I think it was starting this new book – new to me, anyway, used edition, 1984 – L'Amant (The Lover) by Marguerite Duras, that got me started thinking about this thing I have successfully repressed for a long time. That, and our Class of 1967 Harvard Medical School project on Humanistic Medicine. I'm only a few pages into it, but it's a book of images and interiors, a French high school girl in colonial Saigon, with two brothers, a father who is going to die, and a mother who it seems won't last much longer, a mother who is distracted and ineffably sad as she tries to cope. At the same time I'm hearing from my med school classmates about their own coping with the medical care system as we age and our medical needs increase, how some of us are well served and others aren't. And how everyone is coping with the choice to move to a facility for older people or keep on going as we are.
But all of a sudden, as I was reading L'Amant in the bed that my late wife and I shared for years – I slept there last night for the first time in a long time, I've been staying in the attractive front bedroom in the house were I slept when Ann had to sleep alone in our bedroom and be attended our health aides – all of a sudden, the image came to me of my patient Ms. Ratto, I forget her first name, but Ratto is a common name in Oakland and Alameda, there's Ratto's Delicatessen around 8th and Washington in downtown Oakland, and there's Ray Ratto, the local sportswriter turned TV, radio, and podcast analyst and raconteur, known for sardonic humor, whose family became my patients when we opened our Alameda office and he and his wife showed up for a prenatal visit and when I heard he was a sportswriter for The Examiner, I told him I was thrilled to meet him, and he told me I'd get over it. Anyway, this Ms. Ratto, a fair-skinned red-haired-to-auburn, very sweet mother of two, was my patient, and they claimed not to be at all related to any of the other Ratto's that I was familiar with. Right. Somewhere along the line, somebody didn't want to be known to be related to somebody else, I guessed.
So I had the image of her face in my mind, in our Alameda office, an old-fashioned office that took the whole second floor of a two story building that could have been an old house, that we rented from the dentist who occupied the first floor. She was distracted, too, like the mother of the narrator of L'Amante.
What do you do when you are dying of breast cancer and you have two little kids? Thank goodness you have a good husband. But, she looked at me full in the face – I still have tears when I recount this – she was still apparently healthy to look at her, hadn't yet lost her looks or her energy, it looked like, but she said to me, straight-on – what is going to happen to my kids?
Oh, how I wanted to help her. I wanted to take her in my arms and hug her and cradle her and tell her something and do something and make things all right. I could have tried. I could have said that her husband was a good guy and he'll find someone to be a good mother to them, which was probably true. I could have at least said I would be a good and loving pediatrician for them. I could have cried with her, making things worse, no doubt. I wanted to do something. I should have been able to do something, shouldn't I have? I was their pediatrician, and I cared for her and them, and they cared for me, too. It was everything that a medical relationship should be.
But I was helpless. I could have told her how much I wanted to do for her, but I had no idea, and I still don't, of what I could do. What do you do when there is nothing to be done?
I don't recall seeing her again. I must have seen the kids, I don't know, I just don't know. All I know is that it was searing. What do you do when there is nothing to be done? I could have asked her what she was doing, what could she conceive of doing that would give them the best chance ever. True belief in religion used to help with this, the Lord will provide, and sometimes I tell myself that now, knowing that I don't believe in God, but it's a great heuristic, an as-if.
I bet there are people around, in the medical schools and in practice, both, who know a lot more about what I could have done, what the medical system or the social care system could have done. It was probably up to the family, her husband, the grandparents, the aunts and uncles, everyone, to pitch in. I didn't know. But that's not what she was about. We had a relationship, she and me, patient and doctor. She could bear her soul to me. I could listen and accept her projection of what she wanted me to be, as her pediatrician. The way a pastor must feel when parishioners turn to him or her, what do you want me to be. She just wanted to tell me her deepest thought, wish, fear, terror. What will happen to my kids?
If I had known what I was doing, I would have found the time to sit with her, and listen, and reassure. Share her feeling. Then I would have been a good doctor. Avuncular, paternal, something. Helpful. Maybe I did
But I didn't know. I don't know, maybe I did do something good. Maybe I actually reassured her, although I don't remember that. Really, I was in the shock of being confronted by life in all its terrors. Talk about not being prepared. The fact that tears come to my eyes now tells me that I wasn't prepared for that. Maybe I had heard a rumor about her condition, maybe from another patient – so many of them knew each other in Alameda, although apparently not the various Ratto's – or maybe from one of my staff members. The best medical offices have staff and professionals who share a mission, and help each other to cope and do good. But whatever it was, I was still in shock. Face to face. Terror.
I'm just into the first few pages of this book. I don't know what happens to this girl. I don't know how autobiographical it is. I have intentionally not read to much about it, I want to confront it face to face. I just read my sixth Annie Ernaux book, Se Perdre (Getting Lost), and the shock of vivid and consuming autofiction (I doubt there's much fiction in it, really, maybe some compression of facts, and as in all non-fiction, the choosing of facts to fit a narrative) is still reverberating.
Life, literature, reading and writing, medicine, helping people, being helpless, the unrelenting pace of events that won't stop, time stops for no one, the earth is 4.5 billion years old and our universe is apparently 13.7 billion years old, but this is what we have, the here and now, the present, the awful unrelenting present from which we try to extract happiness, love, support, the illusion of eternity here in the present.
But at least, I hope that our Humanistic Medicine Initiative from our HMS Class of 1967 helps some of the present students and trainees, the age of our grandchildren perhaps, at least what little we can do will help some of them to cope and help with their mission of being physicians, and helping people with the burden of life.
Budd Shenkin
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