Alas, in spite of all medical advances the mortality rate hovers at about 100%. If you don’t die of heart disease you die of something else . . .
— Steven B. Tamarin, M.D.It seems as though I have entered into the autumn of eulogies. Another great one has passed away, and this time another one who has cared for me, for my family, and for hundreds in the city of New York.
Steven Tamarin was among the last of what now seems to be literally a dying breed, a family doctor. Sometimes wary of new medical panaceas, he'd posted the comment above on the New York Times Wellness blog earlier this year, characteristically funny and somehow eerily prescient.
Steve, or Dr. T as we sometimes called him, first treated me when I was in my twenties, just back from living in Japan for two years, nearly penniless and without a job or health insurance. I'd come to see him when friends who'd traveled to Central America on aid work recommended him -- I think they'd traveled there together. Despite his Fifth Avenue office he'd said Just pay me $10 when you can. Really, I'd asked. Sure he said. You don't have insurance, other people do, so pay me what you can when you can. That's how we do socialism in this country. It doesn't work well, but that's how we do it. Later he'd move his office to a somewhat more modest, some might say shabbier, space on the Upper West Side of Manhattan.
Steve was my doctor for more than two decades, my husband's doctor since we first met, Sweet M's doctor in the first weeks of her life. He was there at the hospital when Sweet M was born. He was the one who caught the "click" in her hip that presaged hip dysplasia and so saved her from future surgery. He was the one who sent us off to the "lactation consultants" when she lost 20% of her weight in the first week of life, uninterested as she was in nursing. He was the one I went to when there was the first intimations of Sweet M's developmental issues, and he sent us off to one of the finest developmental psychiatrists in the city -- someone who was an old and dear friend of his. He was the one I sought out in the heartbreaking summer of 2002, when our worlds were falling apart in the wake of 9/11, our businesses imploding and finances collapsing, and our nerves worn raw with the progression of Sweet M's escalating tantrums and preoccupations. That summer, frayed as I was, he was the doctor who told me that it would be better for me to go on vacation than to check myself into Bellevue. When I was seized with pain two summers ago, he was the one who found me the most spectacular surgeon. Year in and year out he was listed among the best doctors in New York in New York Magazine's annual doctor Oscars, and yet he continued to run a practice that cared for everyday New Yorkers, refusing to become a boutique practice that catered only to Manhattan's elite who can pay everything out of pocket.
I remember one appointment in particular, when Sweet M's father and I were trying to conceive — a project that took us so long that technically it qualified as infertility. I'd gone to see Steve very late in the day. He was so often at his office late because he always ran over time with his patients. Frankly, an appointment at his office was often trying because he was seldom on schedule in those years. The practice only began to run on schedule much later when he hired a wonderful nurse practitioner called Annie to keep him on track and manage the overflow. That evening his office was quiet, dusty and disordered because he was renovating.
He sat at his big oak desk and I sat in the patient's chair and I said Wow, Steve, you're renovating. And then, to my surprise, for just a moment our roles shifted to the story of his troubles. He told me that he had to do something: that he spent so much time dealing with getting insurance companies to pay, and then often not succeeding, or being paid for just a fraction of his time, that even he was in dire financial straits. He had to do something: the choices seemed clear. He could leave his private practice and go on staff full-time at the hospital where he also worked. Or he could rent out a part of the space to another practice and get a better office manager. He wasn't willing to stop accepting insurance, so he was renovating. I was reading Marx for my graduate work and we talked briefly about how the work of care becomes increasingly expensive relative to the production of things because, no matter how one tries, one cannot mass-produce one-to-one attention. We talked about the folly of healthcare for profit, we talked about the emergence of (mis)managed care.
And then with just a moment's pause we shifted back to our patient-doctor roles and talked about infertility. I said I did not want the high-tech treatments that I'd watched my friends suffer through — that I wanted to conceive or else just not conceive. He smiled with what I can only describe as earnest mischief and said I have just the thing for you. He swiveled around in his chair and started digging around in the credenza of his desk, heaped as it was with charts, files, bills, what-not.
"Here," he said triumphantly. He pulled out a small pink cardboard calendar . . . an ovulation calendar. "This," he continued with a sparkle, "is my magic fertility calendar. I don't know how it works, but every woman I give this calendar to conceives within months. Just mark down the beginning of your cycle and have lots of sex, and you'll see. It shouldn't work. But it does. It's magic."
I was meant to see Steve this morning at 9 am, for my annual checkup. We autism moms are notorious for not taking care of ourselves, and I am no different. I was going to see him because I am feeling the need to start taking better care of myself if I'm going to last long enough to launch my Sweet M to some sort of self-sufficiency. Since she's developmentally delayed, I'm figuring she'll need a couple of extra years for her launch, probably another five or ten extra years, so I'd better make every effort to be around for another twenty.
Steve's receptionist called yesterday to say that they'd canceled the appointments for today. When I said, Okay, so let's reschedule, she put Blossom, the office manager, on the line to share the news that Steve died in his sleep over the weekend.
Part of me has the heartbreaking and heartbroken feeling that Steve died too soon, died of caring too much in a world where caring less has become the only way to survive. Part of me thinks that the pressures of running a private practice under managed care were just simply crushing. But what I know for sure is that with his passing, some of the magic is gone.
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