A Walk Through the Snow with Doctor Astrov

When most people awaken to see the after-effects of a mammoth blizzard, their thoughts don't drift to visions of physicians from long-ago, trudging through mountains of snow to see a sick patient or comfort those suffering from chronic illnesses. But that's what preoccupied me this morning after New York City was blanketed with a titanic storm that has since moved northward.

Such a country doctor was one of my role models, albeit a fictitious one: Dr. Astrov, the world-weary, philosophical character in Uncle Vanya by Anton Chekhov, himself a country doctor. When I looked out my West Village window and saw the entire street blockaded by snow in every direction, walled off to traffic, devoid of pathways for pedestrians, I thought of those heroic "primary-care physicians" in Czarist Russia whose never heard the words "co-payment", "deductible', or "referral."

They were men on a mission of mercy, and nothing would stand between them and human suffering. Dr. Astrov seemingly gives up his whole life for his professional responsibilities; he's unlucky in love and sometimes the patients can't pay. My first and best Dr, Astrov was the incredible George C. Scott, and Julie Christie was the girl that got away ! Talk about dedication ! Seeing those actors in 1973 and experiencing Chekhov's bittersweet musings gave me a taste of what it's like to be a physician, even 100 years and thousands of miles away.

Dr. Astrov might have carried his "little black bag" dozens of miles in sub-freezing temperatures, armed with what we would now consider primitive medications and tools. There were no antibiotics, X-rays, or blood tests. Although superficially understood, heart disease, diabetes, and
hypertension were decades away from adequate treatments. The rural doctor like Dr. Astrov was essentially a general practitioner with experience in orthopedics, surgery, internal medicine, and sometimes pediatrics--something utterly impossible today.

A very real general practitioner in my family, my only close relative who was also a physician, was my great-uncle Abe Fischer. He inspired me for many years, first as a frequent visitor to our home and then as an attendee at conferences at Maimonides Medical Center during the years of my internal medicine residency (1980-83). He looked like a character from a Chekhov play, with theatrical eyebrows and a Freudian goatee. Uncle Abe would immediately sit himself at the head of the table when he came for dinner--the doctor was an honored member of society and thus the immediate focus of attention at family gatherings. He would automatically become the principal conversationalist, and Uncle Abe had plenty of stories to tell.

Some of these stories were about various A-level patients he had treated, such as Al Capone, "Dutch" Schultz, and Maria Callas (during her childhood in Boro Park, Brooklyn). More often, the stories were about his difficult early years as a physician-in-training. In the 1920's, internships at Maimonides Medical Center (then Israel Zion Hospital) were a precious commodity; in contrast to my starting salary in 1980 of $25, 000 per year, Uncle Abe had a salary, as he put it, of -$110 per month----the fee he had to pay for room and board. I was on-call every three nights for a continuous 33 hours for three years. Uncle Abe was on-call every single night for three years. And when things were "slow" in the hospital, the medical residents had to ride the ambulance.

Such a schedule is unthinkable today. So is that type of dedication, empathy, "bedside manner," integrity, and love of humanity. Uncle Abe was perhaps my greatest inspiration, and I can only hope that I have done something analogous over my own 30-year career as a physician. Bad weather would never have slowed him down, and he would regularly make all-weather housecalls during the Great Depression (the fee was a chicken). I assume that Dr. Astrov--and Dr. Chekhov--would have done the same (and the fee would have been similar).

Wading through hip-high snow, scaling mini-mountains from one plowed street onto another, dodging icicles, braving frigid blasts of cold air---that's the least I can do to commune with the spirits of those sublimely inspired healers who forged a path for me. I thought of them as I bundled up this morning and headed for my office, one of very few souls in my neighborhood to even venture outside. And I thought about the life of world-weary Chekhovian physicians, those amazing role-models that captured my imagination decades ago. I remember them now. But who will remember me?