My Kind of Medicine: Real Lives of Practicing Internists: Andy Coates, MD
By Catherine Nessa
American College of Physicians Medical Student Newsletter
October 2009
On any given weekend during the fall of 2004, Andy Coates was never where you might expect—he wasn’t at home with his children or outside working in the yard. He wasn’t at a restaurant having dinner with his wife or at the ballgame with his buddies. He wasn’t at a party thrown by neighbors or friends, or even on a beach chair on vacation. Instead, Andy Coates spent his weekends at Columbia Memorial Hospital in Hudson, NY, with the barest of accommodations: meals were brought in by cooler, his bed was a cot in a room in a recently-closed nursing home across the street from the hospital, and for entertainment, he had his work. For many physicians such an arrangement might be unappealing, but it was perfect for Dr. Coates, who has found satisfaction and fulfillment in unexpected places by taking roads less traveled.
The Late Bloomer
The weekend shift in Hudson was Dr. Coates’ idea. As he explains, he wanted to work in an underserved rural community, and sought a situation which would allow time to study and advocate for Physicians for a National Health Program. He proposed that he work on weekends and actually live at the hospital from Friday to Sunday. He loved it. “To be able to dash across the street to the ICU to help stabilize a patient at 2:00 a.m. on a Sunday? What a marvelous experience, to help save someone’s life!” he says. He soon earned a reputation for consistency during the four-month job. On one occasion, he was called to the ER by nurses for his opinion on another physician’s patient. The nurses felt the treatment ordered would harm the patient, and they were hesitant to question the doctor. “What could I do? I wondered,” Dr. Coates recalls. “I just went over and talked with the physician and asked how things were going. We talked about the case and it was clear that the nurses were correct. I said I thought I’d seen similar patients in the past, with words to the effect that isn’t it amazing that conservative measures would usually work for the problem he had identified. And then I watched as he reached down and crossed out his orders. He never knew that the nurses put me up to it. I remember the moment well. The doctor was struggling, but I could see that he was sincerely trying to help the patient.”
During those long weekends, the 47-year-old from upstate New York had proven himself to be a natural, but Dr. Coates was many things before he was an internist. Although he hoped to become a physician by the time of high school, he was drawn in other directions once arriving at college at the University at Albany. He pursued art, music, literature and history and eventually graduated with a degree in American History. When he married in his late 20s, he put medical school on hold and found work as a carpenter. “It was a choice,” he says. “I wanted to work with my hands as well as my brain.” He also during this time earned a masters degree in American History and gained acceptance to PhD programs at a number of prominent schools. Finally, at the age of 32, he decided it was time to return to his original ambition, and enrolled in medical school at Columbia University in New York City. Internship, residency and chief residency at Bassett Healthcare in Cooperstown, NY, followed, and at long last, Andy Coates was a doctor.
The Shepherd
At his first job following residency, as a hospitalist at St. Peter’s Hospital in Albany, NY, Dr. Coates began to develop a unique perspective on what it meant to be a physician. “I was then the only full-time hospitalist for a multi-specialty group, and I came to understand and see the hospital itself as a living social organism,” he says. “I saw my role in it, and felt it was my responsibility to shepherd the patient through the hospital.” He explains how he would arrange to be notified exactly when a patient’s results came back from radiology or pathology, so he could meet with the patient immediately to talk about it. “I would guide them through the hospitalization. It was enormously rewarding,” he says. He also began caring for many patients at the end of their life, and took to it well, finding poignant meaning in the difficult role.
The weekend hospitalist position in Hudson was his second job; for his third he made another unusual choice, taking a brief assignment as an internist at the Northern Navajo Medical Center in Shiprock, New Mexico. The hospital was a teaching site for his medical school and had an excellent reputation. He says it was the best thing he could have done in many ways. He developed a profound respect for the Navajo culture, and is convinced the experience made him a better physician. “A large percentage of my patients spoke Navajo, not English, and one of the nurses would translate,” he says. “I gained confidence among the Navajo because I learned that I was able to practice medicine effectively outside of my own culture.”
Dr. Coates returned to Albany in 2005, taking a job as a hospitalist at St. Peter’s. He had by that time earned a specialty in hospice and palliative medicine, which he would put to use the following year, when he began working predominantly as a palliative medicine physician. He was gripped by the issues presented by life-threatening illness. “When you are caring for people who face their own end, there are so many more things that should go along with that,” he says, “dignity, difficult decision-making, family meetings—all of that was compelling to me and I was proud to try to help the patients and their families.” He began to augment his palliative medicine practice with outpatient work with patients with severe disabilities, including mental illness. It prepared him for his next roles as director of medical services at Capital District Psychiatric Center and faculty member at Albany Medical College, as assistant professor of medicine and psychiatry, where he has been since early 2007.
Finding His Niche
In these roles, he seems to have come into his own. “Teaching third year medical students and helping with the psychiatric residency—I’ve been very proud of that,” he says. “Teaching the students is absolutely the most inspiring hour of the week. I love to hear my students’ reflections and insight. It’s such a poignant time for them. They’re entering a new world—from here on out they’ll be physicians. Teaching is without a doubt the highlight of my professional life.”
Dr. Coates says his choice to pursue internal medicine has allowed him the opportunity to pursue things he would never have considered otherwise. He loves it all. “The amazing thing is that there has been a convergence of interests and abilities in my career,” he says. “The professional rewards of being an internist have been fascinating and unexpected, ultimately both empowering and so very humbling.” In his work, he believes he has found the perfect outlets for his abilities and interests. “I am most comfortable when patients are on the margins of human experience,” he says. “If I can make a difference, that’s my goal. And as an internist there are many, many ways I have been able to do that.”
One recent patient in particular embodied much of this for Dr. Coates. “She was severely mentally ill and had lung cancer but was adamant in her belief that treatments for the cancer would be worse than the cancer itself,” he explains. “So we went through the process with her and with her family, and convened an ethics committee and a palliative care team. And what meant a lot to me was that we were able to stick up for her, carefully, to defend her autonomy. Working with her family and the psychiatric team was a remarkable experience.” Eventually Dr. Coates and his team were successful getting the patient discharged from the institution, after which he continued to serve as her physician. “She made absolute peace with her life, courageously,” he recalls. “I’m so proud to have been a part of that.”
Dr. Coates doesn’t indulge in a lot of leisurely activity, but he does value his time with his wife of 19 years, Lori, and their three children, Noah, Harriet and Evelyn. One of the benefits of his career he says is the fact that it gives him flexibility, which has allowed him the time when he needs it most, which seems now to be more than ever. True to character, he is pursuing new interests. His volunteer advocacy work for Physicians for a National Health Program led to a spot on the organization’s national board of directors and an ongoing schedule of public speaking engagements. Most recently, he has spoken in a series of community meetings in towns across New York’s rural Delaware County, at sessions of professional societies, in an interview by the BBC, and at the annual meeting of the International Association of Health Policy in Madrid, Spain. In between he does commentaries on his local public radio station, tends a blog, and leads a statewide grassroots coalition, Single Payer New York. He views the effort for national health insurance as his “chance to make a difference for all patients.” Through the years, Dr. Coates has aimed his arrow at many targets—from art to history to carpentry to hospital medicine to psychiatry to palliative care—but he always seems to hit his mark, and finds fulfillment in places that are uncomfortable for most. He will likely do well in his new ventures as he has in others, and will without a doubt bring something different to them while he’s at it—a combination of intangible and atypical qualities and experiences that can come only from Andy Coates.