The subject of weight loss lends itself to analysis from an anatomical, physiological, sociological, biochemical, pathological, psychological, histological, and epidemiological point of view--one at a time, please.
But mention "The Mathematics of Dieting" and even the most frustrated overweight people become fascinated with the intricate workings of the machine we all inhabit, the human body. Like a car, a television remote, and a NASA rocket, we too need fuel, and as one would expect, there are relatively strict numerical formulations involved in the conversion of food to energy. The energy was may utilized immediately during a calisthenics class--or the "energy" may be stored visibly as body fat, encircling one's body like a corset of AA batteries.
3500 calories equals one pound in either direction. To gain a pound, the American equivalent of falling off a log, one must eat an excess of 3500 calories over one's metabolic needs. To lose a pound, not as easy as it seems, one must burn off 3500 calories--by swimming for 6 hours, for example.
How many calories do you eat per day? You can find this number approximately by multiplying your weight by 15. Therefore, a 200-pound individual is ingesting 3000 calories daily in order to stay the same weight. Any physical exercise must be taken into account and additional caloric requirements considered. But the math is still the same, and since many American do minimal if any physical exercise daily, the above calculation is quite accurate...and startling.
A 300-pound worker at my radio station was totally fascinated by "The Mathematics of Dieting" like a child hearing about Santa Claus or the Easter Bunny. And no cross examination was needed: he silently added up his foods for the day and the math was correct. And if that person were to cut out 500 calories per day from any meal or snack, he would lose one pound per week.
Let's invert the formula and express it a different way. Since there are 365 days in a year and 3500 (let's pretend 3650) calories in a pound, any additional of 10 calories per day results in a one-pound weight gain in one year. A single 20 calorie biscuit per day will add two pounds per year. A 150 calorie can of soda per day will make anyone gain 15 pounds per year.
Review your daily food habits with this in mind. Are the extra pounds (daily or yearly) worth it? You might find ways of cutting back on calories that seem insignificant, yet it all adds up. Enjoying flavored seltzer (no artificial sweeteners, please) instead of juice or soda could remove 15 pounds of visible or visceral fat--all by itself.
"The Mathematics of Dieting" is a practical way of explaining that your weight is an understandable phenomenon. There will be a variation amongst people of about 15% due to slow metabolism, certain satiation hormones, and other biochemical parameters. But the basics are most definitely real, so write down what you eat, calculate your energy intake per day (weight times 15), see if exercise or its absence needs to be accounted for...and change for the better.
What's the first step in understanding the metabolic workings of your own body? Do the math !
Monday, February 21, 2011
Monday, February 14, 2011
Notes on "The Park Avenue Diet Show: What Should I Have for Lunch?"; February 13, 2011
Lunch means different things to different people. Having traveled the world and temporarily becoming immersed in dozens of different civilizations. I have experienced as wide of a variety of noon-time meals as anyone I know. In Mexico I enjoyed ceviche, raw fish served as a beach food on the sands of Puerto Vallarta overlooking the Pacific Ocean. In Sherpa villages near Mount Everest, Nepal, I enjoyed momos, a type of dumpling. And in Ouarzazate, Morocco, I dug into chicken tajine, a hearty stew eaten native-style with both hands.
None of these exotic lunches is available in the United States. Moreover, these meals are part of a total cultural experience. A visitor to New York City from Puerto Vallarta, Nepal, or Morocco would probably be fascinated by and drawn to the same fast food franchises that millions frequent every day.
When I was about ten years old, a drive-in hamburger joint named Wetsons opened on Empire Boulevard and Flatbush Avenue, near my home. My mother was shocked that anyone would deny himself or herself the pleasures of a home cooked meal for a boxed cheeseburger and greasy fried potatoes. Unfortunately this was the shape of things to come, as H. G. Wells might have said.
The shape of things to come might also have included the shape of 21st century Americans. Although you can download, print, or read the nutritional content of your local chicken/burger/pizza/hero sandwich menu, few people if any read the fine print.
Except in individuals with highly physical jobs, lunch should never exceed 500 calories. Inattention to caloric content has immediate implications for weight. Inattention to salt and/or macronutrient content has immediate implications for blood pressure, fluid balance, and blood sugar. A high triglyceride level after a meal usually means that the person has the metabolic syndrome and is rapidly transforming dietary glucose into circulating, potentially dangerous fats.
A healthy lunch is not impossible to find. The choice is up to you. Please consider substituting the immediate gratification of fast foods for the delayed gratification inherent in longer life and better health. Which will you have for lunch?
None of these exotic lunches is available in the United States. Moreover, these meals are part of a total cultural experience. A visitor to New York City from Puerto Vallarta, Nepal, or Morocco would probably be fascinated by and drawn to the same fast food franchises that millions frequent every day.
When I was about ten years old, a drive-in hamburger joint named Wetsons opened on Empire Boulevard and Flatbush Avenue, near my home. My mother was shocked that anyone would deny himself or herself the pleasures of a home cooked meal for a boxed cheeseburger and greasy fried potatoes. Unfortunately this was the shape of things to come, as H. G. Wells might have said.
The shape of things to come might also have included the shape of 21st century Americans. Although you can download, print, or read the nutritional content of your local chicken/burger/pizza/hero sandwich menu, few people if any read the fine print.
Except in individuals with highly physical jobs, lunch should never exceed 500 calories. Inattention to caloric content has immediate implications for weight. Inattention to salt and/or macronutrient content has immediate implications for blood pressure, fluid balance, and blood sugar. A high triglyceride level after a meal usually means that the person has the metabolic syndrome and is rapidly transforming dietary glucose into circulating, potentially dangerous fats.
A healthy lunch is not impossible to find. The choice is up to you. Please consider substituting the immediate gratification of fast foods for the delayed gratification inherent in longer life and better health. Which will you have for lunch?
Monday, February 7, 2011
Notes on "The Park Avenue Diet Show: The Hidden Cost of Being Overweight"; February 6, 2011
"A tsunami of obesity" is how an editorial last week in the British medical journal The Lancet described the latest worldwide statistics. One in three people on Earth is overweight, one in nine people is obese. That this could happen in previously healthy, relatively isolated populations is indeed quite shocking. Even more frightening is the fact that the percentage of obese individuals doubled since 1980. "Worldwide" now has another meaning.
No one in the United States will be surprised since here the percentages of overweight and obesity are both 33%. We always stay ahead of the pack! At least initially, because residents of Pacific island nations currently have the highest BMIs on the entire planet. If Mutiny on the Bounty were being filmed today, the romantic scenes might not seem as glamorous.
Everyone will have his or her own explanation of this sorry state of affairs, whether socioeconomic, geopolitical, culinary, or biochemical. That doesn't change the fact that this "tsunami" is a mere harbinger of worse to come. As reported by various experts in the American College of Physicians, obesity is a risk factor for 40 illnesses in 9 different organ systems. Most people are aware of the most prevalent ones, namely hypertension, diabetes, high cholesterol, and circulatory illnesses. Yet obesity is unique in being directed implicated in breast cancer and prostate cancer, diseases worsened by diametrically opposite hormones. Also on this list: asthma, atrial fibrillation, colon cancer, sleep apnea, mood disorders etc...Such is the nature of visceral fat, a topic covered in depth elsewhere on this website and on the WOR radio show.
"The Hidden Cost of Being Overweight" refers to the various medications, emergencies, and hospitalizations due to the aforementioned illnesses. There cannot be a price on human suffering, for every life is precious--and good health is a priceless gift. The media at times have raised fear of global warming to a near hysterical pitch. In epidemic obesity, we have a health crisis that will affect younger generations within several decades. Meteorology is a most elusive science. Internal medicine is not, and unfortunately, things may have to get worse before they get better.
Just this once, please don't think about the rest of the world. Think about yourself !
No one in the United States will be surprised since here the percentages of overweight and obesity are both 33%. We always stay ahead of the pack! At least initially, because residents of Pacific island nations currently have the highest BMIs on the entire planet. If Mutiny on the Bounty were being filmed today, the romantic scenes might not seem as glamorous.
Everyone will have his or her own explanation of this sorry state of affairs, whether socioeconomic, geopolitical, culinary, or biochemical. That doesn't change the fact that this "tsunami" is a mere harbinger of worse to come. As reported by various experts in the American College of Physicians, obesity is a risk factor for 40 illnesses in 9 different organ systems. Most people are aware of the most prevalent ones, namely hypertension, diabetes, high cholesterol, and circulatory illnesses. Yet obesity is unique in being directed implicated in breast cancer and prostate cancer, diseases worsened by diametrically opposite hormones. Also on this list: asthma, atrial fibrillation, colon cancer, sleep apnea, mood disorders etc...Such is the nature of visceral fat, a topic covered in depth elsewhere on this website and on the WOR radio show.
"The Hidden Cost of Being Overweight" refers to the various medications, emergencies, and hospitalizations due to the aforementioned illnesses. There cannot be a price on human suffering, for every life is precious--and good health is a priceless gift. The media at times have raised fear of global warming to a near hysterical pitch. In epidemic obesity, we have a health crisis that will affect younger generations within several decades. Meteorology is a most elusive science. Internal medicine is not, and unfortunately, things may have to get worse before they get better.
Just this once, please don't think about the rest of the world. Think about yourself !
Tuesday, February 1, 2011
Notes on "The Park Avenue Diet Show: The Salt of the Earth"; January 30, 2011
I haven't touched a salt shaker since 1976 when, as a medical student at Maimonides Medical Center, I saw the immediate effects of sodium chloride on blood pressure and fluid retention. When was the last time you used a salt shaker? Did you stop in 1976 as well?
What were those early clinical experiences that so alarmed me? One had to have been repeatedly seeing elderly people rushed to the emergency room after a large salty meal. The patients were sitting upright gasping for breath, blue in the face, alarming their family and friends. Pulmonary edema, commonly referred to as "water in the lungs" was what these unhappy people were experiencing. There was literally a parade of ambulances and stretchers on Christmas Eve after the Feast of the Seven Fishes. That enormously salty meal resulted in fluid retention and terrifying medical emergencies.
Sodium chloride exerts its dangerous effects via an osmotic affinity with water. That's why the people almost drowned internally after overeating on Christmas Eve. The same osmotic effect is responsible for sodium chloride's ability to preserve food. Did you know that? When added to a can of recently cooked string beans, for example, salt will draw fluid from any nearby bacteria, thus dehydrating and killing them. This property has been known for thousands of years and is exactly why Austrian "cavemen" and Roman soldiers learned to use salt as a means of preserving fresh foods. It certainly was not added to make the items taste better.
How much salt do you need in a day? Very little, because our kidneys miraculously extract just the right amount from what we eat. Rarely can adding salt to food be considered life-saving or essential (the only examples of the contrary would apply to people who have fainted or have severe diarrhea or dehydration).
Since only 2,000 milligrams of sodium is recommended per day, why would anyone throw caution to the wind and eat foods that have unnecessarily high amounts included? I have no idea. Even the innocuous gesture of adding salt to water when making pasta needs some re-evaluation. Do you know why salt is added? It's to raise the boiling point of the water. In that way the pasta will cook more quickly and thoroughly, especially if it is preferred "al dente". If salt were added simply for taste, it could just as easily be added afterwards.
Salt and its effect on weight is well documented. The last thing that someone struggling with weight needs is fluid retention. Therefore please consider doing what I did in 1976 and give up table salt for the next thirty-five years. And in thirty-five years, ask me whether or not to continue this way.
What were those early clinical experiences that so alarmed me? One had to have been repeatedly seeing elderly people rushed to the emergency room after a large salty meal. The patients were sitting upright gasping for breath, blue in the face, alarming their family and friends. Pulmonary edema, commonly referred to as "water in the lungs" was what these unhappy people were experiencing. There was literally a parade of ambulances and stretchers on Christmas Eve after the Feast of the Seven Fishes. That enormously salty meal resulted in fluid retention and terrifying medical emergencies.
Sodium chloride exerts its dangerous effects via an osmotic affinity with water. That's why the people almost drowned internally after overeating on Christmas Eve. The same osmotic effect is responsible for sodium chloride's ability to preserve food. Did you know that? When added to a can of recently cooked string beans, for example, salt will draw fluid from any nearby bacteria, thus dehydrating and killing them. This property has been known for thousands of years and is exactly why Austrian "cavemen" and Roman soldiers learned to use salt as a means of preserving fresh foods. It certainly was not added to make the items taste better.
How much salt do you need in a day? Very little, because our kidneys miraculously extract just the right amount from what we eat. Rarely can adding salt to food be considered life-saving or essential (the only examples of the contrary would apply to people who have fainted or have severe diarrhea or dehydration).
Since only 2,000 milligrams of sodium is recommended per day, why would anyone throw caution to the wind and eat foods that have unnecessarily high amounts included? I have no idea. Even the innocuous gesture of adding salt to water when making pasta needs some re-evaluation. Do you know why salt is added? It's to raise the boiling point of the water. In that way the pasta will cook more quickly and thoroughly, especially if it is preferred "al dente". If salt were added simply for taste, it could just as easily be added afterwards.
Salt and its effect on weight is well documented. The last thing that someone struggling with weight needs is fluid retention. Therefore please consider doing what I did in 1976 and give up table salt for the next thirty-five years. And in thirty-five years, ask me whether or not to continue this way.
Monday, January 10, 2011
Notes on "The Park Avenue Diet Show: Log Cabin Exercises"; January 9, 2011
When Americans think of exercise, if indeed they do, it is viewed as a chore or a hardship or an unpleasant atonement for the sin of sloth. Our mechanized society, where transportation is totally automated and home conveniences make housework almost unnecessary, has resulted in epidemic overweight and obesity. But that's not true in other parts of the world.
Having traveled to remote, challenging locations throughout the world, I appreciate the role of daily exercise in the maintenance of good physical health. There are no weight-loss clinics in the villages near the highest Himalayan mountains. I took a two week trek to the base camp of Mount Everest about twenty years ago which I described to friends as the ultimate Stair Master. The Sherpa people, the famed indigenous population of this Shangri-la, do not suffer weight problems at all.
Even in the "lower" ranges of the Austrian Alps or the Moroccan Atlas mountains, everyone appears fit and trim. A walk to the local store in Badgastein takes one down a forty-five degree angled street for twenty minutes. No matter what Viennese pastry one might eat as a snack, it is thoroughly burned off after the ascent back to the train station. Was it worth it? I could hardly move my legs the day after I tried this for the first time, despite going to a New York City gym daily for twenty years.
According to the American College of Physicians, via their workshops and seminars, exercise is much less important than diet if someone is obese. Caloric control is therefore a necessary first step in any attempt to lose weight. However, as one gets closer to an ideal weight or a realistic goal, exercise becomes mandatory. Regular structured exercise is necessary for weight maintenance, for which reason I sometimes call those "last ten pounds" "exercise pounds".
All exercise programs must include strength training and cardio, and the most skillful personal trainers have learned how to teach these to their clients simultaneously. Attention must also be paid to flexibility and balance; these are extraordinarily important for aging baby boomers, especially those born in Brooklyn.
Are there psychological benefits to exercise? I feel that the ability of skeletal muscles to use lactic acid as a fuel (a property that must be developed through cardio exercise) makes an individual more energetic and upbeat. Other researchers feel that endorphins are released during exercise, but I favor the reduction of lactic acid levels as a biochemical explanation of the beneficial psychological effects.
A good personal trainer is not merely a human textbook of calisthenics. He or she must be a motivational speaker and somewhat of a psychologist. Most people who do not exercise need to be inspired, and this will jump start their participation in physical activity. For the 67% of adult Americans who are overweight or obese, this needs to be more than a temporary New Year's resolution. I didn't like to exercise at all when I was in high school and college. Then I grew up. Now it's your turn.
Having traveled to remote, challenging locations throughout the world, I appreciate the role of daily exercise in the maintenance of good physical health. There are no weight-loss clinics in the villages near the highest Himalayan mountains. I took a two week trek to the base camp of Mount Everest about twenty years ago which I described to friends as the ultimate Stair Master. The Sherpa people, the famed indigenous population of this Shangri-la, do not suffer weight problems at all.
Even in the "lower" ranges of the Austrian Alps or the Moroccan Atlas mountains, everyone appears fit and trim. A walk to the local store in Badgastein takes one down a forty-five degree angled street for twenty minutes. No matter what Viennese pastry one might eat as a snack, it is thoroughly burned off after the ascent back to the train station. Was it worth it? I could hardly move my legs the day after I tried this for the first time, despite going to a New York City gym daily for twenty years.
According to the American College of Physicians, via their workshops and seminars, exercise is much less important than diet if someone is obese. Caloric control is therefore a necessary first step in any attempt to lose weight. However, as one gets closer to an ideal weight or a realistic goal, exercise becomes mandatory. Regular structured exercise is necessary for weight maintenance, for which reason I sometimes call those "last ten pounds" "exercise pounds".
All exercise programs must include strength training and cardio, and the most skillful personal trainers have learned how to teach these to their clients simultaneously. Attention must also be paid to flexibility and balance; these are extraordinarily important for aging baby boomers, especially those born in Brooklyn.
Are there psychological benefits to exercise? I feel that the ability of skeletal muscles to use lactic acid as a fuel (a property that must be developed through cardio exercise) makes an individual more energetic and upbeat. Other researchers feel that endorphins are released during exercise, but I favor the reduction of lactic acid levels as a biochemical explanation of the beneficial psychological effects.
A good personal trainer is not merely a human textbook of calisthenics. He or she must be a motivational speaker and somewhat of a psychologist. Most people who do not exercise need to be inspired, and this will jump start their participation in physical activity. For the 67% of adult Americans who are overweight or obese, this needs to be more than a temporary New Year's resolution. I didn't like to exercise at all when I was in high school and college. Then I grew up. Now it's your turn.
Monday, January 3, 2011
National Diet Day
January 2nd has been renamed National Diet Day, at least in my own imaginary calendar. I invented this non-existent holiday 20 years ago as the Associate Medical Director of the Atkins Center when I noticed patients' remorse over dietary indiscretions during the holiday season. The same people who had over-indulged in eggnog, candy-canes, and Chanukah chocolates now felt sorry for themselves. And like penitents confessing a minor sin while omitting a larger one, they "promised to themselves" a more healthful future.
This is properly labeled a New Year's Delusion, something Dr. Stanley Krippner might call a negative personal myth. The mere act of "repenting" is a supposed antidote to the wretched excess of the past few weeks or months. Self-esteem is falsely boosted by the individual's newly found self-observation, as if that in itself melts the pounds away.
And then comes January 2nd, when one's conscience and seemingly the entire "diet" industry revs ups their engines to promote weight-loss plans for all palates and sizes. The American College of Physicians notes that 95% of these programs fail their followers...or is it the other way around? When an industry giant like [name redacted] promises weight-loss via lasagna, cookies, and pizza, who can resist?
You can, if you realize that none of these supposedly "nutritious" programs dare to publish their statistics of success and failure. In tiny type, there is a message flashed on your TV screen for a microsecond: "results not typical", which I rephrase as "it is not typical for you to get results", a perfectly legal recasting of their devilishly insincere message. Those exercise programs like [redacted] and [redacted]? January is an unusually busy month for sign-ups at your local health-club, but lifting the pen to sign a contract is unfortunately the last exercise many people will do there.
Without simultaneous attention to all the components of image, not just the one an overweight post-holiday dieter might focus on, nothing will ever be lastingly accomplished. National Diet Day (and Month, actually) is therefore a form of mock penitence that cannot lead to better health. Our bodies are not aware of any holidays; diabetes and its complications can occur at any time of year. The Angel of Death, unlike many public service union members, goes to work every single day.
My imaginary holiday, National Diet Day, is a reaction to the cyclical nature of many overeaters' thought processes--eat, drink, and be merry, for tomorrow you die(t). But for the 33% of adult American not affected by overweight or obesity, National Diet Day is every day of the year. And for them, the celebration of health--and life--takes precedence over the temporary pleasures of high calorie foods. Statistically, the better your weight is, the more likely it is that you will celebrate many more January 2nds. Now there's a great reason to say "Happy New Year"!
This is properly labeled a New Year's Delusion, something Dr. Stanley Krippner might call a negative personal myth. The mere act of "repenting" is a supposed antidote to the wretched excess of the past few weeks or months. Self-esteem is falsely boosted by the individual's newly found self-observation, as if that in itself melts the pounds away.
And then comes January 2nd, when one's conscience and seemingly the entire "diet" industry revs ups their engines to promote weight-loss plans for all palates and sizes. The American College of Physicians notes that 95% of these programs fail their followers...or is it the other way around? When an industry giant like [name redacted] promises weight-loss via lasagna, cookies, and pizza, who can resist?
You can, if you realize that none of these supposedly "nutritious" programs dare to publish their statistics of success and failure. In tiny type, there is a message flashed on your TV screen for a microsecond: "results not typical", which I rephrase as "it is not typical for you to get results", a perfectly legal recasting of their devilishly insincere message. Those exercise programs like [redacted] and [redacted]? January is an unusually busy month for sign-ups at your local health-club, but lifting the pen to sign a contract is unfortunately the last exercise many people will do there.
Without simultaneous attention to all the components of image, not just the one an overweight post-holiday dieter might focus on, nothing will ever be lastingly accomplished. National Diet Day (and Month, actually) is therefore a form of mock penitence that cannot lead to better health. Our bodies are not aware of any holidays; diabetes and its complications can occur at any time of year. The Angel of Death, unlike many public service union members, goes to work every single day.
My imaginary holiday, National Diet Day, is a reaction to the cyclical nature of many overeaters' thought processes--eat, drink, and be merry, for tomorrow you die(t). But for the 33% of adult American not affected by overweight or obesity, National Diet Day is every day of the year. And for them, the celebration of health--and life--takes precedence over the temporary pleasures of high calorie foods. Statistically, the better your weight is, the more likely it is that you will celebrate many more January 2nds. Now there's a great reason to say "Happy New Year"!
Monday, December 27, 2010
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?
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?
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