Lobstering and RA: Why I Pursued a Fellowship in Rheumatology
The lobster boat tied off at the wharf. It was Ben Shipman, my rheumatoid arthritis patient, and he offered me a ride to Chebeague Island where my medical clinic was scheduled.
Maneuvering the boat into the channel, he sipped coffee out of a thermos and offered me a cup. The steaming coffee fogged up the windshield and Ben removed a work glove to wipe the glass. The knuckles on his right hand were swollen, but improved from several months ago. He slid off the other glove and balanced his hands on the wheel. “I’m a good 50% better, maybe more, on the weekly methotrexate the rheumatologist prescribed. And the shots you gave me for my knees worked — they’re fine.”
I learned more in the 15-minute trip to Chebeague Island about Ben’s rheumatoid arthritis than in a half-dozen office visits. By wrapping the wheel in foam tubing, he now had a larger, more forgiving surface to navigate his boat. Crates and barrels were lighter and smaller. His marine radio’s controls were changed out to larger, oversized knobs. Still, the 28-year old’s RA was not anywhere near remission. He was lobstering, but I could see it was still a struggle. It was more than a half-day trip back and forth to Portland for a rheumatologist visit, but he needed something more than I could provide.
I think that was the day I decided to leave my primary care internal medicine practice on the Casco Bay Islands in Maine, and —at age 37 — apply to a rheumatology fellowship. Or perhaps it was after seeing my giant cell arteritis patient hobble into our island market with a recent thoracic spine compression fracture, 5 months into high-dose prednisone. Or the marble-sized tophi on my alcoholic gout patient paying his bill at the Gull where I often ate breakfast on my way to the 6:15 morning ferry.
Living in the same community with my patients was a privilege that physicians years ago took for granted. They interacted with the same patients in the general store, post office or church that they may have seen an hour previously for an office visit. They responded to emergencies. Perhaps, like me, they ran by the local cemetery where their patients reposed, and wondered, “could I have done more?” On Peaks Island, my failures were always nearby.
When I returned to Maine after completing my fellowship at the University of Pittsburgh in 1993, I joined a community of rheumatologists skilled in recognizing and treating immune-mediated disorders, even if the results were uneven. Then came a revolution in pharmaceuticals and our patients’ lives dramatically improved.
Last summer, I saw my patient, lobsterman Ben Shipman, now well past middle age, pulling traps. Those of us whose practices bridge the divide before and after biologics remember when our ministrations were often insufficient to stem the tide of early disability or premature death. Now? Pass the melted butter and grab a boiled lobster, freshly hauled by a man who has had RA for 30 years.
— Chuck Radis, DO
Clinical professor of medicine
College of Osteopathic Medicine
University of New England