That June day when Randy Combs met Brian Gavin, MD, had not begun as the best of days.

Combs had fallen ill at home and couldn’t breathe, prompting neighbors to call 911. An ambulance rushed him to Spectrum Health Butterworth Hospital, where he soon learned he had developed blood clots in his lungs.

Doctors began treatment immediately, marking the start of dramatic life changes for Combs, 60, of Clarksville, Michigan.

About the only good thing to come from that troublesome day: Dr. Gavin had been among the doctors who treated Combs.

And they didn’t know it at the time, but the treatment marked the start of a rewarding relationship.

When Combs walked out of the hospital about a week later, he had to choose a doctor to oversee his recuperation.

The choice seemed easy: Dr. Gavin, the Spectrum Health internal medicine resident who had been so amazing that past week.

“He cares,” Combs said.

Dr. Gavin’s ability to develop trusting relationships with his patients had already caught the attention of his supervisors in the internal medicine residency program at Spectrum Health. The doctor has been recognized for his keen ability to listen to patients and put them at ease—even the self-described “tough guy” patients like Combs, who are none too comfortable in medical settings.

‘As tough as they come’

On June 6, 2017, Combs had been working in his garage at home when he suddenly felt short of breath. He had leaned over to put some ice in his work cooler when it hit him.

He alerted his wife, Vicki, who immediately called their neighbors, both EMTs.

Combs had no idea what hit him. He had minimal pain, but his blood pressure grew high.

“I’m tough as they come, and I can’t breathe here,” he told his neighbors.


When to watch for a pulmonary embolism

  • After a major surgery or a broken leg or hip
  • During or after a long flight or car ride
  • After starting a new hormone treatment

Signs of a pulmonary embolism

  • Leg swelling
  • Chest pain
  • Shortness of breath

They called 911. When EMTs arrived at the Combs house, they asked which hospital he wanted to go to. They chose Butterworth Hospital.

“It was the best decision we made,” Vicki said. “They have been wonderful to us from the get-go.”

At the hospital, a CT scan revealed several blood clots in Combs’ lungs. An EKG showed the clots were straining his heart, Dr. Gavin said.

Doctors immediately started a clot-busting medication. They also treated him with a catheter-directed thrombolysis, a procedure that uses a catheter to dissolve the clots. They checked Combs into the intensive care unit for monitoring.

He stayed there for eight days, until the clots cleared. During that time, doctors also found a bleeding ulcer in his stomach. They treated that, too.

Trusted care

Following his release from the hospital, he had to schedule follow-up care to monitor his condition and medications.

He got a prescription for a blood thinner to help prevent new clots from forming, as well as inhalers to help treat his chronic obstructive pulmonary disease.

“We still don’t know where the clots came from, so that’s what’s kind of scary,” Vicki said.

But the Combses wanted a doctor they could trust.

Dr. Gavin fit that bill. He had helped save Combs’ life, after all.

“We gave him a thank-you card, and he was so touched,” Vicki said.

Spectrum Health residents see patients at the Spectrum Health Internal Medicine Residency Clinic in Grand Rapids, which operates much like a primary care doctor’s office.

Combs’ follow-up care entailed several aspects, including navigation of his insurance and employment issues and monitoring his blood thinners.

Combs, a welder for decades, faced new restrictions as a result of the blood thinners. He could no longer work from heights, such as catwalks. He had to get a new job as a factory maintenance worker.

“It’s important for us to take all of that into account when we are caring for him,” Dr. Gavin said.

At one appointment, Combs updated Dr. Gavin about the new job and his health.

“How’s your breathing?” Dr. Gavin asked as Vicki looked on.

“I’m not really getting that shortness of breath anymore,” Combs said.

Later, he indicated he felt better.

“You look better,” Dr. Gavin told him.

‘We were lucky’

When Dr. Gavin landed a spot in the internal medicine residency program at Spectrum Health, it came as something of a return home.

Born in the Upper Peninsula of Michigan, Dr. Gavin’s father’s job in the Air Force led to the family leaving the state for a time.

Dr. Gavin went on to complete medical school at the University of Tennessee Health Science Center College of Medicine, and he began looking for a smaller program that would allow him to enjoy more one-on-one attention with patients.

He strives to get to know patients on a personal level, which helps him provide the best care possible.

“It’s absolutely a goal of mine,” Dr. Gavin said. “My long-term plan is that I hope to do primary care. I think it’s very important to form those relationships. Things go so much better for the patient when they trust what you’re saying.”

Spectrum Health’s internal medicine residency program offered him what he sought. He completes his residency in 2019.

Paula Schuiteman-Bishop, senior director of the Spectrum Health Office of Medical Education, said residents like Dr. Gavin are a critical part of Spectrum Health’s goal of bringing the best possible care to the community.

There are about 300 residents and fellows in the program.

Michael Stout, MD, an internal medicine doctor and program director at the clinic, said medical residents become heavily invested in the happenings of Spectrum Health as an institution—not to mention the happenings of Grand Rapids itself.

“It’s always gratifying to see residents be able to make a connection with people who are, in many cases, from very different backgrounds, and form a truly therapeutic relationship,” Dr. Stout said.

For her part, Vicki feels fortunate her husband and Dr. Gavin forged such a strong patient-provider relationship that fateful day last June.

“We were lucky,” Vicki said. “We found wonderful doctors.”

Combs agrees.

“He does care,” Combs said.