A House Call by Doctor Astroff

This week, 30 years ago, I graduated from medical school. My mother, my aunt, and my nanny attended the ceremony; all are gone. You probably know that medical school merely provides the infrastructure and the lexicon of the profession and that the most important learning comes from direct patient care. Only a few weeks after my graduation, I started a four-year stint at Maimonides Medical Center, as extern, intern, and resident in internal medicine.

If asked why I became a physician, my answer has always been the same: to be a healer, to help my community, and to lessen people's suffering. And I'm lucky to have chosen my calling at age 9, thus narrowing my professional aspirations considerably. My idealistic side never evaporated, having been formed and solidified in the late 1960's. And it's a source of happiness and contentment that I've saved thousands of lives by heroic intervention, uplifting motivation, and maybe a book or two.

But the life of a physician is a difficult one, filled with unpleasant tasks, conversations, and decisions. We expect physicians to be humanitarians, not simply scientists, and that is quite a weighty responsibility. Everyone probably has a story of the aid and comfort given to him or her by a doctor, perhaps even an anonymous emergency room physician. The words might stick in our minds forever. I have somewhat more down-to-earth epigrams carved into my memory, such as this one from my internist Benjamin Rosenberg during my teenage years, when I asked him if he liked all his patients: "Stu, I have put my finger into the rectum of people I wouldn't shake hands with."

Perhaps Dr, Rosenberg was being flowery, as we Brooklynites have been known to be. Interestingly, I found out what he meant, metaphorically speaking of course, when I worked as an attending physician at Cabrini Medical Center's emergency room: many of the patients were criminals, Runyoneque-types, or worse, yet my duty was to diagnose broken bones, suture lacerations, and restore vital signs--this was not the location for social change, personal opinions, or dramatic confrontations. I was simply their physician at that moment in time.

My great-uncle Abe Fischer, the only other doctor in my family, had dazzlingly colorful stories that would make me even more excited to be going into his exalted profession. As a general practitioner in 1920's to 1930's Brooklyn, he had suffered through an ordeal in his Maimonides training (being on-call every night for three years), accepted a chicken as payment for a house call during the Great Depression, and treated the high (young Maria Callas) and the mighty (Al Capone and Dutch Schultz). Being a physician, he always sat at the head of the table wherever he went and was the sole speaker, with beautiful silvery hair, orotund tones, and a Freudian beard. He had gravitas, authority, and a wealth of experience, the sort that can only come after witnessing the ravages of disease and the pain of earthly sorrow.

In reflecting on my journey through the medical profession, I recently recalled another early influence, this time a fictional character: Doctor Astroff in Uncle Vanya. I had seen a stellar Mike Nichols production of the classic Russian play on Broadway, with George C. Scott as Astroff and Julie Christie as the woman he loved and lost. The more I watched Astroff's world-weariness, combined with his refusal to stop being a caretaker and healer, the more I knew I was on the right path, challenging though it might be.

Dr. Astroff might be a fictional character, but all students of theater know that he's a stand-in for the playwright himself, Anton Chekhov, also a physician. How much of Astroff is Chekhov? And how much of Chekhov is Sonya, the melancholy and lonely woman who experiences life as a vale of tears and longs for peace in the grave? How could someone have written her final speech without experiencing at least some of the emotions? I'm as ebullient and fun-loving as anyone else yet over the course of 30 years, I've seen, by my own estimate, 3000 people die in front of me.

These conflicting, seemingly irreconcilable aspects of a life in medicine haunted me when I began to record excerpts from Uncle Vanya for my project "The Art of Medicine." A house call by Doctor Astroff proved very dramatic, stirring up memories and feelings that are as much a part of my medical education as pathology and anatomy. How do we become who we are? Sometimes the insights come not from science and textbooks--but from art and life.