The Yale Journal for Humanities in Medicine

A Medical Fairytale

James L. Glazer, M.D.
jamesglazer@hotmail.com

Once there was a young boy who decided to become a surgeon after his father watched him tie flies. His father was a doctor, a small-town generalist with a sleepy practice allowing him plenty of time for fishing. They had been standing under the bridge, the dust hanging thick in the August air. His father's face was flushed and dirty as it never was in his office, before his patients. Fishing was the thing he loved best. He must have loved it, his son reasoned, to have doggedly pursued it despite his continual frustration. The father always dropped the instruments in the rushing water, always stumbled on submerged rocks and he had stopped carrying a basket last year. It had never been filled, and he was embarrassed each time he returned home with it empty. “Your hands,” he had said to his son, nearly ten years old that summer, “are the hands of a surgeon.”

Years later, as a surgical resident, the young man reveled in the moment of escape after grueling nights on call. With a light step he crossed the cafeteria and its clump of workers huddled noisily over a booth in the rear of the room, passing the gift shop with its silver balloons, permanently suspended from the ceiling like stalactites. He finally approached the main doors of the hospital and the inviting splash of sunlight they permitted to encroach on the antiseptic waxed floor before them. The day opened up before him. He and his colleagues hoisted lumpy call bags and stained coffee mugs for their gleeful evacuation of the medical center. The world, his world, seemed filled with boundless possibilities.

One bright day during his residency, free from the hospital for the first time in a month, the surgeon took a walk by the harbor. A sign advertising sailing lessons caught his eye, and the skipper, a smiling young woman with green eyes and long brown legs, drew him back the next month. The first time she took him out on the boat the boom caught him in the forehead, throwing him overboard. But soon he learned about the rigging, the wind, and a little bit about the feeling of freedom.  He sailed with her every possible moment that summer, and one day that following winter, the boat long since moored, he asked for her hand in marriage. He had just returned from a night on call.

As time passed, he learned that his love of medicine was a jealous one, a relationship that would not allow him the flirtation with escape. First there were arguments about his wife’s loneliness, then questions about who would take care of the babies when they cried in the middle of the night. The answer came later; the green-eyed woman left him after he was called away to the hospital on Christmas Eve for the fourth consecutive year. That night he had discovered that families, like acute abdomens, sometimes do not wait. “I will not raise our children alone any longer,” she said. After that the surgeon sat in his empty home, waiting for his patients to absorb the rest of his time.

They soon did, and his constant work mitigated the loss of his family. He learned to take all of his satisfaction from being helpful, in small and large ways, to his patients. He came to the hospital every morning, and every day its doors welcomed him. His practice blossomed. Patients crowded his small office every day of the week. His colleagues began to recognize his skill and success. They invited him to become a clinical faculty member at the medical school, and after only four years the students presented him with an award as the best of their teachers. Their comments lauded him for his tireless advocacy for his patients, for the fact that he always seemed to be in the office until late in the evening. Late one night as he was admitting a patient the ER physician marveled at his stamina, asking him how he kept from becoming overwhelmed by his work. “What else is there?” he replied, turning back to his chart.

Twenty years later the surgeon found himself sitting at one of those flimsy banquet tables for his fortieth medical school reunion. Some trustee in an expensive suit was addressing the alumni about the new molecular genetics building. He referred to it as "important architecture" but it more closely resembled a set of building blocks after a preschool riot. In the middle of this stultifying missive, Ben, the same guy who had lost his lunch three times in freshman anatomy and now a neurologist, studied the surgeon carefully. He leaned over toward the surgeon and said with a frown, "You really should have that tremor checked out."  

At the time he told himself that it wasn't so bad. He reasoned that it was probably from too much coffee, and it only seemed to appear when he was tired. It seemed better when he kept moving. The surgical residents were comfortable doing most of the fine work anyway.

A little while later the surgeon saw an old friend on his office schedule. The patient was 78, skinny and lithe. He always stood up straight when the surgeon entered the room, shaking hands with a firm grip. He was a tiny man, standing only a little over five feet tall. His name, fittingly, was Napoleon, but for all of his life he had been simply Nap. He always greeted the surgeon with the same salutation, delivered empathetically in one word: "Howareyoudoindoc!"

Fevers had troubled him for weeks. One by one, the terrible causes were excluded until finally an abscess revealed itself, lurking behind his psoas muscle. It would be a difficult dissection, but one the surgeon had done many times. It was well-traveled ground for him.

Napoleon insisted on walking himself to the operating room, his Foley bag in one hand, the other gathering his flimsy hospital johnny around his pale legs. As he climbed on to the table, the surgeon noticed that Napoleon wore black elastic sock garters, just like his father.

The dissection was straightforward. The abscess cavity was exposed in only forty-seven minutes. There might be time for a short rest before clinic today.

Days later, the autopsy revealed that the sharp dissection had encroached on the aorta. In the operating room the surgeon lost his way and suddenly the field was filled with blood. The sacred trust that the great vessels of the abdomen held for him had been violated, and with that slip they had sealed his fate.

The very next week the surgeon sat mute and trembling in the institutional review session as a string of his colleagues admitted to having noticed the tremor and looking the other way. One had even spoken with the nursing staff months before: "We'll make sure he is safe. It is not your business."

To preserve his dignity the board had voted to accept his resignation. He signed the form with the green fountain pen emblazoned with his father's name. It had been his since the first day of medical school, a talisman passed down from one generation of physician to the next. His signature looked small and foreign on the computer-printed form, as though a stranger had scrawled his name in agreement.

Napoleon’s widow, having heard of the board’s meeting, sat outside the room in the hallway, alone in her dark coat. Above her hung a print by Norman Rockwell, the one in which a boy scrutinizes his physician's diplomas as he waits, bare-bottomed, for his immunizations. She had not yet taken off her scarf, which she had made herself from bright orange wool. She had made one for him once, too, in purple.

Bright colors always seemed to surround this woman whose life had been defined by hardship. Her mother's left breast had come off by his hands three years earlier. The year before that, her son's appendix had nearly ruptured before the surgeon had been able to operate. On this day, as she had on those, she waited for him to emerge from behind the dark doors. She rose to embrace him as he passed and murmured to him,

"You did your best."

Within six months a young group of hotshots had absorbed his practice. Each of the new surgeons was only a few years removed from residency, still thick with the bravado of inexperience. Finally, the day came for the surgeon to turn in his identification card at the security office. The hospital operator marveled at his pager when he relinquished it to her. It was one of the few remaining voice pagers. “They’ll be glad to get this one out of circulation,” she said.

The very next morning the day began, as always, with the ordeal of dressing. It hadn’t always been so difficult, but the passage of time and the millions of knots he tied had robbed his hands of their dexterity. Today his tie and cuff links would have to wait until after the morning painkillers. It was cool out, and the tiny discs of gold were the most difficult part of dressing. That was another thing his father had told him long ago: you must show your respect for the patients by dressing well for them. A formal man, his father had protested bitterly the advent of loafers. Like Nap, his father had insisted on wearing garters to hold up his high black socks even after he had stopped going to his office every morning.

Breakfast over and the requisite agony of dressing completed, the old surgeon walked slowly to his car, a doctor’s Buick. He looked up at his empty house looming above him and heard the mantle clock chiming from its quiet interior, reminding himself for the fifth time to call the roofers about a persistent leak. The hedges spilled over the cracked concrete driveway, on which tufts of grass were growing like barnacles on a hull. He had abandoned such domestic projects long ago, after his wife had gone. His house, like his body, seemed to be disintegrating.

He settled into the seat and drove slowly as he had for years, finding himself at the familiar entrance to the medical center. There in his car he watched, while young residents spilled out of the automatic doors, the sunlight beaming brilliantly off their rumpled white coats, released for a short time from their world of disease. A stubbled resident swept by the parked car, his coat brushing the fender. His pocket was filled with neon blue, yellow and green highlighters, each emblazoned with the name of a different drug. He muttered as he switched his pager off, finally finished with his night on call.

The surgeon smiled sadly to himself. He had driven to the hospital that morning automatically, simply because that was where he always went. He watched as more residents raced out the doors. He looked at the patients, once his patients, walking the grounds with their families. Sunlight played on the new leaves of the hospital’s walnut trees. An ambulance pulled away from the Emergency department, flashers on but the siren silent. And still the surgeon sat, focused only on his hands. They had finally betrayed him and now they seemed no longer his own. Yet there they rested on the steering wheel, defying his wishes and his will, quietly trembling.

Published: March 1, 2003