What constitutes grace in the everyday life of a physician? I believe that it is in encountering patients, and caring for them. I’m never going to win a Nobel Prize, but I have repeated moments of grace as a result of my life in caring for other human beings.
-Grace in the Secular World of Medicine*
-Thomas P. Duffy, M.D. (1937-2022)
Hello everyone,
I first met Tom Duffy in the early 1990s, at the start of my pulmonary fellowship. His eminence at Yale was well-established by then. Colleagues and trainees revered him. His arrival on a hospital floor, in his starched white coat, bow tie, and spectacles, created a near-sacred aura. His presence meant the patient’s story would be told, the puzzle assembled, the diagnosis made.
Tom possessed encyclopedic knowledge, but his clinical powers reflected an array of talents. He had astounding observational skills. One Thursday morning after Grand Rounds, he congratulated a resident on her pregnancy, which shocked everyone, including the resident, since she’d just found out herself. But from across Fitkin Amphitheater, Tom had discerned a faint flush in her cheeks, which led him to the diagnosis.
Tom’s skills were informed by knowledge of the arts, philosophy, history, literature, and religion. Once, he diagnosed “holy anorexia” in a cachectic ex-seminarian, summoning his knowledge of Catholic mysticism and Ignatian spiritual exercises.
For years, I sat by Tom at 9th Floor Report, absorbing his stories, which always began with “Forgive me if I’m repeating myself.” Tom regularly invoked the foreboding “four horsemen” of pancytopenia- Famine (malnutrition), Pestilence (infection), Warfare (drugs), and Abnormal Social and Economic Clones (cancer). And who could forget Tom’s disquisitions on the relationship between hemochromatosis and the Irish potato famine?
Tom had specific areas of expertise in hematology and bioethics, but his lessons evoked timeless, universal themes. Here are some of his precepts:
Build a storehouse of experience: Tom regularly conjured up rare diagnoses as if by magic, from hairy cell leukemia to IgG4-related disease to HLH. But Tom insisted there was no magic to his work. Over decades of practice, he had collected a wealth of experience. His knowledge allowed him to recognize disease patterns that others missed.
Learn from your patients: Textbooks, journal articles, seminars, and lectures have their place, but we learn the most from our patients. There is no substitute for taking thorough histories, examining carefully, and returning to the bedside to follow up.
Prioritize beneficence: Tom’s patients trusted him completely. His brilliant skills fostered this trust, but his devotion to their well-being mattered more. When Tom sat with patients, he listened. In these fragmented days, we must emulate this practice.
Uphold virtue: Tom was pained by modern medical metrics--especially the worship of efficiency, billing, and RVUs—which pale in comparison to diagnostics, compassion, and healing. Tom detested soulless terms like “client” and “provider,” which too often displace the sacred “patient” and “physician.” As much as anyone, Tom understood the power of language to undermine or uphold professional virtue.
Pursue Medicine as a Vocation: Tom lived a rich home life, replete with books, music, gardening, and, most importantly, family. In parallel, he found grace and satisfaction in medicine, as a clinician and teacher. Tom immersed himself in science and the humanities. He was devoted to his patients, students, and colleagues. By pursuing medicine as a vocation, Tom’s professional life was fulfilled.
Last week, Tom’s son Eamon told me how much his father adored our residency. The adoration was mutual. I am fortunate to have been one of Tom disciples, learning timeless lessons, not just about medicine, but life itself.
Tom's memory will endure on the hematology service that bears his name, in the lives of countless patients and families who benefited from his care, and in the work of thousands of physicians, nurses, and other clinicians who learned from his example.
This morning, we hold Tom, his wife Susan, and the entire Duffy family in our hearts. May his memory be a blessing.
Mark
*H/T to former Yale Resident and Chief Resident, Dr. Dena Rifkin, for sharing this quote.
PS A link to tributes from former trainees and colleagues.
PPS Immerse yourself in the readings attached.
PPPS Memories: