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Haley VA doctor teaches residents to use a personal touch

TAMPA — Jose Lezama herds a team of young doctors in starched white lab coats into the room of a leukemia patient. On the way, Lezama has quizzed them, testing their memories on technical protocol for acute leukemia. But as they enter the room, he wants them to see the other side of medicine.

Lezama sits down on the bed. He tells the patient he wants to check his lungs.

The patient — 74-year-old Angel Reyes — sits up, takes a deep breath, and bellows:

Be my love.

And with your kisses set me burning.

One kiss is all I need to seal my fate.

Lezama lowers his stethoscope. Nothing wrong with Angel Reyes' lungs.

End of Lesson 2.

• • •

Lesson 1 is Lezama's office. It's at the James A. Haley VA Medical Center, where Lezama is chief of medicine. Residents, interns and University of South Florida medical students rotate through that office every month as part of their training.

They don't find much evidence of a medical practice — except a plaque on the wall inscribed "My Daddy M.D." They see photos everywhere of his kids — 5-year-old Kaitlyn and 2-year-old Derek. They see a photo of Lezama and his wife, Amy, on their wedding day. They find another small plaque titled "Mr. Hustle." Lezama won that one while playing for a Northdale Little League team in Tampa that

went 2-22 in 1986.

A mannequin rests in the corner beside the bookcase. It's outfitted in black leather, helmet and shades. It was a gift from the widow of a Vietnam vet whom Lezama treated for eight years before his lungs gave out. The vet called him "Dr. Joe."

A Buffalo Bills pennant by the door is a memorial to a guy who seemed to arrive sick every time Lezama was on call. He had enough ailments to kill him 15 different ways. In his last days, in 2005, he told Lezama he just wanted to live long enough to watch the Super Bowl with his family — at home. That became Lezama's mission. His patient got to watch the Patriots beat the Eagles, 24-21. (The Bills went 5-11 that year.) After he died, his widow told the doctor, "You made sure he got there."

• • •

Lezama is 36, grandson of Cuban immigrants. The VA says he's the youngest chief of medicine in the country. He was born to parents who met at Tampa General Hospital, he volunteered at Tampa General as a kid, he studied medicine in Tampa, married a Tampa girl, and chose Tampa for his residency and career.

Everything about Tampa — from its Latin roots, to its neighborhood cohesiveness and culture of family — shaped him, he says, as a doctor.

His Cuban grandmother shaped him most. He called her Abuela Marta. She had fled Castro penniless, and had a stock answer when asked about the bad days in the early '60s: "We dealt with it."

She taught Spanish for 25 years, first at Our Lady of Perpetual Help, then at the Academy of Holy Names. As a child Lezama watched her teach. She had a nickname for every student. She had a way of making every student feel individually important. When she died while he was at Jesuit High School, the teenager began thinking about a career that would blend his innate interest in science and medicine with teaching. That led to his volunteer work at Tampa General, and everything else.

Now he teaches a subspecialty of his own design at the VA hospital — training other doctors in the practice of humanistic medicine. And he gives them all nicknames.

Lezama was recently among 42 doctors nationwide nominated by his peers for the 2007 Humanism in Medicine Award, sponsored by the American Association of Medical Colleges.

• • •

Lezama's group of lab-coated learners looks like the many other groups roaming the halls: Four or five residents and interns trailing a teaching doctor. Invariably, the teaching doctor walks backward, facing his group, quizzing them on medical procedures as they go room to room. If you've seen the TV drama House, you know how it works.

As Lezama walks, he quizzes his doctors on stroke complications. What are the other risk factors? What about hip fractures? Difficulty swallowing? What's the abnormality? Explain dysphagia. What's in a swallow study?

Lezama adds another component to the walking-backward quizzes. How do you approach complications that medical tests don't reveal? What do you do to get inside a patient's head, to know why he won't eat, why he can't sleep?

1. Get in at 6:30 a.m., before things get busy. Or stick around after 6 p.m., when things quiet down.

2. Sit down on the patient's bed.

3. Touch his arm.

4. Tell him, "I am someone to listen."

5. Remember his name.

• • •

VA social worker Christy Johnson follows Lezama's team from room to room. He likes her to tag along because she may hear more from patients than doctors do.

She first met Lezama in the room of a frail old man who was about to be discharged. The patient was diabetic, and had come in close to death. After his diabetes was stabilized, he was ready for release.

"I'm worried about him going home," she told Lezama. The man's wife was sick, not at home. He might not be able to give himself insulin injections.

Lezama thought about it. "Well then, let's keep him," he said. "Let's wait."

She'd never heard a doctor say that.

John Barry can be reached at jbarry@sptimes.com or (727) 892-2258.

. FAST FACTS

What is humanistic medicine?

Humanism in medicine fosters relationships with patients and other caregivers that are compassionate and empathic. It also describes attitudes and behaviors that are sensitive to values, autonomy, cultural and ethnic backgrounds.

Arnold P. Gold Foundation

Haley VA doctor teaches residents to use a personal touch 03/02/08 [Last modified: Sunday, March 2, 2008 5:00am]

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