When we moved into my childhood home eighteen years ago, my father converted the basement guestroom into a special hideaway just for him.  Never fond of hosting visitors because then he’d “have to smile all the time,” he painted the room a deep hunter green, hung his poster of the Brooklyn Bridge on the wall, and filled the bookcases with volumes of Ophthalmology reference texts.  A picture of our dead dog Scarlet hangs on the left corner of the far wall, and his dead father’s business card rests on the shelf above his desk.  He spends many hours here alone, as my mother and I chat upstairs about my girlfriends, school, and what’s for dinner.  He comes to his study after he has a tiff with his wife about which shirts go to the dry cleaners, and after one of his patients has heart failure coming out of anesthesia during cataract surgery.  He comes here to relax, regroup, and move on.
       One weekend day, when I find a black and white photo of him and his father, I ask my dad if he cried when Grandpa Herb died.  He bends his shoulders down to the bottom bookshelf and pulls out a cracked leather journal from Medical School.  He points to a page that reads “Death is a part of life” in his trademark lopsided handwriting.  He once told me that his handwriting it so sloppy because he skipped the 3rd grade year of penmanship.  With a quick pat on my head he says, “I’m a doctor, and a scientist.  People live and people die, that’s just the way it is.”  He slides the book back into the bleached wood bookcase.  “Now, want to get some lunch?”
       In today’s society, the detachment from death my father exhibits seems to be a requisite condition for becoming a successful doctor.  My father was never a particularly emotional person, but his time in Medical School “certainly didn’t make me into Mr. touchy-feely,” as he says.  Jean Kim, M.D., a first-year resident at Mount Sinai Medical Center in New York City describes this notion of “detached concern” that “has been present in the medical community for many years.”  Dr. Kim explains, “Psychological distancing between patient and physician…protects the physician from being emotionally overwhelmed by illness and death, and protects the patients from the physician’s potential clinical bias and loss of judgment.”  If physicians do not distance themselves from death, Kim believes, “their clinical judgment may be skewed by overidentification with their patients’ suffering.”  In order to protect themselves and their patients, doctors must not become emotionally involved when death arrives.  
       “They teach you that death is just another stage of life, just like infancy or adolescence or old age,” my father says as he clicks his mechanical pencil for the Sunday crossword puzzle I know he’ll finish in minutes.  “I had to accept it.  Otherwise I could never do my job.”  After all, as one experienced doctor described bluntly in an article on the Post Graduate Medicine Online website, “No matter what specialty you choose, in reality you lose every patient you ever have.”  
       My father’s education in medicine has produced a stoic and analytical man, often criticized by my mother as being too introverted with his feelings.  He is a great doctor—compassionate, approachable, and malpractice-free.  As a child, he enjoyed taking radios apart and putting them back together so he could discover their inner workings.  He takes me on annual trips to New York City where he buys more dead butterflies to add to his collection.  When we play Boggle, he finds words like “nemesis” and “quail” and I have no doubt he has the highest IQ of anyone I have ever met.  
       There are days at his Ophthalmology practice when he has to throw away files of patients who have passed away, as the majority of the people he treats are elderly.  He reads the obituaries in the local paper every day and finds a former patient of his featured there at least three times a week.  And while his specialty of cataract surgery is minimally invasive, he has had his fair share of patients who have had emergency complications coming out of anesthesia, and even one patient who flat-lined unexpectedly during surgery—stories he had never shared with my mother or me until I pressed him for more detailed information about his surgery history.  Many of these patients who die he has treated for twenty years, and some for the entirety of his medical career.  Despite this, it is almost impossible to separate the days when death arrives, in one form of another, from all the other days—he comes home every day completely composed, the picture of the perfectly collected surgeon.
       My mother’s father died when I was fifteen, at a time in my life when it had become apparent I was much more like my father than like my mother.  Dad and I liked to do puzzles; mom was never interested.  Dad and I built model train sets together; mom watched with feigned enthusiasm.  Dad took me into his Ophthalmology clinic one day and taught me how to conduct a vision test; my mom chatted with his secretaries.  I had inherited his academic and analytical qualities, and while my mom was always compassionate and supportive, it seemed our personalities just didn’t quite mesh.  Biology was my most favorite subject in school and I eagerly anticipated the day my class was to dissect fetal pigs.  I told everyone I knew I wanted to be a doctor, just like my dad.  So when my mother’s father died, I looked to my dad for how to react.  I was sure he would know what to do.
       It turned out my father knew exactly what not to do.  He knew it was not his place to grieve, that those around him would gain nothing from a public display of emotion, and society’s expectation of the perfectly collected surgeon stood firm.  At my Grandfather’s funeral, my father and I were the only ones who didn’t cry, though at the time I wished nothing more than to force tears out of my eyes so I wouldn’t look like the callous granddaughter who didn’t care.  As we walked on the gray gravel road through skewed rows of grave markers, I realized this was the first cemetery I had ever been in.  My dad walked methodically, kicking the same piece of oblong gravel with the toe of his shiny black shoe.  I felt out of place in my dark grey coat—everyone else was wearing black.  We stood next to each other at the back of the group, numb to the grief my mother’s family felt as the smooth blond wood casket slid silently into its hole.  
       It appears that to become a doctor, one has to learn not to grieve as normal people do.  In a program entitled The End of Life: Exploring Death in America, National Public Radio’s Joanna Silberner says, “to become doctors—that is, good doctors—they need to get comfortable enough with the end of life so that when patients die, including patients they may have known for years, they can leave it behind them in a way that relatives and friends cannot.”  It is this expectation that Medical School curricula respond to when turning students into doctors; reshaping the emotional into the detached, the empathetic into the sympathetic.  When I ask my dad again many years later how he felt when his father died, he says, “I wasn’t really sad, you know.  It was his time.  It hit everyone else harder—my mother was a complete wreck.  It wouldn’t have helped anything if I was crying my eyes out in the corner, and I didn’t need to.”  My father doesn’t seem to feel loss after the death of a loved one or a patient, but perhaps he has simply been conditioned to leave it behind him.
       Not all doctors find this detachment from death to be easy or even possible, but they are still faced with a society that expects them to walk away from death easier than everyone else.  In an article chronically the death of her son, Barbara Wiseman, M.D. explains society’s expectations of doctors when familial death arrives. “Lay people and medical people alike think that because doctors deal with death on a regular basis, somehow they have become immune so that their own grief is less severe, less deep, less profound.  People expect us always to be competent and controlled even when our world has fallen apart.”  Even after the death of her own child, she was expected to be the calm, omnipotent doctor everyone knew her to be.  Not all doctors can meet the demands of a Medical School system that aims to produce physicians who are both skilled in the care of, and ability to leave behind, those who will die.  Whether or not they become able to detach themselves from death, they must still face the different standard to which society holds them.
       Medical schools across the country have recognized the practice of “detached concern” and the need for a comprehensive study of death in the medical profession.  Many of these institutions have restructured their curricula accordingly.  Websites for medical professionals have surfaced offering support and advice on how to stay strong in the face of death.  An article written by two doctors on the Postgraduate Medicine Online website, reminds its readers of what is expected of them when a person dies.  The article reads,  “accepting life's transience and the unknown is perplexing, but coming to terms with these issues forces us to face our mortality, to recognize life's uncertainties, and to accept our personal and professional limitations.”  My father puts it a little more bluntly,
       “Look, Al.  No one wants to see their dead husband’s doctor crying and out of control.  You just can’t do that kind of crap.  No one will take you seriously.  No one will listen to you.”  It seems that my father’s acceptance early on in his medical education that “Death is a part of life” has become as much of a medical guiding light as the physician’s Hippocratic Oath of “First do no harm.”  
       There are times when I come down to my father’s study looking for him and don’t find him sitting in that black desk chair.  Glancing around the room, it is odd how I feel I am entitled to all that he owns and ever did own.  No one else, not even his wife or his son, could ever understand the beauty of his broken Felix the Cat clock and sweat-soaked cycling gloves the way I do.
       Sometimes an ominous feeling comes over me and I wonder if he knows it will ruin my life when he dies.  I have never known this world without him and a part of me will die with him on that day.  I will feel like I’m drifting alone in an endless ocean without the expert cartographer I’ve always had by my side.  I’m sure my friends and family will tell me, with dim half-smiles, that he wouldn’t want me to be sad.  
       That day will come, as inevitable as the days he has to leave behind patients he’s treated for years.  I will not know what to say or how to act when I walk through the cemetery on the day of his funeral, for he will not be there to show me.  I don’t know if I’ll cry.  Maybe I’ll be calm, or numb, maybe I will fall apart in front of my family.  Or maybe the realization that I will have no one’s footsteps to follow on that gray gravel road will simply be too much for me to take, and I won’t even be able to pry myself out of bed.





References:
Personal interview with Dr. Peter T. Lapinsky. 2006.

Kim, Jean, “Emotional Detachment and Involvement of Physicians in Literature,” The        Pharos, Spring 2001, 1-6.

Silberner, Joanne, “Doctors and Death,” NPR.        http://www.npr.org/programs/death/980104.death.html
              
Wiseman, Barbara, “Death of a Child: A Bereaved Doctor’s Perspective,” The        Compassionate Friends Canada.         http://www.tcfcanada.net/articles/professionals/child.htm

Zerbe, Kathryn J. and Steinberg, Deborah L, “Coming to Terms with Grief and Loss,”        Postgraduate Medicine Online.        http://www.postgradmed.com/issues/2000/11_00/zerbe.htm