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I Gave at the Office

Most doctors are grateful for a thank-you note, even for extraordinary work. That doesn't prevent some patients from making equally extraordinary (or weird) shows of appreciation.

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The phone rang in pediatrician Laura Popper's office one afternoon. A terrified mother was on the line, sobbing that her newborn had stopped breathing. "I told her to call 911 and that I'd be right over," says Popper, who grabbed her stethoscope and ran the two and a half blocks to the family's apartment. The mother hadn't overstated the situation; the baby was blue. Popper immediately began resuscitation, did CPR, got him breathing again, and badgered EMS into heading to her hospital of choice, Mount Sinai, where the child was admitted and eventually restored to health.

For her efforts she received a box of chocolates. Now, while Popper likes soft-centers and nut clusters as much as the rest of us, what she really likes -- but didn't get -- was a thank-you note. "I did care about the letter," she admits, and in this Popper echoes the sentiments of her confrères, who insist that a patient's return to health and a few deeply felt scribbled words are the most important thanks. Even if sometimes they're a long time coming.

"I saw you on television," began a letter from one of Popper's patients, who was born with congenital heart problems and spent his first three months in the ICU. "Guess who? Here's a hint: I'm 13 because of you and I'm not your long-lost child. It's Morgan. Remember me?" Notes like that make it easy to believe the sincerity of a doctor like Ian Zlotolow, chief of dental service at Memorial Sloan-Kettering: "We just think we're doing our job. It's a privilege to take care of some of these patients."

Nevertheless, declarations like this do little to stop the flow of liquor and impressive vintages of wine, the delivery of fruit baskets, crystal and silver vases, Persian rugs, gift certificates to exclusive specialty stores, premium seats at sporting events, invitations to dinner, and, every so often, a Steinway, the keys to a Lexus, or, as in the case of Bernard Kruger, an Upper East Side internist-oncologist, an offer by a very well-heeled patient to buy him a practice.

While the American Medical Association has a well-articulated policy about doctors accepting largesse from drug companies, it's still finding its way in the delicate matter of gifts from patients. "We have no inclination to say it's unethical," says Frank Riddick, chair of the AMA's Council on Ethical and Judicial Affairs. "Certainly, gifts shouldn't be excessive in scope, though I doubt we'll ever try to quantify that." Some twenty years ago, he says, when the former shah of Iran was checking out of New York Hospital after treatment for cancer, all the doctors involved in his care were handed Rolexes by a member of the royal retinue. "But you have to understand," says Riddick, "for the shah of Iran, a Rolex wasn't excessive."

Mount Sinai, NYU Medical Center, New York-Presbyterian, and Continuum Health Partners, which includes St. Luke's-Roosevelt and Beth Israel, have no specific guidelines about gifts from patients -- "though it would obviously be wrong for there to be any solicitation of gifts," says Rosamond Rhodes, Mount Sinai School of Medicine's director of bioethics education -- leaving it up to a doctor's discretion. Thus, Michael Gruber, a neuro-oncologist at NYU, accepted a diamond ring and leather ensemble for his wife -- "I felt uncomfortable, particularly because the patient had never met my wife, but I didn't want to insult him," he says -- but has turned down a Mediterranean cruise and invitations to stay in condos around the world. "I like to have a little distance. I'm more effective as the doctor than as the buddy."

Similarly, Russell Portenoy, chairman of the department of pain medicine and palliative care at Beth Israel, returns gifts he finds excessively personal but did accept the underwriting of an annual holiday celebration for the department from Geoffrey Felder, head of Felder Pomus Entertainment. Felder "suffers from the worst chronic pain I've ever seen," Portenoy explains. "He's better now, and his gift is a measure of that. I allow the party because I view it as a donation to the department."

"I thought this would be a nice way of saying thank-you to them," says Felder, who orders the annual spread for 50 -- turkey, roast chicken, bagels, lox, fruit salad, and rugalach -- from Zabar's himself. "Every year the doctor asks, 'Are you sure you want to do it again?' and I say, 'Unless you want me to feed the whole hospital, I don't think it's a problem one day a year.' "

When Andrew Feldman, chief of sports medicine at St. Vincent's, undertook the care of Peter Beard, who'd been trampled by an elephant in Africa, the famed photographer "was gored and crushed and septic. He had a very good chance of dying, certainly of not walking again," says Feldman, who had Beard transported back to New York, where he and his partner did eleven hours of surgery and some follow-up procedures. "He ultimately got better and flew me to the opening of his exhibition in Paris and gave me a lot of artwork. I don't really have restrictions about gifts unless I think patients are trying to date me or get more personal with me."

But few gifts could compete with the one given to Richard Fraser, a neurosurgeon at New York Presbyterian. An elderly woman was so grateful for the care Fraser had given her best friend, "she wanted to sell me ten acres of a large piece of waterfront land she had in Nantucket. She was practically going to give it to me," he says. But as the woman was driving the back roads of the island to the bank to complete the paperwork, she was in a car accident. "She called me to take care of her, which I did. I had her flown from Nantucket to Mass General, where she died ten days later."

Not long after, Fraser got a call from the woman's lawyer, asking if he was planning to attend the funeral and informing him that he was a principal beneficiary. "She had rewritten the will when she was in the intensive-care unit, and I was bequeathed the entire property in Nantucket with three cottages. I felt floored and guilty because I didn't think I deserved it. That lasted two weeks," adds Fraser, laughing ruefully. "We enjoyed it for many years."

Even those with less impressive resources find ways of showing their appreciation. One patient of Alan Gass, director of transplant cardiology at Mount Sinai and a Yankees fan, has gotten him a signed team bat for each of the past three seasons, while another routinely provides him with custom-burned rock CDs. And years ago, when a Roosevelt Hospital internist was practicing in the Bronx, an indigent patient was so pleased by the treatment he said, "Doc, now, you know I don't have money to give you. But if you ever want anybody knocked off, I'm sure I can arrange it."


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