The Good Doctor (3 page)

In Boston, he interviewed at Beth Israel Hospital, which had been founded in 1916 to serve a growing Jewish immigrant population who spoke primarily Yiddish and who kept kosher. By the mid-twentieth century, Jewish hospitals in Boston and elsewhere had opened their doors to a broad range of patients, and Beth Israel had become affiliated with Harvard. But these hospitals also served an unintended role: training Jewish medical students and residents who were excluded from Yale, Cornell, Columbia, and other prestigious hospitals that had secret quotas limiting the number of Jews. My father did not think he wound up at Beth Israel due to quotas elsewhere, but the hospital’s Jewish heritage made it a comfortable home away from home.

Today, residency interviews usually involve a thirty-minute chat with a single professor and only an occasional probing question. In the 1950s, however, would-be residents were grilled by committees of doctors, who assessed each young physician’s clinical knowledge and ability to think on his feet under pressure. For my father, a strong interview at Beth Israel and a supportive letter from T. Hale Ham, who had formerly been at Harvard, did the trick. In July 1958, the quiet, studious boy from Cleveland began his internal medicine residency at the famed B.I., as it was known—a “miraculous coup,” he wrote many years later. Of the nine other interns admitted to the internal medicine program, seven had come from Harvard Medical School, one from Cornell, and one from the University of Chicago. Western Reserve sent almost no students to Boston.

Residents are also known as house officers or house staff. In this case, the house is the hospital, which, in the 1950s, essentially served as a home for those training in medicine. Residents were on call as often as every other night. Many, like my father, lived in rooms either in or adjacent to the hospital, which provided easy access to work. The arrangement was a quid pro quo. In exchange for staffing teaching hospitals for countless hours at very low salaries, young physicians received top-notch training from renowned professors. They were also given tremendous autonomy in the care of nonpaying patients, who were at times callously termed
teaching material
and who often spent their hospital stays in large, multi-bed wards.

Fittingly, perhaps, many residency programs had explicit or implicit rules stating that residents—who were overwhelmingly men—could not be married. Spouses were seen as too distracting for physicians working long hours and weekends. Thus, it was completely unexpected when, in November 1958, my father eloped.

My mother, Ronnie, was a native New Yorker, born in Brooklyn in 1934 to Emanuel (Mannie) and Jessie Hober. Mannie, born in New York in 1901, was a real character. As a young man, he had been both a pool shark and an amateur boxer, claiming, perhaps apocryphally, to have sparred with the great Jewish lightweight Benny Leonard. During my childhood years, Mannie worked in a hat factory. Jessie, born in Poland in 1907, raised my mother and her older brother, Mark, and later worked in a women’s clothing store. When my mother was nine, the family moved to Framingham, Massachusetts, where my mother completed high school, after which she matriculated at the University of Massachusetts in Amherst. Interestingly, by moving to Framingham in the 1940s, my grandparents became a part of medical history. Both Mannie and Jessie were enrolled in the famous Framingham Heart Study, which eventually proved that high blood pressure, smoking, diabetes, and high cholesterol were related to the development of heart disease.

When my mother and father met, she had graduated from college and was a first-grade teacher. As usual, my dad ruminated on the role of fate when he thought of their marriage, which he called a “crazy miracle”: My father had been perusing the little black book of a fellow intern, who was a bit of a playboy, and he asked if he could call one of the women. The intern said yes, and my father randomly chose my mother. They went on a few dates, and at times, she would come over to Beth Israel at 10 p.m., when my father and the other house officers had a snack break. But my mom, beautiful and popular, had several other boyfriends.

One day, my very opinionated grandmother Jessie announced that she’d read in the newspaper’s horoscope section that it was time for Geminis to settle down. A Gemini, and ever the dutiful daughter, my mother contemplated which of her beaus would make the most suitable husband, and then, with Jessie’s approval, she chose my father. Prior to getting engaged, they had spent fewer than forty hours together. It was only years later that Jessie admitted she had made up the whole horoscope story.

The decision to elope stunned both families. The honeymoon itself, in New Hampshire, lasted all of two days and occurred only because a fellow intern volunteered to cover for my father. For my mother, it was a sign of things to come. For years, work would always come first for Dr. Lerner.

As one would expect, there were many luminaries at the Beth Israel. The chair of medicine from 1928 to 1962 was Hermann Blumgart, the first physician to measure blood flow and to inject a radioactive tracer into the blood for diagnostic purposes. Also on staff was Paul M. Zoll, a cardiologist who developed the first functional external cardiac pacemaker. But my father’s favorite attending physician was Louis Zetzel, a gastroenterologist who had originally intended to become a rabbi and who continued to make house calls until he was seventy-seven years old. “My idea of what a family physician should be,” Zetzel once said, “means his availability to his patients, even if this entails the inconveniences and interruptions of his private life.”

The 1950s has been called the golden age of medicine, as physicians, armed with a remarkable series of new treatments, saved or extended the lives of those who surely would have died only a couple of decades earlier. Integral to this perception was a fierce devotion to the science and scientific research that had contributed to these recent triumphs. “What’s new in
Wissenschaft
?” asked Columbia-Presbyterian’s Robert Loeb when interested house officers, students, and faculty members crowded into his small office at 7 a.m. for a daily informal discussion of developments in medicine.

Perhaps the most iconic image of this era is that of a large group of physicians decked out in their white coats surrounding a patient. At most hospitals, these doctors were by and large white and male. At times, a patient’s nurse—a woman—stood quietly near the revered group. Generally such rounds were led by a senior professor; the crowd included medical residents, medical students, and visiting physicians spending the day at the institution. Much ink has been spilled on the significance of the white coat. Although the phalanx of white may have inspired confidence in worried patients, it is surely also true that such rounds could be intimidating.

At Columbia, Loeb, who rounded seven days a week, was known for his fanatical devotion to all the patients—rich and poor—on the medical service. Being a doctor, he believed, meant knowing every last detail of their medical histories and their lives. Loeb imparted this philosophy to decades of trainees. A quote posted on the wall of Columbia’s Department of Medicine, attributed to internist and future Nobel Prize winner Dickinson Richards Jr., summed up this attitude: “Who is responsible for this patient and where the hell is he at?” This demand for excellence extended to medical students, who Loeb relentlessly grilled when he believed they had not adequately prepared. On more than one occasion, patients actually upbraided Loeb for being too tough on their “doctors.” Sure, Loeb was a martinet, Columbia cardiologist William Lovejoy once told me, but why shouldn’t he have been one? Patient care was “life or death.”

The opportunity to learn from great professors inspired generations of physicians. In my book on the history of breast cancer, I wrote about how William S. Halsted of the Johns Hopkins School of Medicine set up the first surgical residency program, training a group of surgeons who then became professors at hospitals across the country and who, in turn, mentored their own trainees. In this manner, it was possible to trace generations of surgeons back to Halsted. This kind of connection had many virtues, such as ensuring that important skills and knowledge were passed down, although, in the case of breast cancer, it also had the unfortunate consequence of ensuring that Halsted’s disfiguring radical mastectomy operation was used for far too long.

My father found his own mentor in his second year, when he was doing a hematology rotation at the New England Medical Center, Tufts University School of Medicine’s teaching hospital. With an hour to kill one day, he attended a lecture on meningococcemia, a severe blood infection, given by Louis Weinstein. Years later, my dad recalled having been “transfixed” at the precision and detail of Weinstein’s presentation. He had found, “by an incredible stroke of good fortune, the proper niche for my medical talents and teaching-research instincts, by falling under the spell of a mesmerizing, dynamic teacher who is fanatic, encyclopedic, opinionated, scholarly and demanding of his specialty and all those who aspire to it or intersect its vast boundaries.”

Weinstein typically spoke without notes or slides for an hour or more, peppering his lectures with memorable cases from his own career. He was a great storyteller. After the lecture, my father introduced himself to Weinstein and rather boldly asked if he needed an infectious diseases fellow one year later, when my dad completed his residency. Coincidentally, a spot had just opened up in Weinstein’s program.

But was my father the right person for the position? In his papers, I found a letter of recommendation written on onionskin paper by the chief physician at Beth Israel terming him an “outstanding” resident who was “well above average in professional capacity.” Even more important than the recommendation, however, was the old-boys network so prevalent in medicine in this era. Weinstein, it turned out, was good friends with Samuel Lewis, a Beth Israel neurosurgeon. As fate would have it, my dad had recently gone above and beyond with one of Lewis’s brain tumor patients, staying up all night with him. When Weinstein called Lewis for the scoop, the deal was done. It was telling to read this anecdote a half century after it occurred; new work-hour rules that truncate hospital shifts might well have prohibited what my father did.

Weinstein was truly one of the pioneers of the field of infectious diseases, “a bridge between the eras before and after the introduction of antibiotics,” according to one of his colleagues. Since Weinstein had trained as a microbiologist before becoming an internist, it would have made sense for him to go on to specialize in infectious diseases—but the field did not yet exist. However, there were still isolation hospitals for people with contagious and communicable diseases, and in the late 1940s and early 1950s, he ran one of them, the John C. Haynes Memorial Hospital, located just outside of Boston. Like the superintendents of the old sanatoriums for tuberculosis, Weinstein lived on the grounds of the Haynes with his wife and children.

It was at the Haynes that Weinstein became a great diagnostician, the skill that made him legendary and most attracted my father. There, Weinstein treated epidemics of several infectious diseases, including scarlet fever, pertussis (whooping cough) and diphtheria. In the case of diphtheria, which had been brought to Boston by soldiers returning from Germany in the late 1940s, Weinstein admitted many children whose physicians had missed the classic sign of the disease, the characteristic thick, yellow membrane coating the throat; those physicians had mistakenly diagnosed strep and prescribed penicillin, which is ineffective for diphtheria. But it was during two polio outbreaks—in 1949 and 1955—that Weinstein really made his mark, often starting rounds at six in the morning and not finishing until midnight. Among the polio patients he treated were four pregnant women who required ventilation with iron lungs. Despite several attempts, he was unable to get any Boston obstetricians to deliver the babies due to their fear of contagion. Fortunately, when Weinstein was a Boston University medical student on call at Boston City Hospital years earlier, he had fetched sodas and magazines for obstetrics residents in exchange for being allowed to deliver babies. So Weinstein himself successfully delivered the four babies—“one-handed,” he liked to brag—as he could not fit both of his hands into the tight confines of the iron lung.

By the mid-1950s, contagious diseases were on the decline. Among the reasons for this development was the growing number of antibiotics available—not only penicillin but the sulfonamides, streptomycin, and isoniazid for tuberculosis. Weinstein was one of many of his generation to witness miraculous cures: in the late 1940s, he saw a moribund girl with meningitis recover completely when given streptomycin. Previously fatal infections, such as pneumonia and sepsis, could now be conquered. As my father often remarked, these dramatic cures were one of the greatest appeals of the specialty eventually called infectious diseases. Other than surgery, there were few interventions in medicine that could so drastically improve the condition of a patient with a serious disease. There seemed to be no limit to what scientific research could achieve.

When it was time for Weinstein to leave the Haynes, he moved to Tufts and the New England Medical Center to continue his work, positioning himself as an expert on both infections and the choice of antibiotics. It was the birth of infectious diseases as a specialty, and when my father completed his internal medicine residency, in 1961, he continued his career as a fellow under Louis Weinstein. By this time, there was another Dr. Lerner on the scene—at least a future one. I had been born in September 1960.

In order to better demonstrate the type of medicine my father practiced and what a career in medicine meant to him, one can create a genealogy similar to that of Halsted and his trainees. The best place to start is with Halsted’s Johns Hopkins colleague William Osler, who was the world’s best-known internist in the late nineteenth and early twentieth centuries. At the time, the majority of physicians were generalists—comfortable treating most medical conditions—but Osler’s knowledge was unparalleled, as witnessed by his authorship of one of the era’s definitive textbooks,
The Principles and Practice of Medicine
. Osler was also an exceptional teacher who helped to revolutionize the Johns Hopkins School of Medicine and, as a result, medical school education. Finally, Osler was a great humanist, and he worried that specialization and overreliance on drugs could deleteriously deflect the attention of the medical profession away from patients. “The good physician treats the disease,” he wrote. “The great physician treats the patient who has the disease.”