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The last lecture

White Coat
In this photo from 2010, James Jamieson (far right) joins other members of the Yale Medical Scientist Training Program, which he directed from 1973-84 and 1991-2014, including Adrian Haimovich, the author of this piece (seventh from left).

This year, the Yale School of Medicine and larger scientific community said goodbye to Dr. James Jamieson, MD/PhD. "Dr. J," as he was fondly known, spent decades at the helm of the Yale MD/PhD program and helped train multiple generations of physician-scientists. It has been almost a decade since I sat in Dr. J’s classroom, but I was present for his last lecture on a cold night this fall.

I am a graduate of Dr. J’s program and now an Emergency Medicine resident at Yale New Haven Hospital. There, my colleagues and I work alongside our attending faculty, nurses, technicians, advance practice partners, environmental services, and countless other individuals to keep the doors of the emergency room open 24 hours a day, 365 days a year. On this October night, a nearby ambulance crew brought in a gentleman whose heart had stopped at home. This is a common occurrence in a bustling emergency department, and resuscitation of those recently passed or close death is one of our areas of expertise. The emergency department has rooms dedicated to resuscitation of the critically ill and there we gathered to help the anonymous individual coming by ambulance.

By the time our patient was transferred from the ambulance to our bed, we discovered his Do Not Resuscitate (DNR) directive in the electronic health record. We complied with his wishes. Resuscitation is often traumatic and the role for advanced directives is expanding. Caring hands in the room dressed our patient and covered his body with a warm blanket from the trauma oven in the hall. As a team, we stepped back to take a moment of silence to celebrate the life of the individual in front of us and to mourn his passing with a family that was not yet aware of his fate. As I bade this man farewell, I asked one of the ambulance crew, “what was his name?”

“James,” she told me.

In my head, I wished James the best of whatever comes next.

It was minutes later at the computer station where we document our patient encounters when the terrific Yale medical student rotating with our team exclaimed, “the patient who just passed was a really important Yale professor.” We rarely get to know the accomplishments and stories of those who pass while in our care. Instead, in these end-of-life moments, the lives of our patients are often reduced to the generic, blanketing compassion of the medical team.  Sometimes, if family or friends are present, we share in their raw emotion, empathizing with their loss. In our worst moments, we leave the room of the sometimes-anonymous deceased without a thought or hope or prayer, hurrying to the side of the next patient calling for our attention.

“Apparently he helped discover the Golgi complex.” I knew that because, by now, I understood that James was Jim. I stood up from my charting and returned to his side. I looked down at my old mentor, this no-longer-anonymous man in a resuscitation room and thanked him. I thanked him for his role in my path to becoming a physician-scientist. And I thanked him for this last lecture of our shared experience where he reminded this young physician that every patient has a story to tell. If we care for every patient, alive or dead, as though they were our friend or family or loved one, we will never be wrong.

Thank you, Dr. Jamieson. From all of us.