Hektoen International

A Journal of Medical Humanities

The last picture show

Katherine White
Rockville, Maryland, United States


Highway 567, junction, near Taos, Taos, New Mexico.
Photo by John Margolies. 2003. Public domain through Library of Congress.

It was a cold December morning, the second day of the 2018 Hot Topics in Neonatology Conference in Washington, DC. Around 800 people trickled into the vast hotel ballroom, with its rows of long tables punctuated by aisles strewn with numbered microphones, settling in for a day of information-packed projected images. Before the lectures began, the screen flashed a picture of illuminated buildings at night, reflected in a body of water and eclipsed by a garish pink Ferris wheel and the sheet of bright pink light it cast onto the water’s dark surface.

“We’ll have a change of venue next year,” the director announced. “The conference will be at the Gaylord Resort at National Harbor.” A buzz of disapproval broke out.

I shot a look at Nick (not his real name), my best friend from neonatology fellowship training. His bushy eyebrows knit together, mirroring my own consternation. Within seconds, he had Googled the facility — situated in Ft. Washington, Maryland, literally East Hell as far as we were concerned — accessible only by car via the notorious DC beltway.

“What the hell!” Nick said.

Well, that was that. Neither of us would be attending Hot Topics in Neonatology 2019, or 2020 and beyond. Game over, as Nick would say. I had been retired for seven years, and he planned to cut back his practice in 2019. We had recently debated whether or not to attend the conference next year, but this made the decision for us. If Hot Topics was not to be in downtown DC, we would not be there.

We had had a good run — Nick, Hot Topics, and me. I had started attending the international conference twenty-five years earlier, once my three daughters were in school and I had settled into a part-time position as a neonatologist at a large suburban hospital. Nick and I had not seen each other for several years after fellowship, barely keeping in touch through Christmas cards. But the first time I attended Hot Topics, there he was, big as life, signing in as I approached the registration table — Nick, my old pal! Though I had once felt some sparks, he was more like a mischievous younger brother — someone with whom I could exchange raised eyebrows when an attending started nitpicking on rounds, or commiseration after a brutal night on call.

“Oh, my God! Kay!” he said, his voice with its thick Greek accent carrying over the line of attendees. He swept me up in a big hug.

“Nick! Great to see you! It’s been so long.”

We entered the lecture hall together and sat next to each other for the rest of the conference. Nick’s rawboned physique had filled out some over the years, and his thick black beard sported some gray. My formerly waist-length hair was now a lot shorter than he’d ever seen it, and distinctly salt-and-pepper.

Our medical practices were very different: while I divided my time between caring for babies in a NICU and my own kids’ classrooms and activities, Nick managed a thriving multi-hospital neonatology practice halfway across the country. He seemed to enjoy the business of it as much as the clinical aspect of providing sick and premature babies with the intensive care they needed. We both got similar things out of the conference, though: intellectual stimulation, excitement about developments in the field — and lots of laughter and eye-rolling at the posturing inherent in a bunch of academics and clinicians presenting information to their colleagues: the one-upmanship, the attacking and defending, the meandering questions and occasional tirades during the Q & A sessions. When a particularly long-winded questioner stepped up to one of the microphones for the third time that day, one of us would nudge the other and we’d both crack up. More than once, a finger to the lips or an angry stare from someone sitting in front of us would shut us up, suppressing our juvenile laughter, at least temporarily. Nick and I were both iconoclasts, which was part of what had cemented our friendship during training.

The years fell into a pattern. I took the Metro as the December day dawned, walking briskly from the station to whichever DC hotel hosted the conference that year. After queuing for coffee and Continental breakfast, I staked out seats for Nick and me; he joined me just before the first lecture began. We elbowed and wisecracked our way — or sometimes listened with rapt attention — through the morning. Once he acquired a smartphone, Nick spent the less-enthralling lectures checking the status of the stock market. At lunchtime, we met people from the fellowship years or current work-colleagues, then joined the other conference attendees jockeying for a table at one of the nearby restaurants. During the afternoon lectures, I often had to gently poke my friend awake; occasionally he was obliged to return the favor. One of the conference’s two nights, my husband and Nick’s wife joined us for drinks and dinner, when we caught each other up on the year’s news and consumed large quantities of excellent red wine.

After thirty years in neonatal medicine, I retired from practice. Though I was glad to leave the world of night shifts and life-and-death decisions behind, I remained interested in my chosen field. The Hot Topics conference was a way to keep up with developments in neonatology; but, more importantly, it was also a way to keep up with my good friend, sharing the tribulations of our now-grown children and the losses of siblings (his) and parents (mine). By the time his wife died unexpectedly in 2017, I had let my medical license go inactive and was about ready to ditch the conference; but I could not desert Nick so soon after such a great loss. Now, a year later, he seemed ready to take the leap into retirement. I assumed this would be my last Hot Topics.

Nick and I followed our usual procedure, greeting each other Monday morning with a hug and kiss on the cheek. We brought each other up to date in stage whispers during the morning announcements, then were shushed by a woman in the row ahead of us when we laughed at some joke one of us made. We went to lunch with one of our mentors from the fellowship years. My husband met us for dinner. The next morning, we got the news about the conference’s change of venue.

That same Tuesday afternoon, one of the lecture slides seized my attention — I nearly gasped. The colorful image showed the endothelial cells that line the lung’s blood vessels exchanging chemical messages with the alveolar cells lining the terminal points of the marvelously complex tracheobronchial tree. The two different kinds of cells were talking to each other — cheering each other on, promoting each other’s growth, much as Nick and I had been doing all these years in these conference rooms. It reminded me of something I had recently read about how trees communicate with each other — issuing alarms about insect infestation, asking for and offering each other water and other nutrients through their roots. So much we hadn’t known before; so many wonders, and more being discovered all the time. This was why I had majored in biology all those years ago, before knowing for sure I wanted to go to medical school.

At the coffee break a little while later, I surveyed the table where textbooks were displayed for sale. Nelson’s Textbook of Pediatrics was in its twentieth edition; the copy I had purchased in residency had been the eighth. The Harriet Lane Handbook, the pediatric residents’ bible, was now in its twenty-second edition; the one I had carried in my white-coat pocket as a senior resident had been the seventh. Avery’s Diseases of the Newborn and Volpe’s Neurology of the Newborn both had handsome new editions. I was pierced by a sudden nostalgia for the times I’d first opened brand-new copies of those texts — their smooth white paper, the lush photographs and complex illustrations, the pages of tables and graphs. I wanted to take those new editions home and devour them like award-winning novels, as if doing so could transport me back fifty years or so, to the time when the world of biology and medicine and all that they promised lay before me like a wide-open highway.

Now I was watching it all recede in the rear-view mirror — the starry-eyed wonder of high-school biology; the joy I had felt at my first college physiology lecture; the moments of beauty, both in the classroom and on the ward, that triumphed over the pain of medical school; and the transcendent moments of being a physician: bearing witness at many births and a few deaths, bringing pulseless newborns back to life. Those years have left a trove of memories and stories in their wake, but they have also left me with the same sense of delight and astonishment that put me on this road in the first place.

And what of my friendship with Nick? What happens when he finally retires? I am determined not to let this forty-year friendship lapse — a friendship that has taken us from energetic youth to the far side of middle age. Perhaps my husband and I will visit him in his native Greece, a country that has always been high on my bucket list. But I will miss sitting next to him at Hot Topics: the clinical tidbits, the personal stories — and so much irreverent laughter.



KATHERINE C. WHITE is a retired neonatologist living in Rockville, Maryland. A 1977 graduate of the University of Maryland School of Medicine, she completed pediatric residency training at the University of Maryland Medical System in 1980 and neonatology fellowship training at Georgetown University Hospital in 1982. Board-certified in Pediatrics and Neonatal-Perinatal Medicine, she has worked at hospitals affiliated with Georgetown University Medical Center, Children’s Hospital National Medical Center, and the Johns Hopkins Hospital. Her publications include “Hypertonic formula resulting from added oral medications,” published in AJDC in 1982; and “Baptism by Fire” in Grace in Darkness, Melissa Scholes Young, ed., American University Press, 2018. She is currently writing a memoir about medical school in the 1970s.


Summer 2019  |  Sections  |  Personal Narratives


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