The Good Doctor (33 page)

One of the many books I read while working on this project was
The Healer’s Tale
, by the anthropologist Sharon R. Kaufman. Kaufman tells the stories of seven prominent twentieth-century American physicians who embodied humanistic, patient-centered medicine. They had all learned their craft in the 1920s and 1930s, when therapeutic options were limited but “medicine could be characterized by its sense of duty, charity and social obligation.” Morality, Kaufman wrote, was thought to be “inherent in the practice of medicine itself.”

I was especially interested to learn that four of Kaufman’s subjects had been the children of physicians who had emphasized duty and caring in both their work and lives. The other three grew up with parents who, while not doctors, were humanitarians who served their local communities in a wide array of volunteer projects.

At this point, you might be wondering if either of Cathy and my college-age children, Ben and Nina, are planning to become physicians and if there will ever be a book about another generation of Dr. Lerners. The answer, at least for now, is no. Nor are they planning to follow their mother into the legal profession. Although I am thrilled to be a physician and would have been happy if one or both of them had wanted to follow in my footsteps, it would never have occurred to me to expect this or pressure them to do so. I don’t recall ever bringing them with me to hang out on the wards when I made weekend rounds. Although I did discover a touching journal note in which my father announced his plans to send medical books to a nineteen-year-old premed granddaughter of one of his cousins, even he, when still mentally sharp, did not urge my kids to pursue medicine. While he still loved the career he had chosen, perhaps too much had changed.

I would be the last person to suggest that being the child of a physician makes someone a better doctor. But growing up with my father, I learned about the interrelationship of family, morality, and medicine. Doing the right thing mattered in the hospital and at home. My mother’s illness and subsequent volunteer work only strengthened my convictions. Through my care of patients, teaching, and writing, I have, in my own way, tried to underscore how medicine—as much as any career—provides an opportunity to do good for vulnerable people. It is a privilege that I will always cherish.

Acknowledgments

Writing acknowledgments for an autobiographical book was particularly difficult, as I was tempted to thank everyone who has ever done me a good turn, something that is clearly impossible. So while I will formally acknowledge only some people, there are many more of you whose efforts over the years I appreciate.

The present task was made additionally difficult by the fact that one blogger called the acknowledgments in my previous book,
One for the Road
, “quite possibly the best I have read.” As for the book itself, she wrote, “it was a wash,” with a “preachy tone” that undermined my arguments. Well, I guess so. But with respect to the acknowledgments, at least, I have large shoes to fill, even if they are my own.

So here goes. My first thanks go to my parents, who are baldly on display throughout this book. When my father learned that I was planning to use his personal journals to tell his story, he was entirely thrilled, even though he knew that I would reveal some of his less admirable characteristics and decisions. He did not attempt to micromanage my writing at all. Nor did my mother, a quite private person. I know it was not easy for her to read about her own experience with breast cancer in the 1970s or her mother’s deteriorating health and difficult death two decades later. But showing the same confidence in me that she has for over fifty years, she trusted my judgment.

My wife, Cathy, and my sister, Dana, read the manuscript in its entirety and made very helpful comments. It was interesting to see how we remembered certain events quite differently. I tried as best as I could to respect their memories, screaming, “Get lost! It’s my book and not yours!” only a few times. My father’s brother, Allan, was also of great help, providing several key recollections. My good friend Tom Frieden, who I first met in medical school and who also had a physician father, made numerous incisive comments on the manuscript. I benefited from presenting a talk based on the book at the Breslau Family Lecture in Baltimore in March 2013. My thanks to Erica Breslau for the invitation. Lee Breslau, my college roommate, was kind enough to remind me of the time my father lost his temper at a restaurant where we had had horrible service. When my dad loudly announced, “I am leaving now!” and started counting to ten, the waiter finally brought the check.

Cathy’s and my children, Ben and Nina, loved their grandfather Phil, known to them as Paw, very much. I am glad that they and their cousin Gianna will have this book as one way to remember him.

Family and friends too numerous to mention have listened patiently and responded enthusiastically when hearing about my father and this project. Some of you may even be having nightmares about having to look at yet another possible book cover! Special thanks go to my mother-in-law, Ellen Seibel, and our longtime nanny, Margaret Frempong, who both always asked about my father when we returned from a visit to Cleveland. Seth Godin and Micah Sifry have patiently answered my embarrassingly jejune questions about blogging and marketing. And of course I need to thank our dog, Akeela, who kept me company as I was writing, asking only for occasional treats in return. Okay, not so occasional. But what a good girl.

In the course of writing this book, I talked to many helpful people about what it means to be a doctor, about the field of bioethics, and about my father. They include William Lovejoy, John Loeb, Jay Meltzer, Daniel Callahan, Willard Gaylin, Arthur Zitrin, Sherwood Gorbach, Larry Altman, Allan Weinstein, Ethel Weinstein, Keith Armitage, Robert Salata, Martha Salata, Robert Bonomo, Walt Tomford, Bob Kalayjian, Michael Lederman, Steve Gordon, Marty and Pat McHenry, Bob and Vincetta Dooner, Cindy Gustaferro, and Sam Miller. Sam, whose life my father saved, was generous enough to endow a lecture series in my father’s memory. I also benefited by reading the manuscripts of new books by Naomi Rogers on the polio nurse Sister Kenny and by Gary Belkin on brain death.

My work colleagues have provided great support for me, both logistically and psychologically. There are many people I would like to thank at Columbia, where this book had its genesis. They include Ken Prager, Don Kornfeld, Ruth Fischbach, David Rosner, Ron Bayer, Amy Fairchild, James Colgrove, NiTanya Nedd, Steve Shea, and Rita Charon, as well as the rest of my former colleagues on the New York Presbyterian/Columbia Ethics Committee and in the Center for the History and Ethics of Public Health and the Division of General Medicine. Also, it was at Columbia where I first worked with the Arnold P. Gold Foundation, which generously made me one of its first Gold Professors at the time when I was starting my career. I would be remiss in not thanking the Robert Wood Johnson and Greenwall Foundations and the Johns Hopkins University Press, all of which have fostered my scholarship.

My new colleagues at New York University have been terrific. Special thanks go to my generous fellow physician-writer Danielle Ofri, who helped connect me with her editor at Beacon Press, Helene Atwan. Andrew Wallach, Marc Gourevitch, Sandy Zabar, Doug Bails, Barbara Porter, Art Caplan, Allen Keller, Cheryl Healton, Arthur Zitrin, and Leonore Tiefer provided support during an unexpected crisis. Thanks also to Bob Anderson, Stacy Bodziak, David Oshinsky, Jessica Wico, and Marty Blaser. The general medicine clinic at Bellevue is an inspiring place to practice medicine and filled with real professionals. There are simply too many to name.

Speaking of Helene, she is a great editor. Perhaps the best compliment about her came from my agent, Robert Shepard, who, after reading Helene’s first set of edits, told me: “This is the way it was once done, and I’m thrilled to see that someone is still doing it.” In addition to being a top-notch agent, Robert is also a first-rate editor himself. I should know. He liberally marked up my articles at the
Daily Pennsylvanian
thirty years ago. I have also greatly enjoyed working with the rest of the folks at Beacon, including Crystal Paul, Alice Li, Tom Hallock, Pamela MacColl, Susan Lumenello, and Marcy Barnes. Tracy Roe did an expert job of copyediting and may have set a Guinness world record by removing the word
also
three times in a single paragraph.

Another group of people deserving recognition is the editors of the online blogs that publish my essays on history and medicine. They include Tara Parker-Pope, Toby Bilanow, and Michael Mason at the
New York Times
and Jim Hamblin at
theatlantic.com
. Finally, I would like to thank my colleagues at the American Association for the History of Medicine, which has been my main academic home for almost twenty-five years. I can’t imagine a smarter, more collegial group of individuals. It is a huge honor for me to be delivering the AAHM’s 2014 Fielding Garrison Lecture, which builds on this book.

Okay, so these weren’t such spectacular acknowledgments. But I loved writing them.

Bibliographic Note

This book builds on the work on many talented physician-writers. Like lots of physicians in training, I read the memoir
The Doctor Stories
, a compilation of stories by William Carlos Williams, the New Jersey general practitioner and author who famously used to write poems on his prescription pads between patient visits. To Williams’s credit, he never romanticized his struggles in caring for poor, immigrant families.

The next memoirist I encountered was Yale surgeon Richard Selzer, whose books of short vignettes, including
Confessions of a Knife
and
Letters to a Young Doctor
, I have often used when teaching. Medical students need only read “Imelda,” the tragic story of a surgeon’s altruistic act gone wrong, to learn an abiding lesson in humility.

I also discovered the works of another Yale surgeon, Sherwin Nuland. In contrast to Williams and Selzer, Nuland wrote about the history of medicine, not his own patients. While perhaps exemplifying the sort of Whig history that has gone out of fashion, his 1988 book
Doctors: The Biography of Medicine
beautifully exemplifies how proud my father’s generation of physicians was of its forefathers. So does Michael Bliss’s biography of the legendary doctor William Osler, published in 1999. But it was
Lost in America
, Nuland’s moving 2003 memoir about his nonphysician immigrant father, that encouraged me to write a biography of my own dad.

Following the 1978 publication of
The House of God
, pseudonymous author Samuel Shem’s fictionalized account of his internship, physician memoirs became a sort of cottage industry. Many deal specifically with medical school or residency training—crucial, and often tumultuous, periods in a physician’s career. Others use stories of past patients to illuminate the challenges of patient care, often among disadvantaged populations. I am fortunate to have many excellent physician-writers as colleagues at New York University: Perri Klass, Danielle Ofri, Jerome Lowenstein, Gerald Weissmann, Eric Manheimer, and Oliver Sacks. I also want to give a special shout-out to my fellow Clevelander David Hellerstein and his wonderful 1994 memoir
A Family of Doctors
, which is perhaps the book closest to this one in terms of style and content.

Other physician-writers whose works I reread in preparation for this book include Jerome Groopman, Atul Gawande, Abraham Verghese, Sandeep Jauhar, Pauline Chen, Siddhartha Mukherjee, Robert Klitzman, and Melvin Konner. I recommend them all. Gawande’s
Complications
is especially helpful for capturing the ethical issues that arise during medical training. Many of my fellow residents and I read Konner’s
Becoming a Doctor
, written by an anthropologist who attended medical school, when it was first published, in 1988. I also recommend the essays of Abigail Zuger, a physician-writer whose work most often appears in the
New York Times
.

I am lucky to be part of a small but talented community of physician-historians. While most of the work we do is pure history, some of us also draw on our own clinical experiences to inform our historical work (and vice versa). Fortunately, my colleague Jacalyn Duffin got many of us to contribute to the wonderful essays in the 2005 book
Clio in the Clinic
.

Speaking of Duffin, I am often asked to recommend a quick book on the history of medicine for health professionals or other nonhistorians. Duffin’s
History of Medicine: A Scandalously Short Introduction
ably fits the bill. So do William Bynum’s
The History of Medicine: A Very Short Introduction
, Ira Rutkow’s
Seeking the Cure: A History of Medicine in America
, and Gerald Grob’s
The Deadly Truth: A History of Disease in America
. With respect to medical historiography—which is the history of the history of medicine—see Beth Linker’s 2007 essay “Resuscitating the ‘Great Doctor’: The Career of Biography in Medical History” for the short version, and Frank Huisman and John Harley Warner’s 2006 book
Locating Medical History: The Stories and Their Meanings
for the long version. On the history of bioethics, two of the books I mention in
The Good Doctor
, David Rothman’s 1991
Strangers at the Bedside
and Albert Jonsen’s 1998
The Birth of Bioethics
, still stand the test of time. For a more recent version of the story, try Daniel Callahan’s modest and informative 2012 memoir
In Search of the Good: A Life in Bioethics
.

Good historians pay close attention to their primary sources, using them to write original articles and books while also scrutinizing their validity. That is, interviews, correspondence, and—especially for this book—journal entries do not necessarily provide straightforward accounts of past events. But in order to write an accessible narrative I have, in many instances, taken these sources at face value. Nevertheless, I realize that words written by or spoken about my father may represent what the historian Jeremy D. Popkin has called “elaborate authorial strategies” and thus may give a “distorted” record of events. So, too, I made very specific choices about which events to include and which to omit in the autobiographical portions of this book. For more on these topics, see Popkin’s 2005 book
History, Historians, and Autobiography
, the historian David Lowenthal’s 1985 book
The Past Is a Foreign Country
, Philip Roth’s clever autobiography
The Facts
, and historian of medicine Nancy Tomes’s insightful essay “Oral History in the History of Medicine” in the 1991
Journal of American History
.