Wednesday, November 03, 2010

On the loss of a great mentor---Coy Fitch

I just learned that Coy Fitch, MD, former Chair of Internal Medicine at St. Louis University School of Medicine, died last May. When I was in my residency at SLU back in the late 70s Dr. Fitch was a ward attending and one of the leaders of the residency program.

When he stepped onto the ward for attending rounds my first week there I was fooled by his soft spoken, unassuming manner. But I soon experienced for myself the sense of reverential fear I'd heard about from the other house staff. What was it about him in all that humility? He wasn't abusive. He didn't yell and rant and rave and he wasn't into “pimping.” I think it was his utter, uncompromising sincerity about excellence in patient care and the fact that he expected the same of you. If you were dumb and green that was understandable but he couldn't tolerate sloppiness or carelessness. You wanted to please him more than anything but that sigh or that Coy Fitch scowl reminded you when you didn't measure up.

He wasn't gratuitous in his praise or criticism, but a little bit went a long way. He said what he meant and meant what he said, and that was that. I think he was the straightest shooter I ever knew in my training. One time after a case presentation at professor's rounds he said “that was a well worked up, well presented case.” That was the highest praise I think I ever heard him give anybody. It didn't sound like much but the team knew it meant a lot coming from Fitch, and probably gloated for a week.

All the same we knew he cared about our personal lives and professional development. I was always welcome to call him at home. He once expressed concern to me about whether I was getting enough sleep, strange as that may seem now as we look back on an era when education was punishment.

He was one of that dying breed, the physician-scientist. He had joint appointments in Medicine and Biochemistry. Although his subspecialty was endocrinology he also maintained a career long basic research interest in malaria. Despite that academic bent he exhibited great common sense and extraordinary clinical instincts on the wards. He imparted many pearls of wisdom which I never forgot and have yet to prove wrong. One time after listening to a presentation in morning report about a patient with unexplained dyspnea he remarked that any time you catch yourself saying “I wonder why this patient is dyspneic” think pulmonary embolism. That was prescient. It's essentially Wells criterion #2, and Fitch predated it by 20 years!

Dr. Fitch talked some time ago about retiring and moving back to Arkansas but as far as I know he continued to work until shortly before his death at age 75. He loved the teaching and practice of medicine and was devoted to the University. SLU will never be the same, and Coy Fitch stories will no doubt circulate among alumni for years to come.

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