Secular Days, Sacred Moments: The America Columns of Robert Coles

July 19, 1997. The doctor who is sick now turns his students into the kind of physician he himself has been with others.

 37 july 19, 1997 The doctor who is sick now turns his students into the kind of physician he himself has been with others. A friend of mine from medical school, now an internist in St. Louis, recently sent me a videotape of a meeting between his brother, also a physician, and some first-year students at Washington University’s School of Medicine. The students are there to talk with a longtime, much-revered doctor and teacher who (they know) is suffering from an incurable cancer that is well on its way to claiming full victory. Even so, this afflicted man in his sixties looks well for his age; he has a full head of dark brown hair that shows no sign of graying, and he is in fit shape. On the other hand, as he talks it is clear that he can’t take breathing for granted—and, of course, the telltale sign not only of his distress, but his vulnerability, his jeopardy, is a plastic tube wrapped around his head, which supplies him with much-needed oxygen. Soon enough, we learn that this hardworking, conscientious, and sensitive physician, who for many years attended hundreds of patients with great care and much medical success, had diagnosed his own disease —cancer of the lung, even though he was a nonsmoker. We meet him well into that illness—symptomatic but ambulatory, to slip into clinical language. He is a forceful, insistent teacher eager to conduct a seminar, 38  and his students are very much the composed yet eager young men and women who nowadays attend our medical schools: hugely privileged (the competitionforadmissionisfierce,statisticallystaggering)butrestrained bytheirobviousrealizationofhowverymuchtheyhavetolearn,nomatter their previous proven abilities. At first the discussion is conventionally academic: the old comparison of coronary heart disease and cancer—the former with its often quick conclusion,thelattersocommonlyrelentless.Theteacherobserveswisely but with a clinician’s detachment that a sudden, fatal coronary seizure can be hard for families—no time to say good-bye to someone who has unexpectedly expired. In contrast, cancer can be terribly demanding on those who suffer from it (the day-by-day awareness of a finality that won’t be deterred), though the patient’s kin do get a chance to come to terms gradually with the prospect of approaching death. Soon enough, however, the students and the teacher are no longer talking in the abstract but concretely: how does this person, the man before them, manage these days—he who is steadily and surely losing the battle for his earthly existence. Now the voice tightens, the body becomes more mobile, the words pour forth with greater volume and urgency. We hear an alert, knowing teacherexpoundonthedyingpatientfromboththedoctor’spointofview and the patient’s. Hope matters, we are told—yet many cancers cannot be stopped. They are slow killers. Patients try hard to rid themselves of that kind of knowledge. The resort to “denial” (that word a banality of our time) is harder for a physician, especially one who is not prone to fancy or illusion. This doctor, a sensible, practical realist and a thoroughgoing rationalist, has seen through so much denial in his patients that it can’t quitesustainitstemptingholdonhim—thoughheconfessestonear-miss  39 moments, when he was almost able to persuade himself that he wasn’t so sick, after all, and that he was on the road to recovery. Moreover, “denial” isn’tnecessarilysomethingtobecondemnedoutofhand.Anexperienced internist reminds his students (and himself) that when patients begin to losehopeandseetheendasaroundthecorner,theylosegroundphysically, as if the body nods acquiescence to a despairing mind. What to think, to feel, under such circumstances? This knowing healer of others, now himself going through a last illness, rejects a traditional religious point of view—an afterlife as propounded by biblical Christianity. He foresees his survival as a remembered person in the thoughtsofhisfamily,friends,patients,thoughheissensibleandsensitive enough to allow that the immediacy and intensity of those memories will yield to time’s erosions—so that forgetfulness will inevitably bring him down, so to speak, a second time. All he can do, then, is talk the matter out—even as he tells his students that all they will be able to do, come their time as physicians, is hear out their future patients as they struggle with their dread of an exit from this human scene. Irony has multiplied: The doctor who is sick now turns his students into the kind of physician he himself has been with others—they listen and listen as he talks and talks, ever more poignantly, insistently. At one point...