It was 7 degrees and snowing – typical Michigan in January – the afternoon Dr. Greg Henry entered the Chelsea Community Hospital for his last shift. When he arrived, he went to the staff lounge just as he had for the last six years, slid his lunch into his locker and then pulled out his white lab jacket. He looked it over slowly, silently running through a “white coat ritual” he’d developed decades prior.
“As I put the coat on I remind myself that for the next eight hours, I don’t represent myself,” said Dr. Henry, “It’s not about me, it’s about the patients. I represent the practice of medicine. And be it on my soul if I am not a better person when I put the coat on.”
Dr. Henry checked that his stethoscope was in place and that his reflex hammer – the same one he’d wielded for more than 30 years – was securely in his pocket, and then he stepped out into the department. It was single coverage that night, as it always was after 4 o’clock in the afternoon, and Dr. Henry knew he’d be the only attending physician in the hospital. As he surveyed the department, it seemed the same – even prototypical – and yet there was something very different.
Greg Henry began seeing patients in the emergency department as a medical student at Detroit’s Wayne County General Hospital in the late 1960s. This was before the time of dedicated emergency medicine residencies. Later he practiced in Saginaw, Michigan, “a tough industrial town full of poor people.” For 21 years, Dr. Henry was the director of the emergency department at Beyer Hospital in Ypsilante, Michigan, another “poor person’s hospital,” he recalled fondly. “I think that these experiences made me a better doctor. Most of the books I’ve written, and most of the case studies I’ve presented around the world, have been from ‘plain old hospitals’ that took care of ‘plain old people’. There are acres of diamonds in your own backyard if you look.”
For Henry, that backyard was the state of Michigan, but his lectures have taken him around the world many times over. He served as the president of ACEP in 1995 and edited the College’s principal textbook on medical/legal issues. He was the first American to hold the Maurice Ellis Lectureship in emergency medicine at Cambridge in England. Only two Americans have received this honor. Though his career has been called “legendary” by some, he is not without detractors. “I am both loved and hated,” he said, quickly adding, “If you’re not a little bit of both, you probably didn’t say anything at all.”
Legendary or ordinary, none of it mattered when Greg Henry stepped onto the floor for the last shift of his career.
His first chart was for a child, an eight year old with an ingrown toenail. Dr. Henry put in a block and performed a hemisection of the nail. “I did him a lot of good. There are a lot of patients for whom I’m not sure how much good I do.”
The night brought “the usual and customary signs of a misguided society,” including a man who shot himself in the finger with a BB gun. “My career depends on the indiscretions of humanity,” he said with a chuckle. “If intelligence breaks out, I’m ruined.”
The night also brought more sobering cases. A woman presented with a swollen left arm that had been worked up at multiple institutions. Dr. Henry noticed that she also had a slight ptosis and a slight change in her pupil. “There’s a series of these things which you rarely get to see,” Henry said. “It’s probably been five years since I’ve seen one, and I write articles on neurological emergencies.” What Dr. Henry was recognizing was Horner’s Syndrome. “Unfortunately, I know what goes with superior vena cava and Horner’s. It means that she has a tumor in her mediastinum and she is going to die. But at least her moving from pillar to post, looking for the correct diagnosis, was finally over.”
Around 6:30 in the evening, when patient flow was steady but manageable, the Chelsea staff gathered together for a brief moment. Nurses, techs and administrators circled up to sing “For He’s a Jolly Good Fellow,” and present Dr. Henry with one of the hospital shirts. It was “dignified and without tears,” Henry assessed, and respectfully efficient, lasting no more than five minutes. Afterward, however, as his shift clock ticked down, each staff member found Dr. Henry to pay their individual, more personal, respects. An old friend, a retired physician whom Dr. Henry had worked with years prior, had even arrived from out of town just to be with him in the final hour.
Dr. Henry mentioned the significance of the evening to only two patients. The first was a chronic pain patient with whom he’d developed a long-standing relationship. The second patient was his very last, a 16-year-old boy who came from a family who got frequent migraines. That night he’d been suffering more than normal, even felt unsteady on his feet, and his mother brought him in to get worked up.
And so, one final time, Greg Henry got down to the basics of examination. “I’ve lectured on this a thousand times. And now it’s the last case I’m going to see. I sure as hell better do the exam correctly.” He checked the boy’s reflexes, performed a Romberg exam, checked for pronator drift and venous pulsations. “And then I reassured him, as I always do, that I could take care of his pain.” Which is just what he did.
As the boy – happy but a big groggy – prepared to leave with his mother, Dr. Henry reentered the exam room with a small wrapped package. “Don’t open it now,” he said to the mother. He explained that her son was the last patient of the last shift of his 42-year career in medicine. Visibly moved, she thanked him for the gift and they all moved towards the exit together.
Earlier in the day Dr. Henry had penned a note to this unknown last encounter. “You are the last patient that I will see regularly in the emergency department,” he’d written in a flowing fountain pen. “I hope I made this experience one that you enjoyed. And, I hope that coming in here and being seen was as good for you as it was for me.” He’d placed the note inside the package on top of a leather box, inside which was a wooden pen, hand made by a Michigan artisan. “You ought to have a pen that you can pull out when you sign important papers,” he said.
The young man and his mother shook Dr. Henry’s hand, and then they were gone; another fleeting relationship in a career of momentary encounters. The shift, so like the rest and yet so unique, was finally over.
After shaking hands with all the staff Greg Henry climbed into his pick-up truck and drove home, wiping his eyes so that he could see the road.
Logan Plaster is the creative director of Emergency Physicians Monthly