“Dr. Greco,” I finally ventured, “This is something they don’t teach us in medical school. How do you tell someone about something like this? And how do you express to the patient that you care but also keep enough emotional distance that you don’t feel like crap to the point that you are ineffective for the other patients that you will see that day?”
Well, Dr. Vega,” he answered after a pause, “In answer to the first question, you make sure you bring the patient in with a family member. Yes, they will know just by that suggestion that something is up, but in a way that begins the preparation. You start at the beginning, Mrs. W, you will remember that you came to us with X and we ordered Y test. We suspected Z medical problem. Well, the results came in and they showed….etc. If at all possible you do NOT do this on a Friday because then the patient will worry all weekend and can do nothing about the bad news. And if at all possible, you have already called the appropriate specialist and made the patient an appointment for the next step of care in the next day or so that they won’t have to wait very long to get started on treatment.
“That makes sense,” I observed.
“As for the second part of your question, Dr. Vega,” he breathed a heavy sigh, “You never stop feeling like crap when you fear that a patient may die or otherwise have a bad outcome. But you do learn to live with it because the next patient needs you just as much.”
After work that night, Dr. Greco and his wife invited me out for dinner. I’m pretty sure he wanted to cheer me up after an emotionally exhausting day. We drove to a little restaurant on the outskirts of town that looked out over a golf course and was known for views of the setting sun. A very attractive older woman with silver hair sat on the terrace in a yellow dress with a blue knit sweater. She stood and held out her hand.
“Hello, you must be Carlos. I’m Delores Greco. It’s so nice to meet you. Albert says you’re quite the gifted student.”
“Very nice to meet you, Mrs. Greco,” I replied, “and thanks for the compliment but I’d better be a good student because it’s clear I’ve still got a lot to learn.” I winced at Dr. Greco.
Greco laughed, “Carlos is pretty modest. He knows a great deal—particularly for his level of training.”
We sat down and ordered some cold drinks. After answering Mrs. Greco’s questions about me, I had a few of my own for her.
“Mrs. Greco, my med school friends and I are getting ready to choose a specialty to study after we graduate. What has your life been like with a family doctor as a husband?”
“Well, you need to realize that we got married 40 years ago, so things have changed a lot. When Albert was in residency, family medicine was in its infancy. He practiced medicine in the army for a few years and then went into solo practice. For many years he saw patients in the hospital almost every morning and did procedures like vasectomy. He even resuscitated newborn infants who had been born in distress. Over time he began to share call with some other solo practitioners in town so we could get away more often. I do recall that despite his long hours he always seemed to get to our son’s baseball games and band concerts. And we avoided over-extending ourselves financially, so he didn’t feel compelled to make huge amounts of money to support an over-inflated lifestyle.”
“Ah yes,” I interjected, “That explains his passion for luxury automobiles.”
“You noticed, did you? Well, that serves several purposes. First of all, we’d rather spend our money on travelling than on a car. Second, no sooner do you buy an expensive car then someone hits it and you feel terrible. Oops, no offense, dear.”
“None taken,” I lied. I realized I would forever be known as the “bumper car” med student at Greco Family Medicine.
“And finally,” Dr. Greco finished for her, “as a family doc, I would rather appear financially normal rather than wealthy. I want to relate to my patients, not rule over them.”
Financially ‘normal’. That made me think of something else. “Dr. Greco, did you ever have second thoughts about your career choice? You could have made two or three times the money you earned if you had chosen a subspecialty. You could have been famous or rich or enjoyed greater prestige. Do you ever think about that?”
He seemed to ponder his answer carefully before responding. “Honestly, the answer is no. As a family doctor in this town, I see my patients on practically every corner and in every aisle in the supermarket. I take care of three generations of some families. I am respected and my advice is sought on all kinds of problems--many of which have nothing to do with medicine. As for money, if you can’t live comfortably on what I earned then I’m not sure what you’re looking to buy. Finally, while I wish I could have had even more time with my family, if I had picked a subspecialty, I might have spent lots more time away from home. No, Dr. Vega, I have no professional regrets,” he paused and grinned evilly, “until I had to take on electronic health records”.
“Where is your son now? What does he do?” I inquired further.
Mrs. Greco answered this time. “Jordan is a chef in San Francisco. He was always a great student and Albert had high hopes that he might one day grow up to be a doctor and take over his practice but Jordan had absolutely no interest in studying medicine. He can’t stand the sight of blood unless it comes from a chicken or a pig.” She and Dr. Greco laughed at what must have been an oft-repeated joke.
“One of the best things for me,” Mrs. Greco added, “is that Albert’s work and income allowed me to stay home with Jordan as he grew up. I am an attorney by trade and could have gotten a job but I’m glad that I could be there for my son.”
I thought about all they had said as our meal was served on the terrace and the sun sank into the surrounding hills. We all ate quietly for a few minutes and just enjoyed the sound of crickets chirping and the sight of the deepening pink horizon.
“So how did the two of you meet?” I asked.
Dr. Greco was the one to answer this time. “We met in college in a drama group. She was the prettiest pre-law student at Swarthmore,” he said with a sentimental smile.
Mrs. Greco wagged a finger at him and laughed, “Albert, there were only a handful of pre-law women at Swarthmore!”
“And you were the only one I dated.”
She uttered a loud “humph” but nonetheless kissed him on the forehead and I saw a look pass between them that I could only hope I might share with someone after forty years of marriage.
I certainly had no hope of sharing it with Jillian Weinkopf.
Chapter 13
I drove home for the weekend after my first week of the family medicine rotation. I had learned a great deal, but I remained convinced that family medicine was most assuredly not for me. There were too few opportunities to make a big “save”. I wanted to be a hero, after all. In Dr. Greco’s world, many of the patients had problems that couldn’t be fixed. His patients had ailments like alcoholism, chronic pain, unemployment, poverty, loneliness and dementia. Often, all he could offer was comfort, empathy and understanding. Where was the heroism in that? I wanted to cure disease and repair broken structures in a clean and defined way. Very little of Dr. Greco’s practice worked like that.
I ate supper at the kitchen table in the home where I had grown up. I hugged my mother and father and went to bed where I slept the sleep of the exhausted.
The next morning, I drove across town to visit Abuela. It was a ritual I looked forward to every time I came home. Abuela was my father’s mother and despite her age of 84 we connected on a level that was very different from anyone I have ever known. It seemed as if she could just look at me and tell exactly what was going on.
I knocked on the back door and looked in the window to see her gesturing excitedly as she spoke on the phone as if the person she was talking to could actually see her. She then waved to me to come in and I heard her finish the conversation.
“Manuel, you know I can’t do the altar flowers the 2nd and 4th Sundays because I am at the soup kitchen those days…Yes, I can still
do 1st and 3rd Sundays…Well, the breast cancer walk is organizing something on that day but I’ll see if I can clear some space, why don’t you email me? Okay, well I have to go because my grandson has finally remembered that his abuela is all alone spending days and nights pining away for him. Give my love to Rosa, will you? Bye”
“CARLITO”, she enveloped me in an enormous hug, “how dare you abandon your abuela for such a long time with no card, no phone call, no…”
“Abuela”, I smiled, immediately falling into our old game, “I saw you two whole weeks ago.”
She wagged her finger at me, “Don’t change the subject just because I am old and sometimes forget details.”
I loved this game. Abuela forgot about as many details as a top of the line computer. “I am so sorry for neglecting you, my dear old grandmother.”
“At least you can show some respect”, she pretended to scold me, “Now sit down with some café con leche and tell your old abuela all about your newest adventures in learning to become a fine doctor.”
And so I did. I told her all about how I impressed Dr. Greco with my driving skills and then how at first I didn’t impress him much with my medical skills. I told her how great it felt to finally show him I could figure out a difficult case. I told her about how bad it felt to not be able to do much for a woman with metastatic cancer of the pancreas. Finally, I told her how much I wanted to be able to help Mr. Weinkopf and especially how much I wished I could get to know Jillian Weinkopf better—which would be easier if I was her type and she didn’t already have a boyfriend. Finally, I confided that this whole two months might really be a waste of time after all if what I really wanted was to be a trauma surgeon.
Abuela took all of this in all the while nodding very sagely. When I was finished, she asked,
“Why do you want to be a trauma surgeon?”
I gave her all the usual reasons, the cool equipment, the fast-paced atmosphere, the opportunity to make an immediate and real difference in people’s lives, the technical and intellectual challenge…
“Carlito, when you were little, you wanted to be a fireman. Then you wanted to be a policeman. Then you wanted to be an Army Ranger. Now you want to be a trauma surgeon. Do you see a pattern here?”
“It’s no secret, Abuela, that if I’m going to spend this many years studying to do something and get really good at it, I wouldn’t mind doing something that makes me feel…”
“Like a hero?”
“Si, Abuela”. There was absolutely nothing getting past this woman.
“All right then. What do you think defines a hero?”
“Wow. I guess I never thought to try to give it a formal definition.”
“I’ll give you one. A hero is someone who makes a sacrifice or takes a risk to do something for someone else with no thought of gain for him or herself. The only gain involved is the deed itself and that is done for love and love alone. Love for a person, for an ideal, for a country or what have you.”
She went on, “So why do you think you need to be a surgeon with fancy equipment and technology to be someone’s hero?”
I absolutely could not answer that question.
That is when she delivered the kicker. “Carlito, you need to learn to read women better. Jillian does not have a boyfriend.”
Chapter 14
I returned to my clinical rotation pondering all the things Abuela had said to me. I was just starting to wonder if maybe Jillian really didn’t have a boyfriend when I decided to check my voicemail. There was a single message from Dr. Greco’s receptionist telling me to show up at the office dressed “very casually” on Monday.
I arrived to meet Dr. Greco the next morning and was more than a little surprised to see him dressed in tennis shoes, a checkered shirt and blue jeans. What was going on? Fortunately, I had taken the advice I had been given and was dressed in older khakis, a polo shirt and not-too-shabby sneakers.
“No babies in the newborn nursery today,” Dr. Greco noted as we went directly into the office. He rifled through a stack of phone messages and prescription requests in record time and then ushered me back out to his stately Grecomobile—the decrepit Honda Civic that I had so graciously tagged on that fateful first day. He opened the passenger door with a grand gesture,
“Getting in?” he inquired.
“Um, sure,” I replied hesitantly, “but where are we going?”
“It’s County Fair Day,” he announced. “No one works today if they can possibly help it. We are going to have a completely unhealthy breakfast and then we are going to spend the day at the Fair.”
“Unless you’d rather see patients…” he added.
“But who will see the patients?” I entreated.
“First of all, most of them will be at the Fair. Anyone who is too sick to go to the Fair will probably need to be in the Emergency Room. And as for everyone else, that’s why I hired a nurse practitioner.”
Our first stop was at the Waffle House. Now you have to understand just how far off the beaten track ‘ol Doc Greco was going here. Every morning since I first met him I saw him eat fruit, low sugar oatmeal sprinkled with trail mix and a glass of skim milk to keep his cholesterol and blood pressure down.
So this morning I about fell out of my chair when I heard him order.
“I’ll have the Triple Play Special please—three scrambled eggs, three sausage links, three pieces of bacon, three pancakes, hashbrowns, orange juice and coffee.”
It was my duty to order something that complemented his order so I quickly added,
“I’ll have the intravenous nitroglycerin and an automatic defibrillator with a side of CPR.”
While Dr. Greco glared at my review of his dietary indiscretion, the waitress was clearly not ready for medical humor at eight o’clock in the morning.
“I’m sorry, I don’t think I caught all of that,” she squinted at her order pad.
“How about if I just go with the bagel and cream cheese, orange juice and a decaf coffee?”
“Okay, that should be out in about 5 minutes”.
Before there could be further commentary about his choice of cuisine, I decided to ask instead about our itinerary for the day.
“So tell me about the Fair.”
“Well, you know the history of this town. It’s an old German farming community going back over 200 years. Every year there’s a fair for each farmer to show off produce, livestock and so on. There are rides and games so you can spend a lot of money to win a stuffed animal you could probably buy for half a buck if it were for sale. You can play bingo or see a country band. You can buy homemade pies and crafts. You can watch competitions involving horses or other animals. At the end there are fireworks. It’s a big party and everyone in town comes out.”
Our breakfast arrived and we dug in. When Dr. Greco had sopped up the last of the syrup with a final piece of pancake and washed it down with a swig of coffee, he paid the check and out we went into the sunshine towards the Fair.
Arriving so early, we got a chance to see a lot of things as they were being set out for display. There were gleaming green tractors (“Nothing Runs Like a Deere”), children getting ready for 4-H and FFA competitions, horses being unloaded from trailers and untold pounds of meat sizzling on grills leaving smoke trails lazily ascending towards a puffy-clouded sky. Amusement rides were already turning awaiting riders who would no doubt be playing hooky from school.
The fairgrounds were already pretty crowded by the time we had made our first circuit of the barns and tents before noontime. As a city boy, this was a completely different experience for me and I tried to take it all in.
Just before noon, I heard the unmistakable sound of a barbershop quartet. Sure enough, approaching us were four gentlemen in pressed black trousers, white shirts, red bands around their upper arms and red, white and blue banded straw hats. As they sang they all had broad smiles and looked like there was no place they would rather be than strolling around the fairgrounds singing close harm
ony.
Goodbye my Coney Island baby, fairwell my own true love, true love (my honey)…
The leader of the group immediately recognized Dr. Greco and made a motion with his hand that halted the singing in mid-phrase, “Albert, c’mon over here and do a number with us!”
Greco laughed, “You guys are doing just fine without me.”
“Nonsense, Ralph’s gotta hit the can again because he keeps forgetting to take the prostate medicine you prescribed. Come on, just one number…”
“Okay, Okay,” Greco capitulated, “Everybody remember Lida Rose from The Music Man?”
There was a murmur of agreement and the leader got out a pitch pipe to give a starting note.
Lida Rose, I’m home again Rose, to get the sun back in the sky…
And so the happy ensemble sang and paraded around the picnic tables to the delight of the early lunchtime crowd.
Lida Rose oh won’t you please be mine… concluded the old tune and everyone applauded as I got a glimpse of my mentor’s life outside the practice of medicine. The barbershop group had no sooner moved on when we heard other voices directed at Dr. Greco.
“I told you he’d forget”
“Good thing we found him”
“Dr. Greco, it’s time for you to judge the apple pie contest. It’s noon and the pies are all set out in barn 3, did you forget?”
“Oh my, ladies, I am so sorry, let’s get going. Can you show me a short-cut?”
We half-jogged over to barn #3 where Dr. Greco composed himself and made his entrance as a leading citizen in town should. After greeting the eagerly waiting bakers, I walked behind Greco as he made a complete circuit of the long table with no less than 16 delicious-looking (and smelling) apple pies. He then drew me aside out of earshot and said with the gravity he would use for discussing a deadly global public health crisis, “Carlos, we must get this right. There are serious bragging rights at stake for a full year. You must pay attention to three primary criteria: First, overall appearance—see the one pie over there with the lacy overcrust—that is a thing of beauty. Second, crust characteristics—crust should be flaky with just the right amount of sweetness and crisp texture. Third, filling—the apple filling should be moderately sweet and any cinnamony overtones or other added spice flavors are a bonus if they blend well.”