Basil

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We all have our role models. My bluegrass skills pale in comparison to some friends I am fortunate enough to have and for the most part they generously encourage my efforts to be a better musician. I wish I had been lucky enough, talented enough and dedicated enough to have had a career as a musician (or even better a major league baseball player). But I did have a career as a physician and I had my role models. And when I think of role models the first guy who comes to mind is Basil.

The process of becoming a physician is kind of weird. It’s basically a lot of school work followed by an apprenticeship. You do the usual four years of college and then you do four more years of medical school. After that in the old days you could get a license and hang out a shingle but nowadays you would be crazy to try that. The fact is that after eight years of post high school work you really don’t know anything!
So you apply for what’s called an internship. The word basically means voluntary slave and that is exactly what you are. You endure eighty hour weeks and duties that nobody else would want to do but the experience of all-night call when you are the only person skilled enough to make a difference at a particular bedside gradually prepares you for the responsibility of caring for patients when you are the person who is ultimately responsible.
After internship you become a resident. You supervise new interns and you look up to your leader, the attending physician. At a teaching medical center this is usually a professor with many other responsibilities like research grants to apply for and to retain. Some of these attending physicians are good teachers on the clinical wards and some are not. When your attending is more concerned about the lab than the wards, you are more on your own as a resident and sometimes that is a good thing.
I was fortunate enough in my training to have an attending physician who ultimately became my role model as a physician. Internal Medicine is a difficult specialty and other doctors refer to Internists as fleas because they pay attention to the tiniest details of medicine. The discussion at morning rounds about each patient can be an intimidating experience for an intern or resident. The attending physician will likely grill you about differential diagnosis which is basically imagining every possible diagnosis a patient might have given the symptoms, x-rays, physical exam and lab findings. And there was a pecking order with this grilling ritual (we called it pimping). First the medical student was queried, then the intern and finally the resident. If a post doctoral fellow happened to be on rounds he or she could fill in missing details but basically everybody was expected to produce a response worthy of their status and then teaching would result for the benefit of all.
My role model for the intricacies of what we called “roundsmanship” was Basil Kasimis. Basil is just about the smartest doctor I have ever met. Basil knew everything and his conduct of morning rounds was impeccable. You always learned something when Basil was the attending. His knowledge base was unmatched by anyone else I have ever worked with. When you rounded with Basil you really had to be on your toes.
I always had fun trying my luck with Basil on rounds but I’ll never forget one time when I got in trouble. I don’t remember the exact details of the particular case we discussed that morning but it was a very rare circumstance and Basil went down the line from medical student to intern squeezing out as complete a differential diagnosis as they could produce. When they ran out of possibilities the onus was on me and I was able to produce a couple of good answers. When you got an answer, Basil would grin and say “and?”. That meant you weren’t done because the list was not complete.
On this particular day of rounds it seemed Basil would never stop saying “and” and I didn’t want to give up even though I knew he was smarter than me and he knew all the possibilities so i happened to think of an extremely rare disease that kind of fit the bill even though I was sure nobody except me and Basil had ever heard of it. Again. I don’t remember the differential diagnosis problem or my desperate answer but lets call it Lampson’s Disease. (Don’t try Googling Lampson’s Disease. If you find anything it will have to do with an old movie. I’m using the made up name simply because I can’t remember the details of the situation nearly forty years ago.)
As soon as i said Lampson’s Disease I saw Basil’s brow furrow. I could tell it was a possibility even he had not considered! I had him! Or so I thought. Basil recovered his composure and acknowledged my effort with a terse “possibly”. Then he asked me in front everybody. You mention Lampson’s Disease. Tell me about Lampson’s Disease.
“Well it was named for Doctor Lampson” was about all I could come up with. Basil smiled and then proceeded to give a detailed lecture on Lampson’s Disease. History, symptoms, diagnosis, pathophysiology. Everything. I had to admit defeat as usual. Basil never lost when it came to being the alpha dog in any medical discussion. I felt that I scored some points that day but it was a very humbling experience to gain his respect that day.
Months later I asked Basil for a recommendation for postgraduate training. Basil was an oncologist and he inspired me to pursue that subspecialty. He encouraged me to train back east and was kind enough to write me a glowing recommendation. As a result I ended up at Yale. I met some incredibly smart people during my four years there but i have never met anybody as smart as Basil before or since.

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