The Good Doctor (9 page)

Meyer was actually the third of the five grandparents who had been present at my 1973 bar mitzvah to die. Ben, Meyer’s father, went first, in July 1974 at the age of eighty-six. Fittingly, given the role that religion had played in his move to America and the raising of his family, Ben died, presumably of a heart attack, at the local Jewish community center where he spent a few days a week “flirting with the old ladies.”

Although I would eventually be a historian, I was not one yet. I don’t recall ever asking Ben for tales of his life in Poland or while struggling to make a living in America. Writing this book, I have realized what a pity that is.

Mannie, my mother’s father, was the next to die, in 1975. He and Jessie, who we called Poppa and Nana, had moved from Framingham in 1972 and joined us in University Heights. Soon after their arrival in Cleveland, Mannie began experiencing memory problems. The cause was probably a series of small strokes, as opposed to Alzheimer’s, but after a while, he could no longer go unaccompanied to the nearby Cedar Center shopping area. His confusion gradually worsened. The cause of Mannie’s death was never officially determined but it was likely due to a piece of intestine that had died, leading to septic shock and then the failure of the kidneys and other organs. It was the first family death that I would observe my father manage. At the age of fourteen, I assumed his therapeutic choices for his father-in-law had been entirely straightforward, but after I became a doctor, I realized that the situation had been more complicated. More family illnesses and deaths were on the way, including those of two of my grandmother Pearl’s sisters. There was actually such a spate of deaths during the late 1970s that my sister thought that a man who was present at all the services—the director of the local Jewish funeral home—was our cousin.

But Meyer’s death was by far the most jarring, and not only because he was still in his sixties. When we moved to Cleveland in 1966, we had actually lived with Meyer and Pearl for a few months while our new house was being readied. And during the next eleven years, we saw them often. Pearl was sharp-tongued, forever arguing with her sisters and fond of Yiddish slang. Meyer, by contrast, was a calm and gentle presence. He wore a shirt and tie at all times and a fedora hat when he went outside.

Despite their devotion to Judaism, Meyer and Pearl had never been to Israel. Part of the reason may have been the expense. While my father and his brother would gladly have helped them pay for it, their Depression mentality caused lifelong frugality. Of Pearl, my father wrote, “It’s alien to her nature not to worry about money, and she’ll never change.” There were also, of course, safety concerns, especially prior to the 1978 Camp David treaty between Israel and Egypt.

My father had not been to Israel either. So when he was invited to be a visiting professor in, of all places, Shiraz, Iran, he decided to begin his trip with a week in the Jewish homeland. And, in an inspired move, he asked me to come. The first two weeks of his trip corresponded with my two-week spring vacation in eleventh grade, in March and April of 1977. The plan was that I would go with him, then fly home from Iran by myself, returning through Israel.

The trip was remarkable for a number of reasons. For one thing, it was an intense father-son bonding experience. My father was still displeased with my academic performance, but the trip was all about exploring our cultural heritage and seeing exciting tourist destinations. We rented a car in Israel and split most of our time between Tel Aviv and Jerusalem, with day trips to places like the Dead Sea and Masada. Particularly powerful was a visit to Kibbutz Dafna, near the southern border of Lebanon, where we stayed with relatives who had moved to Palestine before World War II.

And, of course, there was Yad Vashem, Israel’s memorial to the victims of the Holocaust. My outwardly unemotional father was, I found out later, profoundly moved and disturbed. After I read his journals, I understood how this experience rekindled the feelings of guilt and the sense of good luck that had crafted his personality and helped guide his career in medicine. “The pictures at Yad Vashem,” he wrote, “are the pictures of my family, if only circumstances had been a little different.”

Yad Vashem was an emotional experience for me as well, but I did not connect with it in the same way. Yes, I had met a few Holocaust survivors, most notably Leah Binstock, a cousin who had survived Auschwitz and quietly displayed the numbers on her arm when asked. But, as many historians have noted, as late as the mid-1970s, public discussion of Hitler’s massacre of the Jews was muted. For example, I do not recall ever studying it in any great depth in either my European history classes at Hawken School or Hebrew school. When my sister’s school, Cleveland Heights High School, offered a class on the Holocaust beginning around 1980, it was said to be one of the first of its kind. So as a teenager who had not lived through World War II and did not yet comprehend the enormity of what had happened, I was somewhat detached. My keen interest in the Holocaust actually emerged once I formally began studying the history of medicine and bioethics and learned about the horrific experiments done by Nazi doctors on Jews at Auschwitz and other concentration camps.

Iran was equally amazing. I would have probably appreciated it even more had I known that visiting the country from the United States would become impossible after the 1979 revolution that ousted the shah. Our most intense outing was to the ruins of Persepolis, which had served as the ancient capital during the years 500 to 300 BC and had been invaded by Alexander the Great. We eventually settled in Shiraz, a southern city that housed the medical school at which my father was teaching. As was to be expected, the American infectious diseases specialist and his son were treated almost like royalty by their hosts. On his first day, my dad diagnosed a rare condition, tuberculosis of the skin, by reviewing a patient’s slides himself. He spent his mornings lecturing, and we traveled to various tourist sites in the afternoons.

My father had some trepidation about my returning home by myself. After all, Iran, while a staunch ally of the United States, was an Islamic country, and I was a Jewish teenager flying alone. But the trip through Israel and New York was uneventful. When I arrived in Cleveland on April 9, one of the first things I asked about was Meyer’s surgery. My mother told me it had gone well and that he was recuperating in the hospital. I called him, told him all about my trip, and announced that it was completely unacceptable that he and Pearl had never been to Israel. He promised me that they would go. I later learned that he meant it, and had in fact told Pearl later that day that they were going to get passports as soon as he was well.

The phone rang very early the next morning, which was Easter Sunday. My mother answered it. It was my father’s brother, Allan. I heard my mother scream and I ran out into the hall. Then, she told me: “Grandpa just died.” I remember us hugging and crying.

It was horrible. He was only sixty-nine years old and healthy. I had just spoken with him hours before. My father was thousands of miles away and we had no way to get in touch with him; we had to wait until his planned call that evening.

I had seen the place—long before the era of the cell phone—where my father was going to make the call. It was a public phone located in a communications center in downtown Shiraz. From there, one had to connect with Tehran and reach an international operator. We had done this, with much difficulty, when we first got to Shiraz. The room was chaotic as people waited their turn to use the phone.

When the call came, my mother answered. It was not a great connection. My father asked several times if I had arrived home safely. My mother told him yes, I was fine. She tried to get my father’s attention. “Phil,” she said, “I have some bad news. Dad died. Dad died.” Allan, who was at our house, then took the phone from her and gave him the medical details.

My father later told me what happened after he got off the phone. Another American, waiting to use the phone, realized he was shaken and asked if he was okay. But after that, my dad headed back alone to the small apartment that I had shared with him two days before.

It is Jewish custom to bury the dead as quickly as possible, and my father briefly contemplated staying in Iran and finishing up his teaching duties. But then he changed his mind and decided to return, hoping that the funeral might be delayed and that he would be able to get home in time. Finding a flight from Iran to Cleveland on such short notice, of course, was not easy. Eventually, he made it to Tehran. From there, he was able to get on a flight to John F. Kennedy Airport in New York via London.

My father dealt with his grief by writing. “I feel so placid, calm—certainly in shock,” he wrote after packing. “Dad, walk through that door! Please walk through that door.” Although my father had been writing to my sister and me on our birthdays, this type of spontaneous rumination on a particular day’s events—and the memories they engendered—was different. He would continue to write such entries in notebooks and on yellow legal pads for the next thirty years.

On the plane, my dad could not concentrate enough to read. “I can’t cry. I’m not even sad. I’m just objective.” He suspected he would let loose when he saw my mother, sister, and me at the airport.

My father did make it back in time for the funeral. The night before, he went to see the body and say good-bye. “He could not have looked more beautiful or restful,” he wrote, and he cried a little bit. “The day I’d dreaded for so very long—that moment was suddenly here.” Meyer, he mused, would never see another Passover. It would now be up to my father, despite his lack of religious inclinations, to lead the family seder. In three short years, two generations of Lerner men had died, and he was now the eldest.

Interestingly, although I vividly remember talking to Meyer and the early-morning phone call, I have no memory at all of my father’s return or of the funeral. I was certainly jet-lagged and emotionally exhausted as well. My father realized that the shock to my system was perhaps even greater than the one to his. “Barron seems to be handling it well—maybe too well,” he wrote. For good and for bad, this ability to hold it together in the face of illness and death—what William Osler called “imperturbability”—would persist once I became a doctor. My dad sought me out after the funeral for a walk around the block and told me that we both had to let our emotions come out. This was easier said than done, given our similarly stoic personalities. Indeed, even though it was his father who had died, he was very much playing doctor to the other people affected by Meyer’s death. “Must not give into this,” he wrote. “Too many people depend on me. I must be strong and stronger.” We held the traditional Jewish period of mourning (shivah) at our house and I recall seeing a large number of people from the old Eddy Road neighborhood I had probably never met before. Legions of relatives and friends came to pay their respects.

As with all deaths, my grandpa Meyer’s took a while to sink in. I missed him terribly. As the Cleveland Indians began another year of futility, I could not believe we would never again go to a game together. Fortunately, my grandma Pearl was a strong woman and held up pretty well. She certainly had a huge amount of support from her sons, their families, and her large clan of relatives.

My father took the death harder than anyone, playing it over and over in his head. Every time he thought of it, it was like a
zetz
(punch) to the heart. His chest actually “ached.” “Going to haunt me, haunt me,” he wrote. At one point, he reported having “cracking up thoughts.” Meyer had actually had a hernia repaired on the other side a few weeks before the final operation and had done fine. In doing a postoperative check, the surgeon had discovered the second hernia. My father wondered if, in fact, the second hernia had been there all along. If so, Meyer should have had only one operation to fix both of them. If that had happened, he might not have died.

At times, my father tried to view the tragedy as fate—that, for whatever reason, it had been Meyer’s time. Although he did not believe in a God, he nevertheless found himself asking, “Why did He put me in Iran now? Why Dad now? Why like this? Why at 5 AM? Why after first Israel visit?” Maybe, my dad reflected, he and I had been Meyer’s surrogates in Israel, making the trip that fate (or God) would not let him take.

But my father also believed that he was at least partially to blame, “a key villain” in a preventable death. He never forgave himself for urging his father to get the second operation over with while he was away, especially given Meyer’s history of bad veins. Surely, my dad thought, had he been around, he would have done something to prevent the formation of the blood clot or would have found it earlier and begun treatment to dissolve it. And perhaps the clot formed because Meyer had undergone two operations in such a short time. “Did I do it somehow?” he asked. “I can accept the inevitable but not the accidental.”

Was there any basis for his guilt? It is impossible to know, especially since my grandma Pearl had said no to an autopsy. But it is most likely that my grandfather was the victim of bad luck. All those involved in the second operation presumably did the same things they had done before, during, and after the first successful hernia operation. But this time a known complication of surgery occurred. My father even admitted this to himself on occasion. “I know objectively that my being here would’ve made no difference whatsoever,” he wrote in 1978, “but I keep wondering over and over, nonetheless.”

Another disappointment was to follow, one that may have had a longer-lasting impact than the death itself: the surgeon who had done the hernia operation never personally expressed his condolences. There had been a brief opportunity for him to do so, when my dad returned to the hospital after the period of mourning and the surgeon was in the same corridor. “I saw him spot me,” my father later wrote, “hesitate briefly, then continue on his way, without a word then, or anytime thereafter.”

One can speculate as to why the surgeon did what he did. Losing the father of his colleague had to have caused the surgeon tremendous guilt. Perhaps he thought my father would reproach him. But what my dad really wanted was for him to be a good doctor and offer a warm, human gesture even at the most difficult of times. In retrospect, this event was one of the first of a series of major disappointments that gradually punctured the idyllic vision of medicine that had characterized my father’s early career. Over the years, he mentioned it frequently in his journals as something that continued to bother him. And, in 2006, upon learning that I one day planned to write this book, he mentioned Meyer’s death—and the surgeon’s averted glance—as among the most important events for me to discuss.