By LARRY ZAROFF, M.D.
To operate on a patient without receiving a fee is the most satisfying of memories, the greatest of privileges. It leaves a glow, a high — the feeling young doctors must get these days when they go to third-world countries, repair cleft lips and palates, or build hospitals.
I had those feelings once. It was a time of postgraduate training, with a working wife, no children, no malpractice bills, no office expenses. Just learning.
Those were the days of my surgical residency at Mount Sinai Hospital in New York, days beginning at 5 a.m., going without lunch, finishing at 7 or 8 p.m. (if you had the night off; your nights on, boy were you on). The old days, the ’50s and early ’60s, before anyone belonged to a health maintenance organization: they were the best of times, times of gaining a capacity for hardship and loving it, times of acquiring skills and knowledge, of sucking it all in.
And patients, especially the ward patients cared for by the resident staff, knew how to thank surgical interns making 25 bucks a month.
One patient was admitted with an obstructing cancer of the large intestine. In his mid-70s, a Chinese grandfather with a family he had nurtured all his life. Small, straight with hair the color of smoke, calmly powerful. He needed three operations for the colon cancer: the first, a colostomy, to relieve the block; a second, to remove the tumor; and finally, the last, to close the colostomy.
He had little English but knew the value of “thank you.” A fortunate man. A man respected and admired by wife, children, grandchildren — all attached to the family restaurant business.
I will always remember. A miracle. After each operation, at 7 to the minute, the evening of surgery, his family arrived at the ward kitchen, a sudden oasis, with enough egg drop soup, sweet-and-sour chicken, orange beef, on and on, to feed the entire surgical staff and a few hungry urologists. The dessert was fortune cookies containing special messages of gratitude.
Over time, from other patients and their families, I received other edibles: cookies, fruitcake every Christmas, fresh-baked breads, pickles, jams, honey, cherry pies, a Gouda as big as a lung. Then there were the physical thanks: smiles, tears, shakes, hugs, as digestible and soothing as yogurt. I recall removing a colon for ulcerative colitis in a 7- year-old boy. His mother grasped my hands and said “golden.”
Those poor patients gave what they could. From the wealthy private patients we got cash, a casual 5, 10, 20, rarely 50 dollars, enough to buy an infrequent Italian dinner for my wife and me. Easy for the rich to leave a tip. For them we were accessories, the busboys of the hospital, unimportant compared with their attending surgeons.
Over the decades I have forgotten about delayed payments from insurance companies, arguments about fee schedules, tortured reasoning from administrators, disputes with my associates. I have never failed to remember those patients whose thanks made me feel like a real doctor. Every time my wife and I go to a Chinese restaurant, I remember the meals I had in the ward kitchen. Nothing has tasted as good since then.
Larry Zaroff teaches medical humanities to undergraduates and medical students at Stanford.
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