A Doctor Transformed, Into a Patient

By ABIGAIL ZUGER, M.D.
31 aug 2008--Doctors get seriously ill just like ordinary people, and some of them never recover from the shock. If of a literary bent, they are often moved to reflect for posterity on this disruption of the natural order, detailing their former hubris and the enlightening misery of health care experienced from the other side of the bed.
Against this generally lackluster collection of memoirs, Dr. Thomas Graboys’s stands out as a small wonder. Unsentimental and unpretentious, it manages to hit all its marks effortlessly, creating a version of the old fable as touching, educational and inspiring as if it had never been told before.
The story’s success lies partly in its almost mythic dimensions: Dr. Graboys rose high, and he fell hard. Until age 50 he was a medical version of one of Tom Wolfe’s masters of the universe: a noted Harvard cardiologist beloved by colleagues and patients, happily married to a tall, beautiful blonde. He was a marathon runner, a demon on the tennis courts and ski slopes, and, if he says so himself, a particularly handsome guy.
Then everything fell apart. Over a terrible two-year period Dr. Graboys’s wife died a lingering death from colon cancer. In his grief he barely noticed that he was not functioning quite as well as usual. Those around him figured his fatigue and uncharacteristic fumbling were only to be expected. He pulled himself together, met another woman, and then collapsed on the wedding day — the beginning of physical problems that could no longer be ignored.
It was Parkinson’s disease, the neurological condition that makes the body stiffen and shake, but it took Dr. Graboys many months to take the irrevocable step of giving his problems a name. During that time he went through every rationalization that sick people use to wish away their symptoms, then moved smoothly from denial to deception. “I’m just tired,” he snapped to concerned colleagues, even as he began taking surreptitious clinical notes on his own case.
Only when the chief of neurology at his hospital cheerfully hailed him in the parking garage — “Tom, who is taking care of your Parkinson’s?” — was the terrible word said aloud. Dr. Graboys finally understood that the jig was up.
From this moment his memoir unfolds in multiple layers, some predictable, some quite unexpected.
Dr. Graboys is not the first athlete to go from tennis and skiing to cautious walking and gym work. Nor is he the first good-looking man to watch his body deteriorate, the first father to become increasingly dependent on his children or the first master of the universe to contemplate the loss of his driver’s license.
His reflections as a husband are more unusual. He courted his second wife while still ostensibly healthy, although privately he knew something was wrong. He writes candidly about this duplicity, and the complicated grief and anger that infuse their relationship now as she faces a future of caretaking far different from the one she signed up for.
As a writer, Dr. Graboys is also unusual. Like many patients with Parkinson’s he suffers from a slowly progressive dementia, and is losing not only his physical but also his intellectual self. The memoir is written with a co-author, an arrangement always a little uneasy-making. Yet the voice here is true, somehow almost Parkinsonian in its steady, unadorned, slightly stiff prose.
Finally, Dr. Graboys is hardly the first doctor to find that without the practice of medicine — progressive disability forced him to retire a few years after his diagnosis, at age 62 — he is barely recognizable to himself. But he does one of the best jobs on record of doggedly unpeeling the onion-skin layers of alternating ego and vulnerability that encase the doctor turned patient.
While in practice, Dr. Graboys was a master clinician who often rejected the glittery technology of his specialty for older, slower medicine. His excellence made the transition to patient more difficult than most. He knew how good a doctor he was, and surrendering control of his own case to someone possibly not quite as competent was just impossible. Every instinct told him to be his own doctor, his very own “dream team.”
As he ruefully reports, he is still learning over and over that the doctor who is his own dream team has a fool for a patient. And yet, enough of the old Dr. Graboys comes through that a reader might conclude he would also be foolish to sign off his own case completely.
As he once made a point of involving patients’ families in their care, he invites his own family members to talk directly to the reader. As Dr. Graboys once gave each of his patients a handwritten care plan (“I never gave the patients a photocopy”), he provides readers with Parkinson’s a set of suggestions for improving their own lot.
This is the kind of book inevitably given to medical students to inculcate them in the humanistic dimensions of medicine. I wouldn’t waste it on them. Save it for older doctors, still at the top of their game, gleaming and self-confident. Each of them could use this textbook of the graceful and courageous exit.