Don't Put Off Till Tomorrow...

Those were exciting weeks as I anticipated the opening day of my medical office.  It was to be August 1, 1956, eleven years and ten months from the day I entered Harvard Medical School and approximately ten years since I first laid a hand on a patient.  So much preparation in those years, acquiring knowledge, developing skills, molding attitudes toward patient care, and drawing up schematics of the form my medical practice would assume.

Taking a cue from my brother Jerry’s General Practice before he went off to fight in WW II, I rented office space above my Aunt Sarah’s jewelry store on the main street in Aliquippa.  Adapting it to my physical needs required no structural changes.  At the entrance was a combination secretarial office-waiting room, which led into both a consultation-examining room and a room accommodating an x-ray machine.  A closet became an x-ray developing room and a bathroom. Sharing the waiting room with an adjoining lawyer's office reduced my costs.

I had spent the month of July ordering office furniture and medical and secretarial supplies including calling cards and personalized stationary.  One dilemma arose when it came to deciding on a desk chair.  The corporation president’s chair was too ostentatious and expensive; I settled for the vice-president’s model, also too expensive.  (I remembered the advice of a highly successful accountant who was under my care at Lahey Clinic.  We were discussing my bleak financial situation as I approached entering private practice.  “Don’t borrow a small amount of money from the bank; you’ll just stay awake at night worrying how to pay it back.  Borrow a large sum.  You’ll sleep better knowing that you’ll have to pace yourself over a long haul rather than repaying the loan quickly.”  To wit, the lavish chair.)

The most costly item was the x-ray machine.  Though I was a specialist in Internal Medicine, my training included one year of gastroenterology during which I became proficient in performing x-ray examinations of the gastro-intestinal (GI) tract.  One of my favorite teachers, the chief of radiology at the Beth Israel Hospital in Boston, showed his disapproval by ordering me out of his fluoroscopy room when he realized that I, as an Internist, would be performing GI x-ray procedures.  I rationalized my plans on the basis of the absence at that time of a hospital and a radiologist in my town.  At the outset of my practice a few physicians became acquainted with me by sending patients just for an x-ray.  The fact that Blue Cross Medical Insurance paid handsomely for x-ray procedures years before compensating a doctor for his consultation was of more than subliminal importance in those early hungry days. Oh, yes, my in-laws paid for the x-ray machine -- my request as a substitute for their furnishing our home.

Lastly was the need to find an office assistant I could afford, a woman who could be a nurse, a lab and x-ray technician, and a secretary.  A newspaper ad produced several candidates, one of whom, Pauline, stood out above the rest.  A licensed practical nurse, she had done office work for her husband.  She also had a pleasant personality.

For several days prior to the announced opening date as printed by our local newspaper Pauline and I organized schedules of painters and plumbers, electricians, and instrument technicians.  Pauline practiced drawing blood from me and together we performed the basic blood counts and screening chemical tests.  I also taught Pauline urine tests; this time it was her specimen.  She also performed an electrocardiogram on me and on the lawyer in the adjoining office.  All that was lacking was a special switch to activate the x-ray machine, which was promised for the 31^st of July.

It was Pauline who answered the phone on the morning of the 31^st.  “Good morning.  Dr. Chamovitz’s office.”  It was a woman calling.

“I would appreciate it if the doctor could see me today.”

“Just a moment.”  Placing her palm over the phone’s mouthpiece, Pauline relayed the request.

 I picked up the phone.  “This is Dr. Chamovitz.  Can I help you?”

“Why, yes.  Yesterday morning I awoke with one side of my face flat and I believe it’s paralyzed.” 

“How has your health been otherwise?”

“Fine. But I’m really worried.  Can you see me today?”

“Truthfully, we need today to make last minute preparations but I’ll see you first thing in the morning.  I’m sure you’ll be okay.”  I assumed she had Bell’s palsy for which there was no treatment anyway.  (As I write forty-five years later my attitude appears lackadaisical; were it today, she would have had an immediate Computerized Tomogram of her brain to rule out a stroke.)

I could hear the disappointment in her voice as I turned her back to Pauline.  I gave it no more thought except to whisper a “Eureka!  My first patient.”

The following morning Pauline and I donned our new, dazzling white professional garb, I, a long lab coat, she, a nurse’s uniform.  At the appointed hour Pauline ushered in Mrs. Georgia Lewis, a thirty-nine-year-old housewife dressed in “church-going” clothes.

I noted the faint sagging of the right side of her face as she sat in one of the two salmon-colored leather office chairs opposite my desk.  A faint smile further exaggerated an asymmetry of her face.  I posed my opening question.  “Why are you smiling?”  I anticipated compliments for my office décor or comments regarding my being so young to be a specialist.  (After a few years I no longer heard that latter compliment.)

“Doctor, you won’t believe it but when I looked into the mirror this morning, I could see that my face was much improved.  What do you think of that?”

I should have been delighted.  “You fool,” I said to myself.  “Look at what a hero you would have been if you had seen Georgia yesterday!”  Still I tried to reap some glory out of the situation.  “Over the phone I suspected that your diagnosis would be Bell’s palsy, most often a self-limiting disease that requires no treatment. That’s why I had no qualms about delaying your examination one day and why I tried to reassure you that you would be okay.”

Georgia took the bait.  “It’s true that I felt more relaxed after I spoke with you.  Could it be that’s why I improved?”

I wasn’t a total scoundrel.  “The truth is that we don’t know everything about this illness except that it’s probably caused by a virus but why it subsides quickly in some and very slowly in others, we have no idea.”  With tongue in cheek I added, “Who knows what a positive attitude will do?”  I was shameless.

Without much enthusiasm I proceeded with a history and physical examination and had Pauline perform the screening lab work.  I asked Georgia to report to me in a week and with that phone call our relationship came to an end. 

Well, not quite.  I called her on our “first anniversary” to note the occasion and to inquire as to her health.  “I’m fine and you’re such a marvelous doctor!”  Again, shame on me.