Dr. David Smith practiced cardiology for 35 years. He changed course about a decade ago, past the age when many retire, to become a palliative care physician.
Now 75, he has cared for more patients than he could have expected.
"The last two years have just been so heartbreaking," says Smith, in the midst of the covid-19 pandemic. "We've just seen so many sad stories."
He had lost patients as a cardiologist, but not with the same frequency as a palliative care physician during a pandemic.
"In cardiology we would go for months before one of our patients might die, but with this, some days we would have three or four people dying. Just to be dealing with that emotionally it's draining," he admits.
He refers to his field sometimes as supportive medicine rather than palliative, because palliative medicine is often associated with hospice. The patients he sees can live for years, he says, or they can only live for a few days. His job involves bridging the gap between what can be a rushed hospital setting, and the individual needs and emotions of patients and families.
"We want people to live as long as they can, as well as they can," he says. "We have to walk alongside and deal with advanced illness."
Smith didn't always know he wanted to be a doctor of any kind.
He started out in a one-room school house in Fomby, Ark., in Little River County, where his mother was a teacher, and then attended school in "the big town of Ashdown."
In high school, he delivered the Texarkana Gazette in the afternoons on his motor scooter, his dog running alongside.
"My dad had an eighth grade education and was a self-taught plumber," Smith says. "In the summertime, I helped my dad with his plumbing and electrical business."
Digging ditches under the Arkansas summer sun led him to consider a career that required less manual labor. He was interested in science but didn't enjoy math, so his initial plan to become an engineer or nuclear physicist didn't seem like the best path forward.
He majored in chemistry and biology at Harding University in Searcy. It was his father who suggested medical school.
"I'd had penicillin shots so many times as a kid with strep throat, and I hated shots, but I thought about it for a moment and I thought, 'Air conditioning,'" he laughs.
He went to the University of Missouri School of Medicine in Columbia, Mo., and stayed in that state for his internship and residency.
"But I loved Arkansas," he says.
He met his wife, Linda, at Harding, where there were in student government together.
"She was vice president and I was president so we worked a lot together," he says.
They married 53 years ago. She taught high school while he studied medicine.
"We lived in a little mobile home for six years, and we sold it and bought a new car with what we got for it and moved back to Little Rock," Smith says. "It was an excellent investment."
In 1977, he started a cardiology practice in Little Rock.
"I loved cardiology -- I still love it. I thought I would probably practice it until I was 70, at least," he says.
In 1996, Smith took a sabbatical to learn more about bioethics, a topic that had garnered his interest. In 2000, he completed a master's degree in bioethics from Trinity International University and each fall for almost 20 years has taught a bioethics course at Harding University.
"I knew we needed to do something better," Smith says.
He had met Sarah Harrington, medical director of the palliative care program at the University of Arkansas for Medical Sciences, when she was a medical student. She assisted him in meeting rotation requirements with palliative care interdisciplinary teams.
He was 65 when he sat for American Board of Internal Medicine exams in hospice and palliative medicine.
"Because we were grandfathered in we didn't have to do the re-certification examinations," Smith says of his contemporaries. "I hadn't taken a board since '77 and there I was sitting for my board exam again -- I passed it, thankfully."
He started the palliative care program at Baptist Health Medical Center in Little Rock and continues to practice there.
In 1985, Smith went on a mission trip to Haiti with his church, Pleasant Valley Church of Christ. Five years later, he helped found the nonprofit Haiti Christian Development Center, which furthers education and agricultural business, helps with water conservation and purification as well as medical and healthcare concerns.
He spends part of each week focusing on the group's efforts in Haiti.
People ask Smith sometimes why he's still working instead of retiring so he can travel or ride his bike.
"I've got a ton of things that I enjoy doing. I would be OK without this. But this is a way I can do ministry. It just fits me right now," Smith says. "When Linda's health breaks and my health breaks, I'll have to leave it and go on. It'll be sad, but I've really been blessed. I'm one of the most fortunate happy guys, and a lot of guys my age aren't so happy."
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