Second Favorite

The Palliative Lens

By Andrew Esch, MD

Nancy

My patient, Nancy, didn’t mean to wound me.

“You’re a good doctor,” she said.

Then she paused.

“But my first palliative care doctor… he was my favorite.”

There it was. Clean. Uncomplicated. Honest.

And it stung more than I expected.

Not because she was wrong, but because of how quickly my mind went to comparison.

Scorekeeping. Ego dressed up as professionalism.

I’ve been doing this long enough to know better.

Still, I felt it.

Then Nancy told me his name.

Dr. Randich.

And everything shifted.

She didn’t talk about credentials.

Didn’t mention where he trained or what he published.

She told me a story.

Her husband couldn’t find parking the day of the appointment. He Dropped her off and kept circling. You know the drill, cancer center parking lots as their own kind of purgatory.

Dr. Randich finished the visit.

And instead of moving on to the next patient, he walked outside.

• Into the parking lot.

• Found her husband.

• Stood there and talked with him so he wouldn’t feel like he missed something important.

That’s the story.

That’s the whole thing.

• Not a published paper.

• Not a wRVU event.

• Not a quality metric.

A parking lot.

Nancy kept going.

“He was kind. Smart. Funny.”

And then, almost as an afterthought….

“He was sick.”

Dr. Randich

His first name was Anthony. He died in 2021.

Young. What sounds like a glioblastoma. One of the cruelest diagnoses we ask patients to face, only this time, it was one of us.

A physician who spent his career helping people live with serious illness… forced to live his own ending in public view of the same system.

Nancy told me about his family.

A wife. Pregnant.

A child he would never meet.

I went back later and read more about him. The kind of life you recognize immediately in this field because it is exactly what we all say we want to be.

• Committed to patients.

• Grounded in presence.

• Respected by colleagues.

• Loved by families.

The kind of doctor people remember through stories, not resumes. He had both.

And that is when the sting changed. Because this was not about me being second.

This was about being measured, fairly, against something real.

A standard.

Legacy

We talk a lot in palliative care about legacy.

Usually in the context of patients.

What they leave behind.

What matters most.

How they want to be remembered.

We don’t spend enough time asking that question of ourselves.

What does it mean to be someone’s favorite doctor?

• It’s not outcomes.

• It’s not efficiency.

• It’s not even expertise, at least not in the way medicine tends to define it.

It’s presence under pressure.

It’s choosing the harder human thing when the easier clinical thing is right there.

It’s walking into the parking lot when no one is watching.

Near Misses

I am certain that I had been in the some of the same rooms as Dr. Randich over the years.

Same conferences. Maybe listening to conversations about access, workforce, equity.

Our paths ran parallel.

Close enough to overlap, but they never did.

I wish they had.

• Not for networking.

• Not for collaboration.

Just to understand why he did it, what motivated him to find a husband in a parking lot (literally and figuratively) day in and day out, all while carrying what he was carrying.

Because here’s the truth:

Being “good” at this work is not the bar.

Nancy didn’t say I was wrong.

She didn’t say I missed anything.

She said I was good.

And still….

Someone else set the standard.

I walked out of that visit thinking about all the ways we measure ourselves in medicine.

• RVUs.

• Patient volumes.

• Documentation completed on time.

And none of it captures the moment that defines a career:

A physician standing in a parking lot, making sure a husband doesn’t feel left out.

I hope patients feel that way about me someday.

Not because I need to be anyone’s favorite.

But because it would mean I showed up the way he did.

• Consistently.

• Quietly.

• Without needing recognition.

Nancy came in for symptom management.

Medication adjustments. Goals of care.

But what she gave me instead was a recalibration.

A reminder that the work is not just what happens in the room.

It’s what we choose to do just outside of it.

We inherit standards in this field.

Some are written in guidelines.

Some are passed down in training.

And some…..

are built in parking lots,

and carried forward by patients who remember.

That visit with Nancy will change me.

Because now, every time I am tempted to move on to the next thing, to stay efficient, to stay on schedule, to stay within the lines….

I’ll think about Anthony Randich. Dr. Randich.

And I’ll ask myself a harder question:

What would it look like, right now, to live up to that standard?

Not first.

Not second.

Just worthy of the story someone tells about me when I’m not in the room anymore.