As I Live and Breathe: Notes of a Patient-Doctor

Reviewed by: Barbara J. Martin, MD

Disclosures

November 18, 2002

Introduction

By Jamie Weisman
North Point Press
Copyright 2002
244 pages
ISBN: 0-86547-602-0
$23.00 hardcover

It is easy to see how doctors can seem endowed with magical powers as we peer into the recesses of our patients' brains and hearts; as we bestow new organs on those with dying livers, lungs, and kidneys; and wave our wands to make infections and tumors disappear. But all the molecules and medications and instruments are delivered by human hands, and their use is limited by human knowledge and fallibility. The wizard behind the curtain is only a little man.

From a medical greenhorn, this excerpt from Jamie Weisman's memoir may be expected pontification. But presumably Weisman, a fledgling physician and author of As I Live and Breathe: Notes of a Patient-Doctor, should have a greater understanding of medical care than the average intern. She has endured years of an unspecified congenital immune deficiency (as it was finally diagnosed), which necessitates self-injected interferon and monthly gamma globulin infusions. Her jumbled narrative details her illness, early medical training, childhood, and first pregnancy.

For all the compassion to be felt for Weisman during her intensely described physical suffering, readers of As I Live and Breathe may find Weisman's state-of-medicine-and-the-human-condition discourses, the quality of which is consistent throughout and suitable for concluding morals on any weekly television medical drama, more than just a bit overbearing.

This leads to an overriding problem in Weisman's debut book: missing is a necessary maturity of thought that makes these discourses (if audaciously tackled at all) more than just a solipsistic exercise. Or perhaps alternatively, Weisman fails to acknowledge self-awareness of her relative immaturity when contemplating her own story. She's even willing to take on the meaning of death: "...I am certainly no more likely than Aristotle or Maimonides to come up with an answer." As if anyone were expecting one.

Weisman begins her memoir somewhere in the vast, complicated middle, with her routine antibody infusions already underway at Mount Sinai Hospital in New York City before attending medical school at Emory University in Atlanta. Subsequent chapters concern her internship at the Atlanta VA Medical Center, while taking care of an end-stage cirrhotic; her bouts of parotitis before medical school and her homage to the now deceased surgeon who performed her first parotidectomy; an episode of contralateral parotitis requiring hospitalization while an intern; and her first internship rotation on an oncology ward, where she tended a mother dying of leukemia whom she knew from the infusion-treatment room at Emory.

In the penultimate chapter, Weisman backs way up to her mother's pregnancy with Weisman's twin brother and herself and provides some childhood point-of-view vignettes. These recollections would have been best reserved for another work. Weisman then describes the herpes zoster she suffered as a teenager, followed by the herpes esophagitis she sustained as a young adult. The two infections were evidently the beginnings of her clinically manifest immune deficiency. Weisman concludes her memoir with her highly worry-filled first pregnancy.

This cursory outline excludes Weisman's recurrent mention of her lymphadenopathy and lymphoma scares (primary immune deficiency increases the risk of non-Hodgkin's lymphoma), tenacious upper respiratory tract infections, abnormal Pap smears, leg warts, and persistently dry eyes. And there was an attack of pancreatitis at some time, to which Weisman briefly alludes. Weisman's depictions of her own disease, which are the foundation of the book, are intermixed with sketches of the conditions of her patients, some of whom face imminent death. A running thread throughout As I Live and Breathe is Weisman's exposition on her own mortality vis-à-vis her dying or recently dead patients. Of her arrival at the oncology floor to begin her internship, she writes in what comes off like a case of misplaced self-concern, "I found myself, like Scrooge in A Christmas Carol, in a possible and terrible version of my future."

Regarding her own affliction, Weisman writes: "[M]y body makes antibodies, but they don't function correctly, and I am at risk for a number of viral infections," and, "For some reason, the interferon I make doesn't work, so I flood my body with man-made interferon to do the job."

Stunningly absent from Weisman's memoir is the detailed story of how her uncommon diagnosis was ultimately established (and a more in-depth explanation of her disorder, which should exist, it seems). In the introductory chapter, Weisman writes of itinerant medical evaluations and an accusation of hypochondriasis. But Weisman does not limn what must have been considerably frustrating encounters during these evaluations or how she felt about allegations of hypochondriasis or possibly worse along the way. Consequently there is no discussion of how such experiences influence her attitude as a physician toward patients whose presentations are poorly understood or perhaps even suspect.

Weisman writes only, "Hypochondriacs may love to fantasize about their loved ones weeping around the gravesite, but those of us who have had to seriously think about our own deaths are not comforted by this image." She approaches a peripheral issue of "self-inflicted" disease when at the VA hospital, where alcoholism and tobacco use are often the norm: "[T]o see otherwise healthy men and women cripple themselves is sad, baffling, and infuriating."

Another conspicuous omission is a thoughtful self-analysis by Weisman, formerly a writer, on choosing the vocation of medicine. On this issue, she merely notes, "I needed a real job with a reliable income, and I knew no happy lawyers. My father was a doctor, and I'd unwittingly learned a lot of medicine in the course of my own disease, so I went to medical school."

Such an explanation, in the psychologically charged context of Weisman's own meandering journey with her condition and her father's profession, seems highly disingenuous. Smart young adults with chronic diseases and physician parents don't necessarily become doctors. The absence of deeper introspection on this issue, in the format of memoir, amounts to a kind of profound evasion.

While Weisman may fail to reveal a broader picture of her character's complexity, she writes vividly of her bodily anguish. Regarding her parotitis during internship, she notes, "My face was swollen like an angry Picasso. My mouth gaped open, my right eye twisted up to my forehead. I could not swallow a pill. I moaned and pressed my swollen face into the heating pad, hoping to burn it off." Of her esophagitis at 26: "My throat feels as if it has been ripped from my body, shredded with a metal grater, trampled and then sewn back in with a rusty needle."

Weisman could have used these intense experiences to show how the extreme pain of illness can transform adult composure into juvenile defeatism, and how this awareness informs the care she delivers to her own extremely ill patients. As it stands, this is merely adolescent writing, constructed with an apparent zeal to impress that undermines whatever connection the reader is willing to make with the author.

Weisman prevails when focusing exclusively on her patients. Of a moribund alcoholic, she observes:

Every bone in his hand was visible, the sharp splay of them, and his chest was so emaciated that the flat bones of his sternum stood out, and under them you could see the frantic trill of his heart.

Unfortunately, such acute portraits are too infrequent in Weisman's As I Live and Breathe to redeem it.

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