A Doctor's Doctor Turns in His Stethoscope
“Hi you’ve reached the Caines. If you are a patient calling for Dr. Caine, the quickest way to reach him is through the hospital operator number at…otherwise please leave a message and we’ll get back to you.” Beep.
For more than five decades, this message on the Caines’ home answering machine has remained virtually unchanged. For patients, Dr. Thomas Caine has always been easily available; his number always listed in the phone book. More than likely though, he jotted the number down for them, letting them know that they could call day or night if they had a concern. Even in the midst of raising six children and with time at home a rarity, Caine welcomed his patients into his life; after all, he would likely point out, they welcomed him into their lives.
Mary Ellen, his wife of 55 years, recalls a patient who had returned to Idaho and called Caine consecutively each night before bedtime. “I would overhear him on the phone saying, ‘You are going to be okay, you’ll be fine.’ ” She recalls long-time patient, George Eccles, calling: when one of the children answered, he’d ask for Mary Ellen first, to apologize for disturbing them at home, prior to talking to Caine.
“These calls never bothered Tom,” says Mary Ellen, who has known life with her husband no other way. “He has always cared about people and this included his patients and their families. It is part of who he is.” She tells a typical story: “He tells me, ‘I had a patient who passed away and I want to go to the mortuary tonight.’ Tom, the patient’s wife passed away four years ago, so why are you going? ‘Oh, I want to go to see the children, who would bring their dad in to see me.’”
For the more than 40 years that Dr. Caine has been practicing internal medicine, he has cared for people without homes as well as for those who belong to some of the most prominent families in Utah. His care for all, guided by the same principal: a deep concern for his patient. “He never did care about the trivial or superficial; Tom’s steadfast when it comes to his values and principles,” says long-time colleague John Holbrook, MD. “If you were around Tom, you learned how to treat people well, how to be patient and to be kind.”
In 1972, Holbrook and Caine were the first two of three hires for the new Division of General Internal Medicine, along with Grant Christian, MD. “We were three fellows fresh out of training,” recalls Caine, who had recently finished a fellowship in cardiology at the University of Wisconsin, Madison and was serving as an Assistant Dean for Student Affairs at the School of Medicine. With the development of the new division, he was declared its first chief.
Dr. George Cartwright, then chair of the Department of Medicine, decided the U of U needed an Internal Medicine Division for two main reasons: first, he needed more doctors available to take care of the increasing number of patients at the hospital in between surgeries. Second, he needed faculty interested in teaching. Both fit into Caine’s talents like a key in a polished lock, opening the door to more than anybody expected.
“I remember the day he got the call from Dr. Cartwright to come up and see him,” says Mary Ellen. “On his way out the door, Tom said to me, ‘I don’t want to do research. Not research; I just want to do patient care.’”
Internal medicine was a natural fit for Caine’s connection with people. It is an area of medicine set up for long-term, patient relationships and takes a wide-angle verses telephoto approach to patient care—all aspects of the patient are viewed; it is not just a disease-oriented approach. When needed, internists coordinate a patient’s care across a network of specialists. Dr. John Zone, now Chair of the Department of Dermatology, was one of those specialists, who has worked with Caine for more than 30 years. “He often stopped and walked his patient down the hall to me, asking, ‘John can you see this patient right now?’” Caine always reciprocated the care he expected from other doctors for his patients, adds Zone. “It is this kind of dedication that makes him perhaps one of the best physicians in the history of this place.”
“When a patient comes to us, we became their advocate, helping them navigate the system, and find answers to problems, over an extended period of time,” explains Holbrook, who shared call responsibilities with Caine. “That is how the loyalty builds.”
In 1971, Caine became Chief of the Division of General Internal Medicine (1971-1988); under his leadership the division grew from two to 17 faculty members. Like most leadership positions, decisions had to be made that didn’t please everybody. Yet, Caine was known for his diplomacy and his willingness to put in the effort to get things done. “He really imprinted—to all the faculty, residents and students—the importance of always putting the patient first,” says current Chairman of the Department of Internal Medicine, John Hoidal. “His philosophy was: you give back for the privilege of being a doctor.”
He respected and nurtured relationships not just with his patients, but with everyone he interacted with in his work. His son Bill Caine, MD, a cardio-thoracic surgeon, recalls, as a boy, walking down the hospital hallways with his dad, listening to him greet everybody by name, not just his colleagues. “He would say to me that the quality of care your patient receives depends on a whole team of people—the nurses, especially the nurses, but also the person changing bed sheets, the man sweeping the floor, orderlies. He emphasized that everyone plays an important role in taking good care of a patient.”
His long-time administrative assistant, Mindy Rose, knows this. “Always, at the end of each day, he says to me, ‘thanks for your help today.’” She adds, “His appreciation for others is such a great example for me and everyone who crosses paths with him.”
“You Don’t Feel at a Loss Because He is Always There”
“How many academic positions are there where you make house calls?” asks Holbrook, chuckling. “Tom did.”
Not only house calls. Caine met patients at the ER soon after their calls; he’s checked in on hospitalized patients on his days off; and, he’s been known to show up at doctor’s appointments from his referrals. Patient Dick Baringer, MD, recalls when Caine referred him to a cardiologist. “As I walked into my appointment, who should show up but Dr. Caine. I’ve never had that happen, where my internist would take enough interest in my issues and stay during the entire visit so he had a first-hand view of what was going on with my heart.”
“You don’t feel at a loss, because he is always there,” confides Carol Fay who has been a patient of his for many years. When she called Caine with chest pains, describing what she thought was her reflux, he told her to meet him in the hospital’s emergency room. After an examination, Caine found not reflux but blood clots in her chest. “He picked up on the subtle changes in my symptoms, suspecting something more than reflux,” recalls Fay, adding that while in the hospital for treatment, he would stop by on the weekends to check up on her even though he wasn’t on duty—“Just to reassure me.”
Lanky, bespectacled, and soft-spoken, Caine leans forward in his office chair, positioned more to listen than talk. His office is sparse, functional, with a few shelves of medical textbooks and stacks of manila folders filled with patient charts, meeting notes, and articles. He doesn’t leisure read, except for the book club he and his wife are in with old friends; he says, “we just read short stories now.” The few decorative items are all gifts from patients.
Again and again, the word “humble” comes up in describing Caine. As does, “consummate scholar, skilled physician, ultimate care giver, superb educator. “He quietly and honestly sets a very high standard,” admits Hoidal.
“No matter what the situation or how stressful things were, Tom always had this equanimity about him without ever losing track that he needed to make a decision and still had a sufficient presence,” recalls Willard Dere, MD, who worked for and was mentored by Caine. “He is a combination of analytical thinking, thoughtfulness, and doing the right thing.”
Caine has been recognized by grateful patients with the establishment of three presidential endowed chairs, one professorship and two lectureships, amounting to multi-millions of dollars. “This is unprecedented at the University and is highly unusual anywhere,” points out Art Swindle, who worked with patients to set up the endowments. “I remember thinking if he is this good, I’d better get him as my doctor.” He did.
Call it an attempt to clone. The endowed chairs—the most recent being Katherine White and Ezekiel R. Dumke Presidential Endowed Chair in Internal Medicine—were set up to recruit a young doctor and mentor him in Caine’s ways. “There wasn’t enough of Tom to go around and meet the demands for him as a doctor,” says Hoidal.
“Tom has always gone the extra mile in caring for us and so giving of his time, especially in working with other doctors in regards to our care,” expresses Kay Dumke, admitting it is hard to narrow down all the good in Caine to a few sentences. “Both Zeke and I have both so appreciated his professionalism but also his friendship.”
Caine has been a bridge within the healthcare community in more ways than one. He has been an integral link between the U’s Medical Center and the private medical community in the state. A number of Utah’s community leaders were his patients. “Many of them, when they thought of the University Medical Center, they thought of Tom,” says Hoidal.
While many suspect far more service going on behind the scenes, what is known is that Caine served on multiple boards, associations and committees, including elected positions. He was especially honored by those roles he was elected to serve in by others in the medical community. Some of these roles included Honorary President of the Utah Medical Association, President of the University Medical Staff, and Chairman of the Utah Society of Internal Medicine.
If caring for patients is Caine’s first passion, then a close second is teaching. He is known for striking that fine balance between giving residents enough room to spread their wings to gain confidence while also ensuring that the patient’s quality of care never slipped. “He is a role model on how to care for a patient,” says Barry Stults, MD, who was a resident under Caine and considers him a mentor.
Modeling How to Care, Really Care, Through Teaching
“What he does better than anyone I’ve ever known is combine high-quality medical care with a deep understanding of the psychology and social nature of patients and how that influences their total health,” explains Stults, now Division Chief for General Internal Medicine.
“He is not only worshipped by his patients but also by the residents and students because he was able to translate for them what he did and how to do it.” He points out that this is a rare find in any academic medical center. “He nurtured the students and residents just like he nurtured his patients,” says Stults, pointing out that for more than 40 years, Caine has modeled optimal primary care of the patient for a generation of residents and faculty.
“These trainees would come in full of facts and knowledge but with limited experience interacting with patients,” recalls Caine, who has directly influenced hundreds of students and residents over the years. “It was very satisfying for me to watch them evolve from being uncomfortable to developing interpersonal skills.” His teaching and fresh knowledge of his students kept him sharp regarding advances in medicine.
“His teaching and example had greater impact on me and influenced the way I practice medicine more than any other experience I had in medical school or residency,” says Wayne Samuelson, MD, who spent his 4th year of medical school under Caine’s tutelage.
Baringer, a former Chair of the Neurology Department of at the U, admired Caine’s skill and perceptiveness as a doctor. During exams, Caine listened. He jotted down a few notes with a pencil, remaining undistracted. As technology increased and patient time decreased, Caine stubbornly refused to give into the pressure of cutting patient time or to allow for the “distraction” of typing on a computer as patients talked. “Too much can be missed if you are not looking at a patient’s expressions and body language when they are talking to you,” says Caine.
“He relies a lot on his ears, eyes, and hands to figure out what is going on with a patient,” adds Baringer. “His exam is the model of the kind of things I learned as an intern and resident that is bypassed by a lot of doctors today.”
Caine’s influence has carried forth into the variable careers of many doctors. For Dere, a Senior VP at Amgen, a biotechnology company, he sums up Caine’s influence on him: “The reason we physicians are around is for the honor of serving patients.”
A Boise Boyhood and a Broken Leg
Caine’s style has been described as “country medicine:” a “salt-of-the-Earth” doctor who makes house calls, knows his patients’ families, is easily approachable and accessible. Perhaps this is rooted in Caine’s boyhood, growing up in Boise during the 1930s-1940s. His dad worked in the livestock loan business, spending his days interacting with ranchers and farmers. “You couldn’t walk down the street without saying ‘Hello’ to people you knew,” reminisces Caine, the youngest of four kids and admittedly “babied” and adored by his two older sisters.
At six, Caine got his first glimpse of medicine. After falling off his bike, he broke his leg and spent a month in traction at the local hospital. “I was awed by the whole medical process and by just how much the doctors knew and what they could do,” says Caine, who spent six weeks in a body cast after his stay. This experience powered a dream-turned-goal to become a doctor.
While earning a B.S. in Economics at the University of Utah, Caine joined Beta Theta Pi and became president of the fraternity his sophomore year. His fraternity brother and eventual “roomie” at The Charleston (1957), Spence Eccles, has known Caine for more than 45 years, first as a friend then as a patient.
Cleone, Eccles’ girlfriend-turned wife, set Caine and Mary Ellen up, and the four double-dated on their first date. “For Cleone, it was an instant match” says Eccles with a chuckle. Later, Mary Ellen mentioned that she had a wonderful time but Tom sure was quiet. “Oh no, that was talkative for him,” clarified Cleone. “Tom has always been a reserved, quiet sort of guy. It’s the women in the Caine family that are loquacious,” jests Eccles.
After earning his undergraduate degree (1953), Caine served a mandatory two years in the Air Force’s medical corps and then applied to medical school, which he admits was tough. “The commitment has to be that it’s what you want to do more than anything.” As a medical student, Caine spent his summers working in research labs, where he found his mentors. “They got me involved in research projects so I felt like part of the team and never the kid in back washing the dishes.”
The Caines went onto Oklahoma for a year and then to Madison, Wisconsin, where Caine was an intern then a resident respectively. Mary Ellen recalls one evening calling him up in tears, soon after their first child was born. She had been asked to make two dozen cream puffs for a function the next day—just follow the recipe in a cookbook she was told. Overwhelmed as a new mother, in tears, and feeling alone, she paged her husband at the hospital, “What am I going to do? I don’t know how to make cream puffs and by tomorrow.” “Oh there’s an easy solution to that,” Caine reassured her. “Just call the bakery and order some.” Keep in mind, money was sparse at the time, so splurging on a two dozen cream puff order was a rarity.
This is typical of how Caine handles things, according to Mary Ellen. “He never gets frantic and always remains optimistic that there is a solution and that everything will be okay.” Though she adds, “Even if he was stirred up inside, this is how he came across.”
This calm was true one night in 1987 when Caine woke up and started getting dressed; he told Mary Ellen when she sat up that he was going to the hospital because he was in so much pain. Well, then she was going too. X-rays revealed a suspected kidney stone; blood tests revealed something completely unexpected—Leukemia.
Over the next year, as Caine battled this blood disease, He became the patient; this deepened his empathy for his patients even more. “Dad learned what it was like to be lonely in the hospital, what it felt like to wait for news,” says his daughter Cathy Christensen. During this period of time, letters and cards streamed in from past residents and patients and even the hospital’s telephone operators (who likely knew more about the inner-workings of the hospital than anyone). One former resident wrote: “Dr. Caine, I will do anything to help you. I can take my vacation time and come back and cover for you in your clinic. You just let me know.
But Caine just wanted to get back to work—and as soon as he was able, he was back into his 10-12 hour days. A nameplate on his desk at home reads “Thomas. H. Caine, MD, Chief, Eternal Medicine”—A gift from a resident. “I don’t know why he brought it home,” laughs his son Bill, “All of us here, already knew how much he worked.”
Gifts of time with Caine happened on drives; with teens learning to drive and just two cars, it became habit for Mary Ellen or one of the kids to drop off and pick up Caine at the hospital, a 10 minute drive. “This became precious time for me to connect with Tom without the kids around,” says Mary Ellen, who continues this tradition.
If You Are Going To Do It, Do the Very Best You Can
Setting high standards was part of Caine’s Modus operandi. Bill recalls his first “real” job at 14 delivering newspapers. As his dad would drive him around in the early morning, Bill would toss the papers out the car window. “I’d just throw them out like everybody else did; if they landed on the walkway or grass that was good enough” recalls Bill. “My dad said: “Nope. Good enough won’t work. Each paper has to land or be placed on the front porch.” Young Bill remembers getting out of the car a lot to replace the papers.
“Dad taught me that if you are going to do something, do it the very best that you can,” says Bill. Out of six thriving adult children (and 20 grandchildren), Bill is the only one to pursue medicine, likely due, he thinks, to the many hours he spent as a boy playing with a large model heart in his dad’s office while waiting for him to finish work.
A personal story Mary Ellen tells offers a peep hole into Caine’s way with patients, not just family. When her father was in the hospital suffering from cancer, she got a call from her parents. They were in tears, devastated. The doctor had told her father that he would never walk again. Mary Ellen quickly paged Tom and asked him to go check on them, as she was home with the kids. Her father told Caine what the doctor had said. “We’ll that isn’t the case,” Tom remarked. “You’ll walk whenever you are ready to walk; you just tell me when and I’ll get you out of bed and we’ll go for a walk,” recalls Mary Ellen. “Tom is always willing to give people hope—He never closes the door on hope.”
“I trust him with my life,” adds Eccles, a common sentiment among Caine’s patients. “He is an unbelievable friend and an equally amazing doctor—he is a doctor’s doctor.” Eccles quips, “He’s kept me alive this long, and I’m going to be 80. I’m not sure I should have encouraged him to retire.”
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Contributing writer for UUHC.comments powered by Disqus