the hardest thing

A Community Health Center is not an easy place to work. It’s not an easy place to spend your first year as a new Nurse Practitioner. Even with solid co-workers and bosses that genuinely care about you, its very difficult work. Patients are scheduled to be seen in fifteen minute appointment slots; patients who have a myriad of complex medical problems, social issues, and limited resources.

Several months in, I asked my medical director for some more support. Specifically, I asked if he thought I could start meeting on a regular basis with one of the experienced physicians at Lawndale, Nikhil Siony. I had worked with Siony a number of times, gone to him for help and advice, and just generally liked the guy. Siony was happy to help, so we started meeting every couple weeks.

I couldn’t overstate what a help this became. Aside from providing solid medical advice when it came to treating my patients and working them up with a variety of diagnostics, Dr. Siony was a breath of fresh air in the midst of very challenging job. A straight and to the point guy with a dry sense of humor, Dr. Siony came to Lawndale in 2005 after working as an attending at a New York City hospital. But I can’t remember a meeting we had which he didn’t start by checking in with a, “Hey how’s it going though? Ok? You handling everything ok?” My typical response was something of a general yes, likely followed by some rambling about how I worried I missed something here or could of done something better there. Dr. Siony would always very matter-of-factly tell me there was no reason to stress about anything, especially in your first year of practice. That for the first year you are always learning, and that that was the case for even him when he first came to Lawndale, and that nobody should stress.

Not long after starting to meet with Siony, knowing that he would be in clinic as a resource, or that I could call him with a question anytime, or that I would be meeting with him soon to go over questions gave me a peace about being in clinic. I knew that no matter how tough the patient, or how complicated the medical problem, I could always get his advice, any day, any time. A few months ago, I received a biopsy report on a young patient of mine which came back showing cancer. It was a Saturday when I got the result, and it rocked my weekend. I had never faced anything like this before, and I didn’t even know where to start, how to get my patient seen and where. I called Siony, and within fifteen minutes, my patient was scheduled to see Heme Onc first thing Monday morning.

I remember being in clinic one day, seeing a patient for a simple complaint. She had an ear infection. I think I was discussing treatment with another provider, and Siony asked me what was going on. Before long, he was breezing through this patient’s chart. She’d been to the clinic for the same complaint a number of times. He asked me, “Why does she keep coming back for ear infections? Is she taking care of herself? It sounds like she is not taking care of herself. Let’s see what else we can do for her. Have her see behavioral health, let’s see what kind of resources we can get her connected with, yeah?” He was right. She was a single mom with several children and very little support. He had a way of seeing patients and identifying their needs that went way beyond simple medical care.

At one of our most recent meetings, I had asked Siony how he knew who to call for various things when his patients had immediate needs (like the cancer doc he called for my patient on a Saturday). Like, how could I get something like an immediate heme onc consult over the weekend, or a cardiac cath that needed to happen within a week, on my own. He told me, “You just call me, and I’ll take care of it.” But I said to him, “Yeah but what if you leave or something? What if I couldn’t get you to help me?” He responded with, “Where am I going? I am never going to leave Lawndale.” Even after 9 years of practicing medicine at Lawndale, the guy didn’t have a trace of burnout in him.

About a week after that meeting, I found him in clinic to help me with a patient I was seeing. He greeted me with his usual “Hola, doctora! Como estas?” (he often greeted us midlevels in Spanish, despite his thick Indian accent and the fact that he didn’t actually speak Spanish). Before I started with my question, he told me he had been thinking about what I had asked him about. He said he decided he’d give me the names of the specialists he would go to for specific things, as well as instructions for how to get in touch with them. He told me, “I thought about it. You can call them yourself if you want to.”

Friday afternoon last week I was at home working on some follow up (I was out of clinic because I’d work that Saturday). I had a sort of difficult situation I wanted some advice on, so I gave him a call. He didn’t answer, but I knew he’d get back to me when he could, as usual. Probably within the hour.

About an hour later I got the email: “Attention Staff- Many of you may have heard the news that Ogden provider Dr. Nikhil Siony was in a serious car accident on his way to Lawndale this morning. He remains in the ICU in critical condition. We will communicate any changes in his condition via email.”

My heart sank as I covered my mouth in disbelief. By the next morning, it was clear to me just how bad it was. That Siony may not be coming back to us. I went to the hospital that evening after work, and stood at his bedside, like so many others. I told him it was Erin Mann. That I saw a patient of his in clinic that day, who was wondering what happened to him. That I had tried to call him the day before. I had a question for him. I just wasn’t sure what to do about this situation I had with a patient he had helped me with before. I told him all about it. I told him I couldn’t find that list of specialists he gave me to call. That things would suck without him. That it was going to be rough without him at Lawndale. He lay there still, silent, badly bruised, in a coma.

Today I got the news. Siony died last night, in that ICU, surrounded by his family and loved ones. To be quite frank, I don’t know what we’re all going to do without him. I’m not worried about where he is; its clear he had a steadfast faith in the one true God. It’s the rest of us that have to manage in a world, at Lawndale, without Dr. Nikhil Siony. He was a mentor to me in many ways. I pray that God would somehow teach us all to keep running the race, without Nikhil Siony. That the God of hope would fill us with all joy and peace as we trust in Him