Soon after Dr. Tsuyoshi Kaneko arrived at Brigham and Women’s Hospital in 2011 to learn heart surgery, Dr. Michael Davidson took him under his wing. Over beers and pizza on Mission Hill, the older physician dispensed advice on everything from buying a first home to preparing for dramatic changes in cardiac medicine. Eventually, Davidson welcomed him as a partner in an innovative program to replace patients’ faulty heart valves without major open heart surgery.
On the morning of Jan. 20, the younger doctor attended a research meeting several blocks away. When he returned to the Brigham that afternoon, a secretary told him his mentor had been shot. The last thing a stunned Kaneko wanted to do was work, but one of his patients needed emergency bypass surgery. He operated while, across the hall, colleagues labored into the night to save Davidson’s life.
Nurses “shut out all the information for me so I could concentrate,’’ he said. But as the hours wore on, he knew Davidson was still in there — and he knew that couldn’t be good.
He finished his case near 11 p.m. and walked into the hallway, where he was told Davidson had passed away. He pushed open the doors to the operating room to say an emotional good-bye.
In the days after Davidson was fatally shot by Stephen Pasceri, Kaneko was one of 200 doctors, nurses, and other clinicians who sought help from a unique peer support program, while about 975 Brigham employees received individual or group counseling through the hospital’s traditional Employee Assistance Program. Some were angry at the killer, while others felt guilty for not saving their colleague. Some asked for help, while others, like Kaneko, were sought out because co-workers were worried about them.
After Davidson’s death, Kaneko, 37,broke down at work. “Whenever I saw somebody who had any connection with Mike in my memory I couldn’t hold it together,’’ he said. A fellow surgeon tipped off Dr. Jo Shapiro, director of the hospital’s Center for Professionalism & Peer Support. She invited Kaneko to her office to talk.
“I was desperate to talk to somebody,’’ Kaneko said. “It still doesn’t seem real. I still think that he’s in the office right now.’’
Dr. Maggie Tillquist, a second-year anesthesia resident, walked into the OR for her 12-hour shift at 11 a.m. on Jan. 20 and was immediately assigned to Davidson’s room.
“Dr. Davidson’s murder brings up so many unanswered questions,’’ Tillquist said. “I just wasn’t sure how to answer them.”
Eventually, she decided to attend one of Shapiro’s group meetings. “Some people were very, very angry at the killer, at the system for allowing these situations to get out of control, at the lack of security. Some people were very, very sad. It was reassuring to see that . . . we were all dealing with same strong mixed emotions.’’
The Brigham’s peer support program was formed about 10 years ago in part to help groups of clinicians involved in medical errors cope with feelings of shame and guilt. In 2008, program leaders realized most doctors will not speak up at group session — they don’t want to appear weak, Shapiro said — and began to seek out physicians for individual meetings.
The Brigham program was one of the first in the world where practicing doctors and nurses act as counselors, rather than social workers and psychiatrists. Research published by the group in 2011 supported the approach, finding 88 percent of physicians would rather talk to another doctor about traumatic personal events.
Davidson’s murder brought in the largest wave yet of clinicians looking to talk in group and individual sessions. One common fear was of being held responsible for disappointments in medical care over which they have no control. Davidson had operated on Pasceri’s mother for a leaky heart valve, and Pasceri blamed the doctor for her death last November.
Shapiro and her peer support colleagues organized eight group meetings, the first an afternoon drop-in session largely for nurses in the OR during Davidson’s emergency operation. The second was held in a basement lecture hall minutes after Davidson died that night.
They reached out individually to about 30 doctors who tried to save Davidson’s life or worked closely with him; more than 20 decided to meet with peer counselors.
With doctors who have mistakenly harmed patients, Shapiro can encourage them to improve safeguards. And with those who treated bystanders injured in the Boston Marathon bombing, she reminded them they had saved lives and limbs.
This time, the upside was elusive.
“This one was pretty tough to rationalize in any way,’’ said Shapiro, chief of head and neck surgery.
Dr. Stanton Shernan also searched for something redeeming in the hours after Davidson died. Shernan, the director of cardiac anesthesia, had known Davidson since he was a young resident and worked with him on dozens of cases. The morning of the shooting, he was standing outside his office when an anesthesiology fellow asked if he had heard about the shooting in the Shapiro building. “He said, ‘It’s Mike Davidson.’ I started running over to the OR to help,’’ Shernan said.
The atmosphere was not noticeably different from typical trauma cases, he said, except the team of 20 was about twice the usual size because of the desire of many to help. “There was no yelling, no screaming, no panic,’’ he said. “People were very focused and intense. . . . We worked very hard and we worked very long.’’
Afterward, in the lecture hall, there were periods of open weeping but also of silence among the 50 caregivers gathered there. Staff wondered out loud if they could have done anything differently or better. That’s when Shernan decided to speak up.
“In my experience that was one of the more extraordinary team efforts to try to save a life,’’ he told his colleagues. “I felt that Mike would have been proud in the way we handled ourselves in that situation.’’
When he called his wife later while driving home, “I was not quite as strong,’’ he said.
In talking with Shapiro, Kaneko said, he was able to organize his feelings, realizing that his emptiness was about losing a friend but also about the shattering of their shared professional vision. Davidson had started the structural valve team, which uses imaging technology to allow them to replace heart valves, without having to put patients on a heart-lung machine and make a major incision. Instead, the surgery is done through a tiny hole or cut, using thin instruments. Kaneko made a mental commitment to stick with it. “To keep his legacy going,’’ he said.
He reached another smaller decision. In their last conversation on the morning of his murder, Davidson told him he had sorted through his 2-year-old son’s clothing for Kaneko’s 6-month-old boy.
“Just come pick them up when you have time,’’ Davidson told him. It took him four weeks, but Kaneko finally brought them home for his baby to wear. “Now that I’m finally moving forward, it is more of reminiscence rather than a burden.’’
Liz Kowalczyk can be reached at firstname.lastname@example.org.