One
morning some years ago I found myself in the office of a dermatologist
who, while tearing into my Plantar's wart on my right foot, glanced nervously
up at my chest. “Wait!” she murmured, “Melanoma!” At the time, I did not
know precisely what melanoma was, but I knew the word to which it was most
associated: Cancer. She tenderly touched the mole she had spotted as the
likely suspect and commented: "I don't think this is malignant, but you
need to have it removed immediately.” She paused and continued in a hushed
voice. "Not that I want to worry you.” I braced myself for what was coming
next. “But, three weeks from now, in a worse-case scenario, you could be
dead.”
I smiled bravely. “I thought you didn’t want to worry me.”
She did not smile back. “You need to see a surgeon."
"Well I don't know a surgeon," I said. "Who’s the best in Pittsburgh?"
She replied immediately with a name that, for purposes of this essay, I
have changed: "Sidney Schwartz."
"Can you make the arrangements?"
"I'll take care of everything, Mr. Gutkind."
I did not like the way she suddenly called me by my last name. Through
all of our associations related to my Plantar’s wart, we had been on a
first-name basis. Now that I was three weeks away from a painful demise,
she had immediately adopted what I have come to call the “doctor's distance
declaration,” which establishes a direct line of withdrawal from patient
interaction in proportion to severity of illness and prognosis for recovery.
The more serious and potentially fatal the malady, the more physicians
will study your chart and contemplate their geeky shoes, tending to walk
backwards whenever the patient or family members attempt to talk with them.
Sidney Schwartz was my prototype of this syndrome. First, his nurse said
that he did not need to meet me. Such a minor procedure required no personal
contact or preliminary assessment. Second, it would be 10 days before I
could be squeezed into his schedule. And this, of course, was a favor performed
on behalf of the referring dermatologist, a long-time colleague. Otherwise,
it would have been a month. I appreciated the consideration. However, having
done a little research about melanoma and learning how quickly it might
spread, the 10 days waiting with the dark specter of death I now perceived
hanging over my head was one of the most anxious periods of my life. Those
10 days were nothing in sheer terror to the day of the surgery.
I arrived at the Outpatient Surgical Center (OPS) at 7 a.m. for my pre-op
examination. I was weighed. My pulse was taken. The necessary forms were
filled out, my clothes and personal items stored away safely in a locker
at the other end of the unit. I put on one of those paper hospital robes,
a mini-skirt model that hung about 3 inches above my knees, along with
paper hospital booties. A nurse led me to a tiny windowless room, invited
me to make myself comfortable. Dr. Schwartz was due at 8 a.m. and we were
a little early.
I was immediately bored and jumpy as I waited. I had hardly been able to
concentrate throughout the entire ordeal, and and now was so focused on
the impending surgery that I hadn’t even thought to bring anything to read.
I knew that Dr. Schwartz, the best surgeon in Pittsburgh, would be arriving
any minute to interrupt whatever reading or work I might be doing, anyway.
Even at 9 a.m., when there was no sign of Dr. Schwartz or any other doctor
who might be coming to check in with me, I was confident that it was only
a matter of time. It had been a little naive of me to have assumed that
surgeons would be anymore punctual about surgery than other physicians
were in keeping appointments. After all, there were sick people needing
emergency surgery throughout the city, any one of whom could be bleeding
to death on the operating table with a heroic Sidney Schwartz laboring
to save him. In the back of his mind, Schwartz knew that I was waiting
at the OPS--and he would be rushing in here any second, breathless, spouting
apologies while sharpening his scalpel, getting down to business.
I continued to believe that until around 11 a.m. when one of the nurses
came in to say that she had initially been told that Sidney Schwartz had
been sidetracked by an emergency procedure, but, she confessed, she was
no longer certain that that was true. He wasn't answering his page and
no one, including his partners, could find him. She was more embarrassed
than apologetic--and she was whispering, as if confiding a dark secret
or committing a crime which, in this doctor-friendly milieu, she was. Around
lunch time, the nurse reported that someone had seen Sidney Schwartz in
the hospital in surgical scrubs and heading this way, but when he did not
show up by 1 p.m. she contacted the operator who began to page him over
the hospital intercom. There were 30 separate pages over the next hour
and a half--I counted every one of them as I sat, a prisoner in that windowless
waiting room, listening to the air-conditioning fan and the muffled activity
in the hallway behind my closed door. The hollow persistent sound of the
paging operator summoning Schwartz to the Outpatient Surgical Center triggered
within me a new and more acute wave of anxiety and fear. Periodically,
I wandered out of my room and inquired at the nurse’s station for an update.
Twice I used the nurse’s phone to call Schwartz’s office to complain, but
after being frozen in “hold” limbo for many minutes as Schwartz’s secretaries
were attempting to locate him, I hung up the phone and retreated back to
my cell.
At 3 p.m., when the nurse came in carrying my clothes to apologetically
announce that her shift was over and that the entire unit was closing down
for the day, I was a complete wreck. To me, this was an omen, a clear message
that the melanoma was malignant and that I was going to die. After all,
the dermatologist had said “three weeks;” nearly half of the last days
of my life had been wasted waiting for Sidney Schwartz, the best surgeon
in Pittsburgh, to stand me up. This was torture: eight hours in a windowless
waiting room, no television, radio or reading material. Even convicted
murderers were given breakfast, lunch, perhaps an hour-long walk in the
yard for fresh air--and real clothes. You could hardly take a walk in the
yard in a paper mini-skirt and pastel blue booties.
In retrospect, it was a mistake to have arrived at the OPS without a friend
to keep me company or demand help, but I was recently divorced and feeling
as if I needed to learn to confront the challenges of life on my own without
leaning on a partner. Later, collapsing at home in my bed, I listened to
the messages on my answering machine. The last one was from a secretary
in Schwartz's office explaining that in the frenetic rush of his day, Dr.
Schwartz had simply overlooked my procedure and that he would be pleased
to reschedule for the following week. She offered a couple of dates and
times and suggested that I return her call if I was interested.
But my one and only interest was in killing him if, of course, I lived
through the melanoma. That fear had now considerably paled in comparison
to my burning hatred of Sidney Schwartz. I wrote a number of letters, never
sent, and composed a slew of speeches, never delivered, over a long period
of years. Not that I was afraid of Sidney Schwartz or too sick from chemotherapy
(which, in fact, never happened--I found another surgeon who removed the
mole a few days later, which, after a quick biopsy, was judged benign).
The truth is, I never confronted Dr. Schwartz. I was too enraged to simply
yell and scream and bash his head in; rather, I wanted to humiliate Sidney
Schwartz in front of his colleagues, friends and family--the people who
most respected him. My dream was that I would serendipitously come into
contact with him one day, face-to-face, preferably at a dinner party. He
wouldn't know me, but I would know him, and I would charm and befriend
him, along with everyone else at the table, all the while gently guiding
the conversation toward the issues of ethics and morality in medicine--the
Hippocratic Oath, the physician’s responsibility to the patient, all the
good stuff about which physicians love to expound, at which point I would
begin my melanoma story in basically the same way I have started the story
here, by describing the dermatologist, and the hour-by-hour, soul-twisting
torture in the windowless room waiting for the surgeon to appear. But I
wouldn't say the surgeon's name--not for a while.
I'd wait for the precise and proper moment, skillfully unfolding the details
of the story and building suspense and curiosity about the identity of
the surgeon, dropping a few subtle, pointed clues. In this scenario, I
can literally picture all of the people at the long dinner table, spellbound,
heads strained forward to listen as the scenes and incidents I relate gallop
toward the conclusion. And I can also picture the object of my anger, Sidney
Schwartz, growing ever more uncomfortable in his chair as the intimate
nature of my story finally begins to touch some inner chord of awareness.
I know in my heart that he is beginning to suspect the humiliating reality
that is approaching him. At the end of the story, with my dinner companions
completely primed and totally empathetic and with my final words of dismay
echoing through the quiet, darkening dining room, someone breaks the silence
and asks:
"Who was this horrible doctor?”
At which point, I carefully place the coffee cup in its saucer and turn
ever so slowly toward my nemesis, my enemy, the object of my pent-up, bone-scraping
rage, Sidney Schwartz, and look him straight in the eye, as I quietly announce:
“He is sitting among us at this table.”
It was this dream of revenge through the consummate humiliation of Sidney
Schwartz specifically and my melanoma experience generally that led me
eventually to write about medicine and science. My first books were about
my two great passions: First, motorcycles and the subculture that surrounds
them, for which I traveled extensively, cruising most of the lower 48 over
a period of three years.
The second was baseball. I spent one season shadowing a crew of National
League umpires from ballpark to ballpark. But being forgotten and abandoned
by Sidney Schwartz, the person to whom in good faith I had blindly entrusted
my life, began a process of evaluation that was to change my entire artistic
orientation for the next 15 years. What kind of people could devise a system
in a world with the Hippocratic Oath as the bedrock of healing, that would
engender such an impersonal and unresponsive atmosphere, I wondered? Why
is a medical center designed to function primarily for its doctors, rather
than for the patients it is supposedly created to treat and serve? These
were the questions that came to intrigue and drive me.
Since then, I have written four books about the humanistic aspects of the
high tech medical world. The researching technique I use for these books
can be called “total immersion,” meaning that I literally move into the
medical setting in which I have interest and invest months and sometimes
years learning everything possible about aspects of modern medical technology
from the points of view of all of the actors--physicians, nurses, patients,
family members--anyone with a significant role in the subject that I am
investigating. Using scene, dialogue and specific detail, I hope to capture
and relate the dramatic stories of people enmeshed in real life incidents
and challenges--the defining moments of my immersion experiences--and the
universal meanings behind what I see and recreate.
For my first book about the medical world, “Many Sleepless Nights,” an
examination of the world of organ transplantation, for example, I was initially
enticed by the potential of transplantation to save lives. What began to
affect me, though, was the pain and suffering organ transplantation (and
other forms of high-tech medicine) caused, not only to patients, but to
the families who had to support them through surgery, recovery--and far
beyond. But what also struck me then and continues to affect me now, years
later, is the dearth of humanity at many points along the process. Not
only does the technology (medications, machinery, computerization) divide
the patient and doctor, but it also serves, seemingly, to deny the necessity
for or expectations of courtesy and compassion.
On the organ transplant service, I once listened to a prominent surgeon
impatiently interrupt a resident who was carefully explaining a procedure
to a family member, prompting him to "save lives first--answer questions
later." Another surgeon told me, in defense of his insensitive behavior,
"Psychologic trauma and all that stuff is important, but it doesn't make
a goddamn difference if you are well-adjusted and dead." Saving lives of
dying patients becomes a surgeon's obsession, but in the process, such
a single-minded and narrow pursuit seems to alter or destroy their sense
of purpose--the reasons surgeons endured years of medical training and
took the Hippocratic Oath.
I never experienced that feeling with veterinarians, however, for my most
recent book, “An Unspoken Art.” Here were men and women, obviously interested
in lifesaving, but dedicated and devoted not only to the physical, but
also the psychological well-being of their patients. This is the ironic
missing link in human medicine: many of our caregivers do not regard or
treat their patients as human beings, as I initially discovered so many
years ago with Sidney Schwartz. And this is the part of veterinary medicine
I will never forget, that part that includes philosopher Erich Fromm's
observation that humankind "is biologically endowed with the capacity for
biophilia, the passionate love of life and all that is alive"--and the
way in which it is exemplified in veterinary medicine--by human contact:
touching.
I was lucky to witness a revolutionary cryosurgical technique at the University
of Pennsylvania on a prized harness racer named Cam Fella. The procedure
was fascinating and exciting, but the most memorable part of the experience
occurred long after the surgery, long after the owners had departed and
most of the entourage and the curious onlookers had disappeared. Eight
exhausted veterinarians and nurses, all women, remained in the recovery
area with Cam Fella, sitting in a circle, elbow to elbow, keeping him calm.
Touching him. Kissing him. Talking to him. Until he was awake enough to
stand on his own and navigate the winding path back to his stall.
Although I connected with the veterinarians in a special way because of
their compassion, I came to admire and respect the overall perseverance
of the men and women in the medical community of all specialities and orientations--
especially organ transplantation--relentless in their drive to solve scientific
puzzles in the face of ongoing and debilitating defeat, not over a period
of days and weeks--but years--or even decades. I discovered a great affinity
for these egocentric scientists because I recognized early on that we shared
the same set of values concerning commitment to a potentially unreachable
and sometimes unimaginable goal, along with the same faith in our basic
vocational ethic, which was to come to work every day without any expectation,
except to function at the highest level possible for as long as possible
until or whenever their project or study was completed, its thesis tested--if
not proven. This too is the exact orientation of all serious writers I
know: To write every day, to invent or capture memorable and true characters
and stories, to discover insight spontaneously and to write sentences that
invigorate and charm a reader--without visions of glory or grandeur.
From the information I have gathered through subtle inquiries, Sidney Schwartz
was not such a dedicated and driven scientist; rather he was a skilled
and committed surgeon, popular for his quick and efficient procedures,
but overloaded and somewhat disorganized. Sidney Schwartz almost died--many
years after the day he stood me up on the operating table, of hepatitis,
contracted, I am told, from one of his patients. When I heard about Sidney
Schwartz’s disease, I have to admit to a momentary tinge of elation--not
because I wanted him to die or to be in pain, but in the hope that there
was some sort of prevailing justice. So that when his colleagues began
to pull away from him, as they undoubtedly would, he too would have the
experience of being the unempowered patient rather than the all-powerful
doctor.
I doubt that the justice I imagined actually came about in Sidney Schwartz’s
case, but I am vengeful enough to hope that it did, especially now that
I know, in retrospect, that Schwartz received a liver transplant (another
irony; a few years earlier I might have observed or scrubbed-in on the
procedure)--survived and returned to his practice, a result that is not
nearly as routine as the medical community or the media might lead an unaware
consumer to believe. In fact, I am told that he recently built a new and
luxurious house in my neighborhood, although I still don’t know what he
looks like and don’t intend to find out. At this point in my life (and
in his), I suspect that if I met him at a dinner party, we would get along
fine. Sidney Schwartz and I would discover a special connection because
I could and would empathize with the odyssey of the liver-transplant experience.
Actually, I guess I could say that despite his unconscionable albeit unknowing
actions, I owe Sidney Schwartz a debt of gratitude for inadvertently directing
me toward a phase of my career that helped fuse what had seemed, at one
time, to be diametrically opposed concepts--creativity and science. Because
of Sidney Schwartz, a doctor too busy to remember a frightened patient,
I have been enlightened.
Many of the physicians I met and observed, surgeons especially, were relentless
and persistent and also scientifically daring--willing to take risks--
the hallmark of both great science and great literature and one of the
reasons this double issue of Creative Nonfiction exists. We believe in
the symmetry between science, art and humanism, a concept that this issue
will illustrate, beginning with the lead essay by Alison Hawthorne Deming
that discusses the harmony between scientific language and poetics. Deming,
who is director of The University of Arizona Poetry Center, is the author
of a number of books, including “Science and Other Poems,” a collection
that won the prestigious Walt Whitman Award of the Academy of American
Poets.
Deming is also the winner of the first Bayer Creative Nonfiction Science
Writing Award, sponsored by Creative Nonfiction and the Bayer Corporation
for this essay, for which she receives a $500 award. We will not be sponsoring
a science-oriented issue in 1999, but for the following year the Bayer
Corporation has agreed to expand the award to $2,000 in honor of the millennium.
To my knowledge, this is the largest cash award for a single essay offered
by a literary journal--anywhere.
Although Deming is a poet who writes about science, some of the essayists
collected in this double issue are scientists who write like poets. Gerald
Callahan is an immunologist in the Department of Pathology at Colorado
State University in Ft. Collins while James Glanz, runner-up for the Bayer
award, who received his Ph.D at Princeton, is a writer at Science magazine.
Two members of the National Aeronautics and Science Administration (NASA)
are contributors to this issue. Scott A. Sanford investigates planetary
systems, astrochemistry and the origin of life. Susan Adkins had been a
NASA librarian for most of her professional life, but her passions were
writing and flying, which is how she is remembered in this issue of Creative
Nonfiction, as a fine essayist and dedicated pilot, who died in a flying
accident a few months before this issue went to press. She was 49.
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