Spring 2002

Last weekend I attended a large Podiatry seminar in the Cleveland area. Running into old classmates and peers, and seeing all the latest gadgets, gizmos, and surgical techniques, takes me back to those unsure times of college and Podiatry school, times when I asked myself why I’m doing what I’m doing, would I ever be "successful" at it, and how I would define that success. We tend to judge the apparent "success" of our peers at these conferences by their cars and homes, the size of their practices and surgical case logs.

I remember the first time I walked into my present office. It was eleven years ago this Easter, and I was a third year podiatry student, starry eyed and a bit bewildered by the real world of podiatric practice. I was visiting the office of the residency director of a small rural western Pennsylvania RPR/PSR-12. I was terribly homesick, a small town "kid" looking to return to west central PA, and desperately desiring to secure this slot. As I was shown around the office, I thought, "All I want is an office like this some day, in a small town like this, with good decent folk to treat and help, a decent living, and a home to raise a family." Honestly, that was all I desired, the yardstick I had carved in my mind for "success." Now I own that very office, and daily I treat and help good decent folk, and I have a secure middle class standard of living, and a great family life.

Success? Yes, of a modest sort, at least on the level at which many folks define "success."

One caveat..like many of my peers, I gave up surgery two years ago. I could no longer afford to lose money keeping up surgical malpractice when I have such a small practice and conservative approach to surgery. Reimbursements for the few surgeries I was performing were not covering the surgical malpractice premiums and Pennsylvania’s CAT fund surcharges. Another caveat...I’ll never get my student loans paid off. A secure middle class living does not provide enough income to pay $2400 per month student loan payments. So I consolidated all my loans with the new Federal Direct loan consolidation program and make small income sensitive payments. Twenty five years from now, with my income sensitive payments, the original capital and accrued interest simply will not be paid off. I’m told any amount left at 25 years will be written off as bad debt and turned over to our friends at the IRS that year as income. Success?

Hmmm...the lists of caveats grows, it seems.Once when my little girl had an earache, and was seen after hours by the pediatrician, my wife had to call their business office the next day to make arrangements for the bill. When she gave the billing clerk my name and address, the clerk explained that they extended professional courtesy to doctors. Then the billing clerk called back 5 minutes later, rudely explaining to my bewildered wife that "Your husband is not a real doctor, he’s a foot doctor! You’re going to have to pay this bill!"

I often wonder why half of my patients here call me "Brian" instead of "Dr. Kopp." Do our patients also fail to see us as a "real doctor"? Or is this informal familiarity possibly a form of acceptance or even a compliment? Is this "success?"

And then there are the words of encouragement, smiles, and compliments, the cards, the ethnic foods like halushki, halupki, pierogies, and nut rolls, and candy and gifts for my kids. These cannot be measured in terms of income or practice volume or surgical case logs, or board certification. No one knows that Mary invites you and the family to stay for a Coke and piece of pie every time you do a house call, or that Stan made your kids wooden trucks and cranes in his wood shop as thanks because your daughter, an aspiring nurse, held his hand during a heel spur injection, or that Chiz sends daily E-mail jokes and words of inspiration,

In the end, "real success" just cannot be measured, and the things we think define success ring hollow in comparison with "real success."

When Frances first visited and I asked her what sort of trouble she was having, she broke down in tears. "You won’t believe me. No one ever believes me! I’ve had pain for six years now, and they all say I’m crazy!" Frances was a little crazy, not in the sense of mental illness but in the sense we’re all guilty of being "crazy," worrying over things we shouldn’t. She was only coming to me for an ingrown toenail, which was successfully treated. But her overall treatment success ended up defining for me what "success" as a podiatrist really means.

Frances started having health trouble, it turned out, only after she stopped going to church, due to difficulties her daughter had in their old church. Not one of her doctors or specialists had ever listened enough to realize that Frances wasn’t really sick, she was just afraid to die, and her aches and pains started when she stopped going to church. I sent her to a priest (this is a very ethnic, Catholic town), who got her to go back to church. And many of her pains disappeared. She’s still a little "crazy," but in a very good sense, and we laugh about that. She is a good friend, and makes the best nut rolls in the county. Her daughter now works part time as my receptionist, and her granddaughter helps as a part time billing clerk.

Then there was Stella. She was a patient who lived at one of the local nursing homes, and was very obese and sick and miserable. She was a difficult and demanding patient, but more than anything she was lonely and depressed. One day she mentioned that she liked to watch an old nun that had her own cable TV network, and afterwards we frequently chatted about our shared faith. I even gave her a rosary I often carried in my pocket. Stella always kept that rosary that her "handsome" podiatrist gave her (Stella had eye trouble, I suspect.)

Tonight a friend of the family advised me that Stella died yesterday. She died praying with the very rosary I gave her, and was buried, grasping that same rosary. The friend said that Stella often repeated how much she "loved" her pastor and her foot doctor. I never knew.

Tonight the business mortgage is a week late again (as usual) and the van is sitting in the driveway until we can pay to rebuild the motor. So much for business "success."

But tonight, more importantly, I think I know the meaning of real success.