"Doctors" - A Reverie by my Late Father

After another hiatus--there will be many of them, as recording Dad's many stories on this blog takes time, and energy--I present another of his tales. This one is an observation of his dealings with doctors. I don't know that it's one of his best written, but it is a commentary on our times, and so, to my mind, relevant for posterity. After I read it, it is also a painful reminder that my father's death in 2008, was the result of some of the failures he writes of here. He did not die of heart disease, or bladder cancer, which had been diagnosed, but rather of sepsis after an out patient procedure. He probably had the beginnings of the sepsis when he went for the procedure. I had been concerned about whether he could tolerate the procedure. The doctors, including his cardiologist, the one that my father liked, but whom I found to be a pompous. . . .well, you know. . . were casual and non-responsive to my father's and my, concerns. By the time I got him to the hospital, it was too late, and somehow they couldn't figure out what should have been obvious.  His own regular doctors avoided me while he was hospitalized for four days and never said a word to me after dad died. Dad was 90. Given his longevity, and the fact for me it would never be about money, I didn't sue. They knew I was an attorney. I did write them both a letter. Naturally, likely on the advice of counsel, they never replied. I note they continue to flourish. I wonder if the death of my father ever gave them pause.

And so, without further ado, my father observes:

It is only lately that I am more comfortable with doctors.  

I am at an age generously beyond the biblical allotment of three score and ten. My longevity is perhaps due to some of the ministrations of medical men over the course of perhaps forty surgeries and the consonant after-treatment.

I cannot say that being lanced, sutured, subject to importunate invasive tubes and implements, the mechanical invaders of bodily privacy, has given me great insight into the psyche of doctors. I do feel, however, that I have seen enough to justify my--disquietude--at some of the treatment I have received.  I am, though, fortunately still alive because of some superb thoracic reconstruction done to repair damage caused by the inaction of doctors who, in times gone by had no knowledge to forestall the trauma.

It was the lot of a skilled surgeon at Cedars-Sinai Hospital in Los Angeles to refurbish an area of the heart damaged in 1980 because of the then standard operating procedure. Those were the dark ages in terms of today's progress.

Then I spent six prone days in Intensive Care with little attention. Occasionally, a nurse applied a nitro glycerin paste to my chest.  I had one X-ray in the ICU with an immense camera lumbered into the room by a minuscule technician.

But today, I had a work-up by a young Cedars cardiologist who appears well instructed in the updated manual of the heart.  He is followup up on an elevated pulse that sent me to the Emergency Room the day after Thanksgiving.

So far we have done the standard tests, the four vials of blood, the electrocardiogram and, of course, an X-Ray.  The doctor's name is Joel (not his real name). He is genial, quick, the kind of a kid I would have played handball with in earlier days.  I like him. I like his appearance of humility, and his forthrightness.  I am more confident than usual.

"Boy," he exclaimed on viewing the cardiogram.  "Your heart too a big hit in 1980!"

"They might have saved me the damage had they given me an aspirin,"  I said.

"We've come a long way since then," he mused.

After the Northridge earthquake of 1994, my already anxious nature was honed to critical pitch.  I consulted another cardiologist for mental surcease.  I disliked him on sight--recognizing him as from the 'Elohist' school wherein doctors refer to themselves in the royal "we".  Here was a doctor who set himself apart from ordinary humanity, who thought himself immortal.

He stood too close for my taste as he probed the prescribed areas--chest, back, the left and the right carotids--uttering periodic "hmmmms" as if he were experiencing medical epiphanies.  He punctuated his exam with the usual questions, "Do you smoke?" among them, that philosophers' stone that explains for medicine all the ills they cannot solve.

"Did you smoke?" he persisted.  

"Four packs a day," I said.  This called for several remonstrative "hmmmms."

"Listen, Doc," I said, exasperated.  "I was born when your mentors were still bleeding their patients.  They all smoked.  Just a few years ago when I lay in peril from a heart attack your profession had not yet learned of the preventative value of an aspirin."

My own internist, a childhood friend, the doctor who sent me to the hospital in 1980, examined me, while smoking.  He was never without a cigarette in his mouth."

I guess my impression of doctors is colored by the longevity that has seen the great strides in medicine.  The consequent ill is that the image of Dr. Kildare diagnosing on sight a melanoma on Lionel Barrymore's arm is somewhat dimmed.  The doctor of today is being reshaped in the crucible of equipment and cost.  Medicare has imposed the stricture on hospital time with its limit on payment for hospital stays--hence the "outpatient" procedures which assume that you may be safely returned home within the time allotted determined by how much Medicare is willing to pay.  

I had a hernia operation and a tumor removed from my bladder, on such an outpatient basis.  Throughout the night I monitored the clear plastic catheter as it ran red. It was still red when the surgeon exclaimed, "It's clear you can go home."  

One seldom sees a doctor up close.  There is the consultation and then the office visits in which he plays a minor role.

You are led to the consulting room.  The technicians take over.  Someone takes your blood pressure and other vitals.  Another hands you a bottle or sets you in the prone for a test. I have one surgeon of whom I have only caught a glimpse just before the anesthetic takes over.  There is brief joy in his ebullient post operative visit, the deft removal of some prosthetic device, after which he says, "Take a deep breath."

When I was a child I knew a doctor, one whose human side exceeded by far his knowledge of medicine.  He was old, gray and gaunt.  He occupied a cluttered leathery office on Boston Road, in the Bronx, across from Morris High School.  He did house visits, always accompanied by his tired little black bag.

He guided me through measles, scarlet fever, contusions and minor breaks--for a dollar visit.  Sometimes he did not get the dollar.

There were no outpatient considerations.  He sentenced me to thirty days in bed for the measles and scarlet fever and forbade me meat.  I think of him as a doctor in the way Hippocrates phrased the requirements.  I like him even now, even though he caused the destruction of my model airplane collection to prevent infection of my siblings and the world.

This is not to disparage the modern physician.  He is the product of the times.  He is the human element of a mechanical robotic structure, subject to economic exigencies, his own limitations, human venality and politics--the hubris of little men who are just scratching the surface of the Infinite.