The Good Doctor (8 page)

Meanwhile, I was growing up, staying at Hawken School for both middle and upper school. Decades later, when I began researching events in the history of medicine in the 1960s and 1970s, I was glad that I had started Hawken in 1969. The formal traditions that I experienced at the school must have provided a reassuring contrast with the social turmoil that had come to Cleveland, mostly in the form of riots in the largely African American Hough area that abutted Case Western Reserve and its affiliated hospitals. On at least one occasion, the police prevented my father from getting to the Veterans Administration hospital due to violence in the area. Hawken stayed immune for as long as it could. When I started there as a fourth grader in 1969, we called all the male teachers “sir” and stood whenever a female entered the room. Before winter and summer vacations, each student formally shook hands with the entire faculty. Within a couple of years, all these customs, plus the dress code, seemed antiquated and had been relaxed. But my Hawken experiences reminded me about the varying ways in which social change spreads in different communities.

A notable event during my middle school years was my bar mitzvah. There had been no question that my father would have an Orthodox bar mitzvah, given his religious household. But, in part due to his subsequent ambivalence about Judaism, our family had never even joined a temple. By the time I got around to deciding to forge ahead, at age twelve, the only Hebrew school willing to prepare me for the event was a local Orthodox school, Yeshiva Adath B’nai Israel, located about a mile from my house. The fact that I was the son of a noted Cleveland doctor probably did not hurt in their decision to accept me as a student. Not surprisingly, YABI was like a different world for me, although one my Eastern European ancestors would have recognized. The male teachers dressed in black, had long beards, and wore traditional yarmulkes and tzitzit. The women were second-class citizens and, to my chagrin, had to sit separately from the men at services. Like my father, I had little use for the prayers.

Ultimately, however, I was glad I had a bar mitzvah. All four of my grandparents, plus my great-grandfather Ben, attended. My grandfather Meyer, upset that my father had largely renounced his faith, was thrilled that the service was Orthodox, allowing me to chant in Hebrew for close to two hours. It was especially meaningful to me that Ben, by then a widower and in his eighties, was there. Here was a man who had left Poland without his family or money, somehow leapfrogging over the Holocaust, and who was now attending his great-grandson’s Orthodox bar mitzvah in America. I hope my performance that day was at least partial payback for the remarkable path my ancestors had followed.

And my experiences at YABI were a good stepping-stone for my future career studying bioethics and history. The biblical stories we discussed in class, populated with just and heroic characters (usually Jews) and readily identifiable villains (occasionally Jews, but usually not), were full of ethical lessons about right and wrong. And I recall some provocative discussions about whether these stories were historically accurate or merely moralistic tales that anonymous scholars had penned. I also enjoyed questioning the seemingly straightforward religious traditions that Rabbi Joseph Fabian and the teachers passed down to the school’s students. For example, I remember asking why YABI members offered to come into our homes with some type of blowtorch to remove every last bit of bread (
chametz
in Hebrew) in our cabinets in preparation for the Passover holidays. “Isn’t the symbolic act of eating no bread for eight days much more important than whether or not you accidentally leave a few crumbs lying around?” I asked. The teacher, as I recall, was appalled at my heresy. The medical profession, I would later learn, could be just as dogmatic about its traditions and beliefs.

Meanwhile, middle school was a challenge. I had gained weight, developed a bad case of acne, and, perhaps worst of all, become very socially awkward. As Hawken was still an all-boys school, I had fewer and fewer interactions with girls. My major outside interest was sports.

Plus, I was in conflict with my father. “Barron, I don’t know at all,” he wrote in 1977. “He’s a closed creature, a self-contained enigma.” In my defense, this characterization probably applies to a lot of teenagers. And the apple did not fall far from the tree. My dad kept his emotions locked away as well. The thing that bothered him most was my academic performance—or lack of it. Accustomed to my getting all As, he did not understand why this was no longer the case and why it did not bother me more. Truth be told, I don’t really know the answer myself. One’s teenage years are generally a time of rebellion, but, aside from my solitary nature, I was essentially a Boy Scout. I had no allowance and earned my spending money with a paper route that required me to get up at six in the morning. Moreover, there were neither girls nor drugs nor secret parties; I did not even talk back to my parents. Once I was eighteen, I drank only on weekends and moderately. In fact, after I got my driver’s license, I became the de facto designated driver for my friends, even before the concept had gained currency in this country. My friends and I were fairly quintessential nerds, bonding over sports and ogling girls, undoubtedly to their dismay.

So perhaps taking it easy at school was my brand of revolt. In retrospect, I was probably exhausted. I remember staying up most nights to watch the monologue on Johnny Carson’s
Tonight
show, which meant that I was getting only six hours of sleep much of the time. And I was not doing terribly, by any means, just Bs along with my As. I think most of my father’s frustration stemmed from his own childhood history. Having had a father who had been forced to drop out of school, he had busted his butt at academics while also working part-time jobs. But here I was, attending a prestigious private school and seemingly not doing my best. When I got what he believed were bad report cards, he would yell at me and then give me the silent treatment. Typical of the era’s wives and mothers, my mom quietly tried to defend me but never really challenged my father’s authority.

Some subjects certainly interested me more than others. My first love was history. Going back to my early obsession with the presidents, I had always been fascinated with the past and would read for hours about old sports events, movies, buildings, and political figures. Many of my sixth-grade classmates were bored during a trip to the Henry Ford Museum and Dearborn Village, but I remember staring intently at the early-twentieth-century cars and gasoline pumps, even imagining myself living in that era. I was very nostalgic as a kid and have remained so as an adult. History tests were always easy for me, as I was a great memorizer of facts and an above-average writer. As a high school senior, I became the coeditor of the peculiarly named school newspaper, the
Affirmative No
. I also did fine in math, biology, chemistry, and physics, which would help me as a premed in college.

My summers were largely spent at home, aside from the annual late August vacation to beautiful Wellfleet on Cape Cod. I bypassed the opportunity to go to sleepaway camp. A typical summer for me was spent doing my paper route and either going to a local day camp or taking classes at the public high school. I also “worked” for my father, requesting reprints for him of medical articles—often from obscure journals—the titles of which he had found interesting. In an era before the Internet and Medline, exchanging reprints was an important way for physicians to share information. I also sent out reprints of my dad’s articles. Even though many requests for them came from South America, Europe, and Asia, and thus required extra postage, my father saw the opportunity to share his work as an honor. My job, for which I was reimbursed, was tedious, but once again I admired my dad’s zeal for obtaining and disseminating medical knowledge.

In the summer of 1975, between ninth and tenth grades, I embarked on a new activity. In addition to his other tasks, my father had become the medical director of Montefiore, a nursing home started under Jewish auspices and located in Cleveland Heights, about a twenty-minute bicycle ride from my house. Most of the medical problems among the residents were not infectious in nature, but my father was also a highly competent internist. I suspect he took the job mostly for the extra paycheck it brought in.

As with other nursing homes, Montefiore encouraged teenagers to volunteer as “friendly visitors.” In taking on this position, my main task was to keep the residents company, either in their rooms, outside, or in the small coffee shop. Why did my father want me to volunteer at Montefiore? Perhaps, as with the not-too-subtle interesting clinical vignettes he frequently told me, it was part of his plan to push me toward a career in medicine. But I suspect that it was more related to his larger campaign to get me interested in something other than sports. As usual, I complied with his suggestion. The fact that two cute girls from the public high school were also volunteering there probably did more to motivate me than anything else.

But once I started working there, I had to admit that I liked it. One of my earliest memories is my father taking me upstairs to the nursing home’s second floor, which was essentially a large dayroom for patients who needed full-time supervision. He introduced me to an elderly man, impeccably dressed in a suit and tie, who had been the chairman of medicine at one of the local hospitals. We chatted briefly and he wished me luck. When my father and I went back downstairs, I asked him what such an impressive individual was doing in that location. “He is completely demented,” I was told. “He no longer has any idea of where he is.” It was my first encounter with Alzheimer’s disease and an utterly vivid demonstration of how a healthy body could house a severely dysfunctional brain.

I still remember the first two residents I visited. One, named Esther, was a warm and very talkative woman who probably qualified as the nursing-home gossip. The second, Max, was a polite and generous man who reminded me of my grandfather Meyer. Truth be told, neither of these people needed a volunteer. They were among the most high-functioning and sociable residents of the home. But I assumed that the head of volunteers liked to start out her new charges with simple cases. I eased into my position as a volunteer with little difficulty. I had always been a child who was quite comfortable speaking with adults; I showed them respect, used humor when appropriate, and was eager to hear their stories. Later on, my older patients would often tell me I was the only doctor who listened to them, surely an exaggeration but something I was nevertheless pleased to hear.

The most memorable resident of Montefiore at the time was someone we would now call high maintenance. Ed was wheelchair-bound, for reasons I could never quite understand, and highly emotional. He used his feet to move his wheelchair around the premises, constantly getting into other people’s business. When he learned that I was Phil Lerner’s son, he started crying, an event that would repeat itself many times. He would then proceed to rave about how my father was the most wonderful doctor he had ever met and how I was so lucky to have him as a father.

Such unbridled emotion made me uncomfortable, especially if either of the two girls I liked was around. But I could not help but be moved. My dad did something for a living that really made a difference to people. Even though I probably hated him at the time for putting so much pressure on me, I could see what his intense devotion achieved for people in need of not only medical care but an interested friend. When I read his journals thirty-five years later, I came to understand how the combination of scientific knowledge, clinical judgment, and prolonged face-to-face contact with patients and families enabled a physician to truly excel at his or her craft.

It was my experience at Montefiore that led me to seriously consider becoming a doctor. “I’m delighted,” my father wrote to me on my fifteenth birthday, “that you show this evidence of empathy and willingness to help those less fortunate than yourself.” I returned to the nursing home for a second summer in 1976. I still had no dates, however, with either the Montefiore girls or any others.

The next year, 1977, would be a devastating one for our family. My grandfather Meyer unexpectedly died, and my mother was diagnosed with breast cancer. We all took these events hard, but no one took them harder than my father. His relationship to medicine would never be the same.

CHAPTER THREE

Illness Hits Home

I still remember what my grandfather Meyer’s legs looked like. They were pale and almost hairless, in direct contrast to the very hirsute ones shared by my father, me, and my son, Ben. They also had a large number of varicosities, collections of veins pushing up against the skin. Although they bothered him, the varicosities did not necessarily indicate major problems with the other blood vessels in his legs.

But those other veins are what most likely killed him. Recuperating in the hospital after routine surgery for a hernia, Meyer probably developed an undetected blood clot in his leg. At five in the morning on Easter Sunday, April 10, 1977, when he got up to go to the bathroom, it dislodged, traveled to his lung, and caused a fatal pulmonary embolism. That my father—his son the doctor—was in Iran made everything even worse.

We were still reeling from this tragedy when, two months later, my mother found a lump in her left breast. The biopsy showed cancer—which had spread to the lymph nodes. By the summer, she had undergone a mastectomy and was getting chemotherapy and experimental immunotherapy as part of a clinical trial. It was far from clear that she would survive.

That year, 1977, was a very bad year. The fact that both of these terrible events were health-related also had substantial ramifications. My father, accustomed to being in control of all things medical, now saw medicine as something that was causing powerlessness and pain. A sense of disenchantment with his career, which would accelerate over the coming years, began to creep into his journal entries. But at the same time, my grandfather’s death and my mother’s illness would contribute to my decision to commit to medicine.