Into the Magic Shop

by James R. Doty, MD

  Her heart stopped beating just seconds after her baby boy was born.

  They don’t give you any training in medical school on how to tell a husband and two young children their wife and mother is gone. You can’t be human and not feel the pain of the relatives. Wave after wave of grief, anger, denial, and despair. That is why so many doctors will simply say, “I did all I could. I’m sorry.” Then they will immediately walk away, leaving a hospital chaplain or other staffer to pick up the broken pieces. There is nothing matter-of-fact in telling a husband his wife has died. No sorry that can ease the pain of a child who can’t begin to fathom that this one horrible day means his mother will never make him a peanut butter sandwich again, or read him a story, or kiss and cuddle him after he’s fallen down.

  I took Noel’s husband aside and told him what happened. He closed his eyes, reached out to me, and wailed a horrible cry of pain and despair. There was nothing I could do but hold him as he cried. The two children, seeing their father cry, also began to wail. I did my best to make space for this family’s grief. I tried to tell Noel’s husband about the baby, but he couldn’t hear anything beyond the hard truth that his wife was gone.

  As I sat there with them I noticed that the front of my surgical scrubs was splattered with tiny drops of blood. Noel’s blood? Blood from the baby’s forehead? Did it matter? It’s hard to celebrate a birth when you are grieving a death, but isn’t that what it all comes down to in this life? We are born and we die, and everything that happens between the two can feel so random it defies logic. The only choice we have is in how we respond in each precious moment we are given. In that moment, there was nothing but pain, and my choice was whether to offer comfort and share the pain or to walk away.

  I stayed with them, but for how long I don’t know. I just know I was there for them as best as I could be.

  Noel’s brain had died and all those functions each of us take for granted ceased. And here was her son whose brain was now experiencing the reality of the world for the first time. Again the randomness and arbitrariness of the world. Our experiences and our environment shape us all, and my hope was that this family would recover from this tragedy, and this baby would not carry invisible wounds from the story of his birth and the randomness of his mother’s death.

  It wasn’t my first death as a surgeon, nor would it be my last. It also wasn’t the first time I had walked away from a family with blood on my clothing.

  The first time that happened I was going off to college, and the family was my own.

  • • •

  THE NEWS I had been accepted to UC Irvine was met with both excitement and disbelief by my parents. I had talked about going to college, but I don’t think they had connected my desire with the reality of me getting accepted and leaving. As the date of my departure approached my father disappeared. Whenever there was stress or a significant event was about to occur, my father couldn’t handle it and left to have his fear and his anxiety lessened by his drug of choice, whiskey. The night before I left to go off to college, I paced around our tiny apartment with excitement and nervousness. Everything I owned could fit into one large duffel bag, and I was all packed by bedtime and ready to make my escape the next day. I was even sleeping in the clothes I was going to wear during the ride to Irvine just so I wouldn’t have to pack anything else in the morning or leave anything behind. I wasn’t sentimental or nostalgic. I was just ready to leave. My father had now been gone for almost a week, and while he knew the date I was to get on the bus to Irvine, I wasn’t sure if I would see him before I left.

  I told myself I didn’t care. But I did. I loved my father with all his failings. When he was sober and present, he was funny and smart and kind. He was my dad.

  It was around three in the morning when I heard the yelling and pounding and then more yelling. My father was at the front door, extremely drunk from the sound of things, and locked out.

  My mother stumbled out of her room in her bathrobe, and I saw the terror on her face. She didn’t make a move to open the door, and I could see her staring wide-eyed at the front door. She put her hands up to cover her ears, and I could see that she was shaking and trembling. We debated calling the police.

  The yelling outside the door grew louder, and I knew it wouldn’t be too long before someone else called the police. I had a bus to catch in a few hours and I didn’t want to miss it because I had to spend the rest of the night dealing with the police as they arrested my father. I took a step toward the door just as my father kicked his foot through the cheap plywood, splintering the door almost in half. I saw his arm reach in and turn the knob.

  He stepped through, yelling even more loudly than before.

  “Goddamn it—don’t you ever lock me out of my own house again!” he screamed, looking straight at me. His face was contorted and his eyes were dark and wild. My mother began to move to the corner of the room, and this caught his attention.

  “Why the hell didn’t you open the door?” He began moving toward her, and she quickly started backing up until she was up against the wall. I had never seen my father this angry. Usually when he drank he would just eventually pass out. He had never been physically violent.

  “Don’t go any closer,” I heard myself say. I wasn’t sure if he heard me or not, and he took another step toward my mom, who looked like a little fluttering bird inside her oversize bathrobe. I had never stood up to him before. We had all been complicit in accepting his behavior and his drinking. But it wasn’t acceptable any longer. Not this time.

  I stepped between them and yelled louder to get his attention. “If you move one step closer, I’m going to have to hit you. I will, I really will.”

  He ignored me and took another step toward my mother. It felt like I was moving in slow motion or trying to move underwater as I stepped forward and raised my arm. I made a fist and aimed for his nose. I heard and felt the bone crack. Then he fell, hard, like a tree.

  My mother screamed, and I watched him land on his face as blood spurted and splattered everywhere. I could smell alcohol mixed with a tangy, coppery, metallic smell that I knew was blood.

  Lots and lots of blood.

  The bile rose up in my throat and the nausea was overwhelming. I lurched my way to the bathroom, barely making it before the vomit came. I kneeled in front of the toilet and murmured the closest thing to a prayer I have ever said. Help me. I wiped my mouth with my sleeve and returned to the living room. My father was still facedown, not moving. Had I killed him? I turned him over. Blood and snot streaked his face. I had never seen so much blood. His nose was off-kilter and twisted awkwardly to the left side of his face. What a mess, I kept thinking. What a terrible mess.

  I heard him moan a little, and as he regained consciousness, I put his head in my lap. I didn’t even realize I was crying until I saw a tear land in a small pool of coagulating blood on his cheek. The punch had sobered him. He slowly looked up, and he studied me in a way I’d never seen before. He said, “It’s OK, son. It’s OK.” My mother continued to cry, but I wiped my eyes dry. In that moment, I knew that everything would be different between my father and me.

  It was now 6 A.M. and my bus was leaving at 7:30. My mother was attending to my dad who was now pretty sober and sitting in the chair drinking coffee with cotton balls stuffed in his nose. He looked at me again and then looked down. My mom told me she didn’t want me to miss the bus. And in that bizarre moment I kissed them both, gave them a hug, and walked through the splintered front door and left home for college. As I was walking toward my friend’s car, my ride to the bus station, I noticed some blood spattered on the front of my pants. It was too late to go back and change. And anyway all my clothes were in the duffel bag. I wasn’t sure what the good-byes were like for other kids going off to college for the first time, but I was pretty sure it wasn’t anything like this.

  • • •

  EVEN THOUGH I had been accepted
into college, I was ill prepared for juggling my full-time job with classes and studying. I also rowed crew—determined to get my letterman’s jacket. Year after year, it seemed like I studied harder than anyone else—just to get a passing grade. I rode the bus from Irvine to Lancaster often during the first few years of school, and other times I hitchhiked. Even though I worked hard, the weeks I left school to take care of my mother, manage my father, or help them dig out of one crisis or another added up. When the time came to apply to medical school, not only did I have a GPA of 2.5, it looked like I wouldn’t even graduate. As a premed student, I was failing miserably. The average GPA for acceptance to medical school at that time was almost 3.8.

  I still felt deep down that I would become a doctor. The image of me in a white coat wasn’t imaginary; it felt as real to me as if I were looking at myself in a mirror. For almost seven years I had mapped that image onto my brain, and not making it a reality was unacceptable to me. And even though this was a reality in my mind, I found that several of my fellow students were happy to remind me that with my grades I would never get into medical school. Unfortunately, so many people allow others to decide what they can or cannot do. This was another gift that Ruth gave me—the ability to believe in myself and accept that not everyone will want me to succeed or accomplish great things. And how to be OK with that reality and not react to it.

  The process of applying to medical school began at the end of my junior year. I discovered that part of the application process for UCI students involved obtaining a letter of recommendation following an interview from the premed committee. I dutifully went to see the premed committee secretary to schedule my interview.

  I can still see her clearly in my mind, now over a quarter century later, as she pulled out my file and perused it briefly, then looked up at me in a dismissive fashion and went back to flipping through pages. Finally she closed the file and said, “I’m not scheduling an interview for you. You’ll never get into med school. It’s just a waste of everyone’s time.”

  I stood there dumbfounded. Getting a letter from this committee was imperative. It was the first step in a long list of steps I needed to take in order to apply to medical school. After that there would be application forms to fill out, essays to write, and then hopefully an invitation to interview at a medical school. There were hoops to jump through, and all I wanted was a chance to jump through them.

  I took a deep breath. “I appreciate what you said, but I want an appointment.”

  “I can’t do that. You don’t qualify.” She tapped her finger up and down on the file.

  I knew I was so much more than whatever was in that file. That file wasn’t me. That file didn’t show that I worked twenty-five hours a week while carrying a full load. It didn’t show how many times I had left school to deal with complex family issues. It didn’t show me getting up every morning at 5 A.M. to row. It really only showed one thing—my GPA—and if that was the only criterion for receiving a letter of recommendation, then the secretary was right. I would never get into medical school. But that file wasn’t me.

  Ruth had taught me as much, and my continued practice had helped me discover it for myself. She had also told me that I never had to accept the unacceptable. I had to fight for myself. I had overcome too many obstacles, and there was no way this committee was going to stop me. I had to talk to them.

  “That’s unacceptable.”

  “Excuse me?”

  “I’m not leaving here until I have a meeting with the committee scheduled.” I said this calmly and quietly, and I stared directly into her eyes.

  “I really . . . can’t do that,” she repeated.

  But I had heard a slight hesitation in her words, a gap that gave me hope. “Look,” I said, “I know I don’t qualify. I know you usually don’t do this. But you can do this. I just need a chance.”

  She shook her head again.

  “I’m not trying to waste your time or the committee’s time, and I’m not trying to be difficult. It’s just that I’m really not leaving here until I have a meeting scheduled. I don’t care how long I have to wait. I just can’t accept that I’m a lost cause. I won’t accept it.”

  There was no anger in my voice, and I think she must have heard the absolute conviction and truth in my words. She stared into my eyes for almost a minute.

  “OK,” she finally agreed. “Next Tuesday, three o’clock.”

  “Thank you. I really appreciate it.”

  As I turned to leave the office, I heard her mutter her final words on the subject. “This is going to be interesting.”

  On the day of the meeting, the dean of the School of Biological Sciences took the place of one of the regular committee members. Apparently he was intrigued, and my audacity in demanding an appointment had spread throughout the committee.

  The secretary greeted me solemnly and opened the door into the conference room. A long, rectangular table was at the far end of the room, and the three professors including the dean sat stone-faced, arms folded, at one end. Not a single smile. Each had a copy of my file and transcripts in front of them. There was a single folding chair for me at the other end. Three to one . . . it didn’t seem fair. I was twenty years old.

  I walked in, looked around, and realized this wasn’t a meeting. It was an inquisition.

  And I was the heretic.

  “Mr. Doty,” began one committee member, a chemistry professor whose class I had barely passed the previous semester. “You have several incompletes in classes, and your academic record does not indicate that you will even graduate much less be a successful candidate for medical school. It does not indicate that you will be a successful medical student or hold any assurance that you have the discipline or intelligence to be a physician.”

  “I believe this meeting is really a waste of time for everyone here. Can you convince us differently, Mr. Doty?” said another member of the committee, a female professor known to be very tough, although I had never met her before. “I appreciate that you forced the secretary to schedule this appointment, but expecting us to recommend you for a profession for which you have zero chance of success is the height of arrogance. Medical school is extremely competitive, which I’m sure you are aware, while your GPA is not.”

  I looked to the dean of the school. But he said nothing, just stared at me curiously. He was only there to observe.

  “I would like to say something,” I said.

  “We have other meetings scheduled, and you are free to make your case, but make it brief.”

  The folding chair I sat in was small, and reminded me of the chair I had sat in for hours across from Ruth in the magic shop. Ruth taught me not to let circumstance define me. Not to let other people define my worth. Yes, there was no doubt that my grades were terrible, but there was more to it than that. I took a deep breath and stood up.

  “Who gave you the right to destroy people’s dreams?” I paused for a moment and then continued. “When I was in fourth grade I met a man, a physician. He planted a seed in me that someday I could become a doctor too. It didn’t look likely. No one in my family had ever gone to college. No one had ever been a professional of any kind, much less a medical professional. In eighth grade I met a woman who taught me that anything is possible if you believe in yourself, if you stop the voice in your head that tells you who you are is based on who you were. I grew up poor. I grew up alone. My parents did the best they could, but they had their own struggles.”

  I looked at the committee members. The two professors still had their arms crossed, but the dean had leaned forward a bit. He gave me a slight nod to continue.

  “I have had this dream for most of my life. It has driven me. Sustained me. Been the only consistent in my life. Yes, I haven’t always had the best grades, but not everything has been in my control. I have worked as hard or harder than most, and even if my record doesn’t show it, I will guarantee you that
there is no one who has come before this committee more determined than I am to succeed in medical school.”

  I looked at these three who held my future in their hands. Two of them didn’t seem to be listening, and for the first time in a long time I felt fear and anxiety course through my body. I knew this feeling. It was what the first twelve years of my life had felt like. My heart began racing. I felt like that lost boy all over again, and the doubt began to drift through me like mist in a fog. Who was I to think I could become a doctor? These were the people who knew best. And then suddenly I could hear Ruth’s voice in my head telling me to open my heart. I closed my eyes, and I saw Ruth’s smile. You can do it, Jim, she said. You can do anything. You have the magic inside you. Let it out.

  I continued to pour out my heart for what felt like forever. I told them about growing up poor and my struggle to get into college. I told them about my mother and my father. I told them about the many times I had to leave school to take care of my parents. I told them about how hard I worked in school just to maintain my grades and stay enrolled. It was amazing that I was even standing before them wanting to go to medical school, and I did everything I could to make them see just how extraordinary it was. “You know there is not one shred of evidence that a high GPA correlates with being a good doctor. A high GPA doesn’t make you care. Every single person, at one time in life or another, needs a chance to do something no one else believes is possible. Each of you here today is here because someone believed in you. Because someone cared. I am asking you to believe in me. That’s all I’m asking. I am asking you to give me the chance to become who I dream of becoming.”

  There was silence for a moment when I was done. They told me they would consider all that I had said.

  The dean then stood up and shook my hand. “Jim, I think you have given us a perspective that too often we ignore. We forget it’s a human being who sits before us, not a file. While many have fulfilled all the criteria we require, in many ways, the criteria are arbitrary. It took nerve to come before us. It took passion and bravery to share what you shared. You don’t give up, do you?”