Saul Farber on St. Helena

Peter H. Berczeller
Dordogne, France

 

  Portrait of Saul Farber

I went to see Saul Farber in his new office in the spring of 2000. For some forty years he had been our chief, our role model, the long-term creative force behind the department of medicine and indeed the entire medical school, the man who personified the core values of our institution. He was not a mere local celebrity. His judgment and authority were so respected that he became one of the leaders of American medicine.

I had retired in 1992, but made episodic forays to New York to see friends and also to revisit this place which had meant so much to me for so many years. Seeing Saul again was at the top of my agenda. He would receive me in his slightly darkened inner office, the ceremonial chair deeded and inscribed to him standing in one corner; a silent reminder of one of the many honors bestowed on him. We would chat for a while like the old campaigners that we were; the new crop of students, the excessive dependence on imaging rather than going through the rigors of the thorough physical exam. Then we would settle on a date to go out to dinner. I looked forward especially to the preprandial drinks, when the shaggy dog stories would abound.  By the end of the evening, I would be feeling right at home again, as if I had never left.

It had not always been like that.  The first time I met him, it must have been 1963, I was full of trepidation. I had just been promoted to assistant professor of clinical, and I couldn’t figure out why. Besides, I was a holdover from the old Fourth (Post Graduate) Division, infinitely less prestigious than its counterpart, the Third (NYU) Division. During my residency year in the former, I had been a witness to its Anschluss by the latter. Though now a card-carrying member of the merged divisions, I still felt like a child brought into a second marriage. When I made an appointment with Saul to thank him for the promotion, I am sure he must have wondered what in the world I was doing there. It was not until several years later that he and I began to engage in any meaningful back and forth.

When I paid my latest visit to his office, Saul had retired as Chairman of the Department of Medicine a short time before, about three years after he had been eased out as dean. His former kingdom was now reduced to one room on the ground floor of the medical school, close to the glass entrance to the upper floor of the library. No secretary to greet or obstruct; his desk bare, no ceremonial chair in sight. He wore a crew neck sweater, not his usual accoutrement of starched white coat and forgettable murky-colored tie. He was cheerful enough yet had something about him that I have noted since, incongruously enough, in retired sports figures. The outer shell was intact, but everything that had made them great, squeezed out of them by time and the impatience of their successors. The office, a kind of Siberia, and the tacit acceptance of his diminished status could only suggest one thing: his day had come and gone.

That was not the last time I met with Saul. In 2007, fifteen years after my retirement and last regular teaching tour, I made one final cameo appearance, mentoring a group of third year students. I had been on the beach for a long time, and I was not sure if I had anything left to give. As it turned out, I still had enough in reserve to forestall any potential embarrassment on my part. As I had done for many years, I hosted a lunch for my group of students at one of the neighborhood speakeasies on the last day of the quarter. This was to be preceded by our joint attendance at the monthly clinicopathologigal conference (CPC). To the uninitiated,  an exercise in which the discussant is the designated bull, while the pathologist takes on the role of the matador. The former attempting to make a diagnosis on the basis of the patient’s presentation, with the latter skewering the clinician. Illustrating how often we are completely in the dark as we make futile gestures at pulling our patients back from the brink. There was a wheelchair parked at the entrance to the conference room, and when I saw Saul hunched over in a chair next to the then current chief, it was clear that that was the conveyance that had brought him there. When Saul was asked to weigh in with his diagnosis before the pathologist’s verdict, there was none of the expectant hush which had preceded his right-on-the-mark utterances in the old days. An obscure factor in the patient’s history, a misleading laboratory result which needed to be discarded, a different take on an x-ray shown on the screen at the front of the auditorium. He would tie these dots together in a Houdini-like sleight of hand. He was not always right, in his suppositions, but that was not even the point. What he was trying to do was to teach the essence of clinicianship. Use the information at hand, add tidbits of up-to-date literature, then sprinkle hunch and imagination into the concoction. That was his strength, which he generously shared with everyone in his thrall. But here, now, I had the distinct feeling that most of the students in the room did not even know who he was. Yet, when Saul did speak, he had not lost his usual sharpness. He made some incisive points, but it was his presentation that lacked its former impact. His back pain prevented him from standing up, and his voice had become almost inaudible.

I had left for my home in France the evening of the CPC, so I was not around for Saul’s terminal illness. From what I understood through the grapevine, the combination of sepsis and intractable pain bought him a one-way ticket down the Via Dolorosa. What I have wondered ever since though, was his approach to his own – not other people’s – disease process. Was he still thinking clinically, as he had done innumerable times in the past? Trying to come to a unitary diagnosis, so he could discuss a rational treatment with his doctors? I was taught very early on that patients could not care less about diagnosis; the only thing that matters to them is prognosis. Will they make it or not? Will they live or will they die? I do not pretend to know what Saul had in mind. Maybe he ended up like most of us; hoping, praying we will live to see another dawn.

I was not present at his funeral either, so I could only imagine the goings-on. The Praetorian Guard of his former chief residents surrounding his casket, in one ultimate morning confab with their old chief. Akin to Napoleon’s marshals, their tombs in a circle around the sarcophagus of their emperor, under the Dôme des Invalides. The suits who had displaced him from the deanship waxing tearful about how no one – no one at all – could ever, ever replace him.

Saul has a different sort of monument: the naming of the northeast corner of 30th Street and First Avenue as Saul Farber Way. Yet even endowed street corners are not necessarily safe from being renamed down the line, in honor of a more recent hero. That is why there is something to be said for the alternative:

The memory of the Saul Farber way he changed our lives.

No, no, they can’t take that away from me.

 


 

PETER H.  BERCZELLER, MD, was born in Vienna, Austria in 1931. He attended The Chicago Medical School and received his MD there in 1956. He was a practicing internist from 1960 to 1992, at which time retired from private practice. He was also on the Attending Staff at New York University Medical Center and Clinical Professor of Medicine at New York University School of Medicine for many years. In addition to multiple contributions to the medical literature, he is the author of several books dealing with medicine and one novel. His 1994 book, “Doctors and Patients: What We Feel About You” has just been released as a trade paperback by Simon and Schuster. He now lives in the Dordogne, in France.

 

Summer 2018  |  Hektorama Moments in History