The cardiologist with a big heart, John M. Stang, MD

Lately I have been thinking about John Stang, MD, one of my teachers and mentors during medical school. I am proud to call him my friend, although I do so with mixed emotions.

Dr. Stang made quite a first impression. I was sitting through an exceptionally boring day of medical school orientation, but his presentation was different from all of the others. His entrance into the lecture hall was accompanied by rock music (Jimi Hendrix, if I recall correctly) and flashing lights. He expressed his regret that he couldn’t set up a fog machine, or play the music himself. I remember thinking to myself, “Is this guy for real?”

And he was. I got to know him personally early in my first year of medical school, and I was impressed by how sincerely he cared about his students. As the assistant dean for student counseling and tutoring, he spent hours and hours of his time working one on one with struggling students and facilitating group study sessions. He was a quirky fellow. About once a week he would sent an email to all of the students in the class with updates and info about how to prepare for and register for the United States Medical Licensing Examination (USMLE), and his writing was just as eccentric as he was. He made liberal use of colors, text sizes, and capitalization to emphasize various points in the text, and it took me a while to learn how much of it I could safely ignore.

One of his longtime colleagues once told me a story about Dr. Stang. In the course of a brief conversation Dr. Stang had pulled a long handwritten list out of one of his white coat pockets and added something to it. When his colleague asked about the list Dr. Stang produced another list from another pocket, and two more lists from other pockets, all about as long as the first. His colleague then asked how he kept all of his lists straight, and Dr. Stang produced a master list out of his front pocket which listed all of his other lists, their general contents, and which pocket each list belonged in. That’s the kind of person he was.

Dr. Stang and I became friends, and I would stop by his office to chat for a few minutes whenever I walked by. Our conversations wandered through many subjects, including computer security, the Vietnam War, whether we would be friends with Jimi Hendrix if we knew him personally, and of course various topics in medicine. I shared with him my music recordings, which he enjoyed.  He remarked on how many Latter-day Saints there were in every medical school class, and on what fine students we generally were.

During my second year of medical school Dr. Stang introduced the Myers & Briggs personality inventory, and presented data showing that different medical specialties tended to correlate with different personality types. I think that is interesting, and my own anecdotal observations have tended to confirm that personality is a major factor in specialty choice. Shortly after his lecture I stopped by his office to ask him a few questions about the personality profile scheme he introduced.

In the course of our conversation he asked me questions to try to pin down my personality type, and as we discussed the fourth preference pair I indicated that I lean towards “judging” rather than “perceiving” (see the link for definitions). He pointed out that I wasn’t wearing a timepiece, which is one of the cardinal signs of the “judging” preference. “I’m sort of a cryptic timepiece wearer,” I said, and pulled a Palm Pilot out of my pocket. “All I have to do is push this button, and it will show me the clock on the screen,” I demonstrated. Dr. Stang laughed heartily, and insisted on taking a picture of me with my “cryptic timepiece.”

As a token of our appreciation for all of his tutoring and mentoring efforts, at the end of my second year the members of my class all pitched in to buy him an autographed Led Zeppelin LP. He was so overcome with gratitude that he had tears in his eyes as he accepted the gift.

Manic Depression Is a Frustrating Mess

On the second day of my surgery rotation, early in my third year of medical school, I was in the operating room for about 10 hours on an Ivor Lewis esophagectomy case. Tired and weary, I stopped at my locker at about 9:00 pm in the basement of the medical school, and I was surprised to find that the light was on in Dr. Stang’s office. The door was open, so I poked my head in and found him sitting at his desk, no doubt working on some incomprehensible email for the first year students. We talked for a few minutes, and he seemed down in his spirits. I encouraged him to go home and get some sleep.

Dr. Stang changed during that third year. He had always been exuberant, with occasional melancholy stretches, and this general pattern continued. But his amplitude changed. His highs seemed to be higher and his lows lower. He also stepped on a few toes at the administrative level at the medical center, and got into hot water. During this year I was rotating through a different medical specialty every month or two. In January I rotated through psychiatry, and I began to form the theory that Dr. Stang had bipolar disorder. This was later confirmed to me by some of his colleagues and friends.

Addiction

In the spring of that year I also learned about his fascinating past history, which added a whole new dimension to my understanding and appreciation of this man. He had made reference a few times to his “past life” as a cardiologist, and I didn’t know what he was talking about at first. He had a special interest in addiction medicine, and he invited me to attend a lecture he gave at an addiction recovery facility on a Saturday morning. At this lecture he told the following story:

In the early 1980’s an event happened which changed his life forever. He was a young cardiologist at the start of a promising career in academic research and teaching, and the medical students loved him. (A student who studied with him in his early career told me that Dr. Stang was “popular yet controversial.”) He had a young family with a wife and two small children. The future was bright indeed, until his bicycle crash.

Some significant injuries from the crash led a doctor to give him a prescription for Percocet (oxycodone-acetaminophen). By the time he had finished his first prescription he was an opioid addict. This was the disease of addiction, which had lain dormant in his life until that point when it was activated. Over the next few weeks he rearranged everything in his life so that he could continue using this drug. When his doctor refused to supply him any more he learned how to get prescriptions from other doctors at emergency rooms and elsewhere. He even fantasized about going to the factory where they manufacture Percocet and stealing some. “I wasn’t going to take all of them,” he insisted, “just enough for me.”

His opioid use continued and even accelerated despite adverse events in his life. Consequences started piling up in his home and work settings, and eventually he was referred to a drug rehabilitation program where he learned about the 12 Steps of Alcoholics Anonymous. Following these steps led to a spiritual awakening in his life, and to his sobriety. For the next 25 or so years he generously donated his time and energy to help other addicts, giving a weekly lecture and Q&A session every Saturday morning at the addiction recovery center. “Those were remarkable experiences,” recalled one of his friends and colleagues. He had “such a gift for connecting with hurting people and their families.”

But he was not allowed to return to practicing his beloved cardiology. Searching through the archives I do not see evidence that his state medical license was revoked, but perhaps his board certification was. I don’t remember the details of this, although I do remember talking to him about it. He felt betrayed by the people who had made this decision. Losing his career in cardiology left a massive hole in his heart, which he tried to fill by serving the medical students in his resurrected career as a medical education specialist. But I could see the pain in his eyes on those rare times when he talked about the old days.

I Sing For You and Your Healing Heart

Around the time I started my fourth year of medical school Dr. Stang was asked to retire by the medical center leadership. This had something to do with his mood instability over the prior year, but there were other circumstances that I don’t know the details of. He told me at the time that he was threatened with being fired if he didn’t retire.

I remember the day he moved out of his basement office, which I think he had occupied for nearly 20 years. It filled a large moving van. That empty office left a hole in my heart, and it felt like the whole building would collapse without him there. But I knew that there was more than a hole in Dr. Stang’s heart; there was a festering wound.

Around this time our relationship started to change. Instead of being the student asking for a mentor’s help, I started to think of ways that I could try to help him. I had recently had an experience with the healing power of forgiveness, and I knew that it would help Dr. Stang if he could find a way to forgive the people he was holding this grudge against. With this in mind, I  started working on a music recording. It was a song dedicated to Dr. Stang, called “Healing Heart.” Here were my lyrics:

Look within your own heart
There is always another open part.
This burden, can you forgive?
Oh, please forgive!
I sing for you and your healing heart.

Deep within my own heart
Can I open another another broken part?
This burden, I will forgive
I will forgive!
Oh, pray for me and my healing heart.

(Based on a song by Andrew Vavrek (CC-BY-SA)

I wanted to present Dr. Stang with a recording of this song, but during my fourth year of medical school I was so busy with school, family, medical licensing exams, and residency interviews that I just didn’t have time to do it.

For Christmas that year I gave Dr. Stang a copy of The Book of Mormon with the following letter:

This gift had no discernible effect on my friend. I left it on his doorstep because no one answered the door, and he never acknowledged receiving it.

His depression was quite severe that year, and was no longer broken up by periods of mania or hypomania. Combined with the fact that he was no longer on campus every day, this made it difficult to stay in touch with him. Obsessive-compulsive disorder and toxic perfectionism added significantly to his burden, and if that wasn’t enough he also suffered a head trauma from a bad fall and was in the hospital for a while recovering from it. I accidentally came across his name in the course of my hospital work one day and stopped by his room to wish him well.

At a medical school graduation it is traditional for a graduating student to ask a special friend or mentor to place their hood. I decided to ask Dr. Stang to place mine, in hopes that getting him out of his house and around his beloved students would raise his spirits. During the ceremony my name was called, and I walked up to the stage. As Dr. Stang placed my hood our eyes met, and I said, “Thank you for being here.” He looked miserable, but tried to smile.

Five days later he committed suicide. Placing my hood was probably his last official act as a medical doctor.

Epilogue

I learned about his death a couple of weeks after it happened, and of course I was shocked at the news. By then I had missed the memorial service attended by so many of his former students and colleagues. Dr. Stang’s obituary understandably omitted the cause of his death. If you browse through his eulogies you will see that I am not the only student who loved him. He had a positive effect on thousands of lives, and his death was a great tragedy.

Suicides usually leave survivors with conflicted feelings of guilt and sadness, and anger. I can’t say that I was ever angry with Dr. Stang, but I did wonder whether I could have done more to help him. At the graduation ceremony I missed a chance to walk up and say hello to him because I was feeling shy, and I have regretted that.

I sent a draft of this story to one of his close friends and colleagues, another one of my mentors. She replied, “I still think of him often, about all he meant to folks and about how he suffered and how no one could bring him peace. I hope to G-d that he is at peace now.  There was a terrible black hole in the middle of his heart/soul and it was so painful to watch.   There were so many joys for him to celebrate and so many triumphs that he helped others to achieve and yet none of them could quench his pain for more than a second.  I cry now when I think of him.”

Four or five years after he died I had a short visit from Janice Stang, who had been going through her husband’s things and had found the Book of Mormon I gave him. She returned it to me, along with a treasure from his collection: a 1967 printing of Frank H. Netter, MD’s medical drawings of the nervous system. He had purchased it during his training, and it was a major financial sacrifice for them at the time. I was honored to accept her gift. It sits in my office, along with the Book of Mormon, and I think of him whenever I see it.

Recently I decided to finish my recording of “Healing Heart,” and so I have been thinking of my old friend and mentor, Dr. Stang. I think he would like my recording a lot. May God bless and heal his soul.

UPDATE: We are collecting donations for a scholarship fund in Dr. Stang’s honor. For more information visit this post or this page: https://www.stanglegacy.com/. If you would like to donate to the scholarship fund visit this site: http://give.osu.edu/STANGMEMORIAL.

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Alan B. Sanderson, MD is a member of The Church of Jesus Christ of Latter-day Saints and is a practicing neurologist.