Saturday, July 18, 2015


The title is a bit of hyperbole. We don’t know exactly who the
“last” physician was, or will be, and we don’t know precisely
when the profession as such will pass away from us. It might
also seem especially strange to say “a last physician” when
all around us there is an explosion of new medicine, with new
treatments, new drugs, amazing medical devices, as well
as exponentially growing knowledge about the human body,
its genetics, overcoming diseases and a dramatic
prolonging of human lifetimes.

The physician has been with us since almost the beginning of
human time. Initially, there were “medicine men” in the earliest
human eras --- in the caves, in the tribes, in every form of human
society. Physicians always had a special place wherever they
were because they did something as important as anything else,
curing or alleviating illness or pain --- they “cared for” others,
often when no one else would or could.

In retrospect, it is amazing what early physicians could do
with herbs and potions, crude surgeries, the ancient acupuncture
and remedies of the Orient. But nothing could approach the
accelerating advances of medicine in the 18th, 19th and 20th
centuries. Diseases and pathologies, only yesterday inevitably
fatal, can now be cured or controlled. Pain can be relieved. Life
expectancy is consistently extended. The “map’ of human
genes is known. Artificial body parts now can replace many
hitherto physical failures. Transplants are commonplace.
Anything seems possible.

In this extraordinary abundance of medical advance and
capability, it might seem counterintuitive to speak of some
“last” physician, but I think that is exactly what is happening.

I will illustrate this with a very personal example. No, I have
little knowledge of medicine, but I did have a rather special
physician as a father. He was not at all a widely-known man
of medicine. He was a general practitioner in a small city
with a modest practice of patients, most of whom were
ordinary citizens from many ethnic, religious ad economic

I said he was my father, and he was, but this is not about him
as a parent. It is about his practice of medicine.

He was an immigrant from Russia before the 1917 revolution.
He fled persecution when he was only ten years old, and
settled in Canada. He and his family were penniless, but he
was smart enough to win a scholarship to the local medical
school in Montreal. That school happened to be McGill
University which had been headed by the foremost physician
of the day, William Osler. It had become a legendary medical
school faculty and campus. My father graduated to a modest
medical practice in Erie, Pennsylvania. He remained as a
physician for 65 years, 62 of them on the same hospital staff.
(He spent 3 years as a U.S. Army post surgeon during World
War II.) Until the war, he performed general surgery (as most
physicians of that era did), delivered thousands of babies,
and throughout his medical career, he treated several
generations of the same families.

He stood out because of his uncanny ability to diagnose,
his boundless compassion and the role he served as someone
to turn to if you were ill or otherwise had personal troubles.
While growing up, I did not see him as a remarkable physician,
especially compared with other physicians. Today, most
physicians retire in their late 60s or their 70s, or even earlier.
He practiced full-time until he was 92, making house calls to
the very end. He had no nurse or secretary. He did all his own

Later in my life, when I would go home to visit him, I noted
that virtually wherever we went in public, many would greet
or recognize him. I knew of a young woman who he had helped
deliver (long after he routinely delivered babies) who was the
granddaughter of a woman he himself had delivered when he
first came to Erie. I once met an older nurse who told me he
had delivered her. The stories about his practice of medicine
and the lives he affected were endless.

I do remember often waking up as a child to the phone ringing
in the middle of the night, and of seeing him go out, his clothes
over his pajamas. to care for one of his patients. I also
remember the many cards, baked goods, and other gifts from
his patients at Christmas. I remember the look on the face of
his patients when they saw him on the street.

He was a wonderful father, but no more than any other good
father. He was not a perfect person; he had many little faults
and shortcomings.

I do not want to suggest that he was unique as a physician
either. I have read about several others, many of them of his
generation, beloved by their patients and who practiced
medicine much longer than is done today. Perhaps the reader,
if he or she is old enough, knows of one of these other
extraordinary doctors.

Today, in seeking medical care as I grow older, I occasionally
come across a young physician with remarkable qualities, but
the practice of medicine is forever changed, and there is little
room now for the care and compassion that my father’s
generation could provide. In fact, as the practice of medicine
is becoming so specialized, so technological, so crowded
with patients, medicine is becoming much more mechanical
and much more remote. This, of course, is not necessarily a
“bad” outcome. In fact, in many ways, medicine is much more
effective, even as it has  lost the old relationship between
physician and patient. Sic transit gloria mundi.

At the end of his life, my father lived in an assisted living
facility. My brother and I lived far away. Although he was ten
years older than my mother, he had outlived her. I visited him 
before he died just prior to his 98th birthday, and when I arrived,
one of the facility nurses took me aside to tell me the following

To treat a cold, he had been moved from private assisted living
to a more intensive care unit for a few days. These were
semi-private rooms, and after a few hours on his first day there,
the staff moved in a second patient, another elderly man who
immediately went to sleep. My father was soon alone in the room
with this man who turned out to be a well-known local swimming
coach who had been chief lifeguard for many decades at the city’s
famed Presque Isle State Park beaches, and was a legend for the
lives he and his lifeguards had saved on the swimming beaches.

It was almost midnight when the other man’s breathing became
labored. As the minutes went by, the breathing became more and
more irregular.  My father quickly recognized that the other man
was in a pneumonia crisis. He rang for the nurse. No one came.
He rang again. No response. Apparently the buzzer wasn’t working.
There were no telephones in the room. Cell phones were not yet in
popular use. The special care unit at that hour had a long corridor,
and a night nurse on duty. After decades of front line medicine, my
father knew from the sound of the man’s breathing that he needed
immediate attention or he would die.

At that point, my father, who was 97 years old and unable to walk,
precariously slipped off his bed on to the floor. He then crawled about
fifteen feet to the other man’s bed, and reached up to grab the man’s
wrist to take his pulse. His fears were confirmed. My father then
crawled into the hall, and yelled for the nurse. Finally, she came,
and he told her that his neighbor needed urgent emergency care.
It was his last medical hurrah. He was no longer a practicing
physician, but he knew what he knew, and he was not going to let
a man die while he was in the same room.

The next morning, the resident physician stopped by my father’s
bed to tell him that he had been exactly right. A few hours more,
probably in the middle of the night, the swimming coach would
have died without emergency treatment. All day long, physicians
and nurses came by to pay him homage for what he had done.

There are, of course, countless stories of physicians doing this
kind of thing over the millennia. It wasn’t heroism; it was simply
human service in an age when that made a difference between life
and death.

The new medicine replaces that with better treatments and drugs,
with amazing devices, with unprecedented understanding of the
human body, and with better outcomes. There are still young
compassionate men and woman physicians, but it is only a matter
of time before they, too, will be removed from their first hand
interaction with patients.

Can a government bureaucracy be compassionate? This is a
question that will be debated in the years ahead.

“Star Wars” medicine, however, in one form or another is coming.
A small robotic machine passed over a diseased body or injured
limb will not only diagnose a medical problem, it will repair it
without surgery as if it were a magic wand. Many persons will
live well past the age of 100; perhaps human beings will even be
able to live indefinitely.

But to get there, it has been necessary for generations of physicians
to perform more than mere medicine. Their battles were no less
formidable than the battles faced by generations of soldiers,
although they were less visible and dramatic. The physician has
been a basic component of human life. The sacrifice and devotion
of the best of them, like the best performed by our soldiers,
should not be forgotten.

As we enter a new age, we forget compassion at our peril.

Copyright (c) 2015 by Barry Casselman. All rights reserved.

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