Out Of The Old Black Bag
OUT OF THE OLD BLACK BAG
Friends on Letterhead (Part 1)
This editorial reflects the opinions of the author and not those of The PediaBlog or Allegheny Health Network or the American Academy of Pediatrics. Or Scooby-Doo.
The road is wide and the stars are out
And the breath of the night is sweet,
And this is the time when wanderlust should seize upon my feet.
But I’m glad to turn from the open road and the starlight on my face,
And to leave the splendour of out-of-doors for a human dwelling place.
— Opening lines of “Roofs” by American poet, Joyce Kilmer (1886-1918). During his deployment to Europe in World War I, he was killed by a sniper’s bullet at the age of 31, leaving behind a wife (also a poet and writer) and 5 children. Who of us has not recited “Trees”, the simple, but profound, poem for which his name is synonymous?
Musical accompaniment: “The Circle Game” by Joni Mitchell
“Something there is that doesn’t love a wall.”
So begins Robert Frost’s highly symbolic poem about the boundaries between farms, humans, and the nations that contain them — more relevant in early 2022 than when written in 1914.
I feel the same about obituaries. I have gone so far as to insist to my wife and children that I will compose my own and try to make it more than one-dimensional. “If a well-intended, but saccharine, sanitized ‘pack of white lies’ is to be the content of my final medical record, let it at least be written by the only doctor and clergyman who treated the patient without bias!” I imagine they think I have become so senile and cynical that I think myself to be Mark Twain — however, I contend that rumors of my senility have been greatly exaggerated. I am not yet the conventional unreliable narrator.
In the same vein, when I reflectively read Dr. Mark Bellinger’s obituary last month, I knew that there was more to his long professional life than could be glorified in any eulogy — even of the highest caliber. I knew this purely because we were contemporaries during the same era of medical practice, and that fact alone made us kindred spirits. We surveyed the ever-changing landscape of medicine, including pediatrics and surgery, over the same 40 years and have been first-hand witnesses to its rises and falls.
I must state emphatically that, to my recollection, I never met Mark in person and probably rarely, if ever, talked to him on the phone or after one of his lectures at Children’s Hospital. Our interactions were exclusively via correspondences regarding the patients I referred to him for expert management of their urologic problems — first on paper, then later in our careers by digital technology. Essentially we were “pen pals” whose communications took place on letterhead.
However, more of our “dialogue” took place vicariously through the simple, mundane remarks of anxious parents: “Dr Bellinger straightened out the bend in his penis and now he can finally pee straight into the toilet,” might a mother or father remark with tears of gratitude, “and he was so kind to me and my son.” I probably responded: “A great surgeon can correct anything — Dr Bellinger can probably do this kind of surgery in his sleep! We should be very thankful that Pittsburgh finally has a specialist in urology for children; he trained with a pioneer in the field, Dr. John Duckett in Philadelphia.”
Being the lone wolf in the subspecialty in the tri-state area for many years and taking call just about every night leads me to believe that Mark often had to operate all day after nights on call, catching up on his sleep and operating at the same time. I guess that is a skill great surgeons learn in training — or maybe for some it just comes naturally.
I once casually remarked to a mother who was a nurse in the office of a group of general surgeons, intending to praise her bosses: “I don’t know how these surgeons can operate doing emergencies overnight and then work in the office the next day.”
“That’s why you’re not a surgeon!” she bluntly retorted. I must admit that I laughed out loud but felt a pang of resentment and humiliation inside; after all, pediatricians were still taking direct phone calls from anxious families overnight and occasionally deserting their beds to rush to an emergency C-section in the middle of the night in those days. However, we were pikers compared to the surgeons. I said nothing after the laugh but was thinking of Frost’s admonition in the poem:
I could say ‘Elves’ to him,
But it’s not elves exactly, and I’d rather
He said it for himself.
Old Man Experience teaches that in every professional’s career there will be a detour from the previously travelled highway of familiarity to an alleyway of challenge that has the potential to deliver him or her to the “pot of gold at the end of the rainbow.” For Mark, me, and others with a flair for adventure, the Steel City marked the “X on the map.” Pittsburgh may not have been an upgrade from Syracuse, NY or Clifton, NJ, where Mark and I respectively grew up, but, after stints on the big city streets of Philadelphia, it seemed to us a better-than-average “human dwelling place.”
Afoot and light-hearted I take to the open road,
Healthy, free, the world before me,
The long brown path before me leading wherever I choose.
— From the “Song of the Open Road” by Walt Whitman
Forty years ago, those of us in pediatrics who stuck around here were privy to all the angst and loneliness of any long-distance runner. It took Mark many years of toil and success to earn a partner in his subspecialty. I spent the first dozen years of my career as the only full-time pediatrician in a large multispecialty primary care center. The emotional demands were 24/7/365; the difference was that I covered one practice in the North Hills while Mark covered the entire tri-state area.
Our selfless wives (both from families with double digit numbers of siblings) raised our four children, managed most of the domestic affairs, and learned to promptly fall back to sleep when the phone rang in the middle of the night, never complaining about the stolen time. In those days, pediatricians were like politicians who had to run for re-election when they entered a new exam room every 10 or 15 minutes. The term “burn-out” was applicable to the evolving illicit drug culture, not to those of us in the trenches of the war on disease. We persevered:
“We can’t return, we can only look
Behind, from where we came
And go round and round and round, in the circle game”
Indeed our only intrinsic refuge from the underappreciated and under-rated “compassion fatigue” from which we all succumbed to some degree were the ready acquisition of a sense of humor and the pursuit of some form of distraction.
To be continued…
source http://www.thepediablog.com/2022/04/27/out-of-the-old-black-bag-20/
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