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What's Up, Doc?

March 20, 2008 By:
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I am one of four children, none of whom went into medicine, our father's profession. There were any number of reasons for this avoidance: We never saw much of our father from one day to the next, and when he was present, he seemed never to have the time or the energy for any of us or even to enjoy his many interests (and he had many). His devotion to his work seemed admirable, but the relentless pace he was under clearly aged him prematurely. Add to this the fact that he was something of a domestic tyrant whenever he was around and that, in my mind, this behavior had a definite connection to his functioning as a doctor in the larger community (though he rarely showed his abrasive side to his beloved patients). And so, all in all, medicine didn't seem like the most attractive way to spend the bulk of your adult time on earth, at least in my estimation.

And yet, of the four of us, I was the only one who seriously contemplated doctoring for six months or so before real teenage angst set in with a vengeance. (True, my father did force my older brother to declare himself a pre-med student in his freshman year of college; but then, when the poor guy nearly flunked out, being temperamentally unsuited to the task, he was rescued from failure at the last minute, permitted to switch majors -- and was on dean's list for the rest of his college career.)

But there was that short period when I really did consider such a career, and I spent long periods of time talking to my father with an unmistakable sense of gravitas. I loved children and thought I'd like to be a pediatrician. (I imagine now that I must have seen a movie or read a book in which a physician saves a child's life; something like that must have been the motivating factor.) But, in the end, my addiction to literature and writing eventually won out, and I definitively turned my back on the whole notion of medicine.

In my teens, I nearly came to blows -- quite literally -- with my father and because of my animosity toward him, I came to despise the sciences and math, connecting them with his familial tyranny, and so denigrated them repeatedly in his presence as too far beneath contempt for me to even consider. Ironically, as it turned out, I took so much advanced math in high school that, as a declared English major in college, I could test out of the subject and so never took another numbers-related course for the rest of my academic career.

But, as is true in life, viewpoints change with time, and so as I aged and began reading certain books and articles, especially some that have appeared in the "Science Times" section of The New York Times, about concepts like string theory and the Big Bang and time travel and quantum physics, I came to the conclusion that I was woefully ignorant in a great many significant areas of human endeavor. (In fact, my father used to tell me repeatedly -- and not without reason -- that my head was stuffed with useless knowledge.) To realize that there are people in the world who can think without referents -- especially when I can't seem to think at all unless I have a book, magazine, painting, play or film in front of me -- amazed me, and I wanted to know more about how such people's minds worked.

So now, in penance for how miserably I treated my poor father, whose person and profession, out of sheer ignorance, I abused ceaselessly, I now read certain science and math books aimed for the general reader. And I particularly like to read books written by doctors, especially about how their training and work have affected them, in an effort to understand what my father went through and what my life might have been like had it taken a different turn. (And I must say this, in my father's defense, he never tried to stand in my way when I said I wanted to be a writer. I think he would have been thrilled down to his toenails if I'd chosen medicine, but something in him understood the impulse to put words on paper, and so he wished me well, while reminding me, every chance he got, that I wouldn't make a whole hell of a lot of money doing it. He was even more prescient than I knew.)

Letters to a Child

In the realm of doctorly scribbling, I've especially enjoyed the works of Perri Klass, perhaps because she's a pediatrician who's always been a writer. She's turned out fiction and nonfiction about both the grueling process of medical school and what it's like to function in the world as a practicing physician. Her works include three novels, The Mystery of Breathing, Other Women's Children and Recombinations, and two collections of short stories, I Am Having an Adventure and Love and Modern Medicine. Her essay collections are A Not Entirely Benign Procedure: Four Years as a Medical Student and Baby Doctor: A Pediatrician's Training. On top of all this, she's a professor of journalism and pediatrics at New York University and a mother of several children. (It makes me tired just reading about accomplishing all these things.)

I found her most recent book, Treatment Kind and Fair, published by Basic Books, particularly relevant since it's subtitled Letters to a Young Doctor -- and because the young doctor in question just happens to be her son, her oldest child. The dedication to the book says it all: "For Benjamin Orlando Klass, in so many ways -- born to a medical student, practical pediatric tutor throughout residency, and source of endless and continuing delight -- With love."

Treatment Kind and Fair is one of a number of recent books, some of them, though not all, published by Basic Books, built on the premise of an older professional telling some hypothetical young person what he might expect about the career path he's chosen. Klass' work is filled with solid advice, but is also set up not just as a ruminative extended essay, but as an actual series of affectionate letters penned by an anxious parent to a beloved child.

This particular parent, however, has even more invested than usual since her son has chosen to follow in her footsteps. The opening paragraphs of the book set the tone effortlessly:

Dear Orlando,

So you're really going to do it! You have to give me credit -- I may be your mother, but you have to admit, I haven't pushed you to be a doctor. It was a real matter of principle with me -- first that you should choose work that really drew you, and second, that however much I love medicine for myself, there would be something wrong with pressuring you to follow the same path. But you've been saying ever since high school that you thought you wanted to go to medical school, and now here we are, and you're actually applying, and I have a confession to make: I'm totally delighted. And now I can admit several things that I haven't quite let myself say: I think it's a wonderful choice, I think medicine will let you exercise and extend all your skills and talents, I think you'll mostly enjoy the training process (well, I think you'll hate some of it, but I think you'll kind of enjoy hating it, and I'll explain what I mean by that a little later on), and I think you'll find yourself with a fascinating set of intellectual challenges and choices, and a busy and rewarding professional life. I think medicine will make good use of you, and you will make good use of medicine."

As the book progresses, its medical concerns become more specific. For the most part, Klass prefaces her 10 letters to Orlando -- her son obviously goes by his middle name -- with a case study, a description of a patient admitted to a hospital with certain symptoms, and then goes on to depict and analyze what the interaction, diagnosis and treatment do both to patient and doctor -- all of it presented to help Orlando and others conceptualize what they'll be facing out in the world.

Here is a typical description:

A full-term 3.2 kg male infant born yesterday by a spontaneous vaginal delivery was discovered on physical examination to have a right-sided abdominal mass. The baby is otherwise well-appearing, pink and vigorous, with no rashes, normal facies without anomalies, no lymphadenopathy, normal cardiac exam, S1 and S2 without murmurs or gallops, abdomen soft and nontender with the mass palpable in the right upper quadrant ...

Klass then writes: "I remember once when I was a resident, working in the newborn nursery, one of the neonatology fellows came in and excitedly announced that he had felt a mass in a baby's abdomen." She then goes on to analyze what it means to discover such a thing, and that excitement might not be the first emotion some young doctors would have.

By the end of her long and often emotionally complex explication of her medical practices -- and by extension, her life -- she assures her son that he has made a wise decision.

"This is a privileged profession," Klass writes, "and the greatest privilege of all is to have that contact with other lives, that opportunity to figure in so many people's stories, that chance to teach and learn and help and heal."

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