Thank you for coming…

“Thank you for coming”

For my first 27 years as a Pediatric Cardiologist it never occurred to me to end an outpatient visit with those words.   

I don’t think that I was being rude for almost three decades.  It just didn’t occur to me to say that.  People came for a service and we delivered it.  Deal! A lot of emotions pass through a Pediatric Cardiology visit, in both directions, and gratitude is certainly often one of them.  For those of us who love what we do, we certainly are grateful for the platform to do it.   But while families often thank the doctor – and the staff – on their way out,  parroting back “Thanks for coming” at them just seems perfunctory.  It equates a medical visit with a trip to Arby’s.  “We’ll send a note to your Pediatrician, and did you want fries with that?” 

Then 2020 happened. The world stopped.  We all gave up  many things that mean a great deal to us: sporting events, dining out, traveling, attending services, and just gathering with people we enjoy whenever we want to do it.  I certainly don’t mean to diminish the lives that were lost, but my lingering memory of mid-March and beyond may be the emptiness of forfeiting all the things that make life whole from day to day. 

Those of us in medicine had a specific challenge, particularly in New York, which bore the brunt of the pandemic.  We couldn’t hide from the virus because we had to go to work in the place where it lived.  But the volume of work plummeted, as all medical care that was not urgent was put on hold for the onslaught of COVID-related care. In our Pediatric Cardiology group – since all Pediatric inpatient care including cardiac surgery was herded from Cornell to the Columbia campus of New York Presbyterian – only one or two of our five Cardiologists were coming to work each day.  (Aside:  We did the same with our staff.  I’m proud of the fact that during the teeth of the pandemic, as far as I can tell we were the only Echocardiography Lab that paid our Echocardiography technicians - the backbone of any Pediatric Cardiology service - whether we assigned them to in-person work or not.  We did not make them take the risk of traveling the subways to come in and do no echocardiograms, just to get paid).

And whichever two of us were present in the hospital each day spent a lot of our time staring into space.  Instead of our outpatient clinic buzzing with 20-30 patients a day, we were seeing maybe three or four.  Those visits were really unique.  As sobering and even intimidating as it was for us to come to work each day, at least we were a little bit used to  it.  We spent hours every day watching leadership updates, engaging in Zoom meetings with folks across the network and at other institutions, and doing other things that blurred the stark distinction between the “there” of the rest of the world and the “here” of the hospital.  We had our guard up, but at least we were in our own element, altered though it was by the events of the day. We had a chance to develop some faith in the system.

But for the patients and their families, a medical visit in the Spring and Summer of 2020 was a different story.  For most it was the first time they ventured into the hotbed of the pandemic.  Many had to brave public transportation to get here.  There were long lines (socially distanced, of course) to enter the hospital, and you had to have your temperature taken just to walk into the lobby. Did that wrist temperature gadget actually work?  I’m betting not. It sure disappeared, quickly and completely.

As Pediatric Cardiologists, we have always understood that every family who comes to see us really doesn’t want to be there.  We know that there is anxiety attached to every appointment.  We pride ourselves on helping families overcome that. 

But this was different.  We would walk into a room and see faces (well, parts of faces) that feared for their lives for just coming into the building.  They would literally rather be anywhere else than there.  Yet something that we had to offer made them overcome all of that.  They placed faith in us, in our hospital, to make it safe for them. They believed the benefit outweighed the risk.

And because they came, they not only sought and found care for their children, but they healed us as well.  They gave us back one of the most  important things that we had been missing, the thing that we dedicate our whole careers to, which is the patient interaction that makes Pediatric Cardiology so rewarding. 

On one of the first March days that I was one of the lucky pair assigned to in-person work, I saw a child and his mother (Only one parent! No siblings!) who I had known since, well, before he was born.  I was so grateful for the experience – it felt as if they journeyed to the hospital that day just for my gratification – that on my way out the door I looked into the mother’s goggled eyes and said, sincerely and spontaneously, “Thank you for coming.” 

Then I stood in the hallway thinking of those four words until I cried. 

All of a sudden I realized in a singularly new way how much this field, and every encounter that it brings, means to me. 

The phrase has stayed with me ever since.  It never sounds trite.  It’s never insincere.  And whenever I hear “Thank you for coming” anywhere else – Madison Square Garden, Walmart, the DMV – even if it actually IS perfunctory, I think about what it means to make the choices we make every day to go to the places where we go, and I am again grateful. 

People aren’t dodging a deadly virus any more when they come to a doctor visit.  But they still make the choice to put their faith in us to find answers for their children and for themselves.  It’s a solemn responsibility, and a privilege, every single time. 

All of this has an even more personal meaning for me these days.  Since opening this office, I have a whole new appreciation for each family who comes for a visit.  It’s a leap of faith to venture out to a new endeavor, both for me and for them.  It hasn’t been easy to find us, especially if you’re one of my patients who received an email sent by Cornell (“from me”) that many people interpreted to mean that I was retiring but others concluded that I was actually dying.  (Spoiler alert: I’m still kicking!).  You can’t just Google “Patrick Flynn Pediatric Cardiology” and find us, at least not yet.  It takes a little work.  But families have found us, a few blocks further West than before, and have allowed me the privilege and the satisfaction of doing the thing that I love most: caring for their children. 

So, welcome to Avalon Pediatric Cardiology. 

And thank you for coming!

~Patrick Flynn