DMN: Even in retirement, Dallas doctor nurtures former patients

Dr. Bob's wide reach...

Saturday, May 14, 2011

DMN: JON NIELSEN Staff Writer

The disease tracked Luigi and Valbona Shpati like a shadow.

Cystic fibrosis took their first son three months after he was born. And just days after the birth of their second son, Diell, doctors in Kosovo gave the boy the same bleak diagnosis.

Then on the television news, Luigi Shpati saw the Dallas pediatrician who would change the course of his family forever.

At the time, Dr. Robert Kramer was nearing retirement as Dallas' authority on the incurable genetic disease. And today, the 77-year-old travels the world to see patients he treated 40 years ago when they were children.

In the Shpatis' case, the family left everything in Kosovo to be near the doctor they now call their father, grandfather and friend.

"Ever since, we are not just doctor and patient but friends and family, too," Luigi Shpati said.

Since he stopped practicing full time in the mid-1990s, Kramer has lived his life through the patients he once treated.

When Kramer began the Cystic Fibrosis Research Center at Children's Medical Center in Dallas in 1964, it was a time of space travel and rocketry. But medical science in the field of cystic fibrosis remained virtually unexplored. Patients rarely lived past age 10. Today, they're living into their 40s, allowing Kramer to attend birthdays and weddings of patients he treated decades ago.

When he and his 74-year-old wife, Joan, travel around the world, they'll often find someone who was once in his care.

"We can't go anywhere where we don't see patients," said his wife of 48 years. "He would be devastated if we roamed around town and didn't see anyone he knew.

"I have said occasionally that I wish I were a patient."

Recently, Kramer, who lives in Dallas, received a frantic call from Matt Connally in Abilene. Connally, a Kramer patient since his birth in 1977, was going through a rough time and needed someone to talk to. He knew he could call Kramer. Despite a spate of recent medical procedures and a fall that sidelined him for a few days, Kramer flew out to Abilene to comfort Connally.

"I really don't know what I'd do without him," Connally said. "He's by far more than just a doctor. He's one of my best friends."

Dozens echo Connally's sentiments. But perhaps none captures them more than the Shpatis' story.

From Kosovo to Dallas

The news report that Luigi Shpati saw in Kosovo featured Kramer discussing advances in medicine at the Dallas CF clinic. To shake the disease's shadow, Shpati had to cross the world and speak to Kramer.

"I heard about you on television," Shpati told the doctor through an Albanian translator when they first met in 1990. "I need your help."

After his first visit with Kramer, Shpati knew that he had to bring Valbona, Diell and Diell's 1-year-old sister, Donika, to America. They had to abandon their lives in Kosovo - Luigi was an economist for the government, and Val a medical student - but the move promised better health for Diell.

On their second visit with Kramer, the doctor promised to care for the family as long as he could.

"We were coming from nowhere with nothing. We are a happy family, and Dr. Kramer is a huge percentage of our happiness," Luigi Shpati said.

Controlling CF

Kramer gets a lot of the credit, but so should the improvements in science that help control cystic fibrosis.

Genetic testing and sweat tests (a high salt concentration indicates the possibility of CF) trigger earlier diagnosis of the disease, which attacks the lungs and digestive system. And treatment advances consist of clearing mucus from the airways and keeping lungs healthy.

By 2009, the median predicted age of survival for someone with CF reached the mid-30s, according to the cystic fibrosis foundation. Today, Diell is 24 and talks to Kramer nearly every day. When Kramer calls, he starts the conversation with, "Hey, this is grandpa."

Kramer has treated the family to Thanksgiving dinners at his home and was in the stands when Diell played junior high football. When Donika was scouting colleges after graduating from high school, Kramer advised her on the best places to study pre-med. When, at age 18, Diell was arrested for disorderly conduct in an incident that got out of hand at his Dallas apartment, Kramer was there to smooth things over. The charges were later dismissed.

"I feel blessed because of Dr. Kramer," Diell said. "My mom, my dad and Dr. Kramer: They're the driving force behind me."

Kramer, who has four daughters and four grandchildren, rails against a broken health care system that has left him skeptical about the future of medicine.

He said insurance companies are in the business of making money, not working for the patient. He said too many doctors spend too little time getting to know patients.

"The profession is too precious to allow it to suffer like this. I don't know if we're in it too far to effect change."

He recalled visiting a Dallas hospital with other doctors not long after he retired. One of the patients had a heart murmur, and a young doctor was going to order an echocardiogram without seeing the child.

"You're not going to introduce yourself and pat him on the shoulder?" Kramer asked.

"That doesn't have anything to do with practicing medicine," the doctor said.

The response left Kramer in wide-eyed dismay. It's an example of what Kramer says is wrong with today's health care system.

When he was training in the mid-1950s, he said, the most important aspects of medical practice were knowing your patients and their families and following through.

Old-school methods

Kramer said those old-school methods are not compatible with today's profit-driven bottom line.

"We live in a world of high-tech and no touch," he said.

Kramer has learned that from both sides of the hospital bed. Over the last two years, he has spent 51/2 months in the hospital while doctors treated him for a torn aorta, a bad hip and a recent stumble that left him immobile for a couple of days.

When his patients learned about his deteriorating health, they worried for their seemingly invincible doctor. The news hit Diell hard.

"It was scary," Diell said. "I could see he was having difficulty breathing. I've been there; I know what it's like to not be able to take a full breath."

Despite his health problems, Dr. Kramer hasn't stopped traveling the country or fielding calls from doctors seeking his advice.

"My job isn't finished yet," Kramer said. "I'm not sure it ever will be."