Jack L. Berry, MD

In the end, it’s all about people’s lives. How to make them live better, how to make them live longer, and sometimes it’s about how to save them even though in doing so one can’t make their lives better.

It had been the toughest night of my medical career when I came home at 6:30 a.m. and my wife greeted me with the question, “What happened that could have taken all night?” She had lived through many nights of my rural practice when I had been called back to the hospital to deal with problems that might take an hour or two. But this was one of the few nights that I was gone all night, with no other calls, and not returning home at all. 

I remember clearly the day I first thought being a doctor might be a good idea. I was 5 years old and a really nice and gentle man, Dr. Thorpe, had just stuck a really painful and seemingly very long needle into my arm. He had been so kind and careful when helping me hold my mouth open to look at my pus-covered tonsils, and very quick to hold and comfort me afterward. Even at my young age, such a caring and compassionate act by a large man who was both helping and hurting me made an indelible mark.

Through my years of primary and secondary education, that memory grew into the realization that being able to help while sometimes having to hurt could provide the challenge that I was looking for in life. Being a doctor could be a special way to make a good living for my family. One may not find it hard to believe that indelible memory came to me again that exhausted early morning when Maribeth met me with her question. At the same time, I was asking myself, “Why did you ever get yourself into this?” The answer is straightforward but complex as well.

K was a delightfully pleasant and positively dispositioned young woman near the end of her first uncomplicated pregnancy, an obstetrical patient of my partner who had left town a few days earlier for a vacation. K was in excellent health after following an active and nutritious lifestyle. There had been no reason to anticipate any complication of pregnancy, but near term, she came to my office distraught, not having felt movement for two days. Sadly, on examination I could feel no movement and could hear no heartbeat.

This was 40 years ago and in those days, no ultrasound was available in our small genuinely rural hospital, so K had to travel 90 miles to the closest next larger hospital to prove the fetus not viable. When she returned with the report confirming our worst fears, we cried together and called her husband to come help us decide what to do.

A phone consultation with an ob-gyn friend in Denver helped define our limited options: to induce labor as soon as possible to avoid maternal complications at our rural hospital, or to travel 140 miles to the nearest obstetrician to accomplish the same sad outcome – delivery of a stillborn infant. One must have experienced it to understand the rural physician-patient trusting relationship that led this wonderful couple to choose to stay in our rural town to endure this extraordinarily traumatic experience. And it didn’t get better for them.

Induction of labor, never comfortable, fortunately progressed very quickly, and with terrific maternal effort, she delivered an otherwise normal appearing stillborn infant without difficulty. There, the relatively good fortune ended. As the infant was wrapped in a blanket and placed in their mother’s arms for her to say goodbye, the placenta delivered followed by a gush of blood that filled the gallon basin at my feet. Her uterus would not contract to stop the bleeding despite massage, nor all the medicines that are supposed to do so. Only by heavily sedating the patient and packing her uterus with sponges was I able to slow the bleeding and buy time for the nurse to frantically call our physician assistant and other available nurses to come start another I.V. and call walking donors to give blood for immediate transfusion (this was before modern blood safety practices). 

Another, this time desperate, phone consultation made it clear that we had tried everything possible and there was no option but hysterectomy. My God! I had just delivered her first pregnancy, a stillborn infant! I had never before felt this alone as a physician, 140 miles away from the nearest ob-gyn, even though I was trained and experienced in surgical obstetrics. I was going to have to irreversibly damage this young woman’s life in order to save her!

K was still heavily sedated, so I turned to her husband to get permission for what we were about to do. This discussion was more trying for me than many of the times that I had to tell families that their loved ones were dying. He responded by doing his best to encourage me, as a rancher who had delivered many calves would, saying “Get to it, doc, and do the best you can ’cause I love her.”

Our “circuit riding” nurse anesthetist was 35 minutes away via his airplane, so while he was on his way and my best nurse carefully monitored the patient, we moved her ASAP to the operating room. I had to do the spinal anesthetic myself, as time was critical. The post-pregnant uterus immediately after delivery is the size of a football and the veins and arteries supplying it are enlarged up to the diameter of a small hose. Though I had seen those blood vessels many times during cesarean sections, fear best describes my feeling as I clamped and cut across them and then sutured without another physician assisting.

To everyone’s relief the patient remained stable until the nurse anesthetist arrived, my first post-delivery hysterectomy went well, and K recovered well. During her recovery, she and her husband seemed determined to assuage the anxiety of my inept attempts to support them at the loss of their childbearing capacity after losing their first infant. 

Instead, they reinforced the lesson my first physician had given me by his example: sometimes you must first hurt someone to save them. Do it with compassion and they will thank you for it. 

And there was no greater reward than that I received the day that K and her husband brought their first adopted daughter to me for her first well-child exam.

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Physicians and patients agree that the doctor-patient relationship is essential to make the best health care decisions. Health care can be an especially vulnerable space for patients, and physicians know compassion and establishing a meaningful relationship is necessary to build trust and provide the most effective care and treatment. Physicians understand that quality time spent listening to, responding to, and treating patients is essential to quality medical care.  

• A recent AMA poll found that 84% of national voters agree that their physician values the doctor-patient relationship and helps them make informed decisions about their health.
• 79% of national voters agree that insurance company bureaucracy makes it harder for physicians to provide the best care for their patients.
• 83% of national voters agree that doctors got into the profession because they wanted to treat patients: to understand their health care needs, to take the time to understand how to best help them, and then provide the care they need to get better. That’s why doctors are working to change the system – to get back to the way it should be, so that patients and doctors have the time together to make the best health care decision.

The Colorado Medical Society (CMS) is proud to launch Your Care is at Our Core, in partnership with the American Medical Association (AMA). This new communications strategy highlights the sacred bond between physicians and patients, especially following troubling challenging years when there has been an erosion of trust in science and medical institutions that can spill into the exam room.

To support this new effort, we are asking physicians to share stories that illustrate your strong patient-physician relationships and how they helped you deliver the best care. Complete our online form for question prompts to get you started.