Another Day in the Frontal Lobe (3 page)

THREE

Influences

I grew up with surgical stories. My father is a surgeon—a general surgeon—and I understood from an early age that there was some degree of gore inherent in his job. This was a great source of pride for me as a kid. Most of my friends had fathers who sat at desks all day. What kinds of stories were there in that? I imagined my friends, helpless, subjected to lifeless desk-based tales at the dinner table. Lucky for them, though, I was happy to spread my wealth of secondhand tales from the trenches.

The account of the poor kid with the hair bezoar became legendary. This was a child my dad took care of when he was a resident. The word “bezoar” is probably one of the ugliest words in the English language, and rightfully so. It refers to a wad of any given material that gets stuck in the stomach, often requiring surgical extraction. Typically, this wad collects slowly over time. The word “bezoar” is not used in everyday speech, which makes it all the more intriguing when used on the rare appropriate occasion, as with this story.

The subject of this nonfiction was a boy whose grandfather, I believe, was a barber. The boy hung around the barbershop regularly, and supervision was apparently lax. Between customers, he had a peculiar habit of crawling around the perimeter of the room, picking up scraps of hair off the floor, and swallowing them. Over time (was it months, or years? I can’t remember now), this child developed a massive hair bezoar in his stomach, right under the unsuspecting noses of his family and friends. When things finally came to a head, with the boy having no room left for conventional nourishment, he required major surgery to extract the mass. When the family learned of the contents, they pieced together the chain of events with disturbing clarity.

This bezoar had taken on the exact shape and size of the boy’s enlarged stomach and my father had the foresight to capture the image of the extracted hairball on a thirty-five-millimeter slide. Surgeons like to show each other pictures when they give lectures, partly for teaching purposes and partly as a thinly veiled version of the classic “here’s what I did on summer vacation” show-and-tell. In surgery, more often than we’d like to admit, anecdotes rule, and all the more powerfully when accompanied by high-quality Kodachromes. Surgeons know that in giving a lecture, it is also important to include the results of scientific, controlled, multicenter studies. The accompanying charts and graphs, though, tend to be either confusing or boring, so color pictures of things removed from patients’ bodies are snuck in whenever even remotely justifiable.

As I grew older, it dawned on me that the story of Bezoar Boy was more pitiful than captivating. The case falls into a psychiatric disorder known as “pica,” or the involuntary urge to eat nonfood items. I was recently reminded of this child when I read a short news clip about an elderly man in France with a penchant for eating coins. Over several years, his stomach became so stretched out and weighted down with coins that it descended into his pelvis. During surgery, upon opening the precariously thin-walled, flimsy organ, the surgeons noted disintegrating francs at the bottom and—logically—euros layered at the top. This detail takes the cake and rivals anything I could possibly tell you about the aforementioned hair bezoar. The case is equally pitiful, though, and I feel a bit guilty in exploiting the old man as a supporting anecdote.

My father, in telling his clinical accounts, was always respectful. The patients remained anonymous. He told the stories with a sense of wonder, not mockery. As a kid, I felt privileged to have such insight into the extremes of human behavior. I sometimes thought about his patient who swallowed a pen in jail, just so that he could leave his cell for the hospital, only to do it again upon his return. Talk about pitiful. My father reflected on the inmate’s state of mind, shaking his head in disbelief, and this story became my definition of human desperation.

Looking back, there was another hint of my father’s dignity as a human being, more clear to me now as an adult: he forbade me from going to the so-called freak shows at the summer county fairs in Ohio. We lived in Shaker Heights, a nice suburb of Cleveland, and we visited these rural fairs to gain an appreciation of a different scenery and culture, and for the greasy funnel cakes with powdered sugar. Although there were plenty of other things to see—livestock, choice vegetable specimens, Amish buggies in the parking lot—I always begged my parents to let me go through the Hall of Human Wonders. At the time, I didn’t understand what was wrong with paying money to see the world’s fattest woman, or the wolf man with excessive facial hair, or the rubber man (who I now know probably had a serious, and potentially life-threatening, connective tissue disorder). Although my father was willing to divulge the true story of Bezoar Boy in the privacy of our dining room, he drew the line at paying to gawk at unfortunate oddities.

My younger sister Ingrid didn’t share my interest in gawking. I attributed this to her relative discomfort with human deformity as a youngster. We frequented a Chinese restaurant at a strip mall where one of the waiters was missing a hand, and she never ate much there. I, on the other hand, reached for seconds while marveling at his ability to balance plates with the aid of his stump.

Although I’m sure my father included plenty of uplifting stories in the dinner table mix—the archetypal ones about medicine and miracles, about patients with hope defying the odds—my child’s brain filed away only the more graphic and disturbing ones, in permanent storage.

Apart from my access to gory stories, I took pride in my surgeon-father for another reason: he could handle anything. When it came to the threat of backyard injuries, I perceived my friends to be at greater risk of delayed or inadequate treatment, given their fathers’ narrow desk-based skill sets. I wondered if that made them nervous. What could their fathers do, aside from applying a Band-Aid? I knew that my dad, on the other hand, could always perform emergency surgery if he absolutely had to. He remained calm in the face of active bleeding. For any given backyard or playground trauma scenario, he had seen worse, much worse.

Take, for example, the kid who ran with scissors. My father strongly cautioned against this activity, and he only had to tell me once. This simple lesson lodged itself in my mind, indelibly, because it was accompanied by another slide from his personal archives. This single picture was equal to a childhood’s worth of warnings. The slide showed the face of a young boy, a patient of his years ago, who actually did run with scissors—and tripped. In the small slide, held up to the light in the kitchen, I could see the gleaming handle of the scissors protruding from the corner of his eye socket. Needless to say, from that point forward, I was reluctant to run with anything sharper than a spoon. However, had I become the victim of a scissors injury, I knew my dad had seen it all before and would know what to do.

Although my father never did have to perform emergency surgery at the kitchen counter, we had some of the necessary tools lying around, just in case. For some reason, we always had a weighty pair of curved shiny scissors in a kitchen drawer, packed in alongside other random utensils. Although I suspected that their original and proper home was an operating room, and that they had somehow made their way into our home, I didn’t know that they had a name—curved Metzenbaum scissors—until years later when I became a medical student. These scissors were, at the time, an anonymous annoyance. Although they were fine for low-precision tasks like cutting apart clumps of grapes, they were lousy when it came to wrapping gifts. They created an awkward scalloped edge to the paper that grated on my perfectionist tendencies.

My mother would trim off the ends of my straight hair every few months, and I was charged with the task of hunting around for a good pair of scissors, which often took longer than the haircut itself. Without fail, I would think my search was over when I spotted the shiny handle of a pair in a drawer, only to realize, a moment later, that I had been cruelly misled by the curved ones. In this realm, my otherwise disadvantaged friends had at least a minor advantage over me, as they did not have the rogue operating room instrument contaminating their household items.

I remember goofing around with my siblings, throwing things other than laundry down the second-story laundry chute in the hallway that led to my bedroom. Somehow, I slammed my finger in the door of the chute—hard—and the pain was throbbing and unbearable. I ran downstairs to report the injury to my dad and promptly fainted. I awoke, startled, to the noxious stimulation of smelling salts under my nose. My father kept some of this substance in a black doctor’s bag in a library cabinet, expressly for this purpose. I was thankful for the rapid wake-up. I suppose, in retrospect, that I would have regained consciousness on my own just fine, but the smelling salts were a nice touch and further supported my pride in being the daughter of a surgeon. I haven’t seen smelling salts since, even in a hospital. Its utility must be under question.

Despite having a surgeon as a father, with all of its advantages, surgery was not exactly the job I had in mind for myself as a kid. Some children know they want to be a doctor, and even specifically a neurosurgeon, as far back as elementary school. They announce their plans to everyone, including strangers in line at the supermarket, and when they grow up to become a doctor, nobody is surprised. I wasn’t one of those kids. Maybe I didn’t like the thought of missing dinner on a regular basis, working on weekends and holidays, and spending inordinate amounts of time in a standard issue hospital. I was happy to hear the gory stories, but I didn’t aspire to have my hand in them.

Although I had my own career uncertainties, there was always an expectation among my extended immigrant family that I should, and would, become a doctor. I was the oldest of four children, and though the younger kids weren’t necessarily off the hook, the relatives worked on me first. For my birthday once, an aunt gave me a little doctor figurine—a middle-aged male figure in a white coat. The figurine didn’t really speak to me. It might as well have been a firefighter, or a bullfighter. I decided not to display it on my bookshelf alongside my shells, flashy chunks of fool’s gold, and other highly prized artifacts.

I didn’t know what I wanted to be. I knew what I liked, but my interests didn’t add up to any particular profession that I could display on a shelf. I had a natural curiosity for anything foreign. I collected stamps and coins from as many countries as possible. Monetary value was irrelevant. Obscurity, or exotic design, was what I was after. I wrote to pen pals around the world: France, Thailand, the Congo. (I dropped the one from France when it became clear that she was obsessed with our native Sylvester Stallone, and kept asking me to clip and send any pictures I could find. I felt used.)

I penned a letter to the president of the tiny Pacific Ocean island country of Nauru. Our encyclopedia, which I flipped through for entertainment, included a disappointingly small entry for this country, but did mention its admirable per capita income owing to rich phosphate reserves from bird droppings. I had to know more. I never received a response but blamed the post office rather than the president, figuring they didn’t know what bin to toss my letter in. I have since learned that Nauru’s phosphate reserves have nearly been depleted, leaving large craters in the landscape that dim future prospects for tourism.

In junior high school I decided, on my own, to make a list of every country in the world and each capital city. I memorized the list. I wanted to know at least one fact about every country, including the lesser-known Tuvalus and Bhutans, and felt this was a good place to start. I prided myself on this specialized knowledge, a knowledge that other kids didn’t have (or didn’t care to have). In retrospect, the exercise was a bit obsessive-compulsive, but I’m still pleased to know that Antananarivo is the capital of Madagascar.

In addition to my obsessive focus on the foreign, spending time outside was a priority for me. I enjoyed climbing trees, walking through the knee-high Cleveland snow, and exploring any semblance of woods in our suburb. In high school, I was traumatized by an article that compared the amount of time adults and children spend outdoors. I wanted to remain more childlike in that respect, and a traditional indoor job would be a declaration of defeat. Along with the rest of my high school class, I took a lengthy personality survey. The goal was to match interests, skills, and personality with potential career choices. A few months after answering the several-page litany of multiple-choice questions, I received my own personal career list. My ideal career choices, determined by mathematical algorithm, were ranked in order of best fit. “Forest ranger” was number one. “Physician” was on the list, too, but somewhere down in the teens. I did recall marking “working outdoors” as a priority, but hadn’t considered that the options were limited.

I had no idea how to combine my interest in foreign cultures with the outdoors
and
make a decent living, but I started on the culture focus by majoring in anthropology in college, and signing up for Japanese language classes (requiring several hours of instruction, and several more of practice in the language lab, per week). Just prior to college, I spent part of the summer living with a family in Nara, Japan, as part of an exchange program. My time there was a revelation: I was meant to be born Japanese. I loved the culture, food, traditional architecture, orderliness, Buddhist influence, and the way they wrapped even the most mundane items bought at almost any store.

Partway through my sophomore year, though, I started to fixate on the more practical concerns, like making a good living and maintaining a stable career. I remained an anthropology major but became pre-med, which forced me to quit my demanding Japanese classes just at the point where I had become comfortable writing my own name. It was depressing to think that I had come so far but had to quit early. I would always remember how to ask for directions to the bathroom (using either the formal or informal term for bathroom), but I might not understand the response, which minimized the value of knowing how to ask the question in the first place.