My Kind of Medicine: Real Lives of Practicing Internists: Charles Hamori, MD.
Dr. Charles Hamori has attended live performances of Beethoven’s 9th Symphony at least four times that he can recall, the most recent of which was at the Copley Symphony Hall in San Diego, California. Since the age of 15 it has been his favorite piece of music; he never tires of it. He describes Beethoven’s 9th Symphony as an interesting combination of romantic passion and youthful idealism and says every time he listens to it he is struck by its complex composition. In his eyes, these are the aspects that make it beautiful.
Dr. Charles Hamori at Giant’s Causeway in Northern Ireland.
The 41-year old internist from La Mesa, California, recognizes a similar structure in internal medicine, which he often refers to as a mixture of art and science. In part, the idea took root in the tutelage he received from an attending internist who taught him in his third year of medical school at the University of California in San Diego, where he also completed residency. “I loved his approach.” Dr. Hamori says. “He had an old school way of practicing medicine that I liked. He would say, ‘OK, let’s go down to the lab now,’ and we would go down there and sit and look through the microscope, just trying to figure something out. I think of him as an early adopter of evidence-based medicine.” Dr. Hamori also admired his mentor for his active involvement in AIDS research. “It was the early nineties, which was the height of the AIDS epidemic. I really admired his compassion. I thought it was wonderful.”
It is not uncommon for medical students to make decisions about which path of medicine to follow based on their experience with a teacher or mentor. Dr. Hamori’s experience with his own teacher left such an impression on him that not only did he decide to pursue internal medicine, he also chose to become a teacher and mentor. Dr. Hamori became an assistant clinical professor of medicine in the same program that he previously graduated from. He says the experience has given him some of his proudest accomplishments. One particular case he recalls is providing guidance to a student, which began during the student’s freshman year in college. “I invited him to come to my office and follow me while I worked,” he explains, “and he continued coming to my office all the way through college and all the way through medical school. Today he is an internist. For me, that is a great success story.”
While his enjoyment of giving to others is obvious, Dr. Hamori is also able to recognize when something holds value for him. For example, he teaches as much for himself as he does for his students. “Teaching keeps me fresh,” he says. “When you work with students you really have to be on your game because they’ll challenge you. They’ll ask me ‘why are you doing that?’ and then they’ll go ask someone else on the faculty and compare the answers! But I like that because it is true to the art of medicine—there are different ways to approach it.”
Proud to Be an Internist
Dr. Hamori has a joke he likes to tell his patients from time to time. When faced with the unspoken question ‘are you sure?’ he says the only way he could be more sure of a diagnosis would be to perform an autopsy. He says he gets laughs, but admits to using discretion when deciding with whom it is appropriate to use the joke. Joking aside, making the right diagnosis is something he takes very seriously. “Knowledge is difficult,” he says. “No matter how many times I have correctly diagnosed something, I will always get the book out and try to figure out whether or not I’ve missed anything. Making a differential diagnosis is a hard thing to do, and I’m proud of my identity as an internist because we are specially trained to do it.”
A close call with a patient several years ago reminded Dr. Hamori of just how much weight the right or wrong diagnosis can make. A young man had come into the hospital in San Diego where Dr. Hamori was working. The man’s symptoms were so grave that the doctors thought he might not survive. The patient had an overwhelming systemic immune reaction that was attributed to fulminant Coccidioidomycosis—a combination of pneumonia, liver abnormalities, kidney failure, embolic strokes, and gangrene in the fingers caused by a small arterial emboli. At least, that’s what they thought it was. “In the San Diego region, Cocci is endemic, and it is known to cause the conditions suffered by this patient,” he says. “Since the patient was in a line of work in which he was regularly exposed to soil, his ethnicity was right, and he even had a serologic test that was IgM positive, I thought we had a match.” But after ten days of treatment, the young man’s condition had not improved. “We couldn’t figure it out, we didn’t know what we were overlooking,” he recalls. “After reevaluating, we finally figured out that he was suffering from hypereosinophilic syndrome, which can be devastating. The man suffered a degree of disability from it, but we did save his life. It was an example of how you can’t rule out anything. Everything about his case was pointing us toward that first diagnosis. You always have to go back and consider what you might be overlooking.”
The Finer Things in Life
Currently, Dr. Hamori works in the Kaiser Permanente Preventive Medicine Clinic in San Diego, where he is very happy. “It is professionally very rewarding where I am now. We perform as many preventive services as we can,” he says, “and I feel fortunate to be a part of that because not many hospitals have clinics that do what we do.” His next move will be to a primary care office, a change he says he is able to make because he is an internist. “There are so many different things you can do, you don’t have to be pigeonholed,” he says. “You can reinvent yourself throughout your career.”
Career satisfaction is not the only thing Dr. Hamori appreciates about his job. “One of the big reasons why I chose the group I’m with now is because it’s predictable and steady,” he explains, “which means I can set my schedule to spend time with my wife and two daughters—helping with homework, playing or just spending valuable time with them. Every week we have a night I call Daddy-Daughter Night.”
If you talk to enough internists eventually you start to notice a pattern. Most or all are affable, they derive pleasure from interaction, and while they each have their own style and qualities that make them unique, one thing they all seem to share is an aptitude for people. It was this aptitude that Dr. Hamori drew on one day, as he honored a “do not resuscitate” order for an elderly patient. The patient had suffered a stroke followed by complications which would not allow him to breathe without the help of a ventilator. The patient made it clear to Dr. Hamori that he wanted to be taken off the ventilator and be taken home. Against the wishes of the hospital staff, Dr. Hamori followed through with the patient’s wishes and took him off the ventilator. He then rode with the patient in the ambulance to his home, where his family waited for him. After the family got the man settled in his favorite easy chair, Dr. Hamori removed the endotracheal tube. “He was so thrilled to be able to talk with his family and friends,” recalls Dr. Hamori. “It was bittersweet of course, but they laughed and joked and had a great time. They poured him a scotch and water and he even had a few token sips!” Gradually, the patient grew tired and drifted off to sleep, but before he did he thanked Dr. Hamori for respecting his wishes. “I have never forgotten that,” he says. The man passed away about 45 minutes later; his favorite Frank Sinatra album played in the background.
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