What we do matters – a story of the generational impact of caring for patients

Cleveland Francis, MD, Diversity, Equity and Inclusion Advisor at Inova Schar Heart and Vascular.

Growing up in small-town West Virginia, Jessica Flanagan heard stories about a wonderful doctor. During the late 1970s, an Alexandria cardiologist had treated her late mother, Susan Flanagan, before she passed away from a congenital heart condition. Jessica was only 3 years old when her mother died, but the name of Susan’s cardiologist entered family lore. Jessica listened as her grandmother spoke about the caring attention that “Dr. Francis” had provided.

Over 40 years later, Jessica – now Jessica Barela – faced a health crisis of her own. She saw many doctors, but she kept coming back to what she had heard about Dr. Francis. After much searching online, Jessica reached out through Inova Schar Heart and Vascular’s website. Her note reached Leila Elliot, Senior Director of Growth at Inova Schar Heart and Vascular, who forwarded her email to me.

Dear Dr. Cleveland Francis,

You may not remember me, but I am the daughter of one of your patients. Her name was Susan Beth Flanagan. She died in December 1982, while on the list for a transplant donor. My grandmother told me my mom was one of the only patients you visited on house calls. I want to thank you for all you did for my mother. I was only three at the time of her death, but within our household we always spoke your name with loving thoughts and prayer.

Sincerely,
Jessica Barela

A voice had reached out from the past. Seeing the message from the daughter of one of my long-ago former patients excited and heartened me. I called her immediately, and we had a wonderful phone conversation about her mother’s experience under my care.

Susan Flanagan. Even after 41 years, of course I remembered her. How could I forget? She had been my first consult as a young cardiologist at Mount Vernon Hospital, the facility which later would become a vital part of the Inova system. I learned so much from my brief time with Susan. The experience underscored my conviction that as a physician, I needed to treat not only a condition or illness, but a whole person. I felt that to help Susan I had to know all about her daily routine, her job, her home environment and especially her family.

She was very ill. In cold, clinical language, her condition was “incompatible with life without further surgical cardiac intervention.” I gave the best care I could using the most advanced practices of the day. I often met with her whole family including her mother (Jessica Barela’s grandmother). Susan Flanagan was on the waiting list for a heart-lung donor organ when she died.

I attended the memorial wake for Susan, as I would for any person I knew well. I spoke to her family. We grieved and remembered together. I recall 3-year-old Jessica sitting on my knee.

I kept the memory of Susan in my heart. Meanwhile, within the Flanagan family, her experience with me echoed and reverberated like a tiny bell or a stone dropped into a pool. Sports icon Jackie Robinson stated, “A life is not important except in the impact it has on other lives.” I know that Susan Flanagan had an impact on my life and on the lives of all those who had participated in her treatment.

Decades after her mother’s death, Jessica Barela was now herself the mother of two children. She had been in and out of hospitals and emergency rooms, always anxious that she suffered from the condition that had taken the life of her young mother. Jessica set out on a quest to find “Dr. Francis,” the physician she had heard her family speak about since childhood. During our phone conversation, I promised that I would help her find the answers.

Interactions in medicine can sometimes involve a transformation, whereby the personal suddenly becomes impersonal. One individual is “the patient” and the second is “the physician.” Yet to deliver the best possible care, it is critical that we see our patients as people.

My time with Susan highlighted the need for cardiology rehabilitation programs, then just coming into wide use across the nation. Outside of my role as a doctor – as part of my own individual personhood – I am a musician. I established the Susan Flanagan Fund and launched a series of benefit concerts. The money we raised helped local communities develop cardiology rehabilitation programs.

Throughout my involvement with Inova, my colleagues and I have always embraced the principle of “patient personalization.” We seek to treat the whole person, not just the condition. Empathy and trust must forever be the bywords of our profession. All people stand equal before the caduceus.

The story of Susan and Jessica serves as an example of what matters to patients and their families. Simply by taking time to listen and pay attention to the people we treat, we foster a feeling of warmth and connection. Patients remember that feeling, and in some cases, that memory transcends generations.

The time-honored phrase “bedside manner” has endured for a reason. With the accelerating pace of technical advances and with AI entering all aspects of modern life, person-to-person interactions still remain at the heart of what it means to practice medicine.

Though decades have passed since I cared for Susan, and even though I no longer practice clinical cardiology, the guiding principles of empathy and trust still remain.

Cleveland Francis Jr., MD, is the Diversity, Equity and Inclusion Advisor at Inova Schar Heart and Vascular in Falls Church, VA, and the former founder and president of Mount Vernon Cardiology Associates. He serves as the chair of Inova Schar Heart and Vascular’s committee on equity, healthcare disparities, education and outreach and is a member of the Inova Inclusion Council. Dr. Francis is also a songwriter and performer whose music is featured on the Country Music Hall of Fame and Museum’s recently re-released 82-song collection “From Where I Stand: The Black Experience in Country Music.” He is a former recording artist on the Capitol Nashville Country Music Label (1992 – 1995), and his music has been featured at the National Museum of African American History and Culture in Washington, DC.