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by Hujefa Vora, MD

A note from our committee meeting seemed to resonate with me. One of our editors asked the group to describe the tone of this edition of the Physician. They were asked to clarify the rhetorical question. The point made was that this edition of the magazine read more like a collection of biographies than a medical journal.  Are we physicians compiling and writing a medical journal?  For over a decade now, I have worked with this committee to help produce this magazine.  I don’t know if I’ve ever really thought of it like I do perhaps the New England Journal of Medicine or JAMA.  Such magazines are usually filled with double-blinded studies, research into this and that, and critical analyses of the science of the day.  Our journal seems a bit different.

The President’s Paragraph tells of a rocky childhood and challenges overcome. In reading this, we are reminded that as physicians, we all have stories that define not only who we are personally, but also the lives we lead professionally. We are not automatons or angels with all the answers. We are humans who aspire to be more for the betterment of all of humanity.  We are not brilliant white sheets flowing in the wind.  Rather, we are tapestries with amazing, intricate stories.  The beauty of these tapestries is reflected in the practice of our trade.  Because of our own complexities, our patients connect with us, and so bonded we weave the physician-patient relationship.  Through the experiences of our own pain, we are able to relieve their pain, alleviate their suffering, and embrace our collective humanity.

The student article also speaks to fighting through stigmas and strife to achieve a goal, an almost unattainable dream. Humble beginnings define the immigrant and minority community biographies. The idea that a poor student from a third world country with nothing more than the shirt on his or her back could somehow immigrate to this country and then in a generation that individual’s progeny are successful professionals and entrepreneurs, physicians even. This idea would sound impossible back in their homelands.  Like our student though, many physicians have lived through this dream. We were told that the obstacles were insurmountable. We may not have been recognized as being able to be something more than our station, our family’s station. We may have been told that we don’t belong.  We may not have had the means to support ourselves and our families.  And yet, we endeavored to persevere.  Some students may have been discounted.  Despite this, we fight on.  We work harder.  Become stronger, wiser.  We work so that we can achieve this solitary goal of the betterment of the lives of our patients.

The feature article speaks to our connections. They are not always palpable, but they remain very real. For some of us, the physician-patient relationship comes easy. We are able to effortlessly bond with our patients.  We acknowledge our collective humanity, forging solid connections.  The relationships we have with our families and our friends often remain more evasive.  And so when these relationships cross into our professional lives, we often celebrate them.  The article celebrates the human connection, the love and respect we have for our fellow man, and then the love we have for our friends and family.  Every day in our practices, we celebrate the physician-patient relationship.  Inevitably, we celebrate our patients and the love we have for them.  Many of us agree that medicine is an art, not a pure science.  We weave our tapestries together with our patients.  We often speak of professional distance, but this really does not apply well to medicine.  We often cross our patients with loved ones, and vice versa.  We take care of our patients just as we would our own families and flesh and blood, to the point that our patients often become our family in their own right.

These are the issues which are woven into this month’s edition of the Tarrant County Physician.  If you read back, you will readily recall that these are the issues that are found throughout every edition of the journal of the Tarrant County Medical Society.  In every sense, the articles that are published for your perusal are our collective biographies.  They are the words of our TCMS Family.  These are the stories of the physicians of Tarrant County.  We have always asked our membership to contribute to the magazine, and we have never been disappointed.  All of you have beautiful tapestries to share with all of us.  I continue to encourage you to share your stories with our committee.  After all, in answering the initial question, this is not a medical journal.  We always appreciate and publish any scientific contributions by our member physicians and will continue to look forward to doing so.  If you have any articles or studies or research that you have done which you would like us to consider publishing, please send them in.  And if you think your story, your biography, your words can be shared, then please send these in as well.  The Tarrant County Physician is a direct reflection of our membership.  All of us have amazing, interesting, intricate, and beautiful stories.  Every time you read my own articles, I share my own biography with you.  I hope that y’all will continue to share your stories with me and all of us in your TCMS Family (you can do so by sending them to editor@tcms.org).  My name is Hujefa Vora, and this is Our Last Word.

by Tom Black, MD – Publications Committee

This piece was originally published in the November/December 2020 issue of the Tarrant County Physician. You can read find the full magazine here.

“I can only wait for the final amnesia, the one that can erase an entire life.”
—Luis Buñuel

There is little doubt that my wife will outlive me, likely by decades. Her father lived to the age of 100, and we celebrated her mother’s 101st birthday last month. There is no substitute for good genes. Her father’s memory remained sharp until he laid down one afternoon for a nap and didn’t awaken. He had been quite a baseball enthusiast as a young man—his grandsons loved to hear him tell about the time he met Babe Ruth. In his final years, he avidly watched any and every sport on television and knew every player and their current statistics in several of the major sports. His wife, however, has followed the more familiar scenario of progressive dementia with increasingly poor short-term memory over the past three years. At this moment, she is sitting across the room from me, and she just asked for the third time in five minutes what the temperature is outside. It is sad for me to see this happening to one of the three most wonderful women I know.

I am all too familiar with dementia from my own father’s last few years. He had been a brilliant chemical engineer and remains one of the most accomplished people I have ever known. It was painful to witness his decline. I once watched him read and reread a typed letter on a well-worn piece of paper. Each time he did so, his smile faded and his eyes filled with tears before he sadly put the letter down. Within a few moments he had regained his usual happy demeanor and was about his business until he noticed the letter lying where he had placed it. He picked it back up and reread it with the same sad results. After observing this cycle several times, I peeked at the letter and saw that it was from his primary care physician. It read, “Dear Mr. Black, you have been diagnosed with dementia . . . . .” I disposed of that letter very quickly, and my father never realized it was gone. His memory loss progressed inexorably from short-term to include even long-term during his final year, resulting in a peaceful but oblivious state of total amnesia. It was no longer possible to pursue a meaningful relationship with him because we shared no common ground and could discuss only the environment around us at that moment. We could no longer revel in family memories. He recognized no photographs and could not even recall personal food preferences. Toward the end, we visited him—not for his sake, for we realized our visit would have no significance to him after we left—but for our sake, because it would be of significance to us. 

In his 1985 book, The Man Who Mistook His Wife for a Hat,  the late neurologist, Dr. Oliver Sacks, recounted the story of “The Lost Mariner.” Jimmie G. had developed amnesia due to Korsakoff syndrome. He could remember nothing of his life since the end of World War II, including all events that had taken place more than a few minutes earlier. He believed it still to be 1945, and although he behaved as a normal 19-year-old, Jimmie was, in reality, nearly 50. He was completely incapable of accomplishing anything noteworthy because he could not build one memory upon another to form a progressive narrative. His life had been frozen in time, in 1945. It was a living death.

Is there a better explanation of what makes life meaningful than Memory? Without memory, life cannot possibly be more than a moment-to-moment existence. In his memoirs, the film director, Luis Buñuel, wrote, “You have to begin to lose your memory, if only in bits and pieces, to realize that memory is what makes our lives. Life without memory is no life at all. Our memory is our coherence, our reason, our feeling, even our action. Without it, we are nothing. I can only wait for the final amnesia, the one that can erase an entire life.”  

“Generations from now, their descendants will know about them, but they won’t know them.” 

I am noticing that my forgetfulness is slowly increasing. Doorways have become amnestic devices; as I pass though one into the next room, I find I have suddenly forgotten the reason I came. I am on the hunt for ways to stave off memory loss.

Which brings me finally to the point of this essay. 

The movable printing press was invented in China around 1040 AD using porcelain type, but Gutenberg had the immense advantage of an alphabetic language when he introduced the metal movable-type printing press in Europe around 1450. Suddenly information could be much more easily recorded than ever before, and the past could now be remembered by means other than oral or hand-written accounts. Within 50 years, over 9 million books had been printed, accelerating the dissemination of ideas in the early Renaissance. What defines the Modern Age if not the ability to more thoroughly record and recall past actions and discoveries? And how much greater of an invention is digital storage, which can “remember” and make instantly available entire libraries of information. 

My father lived out west, and I was able to visit him about three times a year. At the time we celebrated his 90th birthday, my mother had recently passed away, and my father had plenty of free time. I asked him if he would do me a big favor, and he agreed. Knowing he had led a very interesting and eventful life, I asked him if he would please write his autobiography so his children, grandchildren, and future descendants could always know what a great man they had as an ancestor. He agreed to have at least one chapter completed by each time I visited, and while I was there, I typed what had he had written into his computer. After the 16th chapter, he declared that he was done. I had the book printed and bound, along with the diary that my mother had kept the last two decades of her life, and each of their living descendants received a copy. This book has become a priceless remembrance of two noteworthy lives, more meaningful to me than to my children, because I knew both of my parents so well that I seem to hear them speaking the words as I read them. For the next several years, my father spent much of his time reading and rereading his autobiography, reliving in his mind, I am sure, the halcyon days of his youth and productive adult life that he would otherwise have been slowly forgetting. 

About that time, I was talking with a friend and former college roommate. His 100-year-old father, a former physician, was living with my friend and his wife at the time, and I asked my friend what his father was doing with his time. “Oh,” he replied, “most of the time he just sits and reads the autobiography he wrote 10 years ago.” With the brain, as with a digital storage device, sometimes a hard copy is helpful to have on hand for when the primary device begins to fail.

Although a written autobiography won’t assure you of immortality in an eternal sense, it will give you an opportunity to achieve immortality in this life and assure that the memory of your existence will long outlast you. Begin writing it now while your experiences are fresh in your mind; small bits of your personal history may be eroding away even as you are reading this. It was labor intensive for my father to write the words by hand and then to type them into the word processor. It is so much easier these days with recording devices everywhere; my iPhone will even transcribe voice-to-text while I am driving, and I can edit later. I can’t imagine the process getting any easier than that, since thought-to-text technology, to my knowledge, is not just around the corner. 

Throughout their last years, my wife and I interviewed her aged parents. We quizzed them about what life was like as they were growing up during the ‘20s and the years of the Great Depression. We learned of their lives as newlyweds during World War II and as they raised their children during the mid-twentieth century. We added to what we already knew of them as empty nesters. We compiled our notes into biographies of them before and after they became a couple. A century from now my father-in-law’s descendants might still read about him growing up in a town with no paved roads and few automobiles, about his visit with Babe Ruth and his stint in the Army during WWII. They will read about his wife’s parents, who were immigrants from the Ukraine; her reputation as the best golfing, bowling, and tennis partner in the area; and how she and her future husband met on a blind date. But it just isn’t the same as my parents’ accounts; they are altogether too brief for such long and noteworthy lives. Most importantly, they lack a personal touch. I don’t hear their voices when I read their second-hand stories. Generations from now, their descendants will know about them, but they won’t know them. Don’t allow that to happen to you. For a future reader to hear your voice rather than that of your biographer, you must write your story yourself. It is your opportunity to have The Last Word.

 ¹Oliver Sacks, The Man Who Mistook His Wife for a Hat, [New York: Simon & Schuster, 1970]

²Luis Buñuel, My Last Breath, [London: Virgin Books, 1983], p. 4-5.