The Good Doctor (11 page)

If my father withheld information in public, he profusely confided to his journals, not only about my mother’s disease and its prognosis, but also about the enormous emotional impact it was having on him. “Cancer is a hard, ugly word,” he wrote on June 15, 1977, the day of her diagnosis. As a physician, he well knew what lay ahead, “how changed our lives will soon become.” This week “we join the ranks of the ‘someone else’ it always happens to,” he perceptively noted. “I don’t want to lose my wife, my life. Can this really be happening to me?” In another entry, he wrote: “If I should lose her, what could there be for me after that? I tremble with fear, even to contemplate such a terror.”

When my father first learned the biopsy results, with the positive lymph nodes and emboli, he wrote, “Today I found out I’ll not have her for very long.” My dad’s devotion to the scientific basis of medicine left him with little interest in religion or the supernatural. But my mother’s diagnosis threatened to change this. “Sudden thunder and a storm as I write the word ‘metastasis,’” he remarked one Saturday afternoon.

The next crisis came in March 1978, when my mother discovered a bump along her mastectomy scar. It was hard not to fear the worst. Scars are a common place for breast cancers to recur. My mother again saw Charles Hubay, who removed the tissue and sent it to the pathology laboratory for analysis. Then it was time to wait. On the first night, my father took my sister to temple “for company” as he prayed for his father. The next night, my mother actually made a rare appearance there. The next day, my dad admitted to himself (only) that he was “quite terrified” and had “lost almost all control.” He called Hubay’s office to see if the result was back but the staff did not know. Then he decided to use his trump card, his MD degree. He called the pathology laboratory at University Hospital himself and found a doctor who was able to provide extremely good news: it was merely a stitch abscess, a small area of infection. “Relief is not the word,” my father wrote. “Flowed, gushed, overwhelmed is more like it.”

Reading my father’s words was poignant for me. Although he had done what he could to ensure that my mother would receive excellent care, beyond that, the situation was out of his control. Whether my mom lived or died would depend on her doctors, the treatments they recommended, and, to a large degree, good or bad luck. Yet staying in control—or appearing to—was what my father believed he needed to do, for his own sake and for others’. So he controlled what he could: information. This was full-fledged paternalism. And while it was understandable, given both my father’s profession and his personality, it was also a burden for him.

My dad allowed himself a little more relaxation on November 8, 1978. It was my parents’ twentieth wedding anniversary and they went to Charley’s Crab, their favorite special-occasion restaurant. Fortunately, Phil had remembered to order flowers; in this case, twenty red roses. My mother was not feeling great and she was hardly out of the woods. But they were at a nice restaurant and celebrating. And my mother was even quietly contemplating the possibility of breast reconstruction. As fate would have it, that same evening, CBS aired what my father termed a “not bad” made-for-television adaptation of the Betty Rollin book
First, You Cry
, starring Mary Tyler Moore. My parents dutifully watched it together, although my father felt my mother “tightening” and “shuddering” as the “similar stories unfolded.”

Phil Lerner may have been doing a pretty good job of managing his wife’s cancer, but, ironically, his professional life suddenly felt less fulfilling. Meyer’s death and my mother’s cancer, I learned from his journals, delivered a one-two punch from which he never really recovered. Only days after my grandfather’s death, my father suddenly felt at sea, undirected. Among those who had come to Meyer’s shivah was my grandma Pearl’s sister Shirley, who had experienced a major stroke and was in “undeserved” pain—both physical and emotional.

“It should have been me,” she told my father.

“She’s right, of course,” he wrote later that day. “How she is suffering.” He then speculated as to whether the stroke had affected her brain or unmasked previously concealed anger and angst.

But then he abruptly dropped the subject. “It’s reached the point when I’m tired of questions because surely there are no answers,” he wrote. “At least they elude me. And I usually have all the answers.”

As a man of medicine, my father knew as well as anyone how random and unfair illness could be. He had certainly seen enough patients and family members die far too young and seen others survive for far too long. Until this point, however, he had been able to use his clinical judgment and professional connections to influence or at least ameliorate these situations. But now he felt helpless. His essentially healthy father had died unnecessarily while he was thousands of miles away. Meanwhile, Aunt Shirley and so many others like her went on living despite chronic misery. As he had with my mother, my dad got Shirley excellent physicians and offered good medical advice to her. But he saw these as trivial interventions compared with her overall health, which was so poor. When he returned to the hospital after Meyer’s funeral, two of the first patients he saw as the infectious diseases consult had advanced, recurrent cancers. “What’s to save?” he asked. “Why prolong the agony?”

Indeed, in the days after the funeral, my father had dreaded going back to work—something that had never happened before. Part of it, presumably, was the exhaustion after what he had just been through. Part of it was having to treat patients with such dismal prognoses without being able to save the Meyer Lerners of the world. But his ennui even extended to his research, which was the intellectual engine that had always kept him going, night after night. “Will I recover energy, want to tackle a big paper again?” he asked himself in May 1977. “Right now, can’t even dream of it.”

What was going on here? Perhaps, my father wrote in one entry, it was depression. But his journals contained a revelation that surprised me. My dad’s working-class childhood had led to his determination to succeed, but his fanatical devotion to medicine and sick patients had specifically been his way of thanking and paying back his family, especially Meyer, who had never had the chance to achieve his own dreams. On the one-year anniversary of Meyer’s death, my father penned him a note saying how much he missed him, writing that “so much of what I did and do, I did unconsciously to give you
naches”
(special joy). Years later, when my dad applied to be promoted from an associate professor to a full professor, he did it “mostly for Meyer.” But with Meyer no longer alive, things had changed. “I think,” my father concluded, “that’s why the zest is gone.”

My mother’s illness only compounded the inertia and soul-searching. In April 1978, my father remarked that she had only two more cycles of chemotherapy and he hoped that when it was over, the weight on his shoulders would be lifted. Putting together the infectious diseases syllabus for the medical students, a task in which he had once reveled, was now “like pulling teeth.” At one point he even confessed that he was doing just enough to get by, the cardinal sin that he so often condemned in others, including me.

Then, in late October 1978, my father began to experience palpitations in his chest, accompanied, at times, by what he called heartburn. He was worried enough to see a cardiologist, who ordered a stress test. When that was inconclusive, he underwent a cardiac catheterization in December 1978. The test revealed a significant blockage of a branch of one of his coronary arteries. There were no other problems and no evidence of a past heart attack, but there were enough worrisome findings for my father to announce to himself: “I am now officially a cardiac patient.”

Like so many other physicians and laypeople who learn that they have heart disease, my dad treated the news as a wake-up call: “If I get my weight down, keep it down, keep [blood pressure] down, get cholesterol down and learn to live a little more relaxed, I wonder if I can’t reverse that
one
damn narrowing.” Even after he received this news, however, my father remained a classic yo-yo dieter, alternating periods of abstinence and substantial weight loss with regular nighttime raids on the refrigerator. He was also a familiar face at the Department of Medicine’s weekly Friday-afternoon GI Rounds, where he enjoyed mingling with the house staff but also ate more than his share of the free food.

Not surprisingly, the heart episode was largely carried out in secret—even the catheterization. My father told his physician-brother but not me or my mother, whom he deemed too fragile due to her cancer and ongoing treatment. “I’m totally unafraid of death at the moment,” he confided in a journal entry. Reading this phrase stirred a memory of my forty-six-year-old father announcing to me, right around this time, that he had lived a long and full life and it would not be so terrible if he died. In retrospect, this was probably his way of telling his son that he had a heart condition and might not be around forever—without actually saying that. I suspect it was also his way of alleviating my guilt if something bad were to happen—exactly what Meyer had never had the chance to do for him.

Stories like this are great fodder for biographical memoirs, but I wish he had just told me the truth at the time. I recall spending a lot of time scratching my head about his statement and was probably a little freaked out. It is another reminder of how paternalistic behavior, while well meaning, may have unforeseen negative consequences. Incidentally, although my father had numerous medical problems over the years, his heart apparently remained fine, even though his efforts at eating better and exercising more were always transient. So much for willpower.

The events of 1977 and 1978—Meyer’s unexpected death, my mother’s cancer, and my father’s heart blockage—cast a major pall over my dad’s life. “The pendulum has certainly swung with a vengeance,” he wrote. “My charmed life is now balancing out with a bang.”

And even though these events were as much bad luck as a failure of the medical system, my father seemed to feel that somehow medicine had let him down. That same field that had given him so much—a path out of East Cleveland, intellectual stimulation, professional status, and a way to channel his gratitude to his family—was now taking much away from him, and threatening to take away more.

I had been giving serious thought to becoming a doctor since I first began to volunteer at the Montefiore Home. The events of 1977, while leading my father to feel disenchanted with medicine, conversely fostered my interest in following in his footsteps, although I would not realize this connection until several years later.

I was sure enough about my potential career choice that, when I matriculated at the University of Pennsylvania in September 1978, I signed up for inorganic chemistry, biology, and calculus. I was officially a premed.

CHAPTER FOUR

The Second Dr. Lerner

These days, it is common for future doctors to take off a year or more at some point during their training—before, after, or even during medical school. This time off enables them to see the world, have a real job, or simply take a break. In my era, such gaps were uncommon, and I, like my father, was a straight arrow.

Thus, from September 1978, when I began college, to June 1989, when I completed my residency in internal medicine, I was thoroughly immersed in as intense an educational process as one could imagine. In retrospect, it almost seems like that amusement-park ride in which a small railcar makes sharp turns and jerks the passenger from side to side before suddenly emerging into the light. But I was also identifying those aspects of medicine—such as bioethics, history, and the doctor-patient relationship—that I would eventually combine with my clinical work.

This decade would be a momentous time not only for me, but for medicine. As I went onto the wards for the first time, in the early 1980s, all the talk seemed to be about two diseases—one old and one new. Tuberculosis, which I associated with the abandoned Sunny Acres sanatorium my father once showed me in Cleveland, had roared back, and we did not even have proper isolation rooms for patients. The hospital and the medical profession were even more unprepared to deal with the acquired immunodeficiency syndrome, a baffling new infectious disease that destroyed patients’ immune systems and then killed them. Those of us caring for these patients had a sense that we were living history, and we were.

My decision to attend the University of Pennsylvania was almost random. For reasons I cannot remember, I never considered applying to small liberal arts colleges, only to large universities located in cities. Penn was one of these, and adding it to my list was practically an afterthought. I made a quick stop there and took a one-hour campus tour while on my way to Baltimore to visit Johns Hopkins, where two of my best friends, a year older than I, were freshmen. Since college is a time to make new friends and try new things, it was fortunate that I did not get accepted to Hopkins. When I looked at my range of offers in the spring of 1978, Penn it was. I did not go back for another visit before deciding.

Considering that I had gone to a tiny suburban private high school, my transition to a large university in a big city was relatively smooth. My proposed plan of study probably helped. I was a premedical student and planned to major in American history, so there were a lot of required courses for me to take.

Not everybody approved of my plan. In the late 1970s, it was customary for premeds to major in one of the sciences, which presumably matched their career interests and evidenced a devotion to science. I remember a few people who thought that being a history major might count against me when I applied to medical school. Fortunately, I stuck to my guns.

One thing that had changed for me was my diligence. Ironically, perhaps, away from my father’s disapproving gaze, I decided to work extremely hard in my classes. Although I did write for the school newspaper, play in every intramural softball or basketball game I could, go to some parties, and hang out with my friends, I could be found most often in the library. Why this change? Part of it had to do with a latent competitiveness. Attending classes with other premeds who, I felt, were often cutthroat, I wanted to do better than them. And by the end of the first month of school, I knew that I could. In retrospect, I think that Hawken, where my grades had been up and down, prepared me incredibly well for college. After having taken the equivalent of AP chemistry, physics, biology, and calculus in high school, I found that the material was relatively easy if I studied hard enough.