Monday, January 31, 2011

Choice of Professions

Peepa and Gpa

When I finished high school, Dad asked me about my plans.

I said, “I want to be a veterinarian.”

He said, “Why not be a real doctor?”

I said, “OK.” I went to college and medical school.

After my internship, I volunteered for the Army medical corps. I served in the South Pacific as a general medical officer with the 102nd Station Hospital, as a dermatologist with the 35th General hospital, and as an anesthetist with the 58th Evac Hospital. When I returned home, I knew I wanted more medical training. The experience as an anesthetist had been so interesting that I applied for a residency in anesthesiology at Charity Hospital in New Orleans, whose chief, John Adriani, mentored the best residency program in the States. It was his books on the chemistry and physiology of anesthesia that I referred to while learning on-the-job as an anesthetist in surgery at the 58th Evac.

I liked Dr. Adriani immediately. We met in the doctors’ dressing room of the surgical suite; he was in scrubs and we sat on benches and chatted. He was in no hurry to end my interview and proceeded to tell me why he had given up his surgical training to become an anesthesiologist: after he had finished his residency in general surgery, he didn’t feel capable of doing more than appendectomies and repairs of hernias. He knew he was better than that which led him to learn about anesthetics and become the medical profession’s leader in that specialty. I left him, excited and ready to learn from him.

When Dad asked me what I was going to do now that I was home from the army, I said I was going to be an anesthesiologist. He said, “You ought to be a heart doctor and take care of people.” I said I would. I canceled the residency in anesthesiology, took residencies in chest and internal medicine, and eventually became an internist.

Now, some fifteen years after I’ve retired from the practice of medicine, I’ve been thinking: What would my life have been as a veterinarian? What would my life have been if I had become an anesthesiologist?

Those are interesting questions. That I still remember the episode after 65 years emphasizes the impact of Dad’s influence on my life. It also points out my failure to have a strong feeling about my right to make my own decisions. I was able to accept the change in my goal; I became an internist with a strong interest in diseases of the lung. I cared for my patients and took good care of them. I was a good role model for my sons; all three became healers, (two physicians and a psychotherapist) and excellent ones, too. I made a “good” living for our family.

How would Dad have reacted if I ignored his wish that I become a “heart doctor” and train to be a vet or an anesthesiologist? He would have been disappointed, I know, but he would have accepted my decision and remained interested and supportive. This recalls my decision to join a reform congregation rather than a conservative or orthodox one that I knew Dad expected when we moved to Houston. To better understand my choice, Dad spoke with Robert Kahn, our rabbi at Temple Emanu El, at a Friday evening service. I don’t know what was said during their brief chat, but whatever it was, it lifted the load from Dad’s heart about my choice. The matter never came up again. Similarly, if I had chosen veterinarian medicine or anesthesiology, I believe Dad would have had a talk with my mentor to gain some insight into my work and, so, would have been more at ease about my future and even actively supported me.

As a vet or as a “passer of gas” as anesthesiologists are accused of being, would I have seen myself as having diminished stature in the medical or professional community? Would I feel I were a slacker, one having less ambition if I were to choose a profession that required less training, less expense, less study, less training than a “heart doctor?” That would be a side issue that I know I would have to confront; it would part of my agenda to be the best of my choice, to explore all new ideas, all frontiers so that I would stand out in my own mind. No matter my choice, I knew Yvette would support me and defend me and make my professional and home life the best for both of us.

If I had chosen to be a vet or an anesthetist, what kind of doctor would I have been? I am drawn to animals and I’m certain I would have loved taking care of them. Loving my patients and wanting them to be well would have been a combination of attitudes that would have made me happy in my work. As to being an anesthetist, I remember, to this day, how much I wanted to be mentored by Adriani. He was thoroughly at ease, had no airs about him, like a good father, a father figure who would never be a tyrant, who would want his house staff to be the best because they respected him, wanted to learn, and wanted to please him. So, I knew that either choice of medicine I had in mind to pursue was really going to be right for me.

I did become an internist though not the cardiologist that Dad aspired for me. With time my practice evolved into seeking out my patients’ inner needs as well as their physical needs. My combination of interest in both physical and emotional matters was deeply satisfying for me; I was successful in learning to take care of the “whole” patient, the goal of a true physician.

The bowtie guys Peepa and son

Sunday, January 16, 2011

Evy's Birthday Story

Evy Evy

This story was read at Evy’s 80th birthday party in San Diego.

All of you are familiar with the story of Evy’s coming to California after Jackson’s Shoe Stores went bankrupt in the recession of the 60s. She got a job as a saleslady in a shoe store in Downy and soon after became the top seller among all the clerks. She expected to be made manager but the position went to the boss’s son. That was unfair and a signal that her efforts were not appreciated. She gave 2 weeks notice and turned her interest and skill to playing bridge. Now she was going to have fun.

She played, studied, and dreamed bridge. With her facility with numbers and her competitive spirit she became a top-grade player. She soon became a Life Master and was in demand as a partner at her bridge club. A top male player confided to her that she was the best woman player in southern California. Bridge became her life.

She visited us in Houston and played with us at Fuzz and Sandy’s house and at our bridge club. We caught fire and her enthusiasm to teach us was matched by our wish to learn.

Yes, that is all very interesting, but remember we are celebrating her birthday so now I want to talk about the actual event of her birth on May 20, 1922. To do that I have looked up Dad’s description in his oral history. I am going to read from it:

Saturday, May 20. I opened the store (a general store in Rosston, Pennsylvania) about 7 in the morning. I hung up my post office sack near the railroad to wait for the next Buffalo Flyer to catch it and in exchange, to throw one out for us.

Ann Duff that worked for us at that time suddenly called me to the telephone. I ran up the steps into the store and I answered the call. ‘Mazel Tov, Mazel Tov!’ and I hear my father-in-law’s voice, ‘A beautiful little girl, a dear little baby!’ I stood there listening to his words and I am so excited that I can’t answer and I am thinking, a little girl? Is it possible? Is it really true? Maybe because they knew that all the time we talked and planned and dreamed about the little girl, right off the bat they are telling me there is a little girl.

I am so happy! I am holding back tears of joy and I did not wait to show how happy I feel inside of me but I grabbed the Buick that we had and I am driving to see my vibel. I really do not want to say that I am ‘flying’ but this is the way I was driving to Pittsburgh that Saturday morning. I was drunk from happiness and in this drunken state God knows I will run over somebody! My father-in-law and my mother-in-law meet me at their door and they are kissing me and wishing me Mazel Tov, Mazel Tov! Wow! Is this a little girl, what a baby doll! I grabbed a bouquet of flowers and I am running to the hospital and I find my Raisel in bed, all dolled up and full of happiness and my Vibel says to me, ‘See my dear, we have a little girl, just like we wanted. A beautiful little baby and we are going to call her Eta Hudel, Evelyn Harriet.’ Even the name she planned out, but I am so happy that I do not care that she plans this whole thing out herself and it really does not bother me.

I waited there a little while and a nurse came and said, ‘Mr. Jackson, the doctor would like to see you.’ My heart begins to pound. I haven’t had a chance to see my baby and why does the doctor want to see me? I say to the nurse, ‘Is anything wrong?’ She does not say anything. My mouth is dry. I am feeling faint. Then I see that she takes me to the doctor and he is holding my baby. He is smiling and I feel relieved and I am sure that everything will be for the best.

He puts my Eta Hudel on a little table and I see my sweet baby. He says, ‘Mr. Jackson, I need your help with a little problem. It is nothing to worry about. I want you to hold your baby’s arm while I try to open her hand.’ I am loving to hold my baby’s arm but I do not understand. Then the doctor says, ‘I want to open her hand. It is closed tightly and I must open it.’ I watch him. Very gently he takes one tiny finger and opens it and then another finger and then another finger. The hand is open and there in that little hand, in my baby’s angel hand is---is the tiniest deck of cards I have ever seen!

Wednesday, January 5, 2011

Danisms

When our sons were in training or in practice, I often met with them over coffee to give them my thoughts on patients and my philosophy about taking care of them. Here is what they called "Danisms:"
  1. The doctor is the medicine that gets people well.
  2. Ten percent of your patients take up 90% of your time.
  3. Don't be in a hurry to give your patient a bad diagnosis.
  4. Diseases are easy; people are difficult.
  5. Listen to the patient and you will hear the diagnosis and often the treatment.
  6. Difficult patients put your kids through college.
  7. Sometimes the only satisfaction you will get from patients who aggravate you is when they pay their bills.
  8. Your most important diagnostic tool is your ear.
  9. When patients love you, they will forgive your mistakes.
  10. The patient always knows the truth.
  11. Depression is the most common disease in your practice.
  12. The most valuable tool in your examining room is your chair--sit in it and listen.