One morning some years ago I found myself in the office of a dermatologist who, while tearing into my Plantar's wart on my right foot, glanced nervously up at my chest. “Wait!” she murmured, “Melanoma!” At the time, I did not know precisely what melanoma was, but I knew the word to which it was most associated: Cancer. She tenderly touched the mole she had spotted as the likely suspect and commented: "I don't think this is malignant, but you need to have it removed immediately.” She paused and continued in a hushed voice. "Not that I want to worry you.” I braced myself for what was coming next. “But, three weeks from now, in a worse-case scenario, you could be dead.”
I smiled bravely. “I thought you didn’t want to worry me.”
She did not smile back. “You need to see a surgeon."
"Well I don't know a surgeon," I said. "Who’s the best in Pittsburgh?"
She replied immediately with a name that, for purposes of this essay, I have changed: "Sidney Schwartz."
"Can you make the arrangements?"
"I'll take care of everything, Mr. Gutkind."
I did not like the way she suddenly called me by my last name. Through all of our associations related to my Plantar’s wart, we had been on a first-name basis. Now that I was three weeks away from a painful demise, she had immediately adopted what I have come to call the “doctor's distance declaration,” which establishes a direct line of withdrawal from patient interaction in proportion to severity of illness and prognosis for recovery. The more serious and potentially fatal the malady, the more physicians will study your chart and contemplate their geeky shoes, tending to walk backwards whenever the patient or family members attempt to talk with them.
Sidney Schwartz was my prototype of this syndrome. First, his nurse said that he did not need to meet me. Such a minor procedure required no personal contact or preliminary assessment. Second, it would be 10 days before I could be squeezed into his schedule. And this, of course, was a favor performed on behalf of the referring dermatologist, a long-time colleague. Otherwise, it would have been a month. I appreciated the consideration. However, having done a little research about melanoma and learning how quickly it might spread, the 10 days waiting with the dark specter of death I now perceived hanging over my head was one of the most anxious periods of my life. Those 10 days were nothing in sheer terror to the day of the surgery.
I arrived at the Outpatient Surgical Center (OPS) at 7 a.m. for my pre-op examination. I was weighed. My pulse was taken. The necessary forms were filled out, my clothes and personal items stored away safely in a locker at the other end of the unit. I put on one of those paper hospital robes, a mini-skirt model that hung about 3 inches above my knees, along with paper hospital booties. A nurse led me to a tiny windowless room, invited me to make myself comfortable. Dr. Schwartz was due at 8 a.m. and we were a little early.
I was immediately bored and jumpy as I waited. I had hardly been able to concentrate throughout the entire ordeal, and and now was so focused on the impending surgery that I hadn’t even thought to bring anything to read. I knew that Dr. Schwartz, the best surgeon in Pittsburgh, would be arriving any minute to interrupt whatever reading or work I might be doing, anyway. Even at 9 a.m., when there was no sign of Dr. Schwartz or any other doctor who might be coming to check in with me, I was confident that it was only a matter of time. It had been a little naive of me to have assumed that surgeons would be anymore punctual about surgery than other physicians were in keeping appointments. After all, there were sick people needing emergency surgery throughout the city, any one of whom could be bleeding to death on the operating table with a heroic Sidney Schwartz laboring to save him. In the back of his mind, Schwartz knew that I was waiting at the OPS–and he would be rushing in here any second, breathless, spouting apologies while sharpening his scalpel, getting down to business.
I continued to believe that until around 11 a.m. when one of the nurses came in to say that she had initially been told that Sidney Schwartz had been sidetracked by an emergency procedure, but, she confessed, she was no longer certain that that was true. He wasn't answering his page and no one, including his partners, could find him. She was more embarrassed than apologetic–and she was whispering, as if confiding a dark secret or committing a crime which, in this doctor-friendly milieu, she was. Around lunch time, the nurse reported that someone had seen Sidney Schwartz in the hospital in surgical scrubs and heading this way, but when he did not show up by 1 p.m. she contacted the operator who began to page him over the hospital intercom. There were 30 separate pages over the next hour and a half–I counted every one of them as I sat, a prisoner in that windowless waiting room, listening to the air-conditioning fan and the muffled activity in the hallway behind my closed door. The hollow persistent sound of the paging operator summoning Schwartz to the Outpatient Surgical Center triggered within me a new and more acute wave of anxiety and fear. Periodically, I wandered out of my room and inquired at the nurse’s station for an update. Twice I used the nurse’s phone to call Schwartz’s office to complain, but after being frozen in “hold” limbo for many minutes as Schwartz’s secretaries were attempting to locate him, I hung up the phone and retreated back to my cell.
At 3 p.m., when the nurse came in carrying my clothes to apologetically announce that her shift was over and that the entire unit was closing down for the day, I was a complete wreck. To me, this was an omen, a clear message that the melanoma was malignant and that I was going to die. After all, the dermatologist had said “three weeks;” nearly half of the last days of my life had been wasted waiting for Sidney Schwartz, the best surgeon in Pittsburgh, to stand me up. This was torture: eight hours in a windowless waiting room, no television, radio or reading material. Even convicted murderers were given breakfast, lunch, perhaps an hour-long walk in the yard for fresh air–and real clothes. You could hardly take a walk in the yard in a paper mini-skirt and pastel blue booties.
In retrospect, it was a mistake to have arrived at the OPS without a friend to keep me company or demand help, but I was recently divorced and feeling as if I needed to learn to confront the challenges of life on my own without leaning on a partner. Later, collapsing at home in my bed, I listened to the messages on my answering machine. The last one was from a secretary in Schwartz's office explaining that in the frenetic rush of his day, Dr. Schwartz had simply overlooked my procedure and that he would be pleased to reschedule for the following week. She offered a couple of dates and times and suggested that I return her call if I was interested.
But my one and only interest was in killing him if, of course, I lived through the melanoma. That fear had now considerably paled in comparison to my burning hatred of Sidney Schwartz. I wrote a number of letters, never sent, and composed a slew of speeches, never delivered, over a long period of years. Not that I was afraid of Sidney Schwartz or too sick from chemotherapy (which, in fact, never happened–I found another surgeon who removed the mole a few days later, which, after a quick biopsy, was judged benign). The truth is, I never confronted Dr. Schwartz. I was too enraged to simply yell and scream and bash his head in; rather, I wanted to humiliate Sidney Schwartz in front of his colleagues, friends and family–the people who most respected him. My dream was that I would serendipitously come into contact with him one day, face-to-face, preferably at a dinner party. He wouldn't know me, but I would know him, and I would charm and befriend him, along with everyone else at the table, all the while gently guiding the conversation toward the issues of ethics and morality in medicine–the Hippocratic Oath, the physician’s responsibility to the patient, all the good stuff about which physicians love to expound, at which point I would begin my melanoma story in basically the same way I have started the story here, by describing the dermatologist, and the hour-by-hour, soul-twisting torture in the windowless room waiting for the surgeon to appear. But I wouldn't say the surgeon's name–not for a while.
I'd wait for the precise and proper moment, skillfully unfolding the details of the story and building suspense and curiosity about the identity of the surgeon, dropping a few subtle, pointed clues. In this scenario, I can literally picture all of the people at the long dinner table, spellbound, heads strained forward to listen as the scenes and incidents I relate gallop toward the conclusion. And I can also picture the object of my anger, Sidney Schwartz, growing ever more uncomfortable in his chair as the intimate nature of my story finally begins to touch some inner chord of awareness. I know in my heart that he is beginning to suspect the humiliating reality that is approaching him. At the end of the story, with my dinner companions completely primed and totally empathetic and with my final words of dismay echoing through the quiet, darkening dining room, someone breaks the silence and asks:
"Who was this horrible doctor?”
At which point, I carefully place the coffee cup in its saucer and turn ever so slowly toward my nemesis, my enemy, the object of my pent-up, bone-scraping rage, Sidney Schwartz, and look him straight in the eye, as I quietly announce: “He is sitting among us at this table.”
It was this dream of revenge through the consummate humiliation of Sidney Schwartz specifically and my melanoma experience generally that led me eventually to write about medicine and science. My first books were about my two great passions: First, motorcycles and the subculture that surrounds them, for which I traveled extensively, cruising most of the lower 48 over a period of three years.
The second was baseball. I spent one season shadowing a crew of National League umpires from ballpark to ballpark. But being forgotten and abandoned by Sidney Schwartz, the person to whom in good faith I had blindly entrusted my life, began a process of evaluation that was to change my entire artistic orientation for the next 15 years. What kind of people could devise a system in a world with the Hippocratic Oath as the bedrock of healing, that would engender such an impersonal and unresponsive atmosphere, I wondered? Why is a medical center designed to function primarily for its doctors, rather than for the patients it is supposedly created to treat and serve? These were the questions that came to intrigue and drive me.
Since then, I have written four books about the humanistic aspects of the high tech medical world. The researching technique I use for these books can be called “total immersion,” meaning that I literally move into the medical setting in which I have interest and invest months and sometimes years learning everything possible about aspects of modern medical technology from the points of view of all of the actors–physicians, nurses, patients, family members–anyone with a significant role in the subject that I am investigating. Using scene, dialogue and specific detail, I hope to capture and relate the dramatic stories of people enmeshed in real life incidents and challenges–the defining moments of my immersion experiences–and the universal meanings behind what I see and recreate.
For my first book about the medical world, “Many Sleepless Nights,” an examination of the world of organ transplantation, for example, I was initially enticed by the potential of transplantation to save lives. What began to affect me, though, was the pain and suffering organ transplantation (and other forms of high-tech medicine) caused, not only to patients, but to the families who had to support them through surgery, recovery–and far beyond. But what also struck me then and continues to affect me now, years later, is the dearth of humanity at many points along the process. Not only does the technology (medications, machinery, computerization) divide the patient and doctor, but it also serves, seemingly, to deny the necessity for or expectations of courtesy and compassion.
On the organ transplant service, I once listened to a prominent surgeon impatiently interrupt a resident who was carefully explaining a procedure to a family member, prompting him to "save lives first–answer questions later." Another surgeon told me, in defense of his insensitive behavior, "Psychologic trauma and all that stuff is important, but it doesn't make a goddamn difference if you are well-adjusted and dead." Saving lives of dying patients becomes a surgeon's obsession, but in the process, such a single-minded and narrow pursuit seems to alter or destroy their sense of purpose–the reasons surgeons endured years of medical training and took the Hippocratic Oath.
I never experienced that feeling with veterinarians, however, for my most recent book, “An Unspoken Art.” Here were men and women, obviously interested in lifesaving, but dedicated and devoted not only to the physical, but also the psychological well-being of their patients. This is the ironic missing link in human medicine: many of our caregivers do not regard or treat their patients as human beings, as I initially discovered so many years ago with Sidney Schwartz. And this is the part of veterinary medicine I will never forget, that part that includes philosopher Erich Fromm's observation that humankind "is biologically endowed with the capacity for biophilia, the passionate love of life and all that is alive"–and the way in which it is exemplified in veterinary medicine–by human contact: touching.
I was lucky to witness a revolutionary cryosurgical technique at the University of Pennsylvania on a prized harness racer named Cam Fella. The procedure was fascinating and exciting, but the most memorable part of the experience occurred long after the surgery, long after the owners had departed and most of the entourage and the curious onlookers had disappeared. Eight exhausted veterinarians and nurses, all women, remained in the recovery area with Cam Fella, sitting in a circle, elbow to elbow, keeping him calm. Touching him. Kissing him. Talking to him. Until he was awake enough to stand on his own and navigate the winding path back to his stall.
Although I connected with the veterinarians in a special way because of their compassion, I came to admire and respect the overall perseverance of the men and women in the medical community of all specialities and orientations– especially organ transplantation–relentless in their drive to solve scientific puzzles in the face of ongoing and debilitating defeat, not over a period of days and weeks–but years–or even decades. I discovered a great affinity for these egocentric scientists because I recognized early on that we shared the same set of values concerning commitment to a potentially unreachable and sometimes unimaginable goal, along with the same faith in our basic vocational ethic, which was to come to work every day without any expectation, except to function at the highest level possible for as long as possible until or whenever their project or study was completed, its thesis tested–if not proven. This too is the exact orientation of all serious writers I know: To write every day, to invent or capture memorable and true characters and stories, to discover insight spontaneously and to write sentences that invigorate and charm a reader–without visions of glory or grandeur.
From the information I have gathered through subtle inquiries, Sidney Schwartz was not such a dedicated and driven scientist; rather he was a skilled and committed surgeon, popular for his quick and efficient procedures, but overloaded and somewhat disorganized. Sidney Schwartz almost died–many years after the day he stood me up on the operating table, of hepatitis, contracted, I am told, from one of his patients. When I heard about Sidney Schwartz’s disease, I have to admit to a momentary tinge of elation–not because I wanted him to die or to be in pain, but in the hope that there was some sort of prevailing justice. So that when his colleagues began to pull away from him, as they undoubtedly would, he too would have the experience of being the unempowered patient rather than the all-powerful doctor.
I doubt that the justice I imagined actually came about in Sidney Schwartz’s case, but I am vengeful enough to hope that it did, especially now that I know, in retrospect, that Schwartz received a liver transplant (another irony; a few years earlier I might have observed or scrubbed-in on the procedure)–survived and returned to his practice, a result that is not nearly as routine as the medical community or the media might lead an unaware consumer to believe. In fact, I am told that he recently built a new and luxurious house in my neighborhood, although I still don’t know what he looks like and don’t intend to find out. At this point in my life (and in his), I suspect that if I met him at a dinner party, we would get along fine. Sidney Schwartz and I would discover a special connection because I could and would empathize with the odyssey of the liver-transplant experience.
Actually, I guess I could say that despite his unconscionable albeit unknowing actions, I owe Sidney Schwartz a debt of gratitude for inadvertently directing me toward a phase of my career that helped fuse what had seemed, at one time, to be diametrically opposed concepts–creativity and science. Because of Sidney Schwartz, a doctor too busy to remember a frightened patient, I have been enlightened.
Many of the physicians I met and observed, surgeons especially, were relentless and persistent and also scientifically daring–willing to take risks– the hallmark of both great science and great literature and one of the reasons this double issue of Creative Nonfiction exists. We believe in the symmetry between science, art and humanism, a concept that this issue will illustrate, beginning with the lead essay by Alison Hawthorne Deming that discusses the harmony between scientific language and poetics. Deming, who is director of The University of Arizona Poetry Center, is the author of a number of books, including “Science and Other Poems,” a collection that won the prestigious Walt Whitman Award of the Academy of American Poets.
Deming is also the winner of the first Bayer Creative Nonfiction Science Writing Award, sponsored by Creative Nonfiction and the Bayer Corporation for this essay, for which she receives a $500 award. We will not be sponsoring a science-oriented issue in 1999, but for the following year the Bayer Corporation has agreed to expand the award to $2,000 in honor of the millennium. To my knowledge, this is the largest cash award for a single essay offered by a literary journal–anywhere.
Although Deming is a poet who writes about science, some of the essayists collected in this double issue are scientists who write like poets. Gerald Callahan is an immunologist in the Department of Pathology at Colorado State University in Ft. Collins while James Glanz, runner-up for the Bayer award, who received his Ph.D at Princeton, is a writer at Science magazine. Two members of the National Aeronautics and Science Administration (NASA) are contributors to this issue. Scott A. Sanford investigates planetary systems, astrochemistry and the origin of life. Susan Adkins had been a NASA librarian for most of her professional life, but her passions were writing and flying, which is how she is remembered in this issue of Creative Nonfiction, as a fine essayist and dedicated pilot, who died in a flying accident a few months before this issue went to press. She was 49.