My grandfather’s problem was that he couldn’t adapt to the new
American conception of the doctor that had taken hold a decade before.
In the first half of the nineteenth century, the United States faced an
emerging physician surplus, as almost anyone could call himself or her-
self a doctor. By the second half of the nineteenth century, American
doctors were required to have actual training, but a glut of medical school graduates left the United States with twice as many doctors per capita as in England and four times as many as in France or Germany. At root, it
was a physician identity problem, with four competing schools of thought
over what a doctor should be. One school, exemplified by Dr. James
Jackson, cofounder of the Massachusetts General Hospital, said the doc-
tor was a gentleman. Another school, personified by Dr. Jacob Bigelow,
said the doctor was a technician. A third school, associated with educa-
tion reformer Abraham Flexner and the new Johns Hopkins University
Medical School, said the doctor was a scientist. A fourth school, person-
ified by Rev. Henry Spalding of Chicago’s Loyola University, said the
doctor was a benefactor. Each cluster of schools churned out graduates,
flooding the country with doctors and adding to the confusion. In 1910,
the Flexner Report on Medical Education ended the debate by giving rise
to a new vision of what a doctor should be. This new vision was a
compromise of the four schools. Henceforth, an American doctor was
part gentleman, part scientist, part technician, and part benefactor. 2
My grandfather failed in each category. As a scientist, he had fairly
decent medical training in Germany—in fact, one of his professors was
Röntgen, the discoverer of X-rays—but he didn’t look like a scientist.
Most American doctors had switched over to wearing white lab coats by
1915, to advertise their connection with science. My grandfather, howev-
er, continued to wear a dark suit, as doctors had in the nineteenth century.
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C H A P T E R 6
The suit made him look like a clergyman or, worse, a mortician. Prospec-
tive patients didn’t like it.
My grandfather’s office compromised his credentials as a technician.
Most American doctors’ offices were well-planned complexes by the
1930s. They included a reception room, a private office and consulting
room, a dressing room, a business office, a room for physical therapy
treatments, and an examination room. The examination room, in turn,
usually had an examining table, a stool, a floor lamp, an instrument
cabinet, a scale, a sink, and a waste receptacle. 3 My grandfather’s office was just one room. Instead of an examination table, it had a low-lying
twin bed. There was no stool. To perform a pelvic exam he would inglori-
ously bend down on his knees and then struggle to raise himself up
afterward. A weak overhead light substituted for a floor lamp. The instrument cabinet was poorly stocked and in disarray. The only sink was in the bathroom. None of this suggested technical competence.
The wooden desk and chair standing in the office corner gave prospec-
tive patients another reason for pause, as did the wooden floor. The
American public had learned the basic principles of antisepsis by this
period. Prospective patients expected medical office furniture and appli-
ances to be made of metal, often with white enamel coating, to allow for
easy cleaning. They expected floors to be linoleum for the same purpose.
The wood in my grandfather’s office was hard to clean and often stained.
Worse, wood was a living thing, like the germs themselves.
My grandfather was an intellectual and not a gentleman—failure
again. He was astute, but his astuteness often degenerated into profundity.
He liked to talk to patients about German philosophy even when they
didn’t want to listen. He also loved mechanical order and would exhibit
an almost mystic fidelity to a plan, making him rigid and inflexible. He
was the stuff out of which idealists are made, but also autocrats. Prospective patients thought him “too German” or simply weird.
True, my grandfather was a benefactor. He often took care of patients
for free or overlooked their unpaid bills. It is one reason why the family finances were in such a precarious state. But my grandfather misunderstood that to be a doctor-benefactor in the Land of the Dollar, he was
supposed to be a businessman without appearing to be a businessman.
The American doctor’s job was to feign a lack of interest in money while
making money all the same.
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My grandmother was poorly equipped to help him. Because the AMA
had erected a ban on physicians advertising, in accordance with the ideal of the gentleman-doctor, doctors had to be less direct in how they
drummed up business. Many physicians relied on their wives to gain
them patient referrals. At Garfield Hospital, auxiliary organizations were staffed with doctors’ wives who worked to improve the hospital (their
husbands’ place of business, after all) but also to connect with other
wives to influence their husbands’ referral patterns. My grandmother had
no such social acumen. She had been educated to be the wife of a German doctor, not an American doctor. She knew how to dance, play the piano,
and cook. She could rush to answer the phone and, with dignity, say, “Let me see if ‘the Doctor’ can speak with you,” or “No, ‘the Doctor’ cannot
speak with you.” She could tell the neighborhood children to keep quiet,
declaring, “There’s a doctor upstairs who needs his rest.” But that was all.
Her psychology was even less suited to business. She lived on her nerves; she was quick in emotion and sentiment, a prey alike to hopes and suspicions; she was excitable, but without an excitable person’s saving store of common sense.
By the late 1930s, my grandparents were close to losing their house.
One day, my mother, then a young girl, went with her father to help him
clean up his office. He sat in his wooden chair and cried.
“I’m sorry. I guess I haven’t been a very good doctor,” he said.
“Oh, Daddy, it’s okay,” my mother replied, trying to reassure him. Old
urine bottles sat on the cupboard behind her.
“I’m sorry. I’m sorry,” my grandfather said repeatedly, his eyes moist.
Fortunately, things ended well. A friend who understood my grand-
father’s personality found him a salaried position as a physician at the
Old Soldiers’ Home in Washington, D.C. 4 By the standards of the day, my grandfather was a failure as a doctor. The AMA saw “salaries” as an
acceptable method of payment for common laborers or civil servants but
not for gentleman-benefactors. Nor did my grandfather have an office in
his new position. But he did have access to examining rooms with proper
examining tables and linoleum floors. He could take care of patients
without having to hustle for a living. He could be himself and talk Ger-
man philosophy to old American soldiers, who were now his captives. He
was even given a white lab coat to wear, in homage to science. To friends and family he became a doctor in full.
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C H A P T E R 6
Twenty years later, my mother was vacationing at a Catskills resort. It
was
the last day of the season. Lying on her lounge chair at the end of the afternoon, she watched an ugly woman make one last trip around the pool
to catch a man’s attention before heading into the locker room. It was the woman’s last chance, her last plea for companionship, my mother
thought. But none of the men looked at her. On the trip’s final leg my
mother observed the woman’s crestfallen face and the silver strands in
her hair. My mother decided that she herself had better get married quick.
A month later, while working as a lab technician, she met my father.
They married the following year, on April Fools’ Day. But the joke was
on them.
Hitler once said that the war in the west, between the Germans and the
British, was a war of conquest, while the war in the east, between the
Germans and the Russians, was a war of annihilation. And so it was with
my mother, the German Jew, and my father, the Russian Jew: their mari-
tal fights were not mere spats, or even shouting matches, but wars of
annihilation. Each tried to destroy the other. Being a busy doctor, my
father had no need of excuses to keep away from home, thereby postpon-
ing the decisive moment, but both knew that one day the moment would
come, that they would have to divorce, although each was equally hesi-
tant to make the break, for their own reasons, even if each knew the break must come.
One evening in the early 1970s, my father arrived home just as my
sister, her boyfriend, and my sister’s school friend were teasing me in the living room. I was thirteen. My sister was fifteen. Her boyfriend was
often at the house, usually bringing his big dog with him and tying the
creature up to a sprinkler pipe outside. My father hated both the boyfriend and the dog. As for my sister’s school friend, southern California’s culture of sex and drugs had aroused an unhealthy curiosity in the girl when she was twelve; by the time she was fifteen she had the air of a dissolute, much too experienced woman. All of us grew up uncontrolled.
“Come here and kiss my cheek,” my sister ordered me. When I com-
plied, she squealed, “Ugh! So wet! No girl’s ever going to want to kiss
you.” Then her friend led me over to a mirror and maliciously said, “Kiss the mirror until you get it right. There should be no wetness on the glass.”
A T A L E O F T W O O F F I C E S
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For five minutes I dutifully did as I was told, until my father came
over and asked me what I was doing. I naively replied, “They said I don’t know how to kiss, and that if I don’t practice, the girls won’t like me.”
“Do you want the girls to like you?” my father asked me.
“Well, I don’t know,” I replied, uncertain and confused.
My father rolled his eyes. With a cynical, world-weary tone of voice,
he said, “Well, when you do, just wag a dollar bill in front of them.”
My mother overheard the comment and grew angry. When my father
sat down to dinner—alone, as the rest of us had already eaten—she
reached into the oven for two lukewarm burnt lamb chops that had been
cooked that afternoon. She put them on a plate, along with a scoop each
of soggy mashed potatoes and canned peas, and thrust the food in front of him as if he were a dog.
“Here you are—choke yourself!” she said to my father. She went back
to clean the counter with an expression of disgust.
“I work all day and this is all I get?” my father shouted.
“Maybe if you made more money, you could wag a dollar bill in front
of me. You might get a better dinner,” she hissed.
“I make enough money. A lot more than your father did. He was a—”
“You shut up about my father!” my mother interrupted.
“You shut up! If you threw some parties and got me more patients, I’d
make more money. Why can’t you be like the other doctors’ wives?” His
face grew as red as beetroot. “You lie around all goddamn day like a
martyr, telling me how tired you are from playing tennis!”
“You’re the one who told me to take up tennis!” my mother protested.
“So you could meet people and throw parties!” my father shouted
back. Then he proudly declared, “I’m doing well enough. When my new
office opens I’ll be doing even better.”
“I’m sick of hearing about your damn office!” my mother shouted.
“Well, I’m sick of you!” my father yelled back.
“Fine, go ahead and build your glorious office,” my mother said sar-
castically. She paused before delivering her knockout blow. “A real big
deal, you think you are. A Jew with plans, a Jew with ideas, a Jew who
thinks he’s going places. Ha!” she sneered in a mocking tone, looking at
my father through the derisive slits of her eyes.
A spasm of rage clutched at my father’s throat. He threw the dinner
plate on the floor and stood up, while my mother’s face grew increasingly purple and distorted. Suddenly the live-in Mexican maid walked into the
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C H A P T E R 6
room. Her presence worked like a cadmium rod in a nuclear reactor and
brought the two people back from the brink of explosion. My sister, her
friend, and her boyfriend dashed into my sister’s bedroom and slammed
the door behind them. I remained behind and turned on the television.
A pleasant warm breeze streamed westward from the desert, reinvigo-
rating the well-trodden grass around our driveway. In the air hovered the never ceasing buzz of bees and the metallic ringing of sprinklers. The
smell of honeysuckle mixed with the acrid scent of seawater. Quartz
crystals embedded in our house’s facade glittered in the sun.
Inside, while waiting for the party guests to arrive, my father went
over the plans for his new office. He had already purchased space in the
professional building. The complex was to have four examining rooms,
an X-ray suite, a laboratory, a lavishly decorated waiting room, a business office, a wood-paneled private office with an ocean view, a consulting
room, a library, three bathrooms, and a kitchenette. The furniture was to be all Duncan Phyfe.
The new office was my father’s dream. It went hand in hand with his
dream of being a doctor. Like my grandfather, my father loved being a
doctor. But unlike my grandfather, my father’s sense of identity as a
doctor was perfectly in sync with the American ideal. As a nod to science, my father always wore a white lab coat in his office. Indeed, he owned six white lab coats. As a nod to technology, my father always kept his stethoscope in his coat pocket, and always so that it was visible, even on days when he knew he wouldn’t need the instrument, because he believed it
was part of the doctor’s uniform. Also, my father had specialized and
become a hematologist. In his role as benefactor, my father gave free care to the poor and never advertised (even after physician advertising became legal in 1975), but, unlike my grandfather, he hustled, building himself a nice independent practice. In his role as gentleman, my father talked with patients without lecturing them (as my grandfather had). He was also
discreet with patients, sometimes even a little mysterious and impassive, radiating a polished aloofness that he had purposely acquired over the
years to keep patients at a distance, and that patients seemed to appre-
ciate, as it made him seem like a doctor and not just any person off the
street.
A T A L E
O F T W O O F F I C E S
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Small things, but to my father they summed you up as a doctor.
The décor of his new office was impregnated with all these themes.
The office was to have a library of medical journals, complete with back
issues, to remind patients that there, in science, lay the springs from
whence medicine drew its strength. The examining rooms were to have
the latest equipment, each machine so beautiful that nothing else was
needed in terms of decoration. Indeed, the chastity of the technical style worked on the principle that the essence of the thing not be spoiled with anything extraneous; the machines were the objects for which patients
came, so it made sense that only they be there. The waiting room, by
contrast, was faux European gentleman, evoking a blend of old manor
house covered with ivy, transoceanic steamer, and Versailles, and pur-
posely conveying to patients a sense of solidity and gravitas. When talk-
ing with patients in the similarly furnished consulting room, my father
would be as a landed proprietor, walking over his estates and talking with his tenants, learning the real state of feelings and needs.
What the office was not was a tribute to money. Some business offices are explicit tributes to money, more specifically to the cleverness, bold-ness, and ruthlessness that created the fortunes that made the offices
possible. Such offices awe people while also reminding them of the ele-
mental unfairness in life. My father’s office strove for the opposite feeling, to carry people on wings into a world where money is secondary and
to lure them away from capitalist thoughts with allusions to distant times and places where thoughtful benefactors once existed.
My mother was conflicted about the new office. On the one hand, she
took her identity as a doctor’s wife as seriously as my father took his
identity as a doctor. She volunteered regularly at the hospital. She felt like an important personage when patients muttered under their breaths as she
passed by, “You see that lady? She’s a doctor’s wife.” Sometimes she
would go to the hospital early, leaving me to get to school on my own.
(As a nine-year-old, before I could tell time, the end of a particular
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