Douglas Paauw, M.D., is a board certified physician at the General Internal Medicine and Virology clinics at UWMC-Roosevelt, the UW’s Rathmann Family Foundation Endowed Chair in Patient-Centered Clinical Education and a UW professor of General Internal Medicine. He is also director of the UW Medical Student Program.
Dr. Paauw enjoys getting to know his patients and providing personalized comprehensive care. He feels his role is to help educate patients, listen to their needs and together work on appropriate goals and treatments.
Dr. Paauw earned his M.D. at the University of Michigan. His clinical and research interests include primary care of patients with HIV disease and sarcoidosis. Personal Interests In his free time Dr. Paauw enjoys softball, basketball, professional sports and travel.
Stories From Practice - By Dr. Paauw
Kimberly was referred to me by another physician who was leaving town. Kimberly was a beautiful woman, dressed elegantly, with tasteful makeup and everything about her declared style and grace. She worked as chief buyer for Nordstrom’s She was here to see me for a transfer of care visit. She was having fevers, sweats and chills. She was dying of AIDS. She shared with me her shocking story. Three years before she was a beautiful bride to be. The Wedding dress was hanging in her closet, the plans for a grand reception were all made and double checked. She received a call from the health department to come in right away. Here premarital HIV test was positive. Her fiancée’s test was negative. Kimberly had no idea how she had been infected. She had never used drugs before, she had only had a few previous sexual partners and none of them were known to be high risk. Her fiancée told her he would not marry her and the wedding was off. Kimberly was devastated. When she was at her lowest in the weeks that followed she spent a great deal of time at a coffee shop trying to sort out her life. It was here she met Matt. He was a kind soul who would listen to her every day. She feared telling him about her AIDS. Would he stop talking to her- after all AIDS was still quite feared in the early 1990's. She decided not to tell him. They spent more and more time together, and grew close. When Matt would try to kiss her she would pull away. He asked her if there was something wrong. She told him that his love and support was absolutely right and what she needed. He asked her, then why was she afraid to kiss him. She said she wouldn't kiss him because she cared about him too much. He asked her what great harm she had suffered, and she mumbled that she had AIDS. He kissed her right there. He told her he wasn't afraid of the disease- that he was more afraid of not showing her how much he cared. Matt and Kimberly got married, and he was by her side through the fevers, sweats, and abdominal pain she developed. He was with her when she died, never leaving her side. _________________________________________________________________________________________________________________________________________________ Shona was my medical student when I took over team C the first of the month. A day earlier she had picked up a patient, a young woman (Kim) with Portal Vein Thrombosis, who had been transferred from UW hospital from Alaska. The senior resident on the team told me of the icy reception Shona had received. Shona was told by the patient she didn’t like her. She felt she did not know enough to be involved in her care and she was annoyed by all the questions. The first day I saw the patient with Sona, the patient tore into Shona, telling her in front of me, that she was incompetent, and was annoying. After we left the room I asked Shona if she would feel more comfortable if she followed a different patient on the team. She asked me a good question “Is becoming a doctor all about being comfortable?” She wished to continue her care of the young woman.
We quickly learned that Kim had many reasons to be upset. Her PVT occurred in the period shortly after delivering her child. She was told in Alaska that there was nothing more they could do for her and that she would probably not live more than a few years. She arrived at the UW hospital and was told by the liver specialist that she could not be helped by a liver transplant, which was the one hope that she had clung to. Shona told me she felt this woman felt abandoned by the doctors in Alaska who referred her to the UW, and even though Kim didn’t like her, she didn’t want to abandon her. I was touched by Shona’s dedication and commitment. The next morning on rounds, Kim again stated how much she disliked Shona, how she felt she was incompetent, and how angry she was to be at the UW. I asked Shona again if she wanted to continue. She was even more determined to try and help.
The next morning was Kim’s 21st birthday. Shona entered her room quietly and put a bouquet of flowers by her bed. When Kim awoke, she awoke surrounded by her nurse, Shona and the rest of the team singing happy birthday to her, complete with a birthday cake that Shona had ordered and bought for her. Kim cried and then smiled for the first time since arriving at the UW. She gave Shona a hug. She cried tears that had been ready to be released for weeks.
When I returned later that morning to check on Kim, she told me how thankful she was that Shona had not given up on her. She told me how scared she was of dying alone and of never seeing her baby again. She was so touched by Shona’s kindness to her, when she felt that her treatment of Shona was so cruel. She felt that today, her birthday, she was really seen as a person, and not just as an interesting medical case, and that was who she felt she was.
From that day on, whenever we talked to Kim, she would always refer to Shona as her doctor and wanted to make sure Shona was in agreement with any plans the consultants or the team had.
Kim left the hospital after a two week stay, returning to Alaska and her baby. About a week later a large box arrived at the 6th floor nursing station addressed to Shona and team C. I opened the box and found a package with a tag “for Dr. Paauw, residents and nurses”, then I found six packages all with tags that said “For Shona, my doctor”. That seemed about right. I paged Shona and had her come up to the floor to see this beautiful testimony to her caring. _________________________________________________________________________________________________________________________________________________ I met Donna my first year in practice, In medicine, we often get the wrong impression of our patients before we even walk into the room. We see their charts even before we see them. The story in her chart was very grim. She had lung cancer, that had spread to the lining around her heart. Patients who have this problem rarely ever survive more than a few months. She had been treated with radiation in hopes of buying her a few more months, and miraculously she was here meeting me as her new doctor 3 years later. I walked into the room, exchanged greetings with her. I was struck by her warmth, She greeted me with a hug, not a handshake. She also had a great sense of humor. She said to me, “You don’t see too many patients with terminal cancer who look like me , do you?” I looked perplexed. “What do you mean?” I asked having no idea what she was getting at. “I mean, fat, like me, I don’t look like a terminal cancer patient, do I?” We both laughed. She told me about herself. She felt that the miracle time she had been given with the surprise remission of her cancer was such a blessing, she had become a volunteer at the hospital, using her humor and optimism to help others who were in need of cheering up. I asked her how she was feeling . She told me she felt great, no breathing problems, pain or even fatigue. She arrived at her next visit on Halloween dressed as a large pumpkin. I commented to her how it appeared that she had gained even more weight, She laughed and explained to me how much fun it was to he dressed up for Halloween in the hospital. I talked to her about how excited my young daughter Carly was for Halloween, and how she was going to dress up as a princess. We talked a bit about what a privilege and joy it was to raise children. From then on, at every clinic visit, Mrs M would ask me about Carly. She would come and see me every 3 months, for a “check up”, but as she said, mostly for a chance for us to visit.
After I had been taking care of Donna for about three years, she made an urgent appointment to see me. She had developed increasing pain in her right shoulder, with pain that would shoot into her hand. Workup of this problem revealed she had recurrence of her lung cancer as a pancoast tumor, with the tumor eroding into her brachial plexus. It was difficult to control her pain, and after a few months she was admitted to a hospice. I visited with her for several hours one evening at the hospice. She talked about how much she had enjoyed life. She told me about pranks she had played on her teachers in high school, about the time she went parasailing, and how fast our children grow up. Mostly she wanted to remind me to enjoy each day, and live in each moment. Three days after my visit with her , Donna died.
6 months after Donna’s death I received a call from her daughter. She asked if she could make an appointment with me to discuss some things. I knew her daughter Wendy a bit, as she worked as an administrative assistant in our cardiology department, I wasn’t sure what she wished to discuss, but thought it might be to process some of her feelings surrounding her moms death. When she came for her appointment I asked how she was doing. She said “missing mom every minute of the day” From all my talks with donna about our children, I knew how much she loved Wendy. I told Wendy about my talks with her mother, and how often she would talk about Wendy, and how proud she was of her.
Wendy started to cry and gave me a hug. She said “ Doug, the reason I am her is I wanted you to know how much you meant to my mom. She was working on a special gift for you when she died” She pulled out a quilt from a paper bag next to her chair and held it up for me to see. The quilt was multiple squares of a pattern of a young girl holding a parasol. “She made this for you to give to Carly. She was so close to finishing it, only had 4 squares left to put on when she died. I took a quilting class so I could learn how to finish it, that’s why it has taken so long for me to get this to you.”
I cried as I thought of all the pain Donna was in while she was making this quilt. The tears included the gifts Donna gave me about living life, the best I could each day. Wendy hugged me and said “I know, I know.” _________________________________________________________________________________________________________________________________________________ From my earliest memories my brother was always a part of them. We were exactly 2 years apart in age. My family moved around a lot when I was very young. We lived in Illinois, Indonesia, Connecticut, Maryland and The Phillipines--all before I was 8 years old. Growing up in so many places, Scott was the only constant in my life. We played together, we fought every day. We shared the same interests, the same friends and we shared many of the same experiences. We were very close, even if his personality did drive me crazy much of the time. Scott left for college when I was 16 years old. We saw less of each other after that, but we would spend all holidays together, he would be home for summer break, and I even visited him for a month when he was on a study abroad program in Malaysia after my freshman year of college. When I got married in 1981 he was my best man. When he got married in 1982, I travelled to Indonesia to be the best man in his wedding. As our families grew over the years, our children became close. My brother’s children Alan and Cindy became like my children; they became best friends with my daughter Carly. Both Scott and I wouldn’t have it any other way.
Scott did not always take care of himself well. He gained weight, didn’t exercise much and started smoking. He did not want his children or me to know that he smoked. I would ask him about it every time I visited him, and every time he would say no, he didn’t smoke. He developed diabetes and back problems which further limited his exercise.
I year ago, Scott called me and mentioned that he had lost a lot of weight without trying. He had lost 25 pounds over about 5 weeks. My nephew told me it was because Scott was vomiting, and now he was just eating cereal. I encouraged Scott to see his doctor. He did, and had some blood tests and was told everything was fine.
In late March he noticed a large lump on the side of his neck. He called me and asked me what he should do. I told him he would need a biopsy, and if his doctor didn’t order one to let me know and I would set him up with a specialist in the town he lived in. I realized I had moved from the role of brother to the role of medical advisor, a position I would never give up. It is strange how this happens to all of us who are doctors. Even being in medical school makes it so people ask you medical questions all the time. You are the person who your family trusts the most, so it is natural that they would want you involved. But it isn’t natural. It is hard. It is stressful. You never get a break from it, and we are often expected to give counsel in areas that we have little experience or knowledge.
Scott had a needle biopsy, and called me and told me they diagnosed him with a lymphoma. I told Scott that that would be a very difficult diagnosis to make from a needle biopsy, that he would need to have the whole enlarged lymph node removed to make an accurate lymphoma diagnosis. He received a call from the doctor the next day, requesting that he be scheduled for removal of the lymph node on Friday (April 11). I called Scott on April 11th to check on how the surgery went. He calmly told me that the surgery had been cancelled because he had been called by the doctor the day before and told that the diagnosis wasn’t lymphoma, that instead the diagnosis was small cell lung cancer. The doctor had told him that it would not be curable, but that it was the best kind of cancer to have when it had spread because it was treatable. My head was spinning. My brother was so calm describing this. I thought “does he realize he has metastatic cancer and he will not survive 6 months?” Scott was experiencing what most patients experience when they hear devastating news: they hear a little bit, and hold on to hope. I have always wanted my patients to hold on to hope. I thought. “How do I help my brother understand that he has limited time left, while still helping him embrace hope?” I knew from his symptoms of severe weight loss, nausea and vomiting that he must have a large tumor mass beyond what was in his neck. He was going to get a CT scan on Monday, and meet with an Oncologist on Thursday.
I called Scott on Monday to check in with him. I had decided that I would call or text him every day, to be available. I asked him what could I do for him? He said he wanted me to encourage his son to be more supportive, to help him more. He wanted his daughter to return his calls and support him. I decided that I would do everything in my power to support him, and make sure he felt it. As a doctor, I had seen many patients die, saw how relentless disease can be…how our tomorrows are never promised. My first order of business was to help my brother stop losing weight. I had cheese sent to him from Wisconsin, Peanuts sent from Georgia. I contacted people who knew him and asked them to call and support him. I talked to my niece and nephew; they were absolutely committed to supporting Scott. I talked to his Oncologist. I realized that it helped me to be active, to be doing. I remembered how many of my patients’ families had taken the same role. I told my brother I would come out to be with him when he received chemotherapy.
I arrived in Rochester, NY to be with Scott for his 2nd round of chemotherapy. He had had his 1st round 2 weeks before and surprisingly told me that as soon as he was treated he felt the best he had in 4 months. This didn’t make sense. How many people feel better immediately with chemotherapy? He said he went home after the infusion and ate the best he had in months. I couldn’t figure it out, but I did file that information in my mind. When Scott greeted me at the airport, I was stunned at how thin and wasted he looked. He had always been fat and now he looked like a cancer patient. It really struck me and shook me.
We had a great visit. I really liked his oncologist. His oncologist showed me the PET scan Scott had which showed tumor in his neck, lung and bilateral adrenal glands. Scott would receive a platinum-based chemo regimen every 3 weeks until August, then be reassess. Scott and I talked about how he was doing. He told me that knowing you are going to die soon puts life in perspective quickly. He said he really could cares less about demanding emails from his boss. We talked a lot about our childhood together, our kids. He told me he wanted me to do two things for him when he was gone, scatter his ashes in Indonesia, and be there for his children.
I arranged for my brother to come out to visit all of us in the Seattle area the next week. I wanted it to be a special visit. I purchased special tickets for Scott and his daughter Cindy to attend a Seattle Mariners game in very special luxury seats. My wife made arrangements for a big party and invited all our relatives and friends who were close to Scott to see him. When Scott arrived in Seattle he looked even worse than he did when I saw him in Rochester. He was so tired that he slept most of the day. When we were at the baseball game, I looked at a picture I took of him and his daughter and it hit me- he was darker than his Indonesian daughter- and Scott hadn’t seen the sun for months- He had adrenal insufficiency! That is why he was so tired!!!! I was excited that I could finally offer something positive and be helpful medically. I told my brother that I knew what would help his fatigue. I ordered dexamethasone for him to take the next morning. The next day was a very good day for Scott, the following day he felt so good he didn’t need a nap. He was able to eat three big meals and go out to both lunch and dinner with friends, something he was unable to do before the medication was started.
I was so happy to be able to help. My goal was to love him the best I could each day that was left in his life. I had to leave Seattle to speak at a conference for a few days while Scott was still in Seattle. I felt bad about being away from him. I was going to Washington DC the next weekend for a friends wedding. This was the area where Scott and I spent important time together in our childhood. I called Scott and invited him to join me. I sent him an airline ticket and we were both so excited to be together in one of our childhood cities.
I met him at the airport with his favorite cousin Julie, who lives in Washington DC. She is a flight attendant, and was able to surprise him by being at the gate to greet him as he got off the plane. We went to a wonderful dinner together, then talked into the night. The next day, Scott and I went to see our old home we had grown up in. We passed the baseball fields we played on together, he told me stories I had long since forgotten. I did not want the day to end. He told me thank you for taking care of me, I cried. He did, too.
The next morning, I said goodbye to him. I was worried as I had to leave for an early flight, and he was leaving a few hours later. He always took his temperature twice a day as his oncologist asked him to do. This morning it was 99.1. That was high for early in the morning. I hugged him and told him I loved him. I texted with him until I got on the plane, reassuring myself that he would be ok. But what is ok in a person who is dying of cancer? Another week, month, half a year?
I would never see my brother alive again. One week later, he collapsed in the early morning hours. We got a 4:30 AM call from his girlfriend. He seized at home, the paramedics were with him. She said something about a cardiac arrest, but he was awake and talking. I immediately got an airline ticket and headed to the airport to fly to be with him. On the way to the airport, my phone rang. It was the ICU doctor. “is this Doug Paauw? You know your brother isn’t going to survive, he is septic and is going to die. I just need for you to confirm that we should not resuscitate him”. Scott was already intubated, I asked that they support him until I arrived (I wanted to be with his son when my brother died). I was upset by the tone of the doctor. There was no concern for what it was like to lose a loved one, just get the work done. I realized, in this sad moment, how happy I was with what I was doing with my life. I would not teach my students to be like this doctor. I prayed that I could teach what matters most, remembering we are all the same. We have loved ones, people who mean everything to us, and as doctors we are privileged to care for these precious ones. My brother passes away 20 minutes before my plane landed. I entered a new world of loss but also a newfound appreciation for what matters most
A Sunny Day in Seattle
“ I am so glad it is not raining today, my mother hated the rain” Monir told me. “ It has been sunny every year when we gather, even though it has been rainy every day before” We were standing at her mother’s grave with her family. Every year, for the past 7 years, on the anniversary of her mother’s death the family would gather. Her Great grandchildren would play in the soft grass of the cemetary as family members would share stories and memories of Batoul. I shared with the family how I would enjoy teasing her by asking her when she would get a boyfriend, always knowing her answer. She would pull out a picture of her husband who had died decades before and say " This is the only man I want to love"
Many times when we meet our patients for the first time it is not memorable. Our relationship with them grows visit by visit, until it seems like we have known them our whole lives. My first visit with Batoul was probably my most memorable first visit ever with a patient. I visited with her, hearing about her life in Iran before coming to the United States. She talked about her four children, including one who was still in Iran. I asked her to change into a gown so I could do a complete exam. When I returned a few minutes later, Batoul could not speak. She was paralyzed on her left side. As I was assessing her neurologic status, her ability to talk returned, and soon she could move her left arm, then her left leg. I sent her immediately for an ultrasound of her carotid arteries. When the ultrasound probe was placed against her right internal carotid artery, she had another TIA, involving paralysis of the left side of her body. Within hours she had a surgical procedure to correct the unstable blockage in her carotid artery.
After the surgery,Batoul did everything I advised to get healthy. She quit smoking immediately, she began an exercise program where she would walk 5 miles every day. This meant walking in the rain that she disliked so much, since it rains so much in Seattle. She preferred walking in shopping malls when it rained. She never missed a day walking over the next 20 years. She changed her diet to help get excellent control of her diabetes. She stopped eating the saffron rice she loved. She would share all her favorite foods that she could not eat with others. If her appointment with me was ianytime between 1030 am to 3pm, she would bring me a banquet of amazing persian food, including lots of her favorite saffron rice. She loved to bring cream puffs, another food she loved but she would no longer eat.
For the first 5 years I knew her, Batoul would always talk about how much she wanted her son to join the rest of her children in the United States. She worried for his safety in Iran, and she missed him. Every year, I would write a letter to be sent to the immigration office about how it would benefit Batoul's health to have her son in the United States. Finally, Batoul shared the good news with me that his son, Saed, would be moving to the US. She was so relieved. This news had a much greater positive effect on her blood pressure than any of the medications I had prescribed for her hypertension. Batoul hosted a persian banquet to celebrate . My family all went to banquet- My daughter Carly and Batoul became good friends. Batouls grandaughter Sarah was present to translate as Batoul spoke very little english. Over the years,Carly and Batoul would arrange to have lunches together, finding a way to communicate even though Batoul spoke little english and Carly spoke no Farsi. At her appointments, Batoul would say with the few english words she knew "I love Carly".
Batoul did so well for many years. Despite almost having a devastating stroke on the 1st day I met her, she remained healthy for almost 20 years. The final 18 months of Batoul's life were very difficult. Monir called me one day to tell me that the night before Batoul had left her apartment in the middle of the night and was out on a major road, screaming that a baby was in danger. She was hospitalized at a geriatric psychiatry facility for several weeks. On most days she seemed her normal self, but she would suddenly become upset, and ask about the baby. She was eventually discharged to live in a group home. On some weekends she would spend the weekend with her daughter Monir. Monir told me that Batoul often lay on the couch rocking an imaginary baby in her arms. As the mind is lost, sometimes deep memories and unresolved pain come out. Batoul never told me about her 5th child. After her death, her family told me that she had given birth to a son, her 1st born child, who died before his first birthday. Batoul never talked about this loss with anyone, but it never became less painful. The green grass between the grave stones was fresh and inviting to the great grandchildren of Batoul, as they played ,safely under the watchful eyes of their parents , enveloped in the love and spirit of their great grandmother.