My “Favorite” Patient and His Leopard-Skin Bra

Chops and a bushy mustache. An indomitable and ultra-cool personality. An endearing smile that no one could resist. With each passing month his wife Becky grew more speechless and in-love. Two basketball playing sons Michael and Matt. Dyspnea on exertion, orthopnea, and 2+ edema to his calves from a disease that was bringing death closer and closer. This blessed and cursed man was Danny West.

It was our lung transplant team that had the good fortune of making his dream of “extra days” come true one midnight. “Danny and Becky, we have a single lung for you. Come to the hospital for your transplant.”

A few years earlier while playing basketball, he’d noticed that he couldn’t catch his breath. Still in his 40s, he had developed the skull-and-cross-bones diagnosis of pulmonary fibrosis, a progressive scarring of the lungs that leaves you sucking wind and inexorably dying. With that backdrop, this story pivots on the odd point that from the moment I met Danny, he signed every email, note, or letter with “Your favorite patient, Danny.” A doctor really doesn’t want to have “favorites,” and for good reason we strive daily to treat everyone with equal effort and compassion. What student has not been on the receiving end of watching a teacher’s favorite get more attention or special treatment? No way, I always remind myself, is that going to happen on my watch as a physician. At first I surmised he wanted to will it to be true, as if writing it over and over would make it so. Now with hindsight, I see how Danny’s persistence taught me something very important about us as humans.

For years I have been instructing the second year medical student class on the physical examination of the chest, and I thought Danny would be the perfect guest. His transplanted lung could provide normal breath sounds, while his native (non-transplanted and scarred) lung would sound like a war zone of crackles, squeaks, and Velcro. On cue during his first visit, I asked (as I did each year) for a volunteer student to come down, take his shirt off, and allow me to demonstrate the exam. Much to my surprise, a 22-year-old blonde Yale grad erupted from her chair and began bouncing down the steps while unbuttoning. Once down front, she took her blouse off. Though completely speechless already, I stood agape and more nervous as I realized that that she was wearing a leopard-skin bra! The rest of the class, including the women, went nuts and I fumbled through the exam as far away from her as possible (I just kept thinking, “people get fired for stuff like this”). Anyway, the next year, I asked Danny back and did NOT ask for a volunteer. As he got up to take his shirt off, I turned to grab my stethoscope and heard a thunder of laughter. Danny had on a leopard-skin bra and was beaming at me from across the room. The moment was priceless and is still passed on from class to class. We even took a classic picture that his sons used to swap our heads around so that I was wearing the bra and Danny was wearing my white doctor-coat. Somehow, that picture was emailed all over Vanderbilt’s campus, and yet I remain employed there as of now.

So other than the obvious gift of friendship, what did I learn from his “your favorite patient, Danny” moniker? While a freshman in college, I read CS Lewis’s tip that we must “will” our most important values and goals into the forefront of our minds (i.e., our RAM or “mental desktop”) rather than file them away for mere occasional recall. At first, this feels somewhat forced and must be deliberately repeated. But eventually, as Lewis predicted, it becomes ingrained. Danny helped me with the simple truth that our minds can be trained and our actions aligned automatically with our most precious values.

A few months after the bra incident, I saw Danny and Becky in the clinic. He was “walking crooked” from a tumor that we’d discovered had spread from his native lung to his brain. The transplant had worked, and his gift of extra years had been a huge success, but as commonly happens, the immunosuppression medicines had weakened his ability to fight tumor cells. As he walked “drunk” over to me that day with Becky looking on, he had a sheet of paper in his hand and said, “I want you to have this, Wes. I’ve been carrying this in my mind constantly these days. Becky will give it to you later.” I gave him a hug and turned to leave, knowing it would be the last time I’d ever see him alive.

Only a few days later, Becky called to say that Danny had wanted me to speak at his funeral. As I drove the hour to Dickson, TN, never did I imagine the hundreds and hundreds of cars and overflowing mass of people that were drawn there that gray day. After two other friends spoke, I was last to the podium. Just as Danny had scripted for his sons to execute, the song “Spirit in the Sky” began to blare over the speakers, “When I die and they lay me to rest, Gonna go to the place that’s the best, When I lay me down to die, Goin’ up to the spirit in the sky…” As if that wasn’t hard enough to hear, I looked down at the podium and the picture of the two of us, him with my doctor coat on and me with the leopard-skin bra, was framed as a parting gift alongside the paper he’d been holding at our last visit. A little later in a quiet place, I stopped to read what he’d been carrying, by then effortlessly, in his mind:

A Place at the Table, By Danny West

I hope He says “There’s a place at the table”
When I make it there
And with a wave of His hand He points
To my chair

I look around the table and
I know everyone here
They’re all so happy and healthy and
Not one with a tear

He says. “You’re at peace now and
Many miracles you will see
Because you came to the Father and
You came through Me.”

We walk through the heavens above
The sun and moon
He says, “Don’t worry my son, the
Ones you’re missing will be here soon.”

There’ll be a place at the table
When you get there
Where all the pleasures and treasures
Forever we’ll share.

Your favorite patient, Danny

By this time, the salutation had become true.

Story by E. Wesley Ely, MD, MPH
Professor of Medicine and Critical Care
Vanderbilt University School of Medicine


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