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A Doctor’s Kid

Thursday, February 2, 2012 // Uncategorized

I was a doctor’s kid, so I read with interest this essay in this week’s JAMA (Journal of the American Medical Association) by Mike Brake.  It resonated with me.  The absences from school events.  Making rounds with him on Sundays.  Today’s generation of physicians want to have time to spend with their families.  They aren’t willing to let the importance of their profession outweigh the importance of their personal lives.  It is understandable, but there is a price that we all pay for that.

A Piece of My Mind
JAMA. 2012;307(5):465-466. doi: 10.1001/jama.2012.38

A Doctor’s Kid

Standing beside my father’s bed in a cramped, makeshift intensive care unit, listening to his Cheyne-Stokes respirations, I realized that he had certainly rounded on hundreds of patients in this very room. The old hospital, like the not-so-old man in the bed, was nearing the end of its useful life. The room still bore an antique wooden louvered half-door, and you almost expected to see a grainy black-and-white Lew Ayres as Young Dr. Kildare hurrying through the narrow halls. My father had trained here, at mid-century, and he had driven back here to die, just months before its staff and patients were to move a mile east to a shiny new 1970s facility.

As his breathing slowed, I thought what it had meant to be a doctor’s kid.

It had been a mixed blessing.

The children of physicians, especially in the 1950s, could be forgiven for feeling a bit smug. Doctors were then held in maximum regard, and that reverence spilled over to their offspring. In elementary school I was one of two kids who could proudly say, “My Dad is a doctor,” which brought awed looks from classmates and teachers alike. I never heard, “You must be rich.” Internists in those days made a decent living, but their incomes were hardly princely. After my father died I sorted through some old patient billing cards in his basement. Office calls then were $5, and a house call, often conducted at 2 AM in a sleet storm, was $12. Of the hundreds of yellowed index cards in those boxes, perhaps a third were marked “Uncollected,” since his mid-50s practice was in a less affluent part of town.

The reflected aura we basked in as doctor’s kids was not one of envy, but of respect. Few Americans questioned the primacy of the medical profession in those days. Fewer still proposed any fundamental change in the traditional fee-for-service, family doctor at the bedside model. My grandfather had been a physician too, and my father retained his battered and creased old leather bag, with its chrome speculum and reusable glass syringes and suture kits. My grandfather had gone directly from high school to medical school in the years just before the First World War. My father completed college in 1941, spent four years in the Pacific in the Army Air Corps, and returned to enroll in med school in 1947, the year of my birth. Yet their practices, and the drugs and technologies they employed, were similar. So were the aphorisms passed along to medical offspring of that era.

“Ninety percent of what goes wrong with people, they’ll get better on their own,” my father once told me. “Two or three percent will kill them no matter what we do. We can really only cure the other seven or eight percent.” A good summary then, a good summary in 1917, and not a bad estimate even today.

He came home following duty in the occupation of Japan and landed on the clogged waiting list for medical school. That fall his name came up one short . . . until a newly admitted student was badly injured in a freak automobile crash. Thus he found himself a member of the entering class of 1951.

The shared secret of medical families then, as now, was how grueling the training could be. Before she died my mother assembled a scrapbook for each of her children. In mine are two snapshots, stamp dated 1951, of my father in his medical school graduation cap and gown, holding a 4-year-old me. The next several pages include snaps of birthdays and Christmases and zoo outings, but he isn’t in them. He was at the hospital—that same hospital where he would die two decades later—pulling the endless duty and on-call shifts that then, and for decades to come, would characterize internship and residency training. I have no doubt that it made good doctors of most.

We heard some of the stories at rare dinner-table conversations. The patient with uterine cancer who would soon die. The obese woman who came to the ER complaining of abdominal pain, only to deposit a full-term infant in the toilet. (“I pulled him out and scraped off the toilet paper and he was fine,” my father chuckled as my brother and I stared wide-eyed at this godlike figure who could retrieve a life from the plumbing.) His growing interest in cardiology in the years before that field became such a prominent subspecialty.

After he entered private practice, he occasionally took his two oldest children along on weekend hospital rounds. We’d sit stoically in the ER waiting area, closely monitored by a stern white-dressed nurse in her rigid batwinged cap, while he went upstairs to do . . . well, mysterious and wondrous things, we were certain. My interest in things medical grew as a natural result of such proximity. I asked questions, and often received answers. “This is your liver,” he would tell me, showing me where to press. “This is your sternum. The bones up here are called the clavicle.” When I badly sprained my ankle playing baseball I learned how to wrap my own Ace bandage. When I had a minor surgery in second grade I chatted with the anesthesiologist, asking what he would use. (“Not ether,” he assured me.)

Doctor’s kids were always a bit different. When the Salk and Sabin polio vaccines debuted, my classmates lined up outside the school clinic, nervous and frightened by the cattle call atmosphere. We got our first polio shots in the dining room while Mom set the dinner table.

“Here,” my father said. “Roll up your sleeve.” Swipe, dart, plunge, extract. “You’re good to go.”

We later joked, as most medical offspring do, that our legs could have become detached from our bodies and Dad would have tossed us some Band-Aids with a curt “You’ll be OK.” My sex talk, at 14 or so, consisted of being handed a worn textbook titled Principles of Obstetrics and Gynecology with the admonition to “Look through that and let me know if you have any questions.” It took the loss of virginity some years later to inform me that there were healthy pudenda in this world.

I am sure that the children of engineers take well to math. The offspring of geologists probably find volcanoes especially fascinating. Kids born to mechanics likely learn to work on cars from an early age. But the doctor’s kid often takes a unique interest and pride in his or her parent’s profession. My adolescent reading included Intern by the anonymous “Doctor X,” one of the first personal accounts of postgraduate medical training. I devoured the books of Dr Tom Dooley, the medical missionary who became a minor celebrity for his work in Vietnam and Laos. On my rare encounters with medical practitioners, I asked questions beyond my years (“What’s the prognosis for acne?”), often eliciting chuckles when I mentioned that my father was a doctor.

“Ah, yes,” the ENT or dermatology specialist would say knowingly.

My father left private practice for institutional medicine. He retained his military reserve status through the years, serving as flight surgeon for an Air National Guard unit. And then he died, too young, not a great doctor, with no accolades or professional honors, without even a roster of loyal and grateful patients to mourn him. But he had been an MD. I would not.

Despite a strong intellectual interest in things medical, I chose journalism and literary pursuits. None of my siblings would enter medicine either. It may be that we were simply unsuited for it, or that we had seen the toll it can take on a family. But we remained indelibly and positively marked by our exposure to the noblest of professions, as I believe all doctor’s kids are.

As a young newspaper reporter I specialized in crime, which involved daily encounters with trauma and the medical system. ER staffs soon learned that they did not have to offer a tedious explanation of a pneumothorax or why a chest tube was necessary when I was covering the story. “My dad was a doctor,” I would explain.

“Ah, yes,” they would say.

Attending autopsies with homicide detectives, I would point to the transverse colon and note a bullet hole. The medical examiner didn’t need to explain the connection between a hyoid fracture and ocular petechiae in a suspected strangulation death.

“Doc’s kid?” he asked me early on. “Ah, yes.”

Much later, as a Crohn’s patient undergoing periodic colonoscopies, I would decline sedation to watch the monitor. A nurse once marveled at that. “Why not take the drugs?” she wondered.

My gastroenterologist, snatching biopsies from the cecum, laughed. “Doc’s kid,” he said through his mask.

Ah, yes. It stays with you. It marks and shapes and molds you in a way that no other parental profession can.

More than 35 years after my father’s death, I was watching televised coverage of the medical briefing by the neurosurgery team that salvaged wounded Arizona Congresswoman Gabrielle Giffords. Two things about that broadcast were striking. One was the calm, professional demeanor of the lead neurosurgeon. He answered every question, even the frequently foolish ones, with clarity and assurance. Only a fine physician, tempered by decades of meticulous training and experience, could handle both the intricate surgery he had just performed and the baying media corps he was now taming. He was, I thought, the best man in that room.

My second thought was that no one in the pack of reporters had the sense to ask the obvious question beyond survival: This is a woman who talks for a living . . . was Broca’s area affected?

Of course, none of them was a doctor’s kid.

I have no idea if today’s children of physicians feel the same, but I hope they do. Doctor’s kids should feel a bit special. Not smug or superior or better than, but proud. I was, and I still am, proud to be a doctor’s kid.

Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Senior Editor.

 
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