Nor cast one longing lingering look behind
Thomas Gray, Elegy in a Country Churchyard
by Richard Ratzan, M.D.
On the eve of retirement after 45 years as a physician, the author reflects on a lifelong inclusion in medicine, from early childhood days as the son of a medical couple to a career in emergency medicine. He anticipates with dread the day when he will no longer belong in the ranks of those who are unquestionably healers.
Two years ago I walked out of my emergency department ending 43 years as an employed academic physician. Although I realized at the time that this was not the end of my career, it was certainly a milestone. It was the end of my status as a full time member of the medical guild I had joined when I graduated medical school in 1971. After six years in internal medicine, I emigrated to emergency medicine which I have now practiced for 37 years. At 68, I decided to retire a year or two earlier than planned. Why? A dislike for the new administration at my hospital and a much more profound distaste for the turn that my profession had taken
Almost two years ago now, as I walked out of the door of our emergency department, the door to my “official retirement” and “per diem” life, I was heartened to see a Hartford Police Department cop with whom I had become friendly. I don’t even know his name, yet I found it comforting to have someone who likes me say goodbye and wish me well. An aside: ever since I began working in emergency departments, I have been friendly with the security forces that protect us. More often than not they are professional policemen, and they enjoy our company as much as we do theirs. We establish an uneasy alliance since neither is wholly sure at any given moment that the one can professionally support the other’s mission, But we are both serving the public good and feel – noble, perhaps? – because of this shared benevolence we profess to the body politic. As I walked out that evening I thought back to the earliest times when I began to frequent the halls of medicine, or what my dear, recently departed friend, Richard Selzer, used to call “the vineyards”.
My father was a chest surgeon and family practitioner in Brooklyn when I was growing up in the 1950’s. He removed my friend’s cancerous lung; cared for my playmates; set fractures after taking the requisite films with the x-ray machine on the ground floor of our house – where his office in Bay Ridge was – and became the family doc for the alcoholic down the street who traded his care for renovating our basement. Ah, the good old days of barter and value exchanged! We – my mother, an accomplished administrative RN, my father, and Robbie and I – we lived on the second and third floors of the same house, above his office. Robbie, my cadet brother by 18 months, and I had wonderfully spacious bedrooms on the third floor with closets the size of a normal room. (I recently revisited the memory of our bedrooms when I read Lawrence Block’s mystery, When the Sacred Ginmill Closes, in which he has a cowardly and philandering villain arrange to have his wife killed in our very house, in Robbie’s bedroom to be precise!) My father used to take me on house calls, to patients like Mrs. Caputo, whose house I vividly remember visiting. She was a lovely, short rotund woman with probably not much wrong with her, In her small dining room Daddy would open his black bag, remove some instruments, take measurements of mostly a benign sort, if I had to guess, and re-assure her, which was worth more than any of the measurements. And once a year, Mrs. Caputo would have us all over to her house and give us a homemade Italian dinner that would have made anyone within a hundred miles of Rome proud and Salvo Montalbano, the detective in Andrea Camiller’s wonderful mystery series, smile. (Thank God the politically correct Gods of HIPAA and pseudo-morality had not even been born yet. As someone who has studied and written his share of ethics, my conscience remains not only untroubled by such memories but enriched by their purity.)
What I remember the most, however, were the trips to Brooklyn Doctors’ Hospital. Before making rounds, my father would park me with the telephone operator, who would effortlessly play Concentration with a huge telephone switchboard of jacks, accurately removing a cord from this jack here, swiftly inserting it into that jack there with one smooth practiced motion, connecting a caller from Flatbush, say, with the nursing desk on the fifth floor, all the while speaking into her headset with another caller, or talking to me. I must have been 12 or so at the time, maybe 13 or 14. Sometimes Daddy would leave me with Danny, a pathologist – THE pathologist, for all I knew – in the pathology lab. Danny had reddish hair and a thin mustache and was very friendly to me, as were all the staff in the hospital. It was during these visits and my trips to households for house calls that I realized my father was royalty of a sort, a visiting dignitary like some of the physicians in William Carlos Williams’s doctor stories. This was probably the end of the naïve era of physicians as noble, blameless knights of the salvific stethoscope.
One day while I was in the pathology lab, a frozen section came in. Frozen sections are stat (from statim, Latin for “immediately”) pathology preparations on specimens from the operating room. While the pathologist receives the tissue, prepares the specimen under freezing conditions and then reads the slide, the surgical team and patient wait. And the family waits, and the rest of us in the pathology lab wait. As did, it seemed to me, most of humanity with their fingers crossed. For, if the diagnosis is malignancy, the surgery is different, naturally, than for a pronouncement of “benign”. This is high drama for anyone, but for a 12 or 13 year old, it is what reality TV today strives for and rarely achieves – edge-of-seat breath-holding, knowing that a woman will lose a breast, or not, depending on what Danny says when he looks up from his microscope. I think it may have been that precise frozen section visit that hooked me, converting a boyhood dream to be a physician like my father, from as far back as I can remember, into a certainty.
It was the unconditional welcome into Mrs. Caputo’s world as patient, and this equally generous acceptance into the medical community at Brooklyn Doctors’ Hospital that initiated me into the world of clinical medicine as someone who belonged and did not need to explain himself. Thenceforth, I never questioned that I belonged. When I visited my mother in a Florida hospital as a 45 year old physician from 1500 miles away, I walked the halls as though it was my hospital. I was, after all, a card-carrying member of the fraternity and, increasingly over the last 30 years, sorority to which we physicians belong.
This membership does not depend on my wearing a name tag, or the now universally required badge on a lanyard which is more about being an identified and identifiably safe presence on the premises than a membership card. My belonging never needed a secret handshake or the utterance of a shibboleth. In fact it was not really a physical or external token that granted me this status. Rather, it was the purely conscious self-acknowledgment, a self-acknowledgment that I exuded with confidence, that I had passed the requisite tests, had been accepted as one of them by other physicians and nurses. It was not so much internal or inside me as it was me. It is this consciousness of my identity as medical that my cessation of doctoring threatens.
But until then, I go to the ED and work a per diem shift or two a week, usually entering by the lobby, rather than the ambulance entrance, so I can say hello to my new friend, John, an extremely amiable hospital security guard who stands at the passageway from the main lobby to the hospital elevators, verifying that all who enter have some highly visible reason to be there on their lapels or outer garments – whether it be a hospital badge or a visitor’s name tag recently obtained from the visitors’ desk in the lobby. John and I pass the time for 10 minutes or so – with frequent interruptions for him to tell someone how to get to the surgical ICU, or to return to the desk and get a visitor’s name tag – and then I proceed to the ED, which is immediately behind his post and to the right. If I do enter by the ambulance bay, punching in the code for the doors, I walk a short way past multiple stretchers that are waiting to be triaged and entered into the system. Often, I walk past colleagues and friends who do not even acknowledge me or say hello. They may be too busy but more often than not there is no reason to take notice or say anything. They see me but do not feel that this fact merits even a verbal greeting. It is not so much rude as familiarity and not only do I not mind it. I relish it. Who acknowledges an old shoe?
For it is this understanding that I belong, that I am a recognizable associate – it is this tacit agreement on all sides that I am an accepted and well worn member of the team that I dread missing one day. I do not want John, or someone like John, to ask me to return to the visitor’s desk to get my visitor’s tag. I do not want someone – anyone – on our staff working in the ED entry way to look up at me and ask, “What are you doing here?”