paper charts when seeing the patients and tried his best to enter the stuff into the EHR when he got home at night. But the system was frequently down and he was often up until one in the morning getting the work done.

Six weeks into the practice, his invaluable paper charts were sent away to be scanned; he would have to make do with a few bits of information clumsily abstracted from his carefully organized records. 

A Quick Decision

When he was to see a man with a routine cold he was allotted five minutes for the visit. The (temporarily uninsured) patient (who adamantly refused to go to the hospital) had type 1 diabetes and was in florid ketoacidosis, a complex acute medical emergency. It required time and skill to address as an outpatient. The office manager soon knocked on the exam room door, peeked in, and told Dr. Mathews he was spending too much time with the patient.

His response? (In tennis, Eric’s game, you keep your eye on the ball, quickly size up your opponent, and always change a losing game.) “Here’s what I’m going to do. I’m going to finish this week, and then I’m done. If this is what medicine is nowadays, I’m done. I quit. I’ll be here until the end of the week” So Dr. Mathews left the practice less than two months into his contract. 

The agreement with the system included a “restrictive covenant.”  So, to provide for his family, Eric was forced to leave his long-term patients (his “tribe,” added his wife) and find a place to work that was more than 32 miles from his former (but brief) employer. 

Patient First and Family First Practices

He bent the rules somewhat and found a suitable job at a free-standing walk-in facility in East York, Patient First Primary and Urgent Care. It was “kind of fun” for five years. And, importantly, staying in the York-Hanover area allowed his three sons to finish high school and go off to college.

The distinctive green Patient First office in York (Credit: Patient First)

At that point, Eric’s father and his wife‘s dad were both in assisted living facilities and were (in his wife’s words) “miserable.”  So Eric stopped working and he and Lisa took their fathers into their home and cared for them for about a year and a half. After his dad passed away and her father needed skilled nursing care, Dr. Mathews would resume his winding career.

By then, he told Lisa that he wanted to go to an Indian Reservation to get away from administrative work and to help people who needed him. His wife convinced him that he could give back locally. She suggested he look into Family First Health, a well-established federally qualified health clinic she often drove by on her way to work. 

He did and saw that they were looking for physicians. They had several practice locations and Dr. Mathews told them he would “go anywhere except Hanover.” They (of course) sent him to Hanover. 

Family First Health (Credit: FFH)

Working there turned out to be an “awesome” and “rewarding” experience. However, their somewhat haphazard charting “didn’t make a lick of sense” and Eric spent a lot of time fixing that problem.  

As he listened to many harrowing stories from his often disadvantaged patients he saw that these poor and traumatized people were just “trying to make it.” He realized that taking care of “disasters” who were (in his wife’s words) “broken” was what he did best, and was the reason he was here.  He felt fulfilled, and he worked there until he retired recently. 

(Lisa added that Eric had the support he needed to be able to practice medicine his way.)

Retirement

Since Dr. Mathews and his wife liked to go “everywhere” to learn about different cultures and meet new people, and more travel was the plan on his retirement. But their needy dog Max (whom my husband and I met as they walked him through Reservoir Park one hot afternoon) has made that a little tricky. In addition, Lisa’s “as needed” work became almost full-time (since they were understaffed).

Early morning at Reservoir Park (Photo by SC)

As Eric and his wife traveled as a family they tried to show their three sons “the world outside of York,” the real world. And they limited the time the boys spent with technology. Eric would sometimes say, “You guys are on the computer too much; here’s a ball, take it outside and throw it back and forth to one another!” Indeed, the whole family carefully avoids the insidious trap of so-called “social” media. 

Dr. Mathews, among other things, still plays high-level tennis, reads (he just started a translation of the Bhagavad Gita), and enjoys birdwatching (when I sent him a first draft of this for his review he and Lisa were in Maryland doing just that). 

Concerns

In this highly tech-influenced world, Dr. Mathews is very concerned about the future of medicine. In fact, he (not one to mince his words) thinks it’s “terrible.” He is worried about the quality of the training of physicians, and he worries as he sees doctors being replaced by Physician’s Assistants and Nurse Practitioners who are often left all alone, unsupervised. He believes having the computer in the exam room “completely ruined the doctor-patient relationship.” And he witnessed what he considered avoidable “mistake after mistake” (for which there are many sources) in urgent care settings.   

Causes for unsafe acts, including errors
(From rushem.org)

For example: His 97-year-old mother (who walks five miles a day!) called him one morning about six months ago because she "couldn’t feel" her left side. He took her to the hospital and she stayed overnight.  Nothing was found. When Eric showed up to take her home, as planned, he discovered that she had been discharged. There was apparently no attempt to notify him.

Another example: His wife’s mother (on hemodialysis)  went to the ER recently with Covid-19. Dr. Mathews was appalled by the perfunctory fragmented care she received while there ("Do you have a cough? I will send you for an x-ray,").  He had to intervene (with leading questions) to prevent misuse of an inappropriate antiviral.

And he is shocked and dismayed by the cavalier and uniquely American direct-to-consumer advertising of medicines, especially for the latest targeted cancer treatments: ”Ask your oncologist about…” He is troubled that primary care often seems to have come down to “What organ is involved?” and “Who do you send the patient to?”

And in The End...

Looking back, after years of experience in various forms of medical practice, it was with Family First that Dr. Mathews felt that “this” was what he was put here to do, that “this” was what he was supposed to do. Sometimes it was “train wreck after train wreck,” but he tried to figure things out. He was struck by the remarkable resilience of people who had suffered so. 

And it was during the year and a half that Eric left medical practice to take care of his ailing father that he was finally able to be close to him; growing up, his stern father was not ” touchy-feely.”  When with his dad at the end, there was no complex computer screen competing for attention and no mandatory guidelines to mindlessly follow. There were just two men together, trying to do the best they could. 

Thank you, Eric, for showing me the way. Set and match.

Suggested Readings:

1. Easwaran, Enkath (trans). The Bhagavad Gita (second edition). Nilgiri Press, Tomales, California, 2007.("At the beginning, mankind and the obligation of selfless service were created together." 3:10, p. 105.)

2. Murthy, Vivek N., M.D. M.B.A., "Healthcare Worker Burnout and Well-Being." New England Journal of Medicine 2022, 387: 577-579. ("Burnout manifests in individuals but it's fundamentally rooted in systems...Causes include inadequate support, escalating workloads and administrative burdens...and moral injury from being unable to provide the care patients need.") 

3. Saddicha, Sahoo. "Diagnosis and treatment of chronic insomnia." Ann Indian Acad Neurol 2010;13:94-102.(Behavioral measures are much preferred to using pills, but are not always enough.)

4. Tilden, William T. (Champion of the World). The Art of Lawn Tennis (second edition). Methuen & Co. Limited. 36 Essex Street, W.C., London, 1921. ("Fully 80 percent of all errors are caused by taking the eye from the ball in the last one-fifth of a second." And: "One can only control one's mental processes after carefully studying them; pp.8 and 48.)

By Anita Cherry 9/22/24

Watchful Great Blue Heron
Clearwater Beach 2019 (Photo by SC)