THE FOURTH WALL

In medical school, during my surgery rotation, I was expected to report for service rounds at 5:00 a.m. All of the patients on the floors needed to be rounded on prior to the OR cases, which began at 7:00 a.m. Therefore, to pre-round on my patients, I arrived at the hospital at 4:00 a.m. I figured this was a good time to experiment with growing out my hair and not shaving. Midway through the rotation, a cardiothoracic surgeon suggested I get a haircut and shave. He did this in private; it was not a rebuke, rather a suggestion. He advised, "Your patients want you to look and talk like the doctors on television." He was tall and trim and had perfect hair and teeth. He spoke slowly with a regal South African accent.

For the most part, I've followed his advice to this day. Every once in a while, I break the fourth wall and let the patients know I am as frustrated and disappointed with the medical system as they are. Usually, this is when they see me on the phone with an insurance company or witness my struggle in trying to obtain their medical records from another hospital.

My father, who just turned seventy, intuitively plays the part of the iconic television doctor. He defines himself as a doctor. He's been a pediatrician for over forty years; many of his patients are the children of his former patients, and some now are even the grandchildren of his former patients. When kids dress up as a doctor for Halloween, my father is the kind of doctor they are simulating. Indeed, a number of children have specifically dressed up as Dr. Bomback for Halloween. A local magazine, which profiled him as the top pediatrician in the county, asked him to pose for the cover of that issue. He and one of his patients re-created a Norman Rockwell Saturday Evening Post cover, my father cast as the reliable family doctor about to give a shot into a boy's rear end.

It's a morbid but entirely true thought: my father's obituary will mention his doctoring in the first sentence. That first sentence of my father's obituary — after labelling him as a husband, father, and grandfather — will say he was a devoted pediatrician to tens of thousands of children. If asked for input, I will also suggest the phrase "master diagnostician" be used. My father did a fellowship in genetics but has never used that training in his practice. He's a general pediatrician, without a true subspecialty, although websites and magazines have given him a subspecialty distinction of "difficult diagnoses." The obituary should say, "When other pediatricians needed help, their first call was to Dr. Bomback." My father was Dr. House before Dr. House existed, except my father is kind, humble, and needs sixty seconds (and not an entire TV episode's worth of drama) to make the diagnosis.

The obituary won't mention his stutter — it would be an odd detail to include in an obituary, I concede — but it should. My father does not stutter the way people stutter in movies. He doesn't repeat a consonant over and over again. His stutter is more accurately labelled a block. He blocks on words. He can't get started. He produces the sound of someone trying to clear snot from his nose without the aid of a tissue. This happens every time he answers the phone. This happens even when he is the one placing the call. "Mmmmmpphhh. Mmmmppppphhh." A pause, then: "Hello." When he's on service, returning calls from patients (more accurately, the parents of patients) is a process. He starts his speech while dialing, hoping the block ends while the phone is ringing. He's worked with a speech therapist for years, practicing a way to essentially cough out a greeting when he calls his patients.

The doctors in movies and on television don't stutter. The best on-screen doctors see a patient, make a diagnosis immediately, and then calmly and fluently communicate their recommendations to the patients and/or their families. Think George Clooney in ER. Think Jerry Orbach in Dirty Dancing. Think Patrick Dempsey ("McDreamy") in Grey's Anatomy. My father knows exactly what will help the patient, knows exactly what he wants to say to the patient's parents, and then can fall into a block that looks like dry heaving. I've shadowed him in clinic and seen this happen. The parents wait for him to get out the words. They are patient, because they know his reputation; they've often traveled far distances and endured long wait times to listen to his expertise. These moments only bear the slightest embarrassment for them, but I know, because my father's told me, that these blocks are excruciating for him.

I haven't quite figured out my feelings about my father's inevitable, upcoming retirement from medicine. I should say that he hasn't decided to retire. He claims he doesn't want to retire. He just turned seventy and always pictured himself practicing into his eighties, but the moment of reckoning is fast approaching. He is virtually computer illiterate. He's lost with the electronic medical record. Two or three times a year, he asks me to help him complete an online training course required by the hospital. "I can't do this," he laments. Because his quick, illegible handwritten notes are now considered insufficient documentation, he's had to cut down his daily patient panel almost in half. He's never had to think about billing, about collecting, about the financial part of his practice. In contrast, his junior partners are de facto experts on medical economics. When the partners sold their practice this past year to a large, multi-specialty medical group buying up independent practices, my father was the only one not involved in the negotiations.

My father doesn't need to work from a financial standpoint, but he is struggling with the idea of life as a non-practicing physician. His only hobby is exercising at the gym, but he mostly goes to keep my mother company. On vacation, he brings medical journals as his pleasure reading. For as long as I can remember, the magazine rack in my parents' bathroom has been stuffed with my mother's New York magazines and his latest copy of Pediatric Infectious Diseases. A retired medical school librarian, whom I cared for in the hospital, asked me if I was related to my father after I introduced myself. She told me she used to hold tapes of medical textbooks for him at the circulation desk. I remember these tapes in his car. He listened to them driving to and from work. "Your father used to thank me so much for holding the tapes for him," the librarian said, "and I didn't have the heart to tell him that no one ever checked them out except him."

"I...