One night, while I was lying in his bed, staring up at the fluorescent stars on the ceiling, he asked me, “What if somebody tries to rob a bank in the middle of the night?”
I thought for a moment. “An alarm would go off and the police would come,” I said.
“No, they wouldn’t. You’re just saying that. They couldn’t hear it.”
Sensing he needed reassurance, I said, “If the alarm goes off, the police get a phone call.”
“What if they’re sleeping?”
“There’s always somebody awake.”
“Always?”
“Always.”
He sighed, obviously relieved. “Oh, that’s good,” he said.
Gradually, as the weeks wore on, the pieces of our new lives started to fall into place. We built our first snowman, a grotesque, haphazard sculpture at the base of the driveway. We joined the aquatics program at the Jewish Community Center in Roslyn and started going for family swims on Saturday afternoons. I even restarted my evening runs, sprinting through air crisp and heavy with the fragrance of burning wood. Before long we were shopping for bathroom fixtures at Target on Saturday night. The white fluorescent lights and the immigrant families pushing metal carts transported me back to that time in my life when my parents would pile us all into their beat-up old Buick and take us to Kroger’s or Food Town. Buzzed on the scent of fresh-roasted chicken, Rajiv and I would race up and down the aisles with the grocery cart, grabbing boxes of frozen pizzas or TV dinners, tormenting my mother. I missed my parents. Despite all the obstacles they’d faced, they’d succeeded in creating stable and secure lives for their three children. There was a measure of comfort in knowing that I had come full circle, returning to what were more or less my roots.
We were reluctant travelers. We moved to the suburbs because we could no longer afford a certain life in the city. But against all my expectations, it has provided peace of mind, respite from the stresses of urban living, which quelled much of the anxiety I’d been living with. I quickly learned to savor the predictability, the fewer choices, the circumscribed nature of the experience. Just as cells integrate into the matrix in which they land, obeying signals that we can barely fathom, so, too, did we integrate ourselves into our new environment. In fact, I was probably a suburban guy all along. I just hadn’t known it.
We enrolled Mohan in a wonderful little school not far from our house. Most mornings I’d drop him off at class, and some afternoons I was even there to greet him at the bus stop. A few weeks after he joined, I ran into one of the school moms at drop-off. “How’s it going?” she asked pleasantly.
“Oh, you know, the same,” I replied with faux weariness.
She laughed. “Yes, I know. Same thing every day.” But I wasn’t bothered by the routine, and I suspect neither was she. The routine offered calm and security.
Though we had both grown up in suburbs, Sonia made the move out of the city more gracefully than I did, pulling me along whenever I faltered or lost heart. Perhaps she had been more ready to leave than I’d realized. By springtime she was saying stuff like “It feels like these trees are our friends, even though we cut their limbs off.” She made the frequent trips to Home Depot or Britton Hardware to make the house into a home, rushing home to take Mohan to soccer practice, stopping by Whole Foods to pick up groceries or dinner, multitasking constantly.
She also quickly got credentialed at LIJ and started seeing patients. I’d assured her that I would send her referrals, and so would Rajiv and his friends. By then I had learned to accept the referral game. At one time I’d viewed it as a racket to be avoided; now I saw it simply as realpolitik. Insurers can make doctors jump through hoops to get paid. They can tell patients which doctors they can see. They can restrict medications and tests. But they still cannot tell doctors whom or when we can ask for help.
One wine-soaked evening when we were relaxing in front of the fireplace after the kids had gone to bed, Sonia said to me: “Even our bad times have had some good in them. Remember when Mohan was Babydeep?” Her eyes watered, and mine probably did, too. “I’ve already forgotten. He is so much his own person now.”
Later she wrote me this note: “I just wanted to tell you how much I love and adore you. You are EVERYTHING to me: my light, my hope, my best friend in this funny journey. I think what I’ve always loved about you is how you always have long pieces of black curly hair falling over your prominent and shiny forehead. Little Mohan isn’t there … yet.” Relaxing that night amid bookshelves in the armchair in my tiny den, my kids in their animal pajamas asleep in their beds, I felt a contentment that had been missing for too long.
* * *
Rajiv invited me to join his tennis group. They hit every Sunday morning at an indoor tennis complex in Huntington, a community of steeple churches and conservancies about ten miles from where I lived. The first time I played with them was a few weeks after we moved. I left the house at 7:00 a.m. and nearly slipped on the front steps. The frigid air burned my bare legs. The wipers on my car were stuck, so I turned on the defroster and waited for the ice to melt. (Be patient, you cannot rush it. Things don’t happen immediately.) Gradually the car warmed up, and the frozen sheet on the windshield shattered into countless pieces.
Joggers in polychromatic Gore-Tex were out on the slushy road. I sped up Northern Boulevard, past the docks in Cold Spring Harbor, past the golf courses and plant nurseries and estates sequestered by iron gates and pointy yew hedges. Walking trails branched out from the roadway, ducking into the snow-shrouded woods. When I arrived at the court, Matt, a stent salesman at Medtronic and a former college player, was feeding balls to Rajiv and three of his doctor friends: Chaudhry, Gupta, and Goldner. “Nice shot, Confucius,” Rajiv called out to Gupta, a cardiologist in private practice, who was growing a beard. Gupta reached to hit a low backhand volley, which he dumped into the middle of the net. “For a man, you bend over well,” Rajiv taunted. Then he hit a passing shot. “There you go, baby. Can’t touch this!”
Matt was lobbing balls to Chaudhry. “No overheads,” Chaudhry protested. “My back is too stiff.” He was an enthusiastic, if stodgy, player, with the slightly awkward strokes of someone who had picked up the game as an adult. He turned his shoulders to protect his back, ironically just the right move to allow him to line up the shot perfectly. “Do that every time and you’ll be fine,” Matt told him.
Already drenched in sweat, Gupta came over to rest on the bench where I was stretching. Rajiv held up his hand to stop play. “Let up on him, Matt,” he said, grinning wickedly. “I’m on interventional call. If he has a heart attack, I’m going to have to leave.”
I took Gupta’s place on the court. Everyone greeted me pleasantly, though I could tell that Chaudhry was a bit uncomfortable with my being there. “All right, it’s the Jauhar brothers,” Matt announced as I hopped up and down at the baseline to warm up. “Let’s get some good old-fashioned competition going. I know Sandeep is not going to want to lose to your ass.”
Soon I was sliding from side to side on the Har-Tru as Matt fed us balls. Though I’d played a lot in high school and occasionally on weekends since moving to New York, my strokes were off, and I was hopelessly out of shape. “Move to the ball!” Matt commanded. “One bounce, one bounce!” After long rallies I’d crouch at the baseline, panting. Matt came over and instructed me on the proper form for my backhand. “Follow through,” he said, extending my arms upward. “Never stop in the middle. When you stop halfway, that’s the worst thing you can do.”
After about fifteen minutes of intense workout, my back started to spasm, and I had to lie down on the side of the court to ease the tightness. Gupta held up my legs, angling them to stretch the muscle, as I tried in vain to dodge the bullets dripping off his chin. “You’ve got to stretch more,” he said, while the others kept playing. He told me he did kung fu to stay fit. Crouching beside me, he told me to throw a punch at him, which he easily slapped away. Then his hands went into a rapid circular motion, and
before I could say anything, his right hand had grabbed my throat. “See, that’s how a tiger moves,” he said proudly. “You should try it sometime.”
When the hour was up, the others shuffled off the court. I overheard Rajiv and Chaudhry talking business on the sidelines. “It’s forty percent overhead, boss … no, we can get you the space. The tech will come in, but you need to establish the accreditation…” They walked up to where the rest of us were.
“When I leave here, I always tell myself I’m going to get into shape,” Rajiv said.
Goldner added: “Mine is the opposite reaction. I feel like I’ve gotten my exercise for the month.”
We started to gather up our wallets, watches, BlackBerrys, and beepers. Matt surveyed the accessories. “Take a picture of this, guys,” he said. “This is our lives.”
Rajiv slung his tennis bag over his shoulder. Pointing at Matt, he said to me, “He’s having a midlife crisis, too. What do you always say, Matt?”
“The older I get, the better I used to be.” Everyone laughed.
Rajiv and I walked out together to our cars. I told him that Sonia and I were planning our first dinner party for physicians. He quipped, “If you don’t get at least a couple of referrals out of it, it’s a waste of time.” I asked him how Chaudhry was doing. “The same,” Rajiv replied. “He says every day is a headache. He’s thinking about taking on another gig, reading studies for some doctor named Hasani.”
“Hasani?” I was nonplussed. “I thought Chaudhry hated Hasani.”
“Who’s going to turn down a chance to make more money?”
“When you’re making as much as he is?”
“It doesn’t matter how much you make. Most people want to make more.”
* * *
One night in Mohan’s room, I banged my knee on his bedpost and cried out in pain. Later he asked me why dads don’t cry.
“Sometimes we do,” I said.
“When?”
“Like when we’re happy. Like the first time you scored a goal in soccer, I got a tear in my eye.”
“What about when you get hurt?”
“Not so much.”
“Why?”
“I don’t know. The tears get dried when you get older.”
“Do you try to cry?”
“No, but even if we did, the tears wouldn’t come out.”
“Because you use up all the tears in your tear ducts?” he said, showing off some knowledge he’d acquired.
“Yeah, I guess so,” I replied, chuckling.
“That’s good,” he said, settling into his pillow.
I put on a Beatles song, as I often did when putting him to bed.
“This song reminds me of going to the park in New York,” he said.
“Yeah, when we were lying on the grass. Do you remember?”
“Yes.”
“Do you miss the park?”
He thought for a moment. “Not really.”
I felt relieved. “This song reminds me of when I was younger,” I said.
“When?”
“When I was in college, before you were born.”
“Before I was born?”
“Yeah, I wasn’t always your dad.”
For a moment he didn’t say anything. Then he said, “Did you want me to be a boy or a girl?”
I laughed. “I wanted a boy. And I got you. I didn’t just get a boy; I got the best boy.”
He smiled. I switched off the light. We were lying in the dark. “Dad?”
“Yeah.”
“If you’re bored, instead of putting me to bed, you can just go do your computer.”
“That’s okay, Mohan, I like putting you to bed. Remember when I never had time to do that?”
“Now you do it all the time.”
“Well, I love spending time with you.”
“I love spending time with you, too, Dad.”
He turned and put his hand on my shoulder. I stroked his head and told him to go to sleep.
* * *
The Huntington Historical Society was doing an exhibit about Long Island medicine. It was in an old farmhouse on a quiet street of quaint shops and galleries not far from where I played tennis. The exhibit featured a former chief of obstetrics at Huntington Hospital named Samuel Teich. Born and educated in Huntington, he joined the army in 1940 and landed at Normandy on D-day, for which he was awarded the Bronze Star for bravery. When he came home from the war, he hung up a shingle in Huntington Station and started a private practice. He became the chief surgeon of the Huntington Police Department and eventually the chief obstetrician at Huntington Hospital, which had opened its doors only three decades earlier.
Teich’s career spanned an era of great change in medicine. A big shift, thanks to the GI Bill, was the rise of specialists. In 1940, three-quarters of America’s physicians were general practitioners, but by 1960 specialists outnumbered generalists, and by 1970 only a quarter of doctors counted themselves general practitioners. (Today the trend away from primary care continues, threatening access to care for millions of Americans.) Physicians’ average salary (corrected for inflation) increased dramatically over this period, too, and the average net profit from private practice quadrupled. This increase paralleled an equally dramatic rise in national medical expenses, from $3 billion in 1940 to $75 billion in 1970.
The venue of care also shifted. In 1930, 40 percent of encounters between doctors and patients took place in patients’ homes. By 1960 that number had dropped to 10 percent. In 1935 half of all births presided over by doctors were home births. Twenty years later, only 4 percent of all births took place at home. In the early 1930s, only one physician in sixteen worked in a hospital full-time. Today that number is more than 50 percent and rising as hospitals and health systems, eager to acquire more leverage in negotiating contracts with insurers, rapaciously buy up private practices.
Perhaps the biggest change has been in the doctor-patient relationship. The exhibit showed a replica of Teich’s examination room, like my grandfather’s, with old-fashioned instruments, evoking a bygone era: an exam table with wooden stirrups, a cystoscope, a hemometer for estimating blood counts, an old-style wicker baby scale. There were photographs of Dr. Teich with nurses in white vestments and white hats. On display were Christmas cards with pictures of some of the ten thousand babies Teich had delivered, some spanning three generations. But most striking were the scores of patient testimonials. “We shall always remember you as a friend, and it is a privilege to know you,” a patient wrote. “Some Saturday we shall grace your office just to say hello. We have planned that for a long time, but it is not so easy to borrow a car.” Another said: “I am enclosing a check in your favor for the amount of one hundred dollars, as an additional payment on account of the services you rendered us and for which your statement has never been received. I have no idea of the actual amount in dollars and cents, but I am convinced that any further payments that may be required to balance the books would indeed be a very poor substitute for the feeling of gratitude that we bear toward you.” And another (in May 1964): “Words are inadequate. My husband and I were heartbroken when we lost the other baby, but now we have a beautiful, bouncing baby boy. You were so kind and thoughtful all through my pregnancy that I felt I just had to say thank you again.”
Doctors in Teich’s era, practicing on the heels of revolutionary medical advances, commanded unusual respect and influence. However, as Dr. Abigail Zuger argues in a 2004 article in The New England Journal of Medicine, this golden era was probably an aberration. Several nineteenth-century American doctors wrote in their memoirs of their fathers’ “contempt” and “disgust” on learning that they had decided to enter medicine. One doctor, writing in a medical journal in 1869, called medicine “the most despised of all the professions” for educated men. At the beginning of the twentieth century, medical education was not standardized. Quacks routinely cut into doctors’ business. In 1913 the American Medical Association estimated that no more than 10 percent
of physicians were able to earn a comfortable living. “A doctor’s life is made up of moments of terrible nervous tension,” wrote a physician in the early twentieth century. “There are times when the powers to continue such a life are entirely exhausted and you are seized with such depression that only one thought remains—to turn your back on all and flee.”
Gauging our professional lives by the short-lived golden era of medicine is a bit like judging a marriage by a honeymoon. Expectations are impossibly high, a recipe for dissatisfaction. Fulfillment in medicine, as with any endeavor, is about managing hopes. Probably the group best equipped to deal with the changes racking the profession today is medical students because they are not so weighed down by their expectations. It is the doctors ensconced in professional midlife who are having the hardest time. Of course, there are many factions to blame for the state of American medicine—insurers, malpractice lawyers, the federal government—but doctors must take a hard look at themselves, too. Managed care alone didn’t create medicine’s midlife crisis. Indeed, this crisis was also spurred by the abandonment of professional ideals in the pursuit of profit that made managed care necessary in the first place.
* * *
Today I am living my life in archetypal roles: often doting father, occasionally reserved husband, at times discouraged doctor. There are recurring patterns in our lives, in the characters that we play. In thermodynamics the triple point of a substance is that temperature and pressure where three phases (gas, solid, and liquid) coexist. This feels like the point I am at in my midlife: husband, doctor, father—all in uneasy equilibrium. I am learning to be more modest in my expectations and more humble in my ignorance. Like my father, I have begun to appreciate that the old wisdom has a lot to offer.
Of course, I wish I’d more consistently lived up to my youthful ideals. I’ve made the same compromises that Rajiv, Chaudhry, and others have made and continue to make. But tolerance develops for life’s circumstances, especially if they develop slowly. In congestive heart failure, if cardiac pressure increases gradually, the left atrium enlarges and becomes more compliant, thus able to accommodate the increased volume of blood. It is only when the pressure increases rapidly that the patient crashes and burns.
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