Legacies from Our Ancestors

June 3, 2007
Philip R. Alper, MD

Internal Medicine World Report, March 2006, Volume 0, Issue 0

Dr Alper is a practicing internist in Burlingame, Calif, and a Robert Wesson Fellow in Scientific Philosophy and Public Policy, Hoover Institution, Stanford University, Palo Alto, Calif.

Why we become doctors is sometimes a bit of a mystery. Often enough, we have role models?people we have met as children who have deeply impressed us and whom we wish to emulate. Sometimes, the individuals who profoundly influence us are people we feel connected to, but may not even have met.

My earliest memories of doctoring come from a family friend who is still alive, and is now approaching 100 years of age. This general practitioner carried his black bag up and down apartment house stairs any hour of the day or night during the years of the Depression. His home office smelled of disinfectant, and the things he did seemed almost magical to my young imagination. Though he worked much harder than most people, he seemed in some way independent of the restraints that bound most job holders who did less "important" work.

Those who know me may see an important influence here. But I suspect it was my maternal great-grandfather who was even more important to my psychic development as a physician. Though not a doctor, he was a scholar, renowned for miles around the town of Stroznitz, in which he lived. (I don't expect that anyone has heard of Stroznitz, though I recently ran into a young San Francisco physician who actually grew up there.) Stroznitz is not far from Chernovitz, a city that has been called "the Paris of Central Europe." The whole region was part of the Austro-Hungarian Empire until World War I, when it passed into the hands of Romania, only to become part of the Ukraine after World War II. The city is now called Chernovitsi.

I said that great-grandfather was a scholar. He was, in the sense that he studied widely, but entirely independently, attached to no specific professional group, whether lay or religious. In the years before World War I, study and scholarship were highly respected by the less educated. Respect sometimes ap?proached adulation. My mother told stories of peasants who kissed the hem of great-grandfather's cloak as he passed through town. In time, his growing wisdom came to be recognized as a communal resource.

It seems that great-grandfather served as what today might be called a mediator, arbitrator, or judge of a proprietary private court. It was a time during which the civil courts were costly and corrupt, and he provided an alternative. Legend has it that, without any enforcement powers at all, the moral force of his judgments was sufficient to dissuade anyone from ever defying them. He was trusted to do things ranging from counting the local farmers' money after harvest, to adjudicating partnership and marital disputes, and even quarrels over property lines and the ownership of cattle.

But all through this, great-grandfather kept studying to be able to understand more. Some?time in his thirties, the relatives suggested he might consider marrying. He agreed that it was a good idea, and the eligible maidens from the village were introduced to him. Family legend has it that he chose the one with the best teeth?in the manner in which one chooses the healthiest horse. I have no idea whether that apocryphal story was a joke or not, but great-grandmother did go on to bear 19 children (of 20 pregnancies); she ran the farm, sold the produce in a store she also ran and, of course, raised the children and tended to great-grandfather. Meanwhile, he continued to study.

Great-grandfather was apparently much loved. Settling disputes and promoting a greater measure of happiness among the people in the community gave him immense satisfaction. It was a form of love that he showed his fellowman. His funeral procession was said to be the longest ever seen in the village, and people came from all over the province to attend. It was also remarkable in that the mourners included even more Gentiles than great-grandfather's Jewish coreligionists, at a time when the two communities did not intermingle that extensively.

Great-grandfather was not a rabbi or a religious authority. Yet he must have believed deeply in the Jewish precept that good deeds serve as their own reward, because they are pleasing in God's eyes. Whether the details I have provided are entirely true or part fable, now?a century later?great-grandfather remains very real in my mind, even though I can no longer recall either his name or that of my great-grandmother.

In the course of my own life, I have informally mediated a couple of disputes in the manner in which I imagine great-grandfather might have proceeded. One, which occurred years ago, involved 2 very able physicians who got into an argument over the functioning of a hospital special care unit. The intensity of bad feeling alarmed me, and I experienced something of the pleasure that I imagine my great-grandfather must have felt when I succeeded in resolving the conflict with my own form of shuttle diplo??macy. More recently, I did something similar in a painful divorce situation in which both parties were my friends.

But it is in the care of patients where I believe my great-grandfather served as my greatest inspiration. I see and feel a connection between what I do in my work and what he did in his. It makes me feel close to him without my ever having met him.

How were our jobs alike? We both needed to secure the trust of the people who put their well-being in our hands. We had to understand them and address problems that were very important to them. In great-grandfather's case, there were often adversaries to consider. But in medicine, competing viewpoints, the media, skeptical family members, and upbringing also provided plenty of adversaries to what I wanted to accomplish for my patients, at least some of the time.

Great-grandfather sought balance. That is a value that I have tried to bring with me into medicine. Where we cannot always be absolutely certain of our diagnosis and prescribed treatment, balance provides safety for the patient and protects us, too, from the consequences of rash or careless decisions.

My ancestor's example showed me that we do not go through life or do our work alone. I have no doubt that he fully valued the extraordinary wife he chose as the sustainer and facilitator of his efforts and who allowed him to achieve what he did, while still living a full life. Our families and our staff help us in the same way. Directly and indirectly, they contribute to the therapeutic experience we offer our patients.

The place physicians like me occupy today differs in one important respect from great-grandfather's experience. The "specialness" that he knew and that the general practitioner family friend of my youth also shared was an integral part of their lives and, far from breeding conceit, was a spur to duty. That sense of special importance has eroded over the years of my own practice, coincident with the drastic intrusion of third parties between physician and patient. Perhaps consumerists would approve. But I have serious doubts about the long-term ability of people who do not feel and are not viewed as special to do a job that is special. ?

That's my story. I can only imagine how many variations on the theme my colleagues can offer in its place.