Love: The Final Fight | Nations

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2nd March 2024

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Love: The Final Fight

A Gifted Surgeon’s Battle for Healing

 

If a man is called to be a street sweeper, he should sweep streets even as a Michelangelo painted, or Beethoven composed music or Shakespeare wrote poetry. He should sweep streets so well that all the hosts of heaven and earth will pause to say, ‘Here lived a great street sweeper who did his job well.”

Martin Luther King, Jr.

Faith’s First Light

We are all common people, until the light breaks in. That light is love. Sometimes it is suffering. Often, it’s both. 

When the future Dr. Bryan Fisher was a young boy, he watched his mother, Marva, give his brother Edward around the clock care. Edward suffered from Cerebral Palsy. Care-giving became the rhythm of their home.  When Bryan was a young man, Edward had a Grand Mal Seizure so severe that a panicked Marva called 911. In the aftermath of the seizure’s chaos, Bryan worriedly asked a paramedic what would happen if his brother’s seizures persisted, or worsened. The reply: his brother’s brain could swell, leading to a possible early death.

At the moment the paramedic’s prognosis became clear in Marva’s mind, her eyes flashed with both helplessness and fierceness, an acceptance of circumstance and love’s rebellion against it. Edward would not die that day. “The doctors said he should’ve died around 15,” Bryan said. Instead, he lived to 59. But in that precarious moment, light broke in. Seeing his mother’s eyes birthed in Bryan a conviction that love drives care and hope.

Each of Bryan’s parents gifted him with the ability to look beyond the present and peer into the possible. His biological father, Robert Fisher, was a Freedom Rider, who’s non-violent resistance played a crucial role in the fight to end segregation and extend the promise of freedom to all Americans. From him, Bryan learned you don’t stay passive when you see something that’s not right. Or, as minister and Civil Rights leader, Vernon Johns told his children, “When you see a good fight, get in it.”

Love is a movement bigger than just you in the world. His step-father, Robert Bredendick, not only loved Marva deeply, but as Bryan said, “as a white man, he took in five children, one with a severe disability, as his own.” From him, Bryan learned that love commits to the long-haul and is sacrificial. Love bears responsibility.

When Bryan was a freshman in high school his girlfriend’s father, Dr. Fred Thomas, asked him the rather pedestrian question, “What do you want to do with your life?” Bryan tentatively shared his dream of playing basketball after high school, despite the naysayers like his sister who told him he physically didn’t have what it would take. Fixing him with a steady gaze, Dr. Thomas then said something that would change the trajectory of Bryan’s life, expanding his vision from the boyish dreams of ball to a horizon of greater possibility and responsibility. He said, “Bryan, I think you should be a doctor. You’re smart enough, it’ll just take work.” 

Over the next three and a half hours, as Bryan listened to Dr. Thomas outline what that would look like, he felt the inner resistance to being ridiculed for his intelligence begin to give way. He remembered the look of desperation in his mother’s eyes. He saw what his brother had endured. He wanted to make a difference and Dr. Thomas had just shed light on the path toward being of service. That pivotal conversation with Dr. Thomas ultimately lead Bryan to graduate with honors from Tennessee State University and gain admittance to University of Wisconsin Madison School of Medicine and Public Health, but an unexpected turn of events would delay medical school a year and prove monumental. 

A Detour for Love

“I saw her from 100 feet away and that was it,” Bryan said, “I needed to be by her.” The woman was Latita Pratt. Driven to respond to love’s beckoning he put medical school on hold for a year and took a job teaching inner-city kids just to be nearer to her.

Timeouts and detours make for good training. Frequently, it is in these unexpected liminal spaces that we see or experience things that shift our perspectives and deepen our character. Mandela on Robben island or Martin Luther King Jr. in a Birmingham jail are two dramatic examples. Bryan’s nine months teaching at Belmont was a gestation period for loving people more deeply. “It was a wake up call,” Bryan said. “I had seen some semblance of poverty, but I didn’t know this kind of poverty existed. Rats in houses, drugs on the streets, gunshots in the air. I had a class full of kids so underserved, and so needy. It changed my approach to dealing with people.”

Bryan said of that year, “God’s greatest gift is love. If you can carry that in your heart, and if you let that shine to other people, you will make a difference. I could tell over time I was making a difference in the kids lives. They needed people to tell them they could succeed. To tell the boys they look handsome and could do well. To tell the girls they are smart and their hair looks pretty.” This glimpse into the challenging reality so many face, and the opportunity to carry the light of a loving presence into that reality, would prove to be a foreshadowing of the future work Bryan would undertake reforming a broken and neglected area of the healthcare system.

Discovering An Overlooked Crisis

It was not long into his studies at University of Wisconsin School of Medicine and Public Health that he began to discover the inequity that currently exists in the healthcare system. “What’s depressing about med school, and being a black person, is realizing that we do worse in almost every determinant there is. When we finally got to melanoma, I remember thinking, ‘Ok, there’s no way we’re going to die at a higher rate. We’re tan.’ Sure enough, the most aggressive, under diagnosed melanoma effects black people. We get it on the soles of our feet.” This is the cancer that took Bob Marley from us. Upon graduation, Bryan would go on to complete a five year general surgical residency at Ohio State University before going on to specialize in vascular surgery at Vanderbilt University.

The first instance Dr. Fisher can remember encountering the crisis that would become his calling was near the beginning of his practice. Walking into the examining room, Dr. Fisher met a patient, a middle-aged black man. “He had a classic presentation of Peripheral Artery Disease, or PAD, (a circulatory condition in which narrowed blood vessels reduce blood flow to the limbs), and was told his leg would have to be amputated.” Adamant that his leg would not be cut off, this patient had come to Dr. Fisher for a second opinion. Upon examination, Dr. Fisher was shocked at the first diagnosis and was confident the leg could be saved. “It made me pause,” He said, “If he had just followed the doctors orders, the paternalistic approach, he would have had an above-the-knee amputation. One he didn’t need! That was when I started paying more attention.”

What that newly sharpened attention unearthed was that patients overall, and particularly black patients, were simply not getting a chance for interventions. He was seeing a lot of end-stage renal disease resulting from diabetes, “and just too many folks missing limbs,” leading him to think, “Something’s not right here.” A closer look showed that nearly 500 Americans lose a limb each day, many resulting from PAD. Strikingly, African Americans are 50% more likely to have an amputation than their white counterparts.

As his practice progressed and his research deepened, the crisis of unnecessary amputations and the preventable gaps in medical care continued to weigh on him. He thought about his father’s civil rights activism. He thought about his mom advocating for and serving someone with additional needs. He thought about his step-dad’s bearing responsibility beyond just his own needs. He had to do something about it. “I started reading the literature and it upset me. When you see the percentage of patients who get no work-up at all. It’s infuriating. It often skips right to, ‘We’re just going to take your leg off.’ I’ve seen 40 year-olds come in with lymphedema (a condition of the lymphatic system that often leads to fluid back-up and limb swelling but doesn’t necessitate amputation). So, they have a whole different problem (from PAD) and the doctor still says, ‘You just need both your legs cut off.’”

Amputation is devastating. Studies find that nearly 50% of amputees age 65 and older die within one year of amputation, underscoring the importance of limb salvaging procedures. Interestingly, these deaths don’t stem from complications with the procedure. Instead, it is typically a complex cocktail of increased hardship and the psychological toll suffered. A limb lost is independence lost. Body image and self-confidence are shattered.

Dr. Fisher said, “God designed us to be able to move, to ambulate. Not being able to move deteriorates the quality of life for patients as well as their loved ones. It is a financial, mental and physical burden for the entire family and it often ends up being the families who can’t afford the necessary housing and vehicular modifications required in the aftermath. Tragically, those who suffer amputation have the same mortality rate as cancer. I believe that Jesus has a calling for all those that would ask and listen intentionally. This is my calling, and I can utilize my craft to alter the paradigm to make an impact for the greater good of humanity.” 

The journey of unearthing his calling led Dr. Fisher to become more involved continuing to learn about the complexities underlying the crisis. He is quick to state, however, that, “Some of it’s on us, the Black community. There are things we have to do to be better from a health standpoint. But, some of the things are not in people’s control directly. Whether its education, health care, or monetary (renumeration), we seem to come out on the short end of it too often. These are patients that look like me and I believe I can make a difference.” He concedes it’s one thing to see the problem and it’s another to fix it. “In medicine we have a whole cohort of competing interests. Yet, if we can admit the bias, if we can give it a name then we can make progress. If we can’t admit that African American people are at a 50% greater risk of amputation, then it makes it really difficult to develop a remedy.”

While there is always an irreducible component of individual responsibility connected to conditions such as PAD, it is the shortcomings of the medical community that animate much of Dr. Fisher’s frustrations. In his view, central to the crisis is the extreme autonomy that physicians currently have in the field and the lack of consequences or accountability for unnecessary amputations. But more than that, he believes that the racial disparity currently reflected in amputation rates all too often reflects a larger pattern of non-white communities receiving an impoverished level of care. Whether that is a result of ignorance, laziness or racial bias is difficult to determine, but it is something that Dr. Fisher is passionate about uncovering and calling to account. 

Operating With Faith and Excellence

One thing that immediately stands out when first entering Dr. Fisher’s orbit is his boundless energy. It contains an effervescent positivity combined with a fierce willingness to stir the pot and push back against a system notorious for changing at a glacial pace. His reputation for compassionate, exceptional patient care in even the most dire situations sets him apart in a profession that is often accused of placing profits and efficiency over the humanity of the suffering. It is that rare blend of giftedness, passion and love that has propelled Dr. Fisher to unusual heights of success and influence at a relatively young age.

Just 40 years old, Dr. Fisher is the Chief of Vascular Surgery at HCA Centennial Medical Center in Nashville, TN. Centennial is the flagship hospital of HCA, the largest healthcare system in the United States. In his years there, Dr. Fisher has grown into a globally respected Key Opinion Leader, an industry expert within his speciality of vascular surgery and complex interventional procedures. His reputation for excellence in the field not only has him speaking at industry conferences regularly, but he is often the one that medical device companies come to when they need someone to test new and advanced technologies. In the highly competitive field of surgical medicine Dr. Fisher’s success at such a young age puts him in rare company.

 Vascular surgeons are a unique breed as a discipline. Not only are they trained in performing open surgery—the act of cutting open up the body in some capacity to address issues—but they also specialize in developing what is known as an interventional skillset. This is the art of minimally invasive procedures, often using small wire catheters to restore healthy circulation within blood vessels. This is the area of Dr. Fisher’s particular genius, where he so often succeeds in saving limbs that others would simply amputate. This is where he has forced his way into the secrets of his art. It is this frontier where his faith and reliance on God is clearest.

When experience and human ingenuity fall short, hearing the still, small voice of God can illuminate the path forward, the breakthrough that leads to healing. When crisis comes, Dr. Fisher believes in God’s faithfulness, in his desire to partner with humanity in the work of healing. “I have stepped away from a case on more than one occasion. When I don’t know what’s going on (in surgery), you get nervous. No one else in the room knows what’s going on, but I know it’s getting crazy. So, I’ll stop, take everything off, go to another room and start talking to Jesus. I start praying, ‘What’s going on here?’ And every single time I walk back in and do one thing, and everything opens up. That’s the power of God. Christ died on the cross for us to be able to hear things like that. To help in the healing.”

When experience and human ingenuity fall short, hearing the still, small voice of God can illuminate the path forward, the breakthrough that leads to healing.

A Tireless Advocate

How many of our fallen problems could be fixed if we were willing to take a higher look. To look morally. Look ethically. Look compassionately. Look justly. Look Humbly. What if we held ourselves responsible in our vocations not just for the conditions of others, but for the systems that either produce suffering or wellbeing? What if we believed in God’s design of wholeness? What if we believed, “The Lord is good to all; He has compassion on all He has made?” (Ps 145:8)

Cultural change starts at pain points. Reformers are those that live in tension. Suspended between the brokenness they bear witness to and a hungry vision for a world brought into harmony, wholeness. The results can take years. The great ones work in the waiting, acting within their spheres of influence and capitalizing on any opportunity to expand the circle of light. Yet, they also honor the pain and disorder they see with their grief. Lasting change, of the sort that will make a real difference, is always motivated by the heart.

“When one of my patients losses a limb it’s devastating. When that doesn’t take a piece of my soul, I’ll do something else.” Dr. Fisher said. A colleague of Dr. Fisher’s views him as more than just a surgeon, he calls him “a pastor in disguise,” saying, “Dr. Fisher’s work is truly the work of Jesus, intersecting with the marginalized when they are most in need.” This passion and commitment to the humanity and dignity of the patients does not end in the operating room for Dr. Fisher. It influences his whole practice. 

There’s no money in helping the poor or sick. Why should health care be different? “We have a mandate. We took an oath to do no harm. We have a fiduciary duty to meet our patients where they are.” What is the disease and how can it be treated? I’m blessed to be in this position, but when I see a patient in clinic I don’t ask them if they have insurance. I don’t care if they have insurance. My partners and I take all comers. Some say we treat homeless guys and gals better than our insured patients. That’s not true, but it I think it’s relevant. It shows how people from lower economic status often just get bounced around from place to place with no options for treatment. I’m not treating your wallet. If you do the right thing the rest takes care of itself.”

For Dr. Fisher, his colleagues and his hospital, doing the right thing is not simply limited to compassionate care and generosity. It’s revealed in a commitment to learn from mistakes and to chart a new path forward. “We are at an inflection point” he says. “We have some key stakeholders, as far as physicians, that are totally invested in making a difference. We are doing what no other hospital has done. We are going back retrospectively. What are the options we have missed to get this patient in sooner. Imagine, if we did that across the country. I bet you’d cut amputations in half just like that. If you had any semblance of accountability I believe you’d see a 20-40% drop in amputations just because somebody’s paying attention. Suddenly you have eyes.” A mark of a leader and the burden of a reformer is the long-suffering work of helping others learn to see the deeper reality visible to you, but not yet made manifest.

Dr. Fisher’s discoveries and innovations in vascular surgery have come from breaking with old protocols and setting new rules. If amputation causes so much havoc, then God’s order would prescribe not just saving the limb. It would transform the system that fails to honor the fullness of a patient’s humanity. 

Dr. Fisher has tirelessly advocated for the vulnerable in the halls of power. Breaking decorum in industry meetings he has used his position of influence to passionately call the executives of medical device and drug companies to remember that the business of healing is not fundamentally about sales and profits. No, it must be about restoring the health and dignity of the suffering individual. Frustrated by the lack of accountability, Dr. Fisher has been a key adviser in the development and proposal of legislation called the ARC Act (Amputation Reduction and Compassion) which, according to the Cardiovascular Coalition, would “Prohibit the use of amputation without the completion of arterial testing to determine if alternative interventions could be applied.” Love elevates the standard of care and demands excellence.

The government, legislation, Global Vascular Surgery Societies and the multi-billion dollar medical device industry are now acutely aware of the direct and critical bridge between race, Peripheral Artery Disease and amputation rates. As Dr. Fisher has hand shoveled a trail—where before there was none—to the most powerful groups in the US, government and medical device industry we are now starting to see fruits of his faithful and, at times isolated, calling and journey to-date. Though he would never claim sole credit, one of the fruits of his advocacy is Johnson & Johnson committing $100 million in this area.

Barrier Breaking

A voice for the voiceless, Dr. Fisher is an uncommon doctor for the common man. God took a wounded soul’s discomfort at the status quo and called to him through that discomfort. Professionally, Dr. Fisher seeks to bring order to the chaos of American medicine. Minister and civil rights activist, John M. Perkins, said, “Love is the final fight.” Dr. Fisher believes it is the beginning and the end, the first and the last driving passion. His love challenges himself and his profession.

What if God created the world for wholeness? What if God, in wanting to bring his fallen creation back to that intended wholeness, uses people who believe in his original vision? People who speak and act in ways that bring harmony into their unique stream of chaos. These are the barrier breakers, artists, scientists, innovators and reformers who understand the fundamental rules of their area of mastery. They appreciate how the laws that govern their spheres came into being. Then, the great ones break those protocols and take their vocation further into God’s creating movement. Dr. Bryan Fisher is a barrier breaker, who in his own way, has heard God’s call and is taking up the good fight on his given ground. 

Dr. Fisher | Operating Room

Photos by James Younger

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Wendy Winman

Wendy Winman