Open Heart (37 page)

“It was very fortunate I was a good athlete,” Rich says. “This was an enormous boon to my battered self-esteem—to my having
any
self-esteem. I was unequivocally good at something, and everyone in that world acknowledged it.” Rich worked as hard at being a good tennis player as he later would at becoming a good doctor, and in three years of varsity tennis at Erasmus, he never lost a match.

Several months after my visit to California, when I call and describe a problem I'm having with my (tennis) serve, he immediately diagnoses the problem and gives me a prescription (throw the ball higher, in the same spot each time, and hit it at its peak). When I call back a week or so later to tell him my serve—like my heart?—is working well again, he laughs, and says I called the right guy, because
though he doesn't believe he knows much, really, the two things he does feel somewhat confident about are tennis and cardiology.

At Tufts, Rich did not go out for the tennis team, but played freshman basketball and then, though he had not played organized baseball in high school, went out for and made the varsity baseball team as a third baseman. In his senior year, playing in an exhibition game against a minor league team at Braves Field in Boston, he got his team's only two hits, including a home run, against a highly touted bonus baby pitcher.

“After the game, this guy came up to me, and said he was a scout for the Philadelphia Phillies, and we talked for a while, and he made me feel really good,” Rich says. “He told me I was a natural and had major league potential, and then he asked what my plans were after graduation, and when I told him I was committed to going to medical school in the fall, he just waved goodbye and walked off.”

Rich learned to play tennis during summers spent in Newport, Rhode Island. His father bought a ladies' apparel shop in Newport shortly after World War II, and he worked there five days a week all year long.

“The four of us—my mother and father, and me and my sister Lucy—would get to spend summers together in Newport, and it was a wonderful place for us, and for me,” Rich says. “I learned to play tennis there, mostly by sneaking into the country club and watching the older players.”

When he was thirteen, Rich entered the city's summer tennis tournament, made it to the finals, and, in a three-set match, won the city's junior championship by defeating Dan Topping, Jr., son of the owner of the New York Yankees.

“He arrived with all his preppie WASP friends—” Rich says, “—the girls in their summer dresses, and the guys in their white bucks, all of them, at least in my memory, very, very blond—and I was behind five-to-two in the third set, but I came back and I beat him, and it felt good, really good.

“I had my first girlfriend that summer,” he adds. “Her name was Irene, and she was older than me, and we played tennis together all the time. She was a terrific player—she beat me regularly—and at
dusk, when the club members were gone, we would hop the fence and go out onto the courts—the birthplace of tennis in America—and play there until it was too dark to see the ball.”

Although Rich entered Tufts intending to become a doctor, his decision had not been based on any great desire to pursue a career in medicine.

“My father was a classic Depression product—worrying endlessly about money,” Rich explains. “But we shared a love for baseball, and he was unequivocal in his love for me—he truly thought I was a miracle come to life. He was always gone during the school year, however, and when we were in Newport, I would watch him agonize over his adding machine, trying to make the numbers work, so that the one thing I knew for sure was that I did
not
want to be a businessman like him. But nothing else appealed to me.

“My mother, though, was a fury of ambition for her son, constantly on my case to make up my mind to do something so I could be somebody. She made me take all these aptitude tests, but they only showed that I could probably do well in everything, and they pointed in no specific direction.

“Then one day I come home from school and she informs me she's made an appointment for us to see the wisest and most important person in her life, my pediatrician, Doctor Abram Kanof.

“I was embarrassed because I was fifteen or sixteen years old and even though he was a baby doctor, he was still
my
doctor. I had always loved him when I was a kid—he was a wonderful, sweet man, a very caring man—he made house calls, and he treated me warmly, in a way unlike anything I knew at home—and when he started talking to me about the field of medicine that was his, and that was his wife's also, and told me that both his daughters were going to be physicians, I listened.”

I tell Rich that I was friends with Dr. Kanof's younger daughter, Margaret—that we used to play hooky from Hebrew School together after we were let out early from P.S. 246 on Wednesday afternoons for something called “released time for religious instruction,” when the Catholic kids would go to their churches, and we were supposed to go to our synagogue.

“But remember,” Rich says, “this was a time, in the early fifties,
when there were virtually no women doctors. Women were nurses. And when Dr. Kanof talked about his life, and about his feeling for medicine as a kind of holy calling—this came through to me.

“Still, though I was moved by what he said about the wonders of being a physician, this had little to do with my decision. What happened instead was that my mother suddenly cut in and asked what I would have to do in order to become a doctor, and he answered that there was a school in Boston called Tufts, which had an excellent pre-medical program—unlike most other elite New England colleges, it also had less stringent quotas on how many Jews it accepted—and that if I went there it would greatly increase my chances of getting into a good medical school.”

Rich says that his mother told Dr. Kanof she had been planning to send him to Brooklyn College, because it was free and because he could live at home, but that if the doctor thought Tufts was the best place for him, she and Rich's father would do whatever it took to send him there.

“And suddenly,” Rich says, “I hear—‘Tufts…Boston…hundreds of miles away from Brooklyn…!'—and I immediately agree to becoming a doctor.”

I tell Rich about Phil's nightmare, and what Phil has said about his determination to escape Brooklyn and his apartment. Rich nods and, in words identical to those Phil used, declares that he too would have done anything—
anything at all—
to get away.

We talk for a while about convergences in our lives—Rich's grandparents coming to America from places near the villages from which my grandparents came (his mother's mother from Minsk, his mother's father from Pinsk); his mother and father having the same names, Anne and Dave, as my parents; his sister being in junior high and Erasmus with my brother Robert (and Phil's brother Allen); the two of us being trained for our Bar Mitzvahs at Congregation Shaare Torah by Dr. Emanuel H. Baron, and Dr. Baron having trained the two of us (rare event in our synagogue at that time) to chant both the
Haftorah
(a portion from Prophets) and the
Maftir
(a portion from the Torah)—and then I ask if, during his years at Tufts, Rich ever doubted his decision to become a doctor.

“I never thought about it,” he replies. “I just knew I had to get certain
grades in order to pass muster at home, and to my great joy I found I could get them effortlessly. Two or three days before big exams, I became a demon—I sucked up everything like a sponge, regurgitated it for the exams, got A's, and promptly forgot it all. At Tufts, I didn't think about anything except having a good time. I played on teams—school and fraternity—and I partied, and along the way I also discovered a love for literature, words, philosophy, and for music. These were wonderful years for me, but then the chickens came home to roost.

“I hated every minute of my first two years at Bellevue, you see—they were, and to a large extent in my view, still are, a sort of Marine-like boot camp that has virtually nothing to do with being a physician—and at the end of my second year, I went through a real crisis. I was halfway through to becoming a doctor, and I didn't know anything and I hated all of it. So what was I doing there? I had crammed to pass exams, but it wasn't working anymore—my grades were slipping below acceptable levels, and I began to realize I was going to have to tell my parents that this had all been a gigantic scam.

“And then I saw a miracle take place, where a life was saved right in front of my eyes. What happened was I was working with these two guys, Dan and Jeff—Dan was an intern and Jeff was the resident, and I was assigned to them as part of a three-man team. They were these swashbuckling young doctors right out of M.A.S.H., and we were called down to see a woman in the emergency room, and she was dying, and for the first time Dan and Jeff had no idea of what was going on or of what to do. None at all.”

I tell Rich what Arthur has said—how, like me, he grew up believing that doctors knew
everything
—and Rich laughs, says what he has said before about the essence of medicine being fallibility and uncertainty.

“The woman lapsed into a coma, her blood pressure started to drop, froth was coming out of her mouth, and I felt I was in the middle of a nightmare,” he continues. “So they telephoned a man, and he came down—he was this little old Czechoslovakian professor Jerry, Phil, and I talk about all the time—Dr. Joseph V. Brumlik—and he has on these pince-nez glasses, and Jeff is waving frantically,
and Dan is telling him what little he could figure out about the woman's story—but she had been in a coma, so we knew virtually nothing—and without even seeming to hear these two totally panicked guys, Dr. Brumlik just stood at the foot of the bed with his hands on the soles of the woman's feet, and he studied her, very calmly. Then he looked up, told us the diagnosis—which meant nothing to me—told us what to administer intravenously, and walked out.
^*
Jeff and Dan drew the syringe, injected it into her tubing, and within minutes, right there in front of my eyes, the woman woke up.

“It was like a miracle—it
was
a miracle—and I asked Dan, ‘Who is that man?'—I mean it was like right out of
Butch Cassidy and the Sundance Kid—
and then—well, the short of it is that Dr. Joseph Brumlik became my mentor, and my life was changed forever.

“Dr. Brumlik had been a professor of cardiology in Prague when the Nazis took over in 1938. He fled for his life, wound up in Mexico City for a while, where he worked as a cardiologist, and then somehow made his way to Bellevue. And from the moment I met him from that moment in the ER—I became a born-again cardiologist. I mean, when I finished medical school I hardly knew where the liver was, but I had become a sophisticated cardiologist from having sat for two years at Dr. Brumlik's feet.

“He ran a famous clinic at Bellevue called The Thursday Night Cardiac Clinic, and for some reason he invited me in even though my grades for my first two years were atrocious. Then, in my fourth year, he and about a dozen of the leading cardiologists in New York would gather at Bellevue every Saturday morning and look at the most interesting, involved, and difficult cases. Dr. Brumlik was the acknowledged leader of the group, and he and the other doctors would evaluate the patients, and discuss them, and I would sit there and just suck it all up.”

I mention having read a book by Bernard Lown, the Nobel Prize-winning cardiologist responsible for the invention of the defibrillator and the development of the cardiac care unit—a man under whom Rich worked in the late sixties when Rich was a research fellow at the National Heart Institute and Peter Bent Brigham Hospital in Boston—and I cite Lown's claim that a doctor who takes a careful
history will reach a correct diagnosis 70 percent of the time, and that taking a careful history is far more efficient than relying on all the elaborate tests and technologies currently available.
^*
Lown also reports that in his forty-five years of experience with thousands of patients whose presenting complaint was chest pain, he could, through just an unhurried interview, rule out a diagnosis of angina pectoris 90 percent of the time.

“You could quibble about the percentages, but essentially I do not disagree with him,” Rich says, and then: “I mean, you are the classic example of that, Jay. I made the diagnosis of what was going on in you from three thousand miles away, on the phone, by listening to you give me your history. I didn't have to examine you, let alone do a fancy test. All the fancy test did—the coronary angiogram—was to confirm what was already clear from talking with you.”

He begins to explain how and why he knew this—he talks about what Osler taught still being true: about the patient giving you the diagnosis if you listen carefully enough—and I tell him about Phil answering his patients' questions with a shrug and an “I don't know”—and ask if many doctors would do the same.

“Damned few,” Rich says. “Ninety-nine percent of doctors, in my experience, will just make something up. It's remarkable that Phil does that, and quite wonderful from my perspective, you see, because all my life I have taught that the very first step is to admit out loud that we do not know things, and that only by acknowledging this can we really find anything out. If you fool yourself with a lot of biomedical jargon, it can obscure the basic fact—what many doctors cannot acknowledge, and what is too scary for them—and that is the vast sea of ignorance in which we all work.”

After we return from playing tennis, we return to our discussion of how it was Rich could diagnose my condition by telephone, and I thank him again, but he only repeats what he said to me a few weeks before: that I should really be thanking my brother Robert and the Redondo Beach Public Library. For if I had not written a book about Robert, and if Rich hadn't come upon a copy of the book in his library, and if the book hadn't moved him to write me, we might not be sitting here today and talking.