Dr. Ernest Guy Ceriani
By Paul V. DeMarco
Guest Columnist
As a graduation present, one of my best friends from college gave me a book titled Let Truth Be the Prejudice by photojournalist W. Eugene Smith. She knew I was on my way to medical school and chose the book because of a photo essay called “Country Doctor.” It documented the work of Ernest Ceriani, the sole physician for the people of Kremmling, Colorado, an isolated hamlet of about a thousand. The essay was published in 1948, when Ceriani was 32.
The images captivated me. There was a reality, a chest grabbing truth contained within. Smith said of the essay “I spent four weeks living with him. I made very few pictures at first. I mainly tried to learn what made the doctor tick.”
His patience was rewarded. The image that has been my lodestar captures Ceriani in the wee hours. He is in a homey hospital kitchen after completing a lengthy surgery. He wears a cloth surgical gown and cap. His mask is untied. He is slumped against the counter with the stub of a cigarette in his left hand and a slightly listing cup of coffee in his right. His exhaustion is palpable. In another photo (see below), he is holding the head of a 2-year-old child who had been kicked in the head by a horse. His brow is deeply furrowed. He is worried, afraid for the child’s sight. In another, he is on a home visit. He is sitting on a bed, listening to the chest of an elderly man dying of a heart attack.
I must admit that I had no idea what I had signed up for when I committed to medicine. I was the first doctor in my family and had never experienced a serious illness, nor had any family member or friend. I didn’t have a mentor to tell me what medicine would be like, but in a moment, these stark black and white photos showed me. I saw that being a doctor means to sometimes be afraid, to sometimes suffer, to carry the burden of your patient’s illnesses, to watch them die.
I write this not to tell you I have succeeded in my hope to follow in Ceriani’s footsteps. He bore a burden that I doubt I could have carried. Nor is it to say that the type of medicine I do is the most important or most difficult. There are physicians that put their lives on the line in war zones, brilliant bench researchers, and masterful surgeons whose accomplishments dwarf mine.
I tell you this for two reasons. First because Ceriani’s example is still powerful, and should remain relevant in patient care of all kinds, including quotidian practices such as mine. I teach medical students and give a talk every year entitled “Joy in Medicine.” Perhaps that wasn’t the title you would expect, given my description of medicine’s trials. Medicine is, of course, also full of joys and rewards. But accepting those requires no training. What allows doctors to maintain their sanguinity is an ability to anticipate and then face tragedy.
Physicians can make two mistakes confronting this reality. One is to be subsumed by the distress of their patients and become overwhelmed. But the more common mistake is to remain aloof, to treat medicine as a job rather than a vocation, as a means to a lifestyle. In these days of incentive contracts which reward physicians for increasing the number of patients they see or procedures they do, patients who gum up the works with thorny problems or unexpected complications become unwelcome. I can’t count the number of patients who over the years have broken into tears during a visit. There is no extra reimbursement for giving a despondent patient your undivided attention. I can rarely offer any helpful advice. But I do all I can do, which is listen. Surprisingly often, we both feel better for the time we spend together.
I ask the students to imagine a middle way in which we do our best to fully acknowledge our patient’s dignity without losing our bearings. I have had patients who have suffered unimaginably. One dealt with the death of her husband and then the tragic death of her son two days later. I can only go a certain distance into that pain. But I try to walk with the patient far enough.
Students want to know how far that is. I can’t fully articulate it. It’s the same sense I have that keeps me from getting too close to a campfire or to a cliff. Sometimes I go farther than I might, knowing that I will have help recovering. My medical colleagues, including my wife, who is a nurse and has lived the pressures of primary care practice with me, are there to support me in my temporary grief for my patients.
I have walked that line mostly successfully for thirty years thanks to the lessons contained in “Country Doctor.” Some days I don’t give enough, and others I let the pressure of getting the work done truncate my ability to fully engage. I could not have lived Dr. Ceriani’s life as a solo practitioner in the Rocky Mountains. But he has been my constant inspiration, and I am surely better for my friend’s thoughtful gift, one of the most important I have ever received.
A version of this column appeared in the April 16th edition of the Post and Courier-Pee Dee.
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That’s a great story well told, Paul. You’ve shared something important to know about yourself, and also made us aware of someone else we should know about — Dr. Ceriani, and those like him.
It’s good that you have such a story that you can tell, that in some partial way explains you.
It makes me think whether I have such “images,” and I’m not thinking of any right off, despite my longheld fondness for photography. But I can think of other things that nudged me, here and there, along my career path.
There was, of course, the message I absorbed early on of the importance of journalism — that is, real journalism, serious journalism, thoughtful journalism — to the existence of our nation. I think of what it meant from the earliest days of the republic — even when you were seeing things that didn’t fit well with the canons the profession would later embrace, such as the dog-eat-dog battles between Federalist and Democratic-Republican papers during the election of 1800 — to that point late in my own career when it all came crashing down, and the nation followed it.
You know, the thing Jefferson (who was flayed unmercifully by those Federalist scribes) was trying to express when he said, “were it left to me to decide whether we should have a government without newspapers or newspapers without a government, I should not hesitate a moment to prefer the latter.”
Then there were less-noble sources of inspiration, such as my realization in school that while true-false and multiple-choice tests were easy enough (and it’s understandable why many like them), if I wanted a really good grade, I hoped for an essay test. I preferred taking off on a topic to parroting simple answers, and most (but not all) of my teachers loved it when I did. That sort of nudged toward doing that for a living.
But if we’re talking inspirational figures, I think of people like Stephen Crane and Ernest Hemingway. Not like, “Oh, what wonderful men! I want to be more like them!” I was just drawn to doing what they did as writers.
Crane especially, I think. He didn’t have much of a newspaper career, although what he saw of travel and adventure sounded good to a kid like me. (and Hemingway mostly gave it up once his novels took off), but the way Crane built The Red Badge of Courage upon his extensive, journalistic interviews with men who had personally fought in the Civil War was stunning. It may not have have saved the world or anything, but he did give generations to come a clearer picture of what combat was like (if, you know, the generations to come would pick up a freaking book!). And he gave birth to the new fiction school of Naturalism. Which I appreciated. Imagine what he could have accomplished if he had lived past the age of 28.
I’m not that into either writer today. I’ve sort of drifted away from them (looking up Crane just now gave me a pang of guilt when it hit me that I don’t think I ever DID read Maggie: A Girl of the Streets). So I don’t have as good a story to tell as Paul does, But Paul made me think of them again…
FYI, Paul, I don’t know if you had seen that picture I put at the top. I really liked it as a starting point, because it sort of says “country doctor” in a quick, readable way.
I got it from a database where I spend a good bit of time in working on the family tree, FindaGrave. It’s a very useful site. Often as not, the page for a given individual will have an obit on it — which would have been great in this case — but alas, his page did not. It did have these pictures, though. The files were kind of small and diminished, so I didn’t post them as big as I usually do (in terms of what you see when you click on them) but they were good enough.
Of course, after all that, I also found it in The Guardian. They used it the same way I did…
This is actually a response from Paul. I’m posting it for him because he can’t — as he explains below:
Thanks for your commentary on my post. This is a picture of me on a home visit for hospice which I do about once a week. My main practice is still in my internal medicine office. I see patients for HopeHealth, the community health center in Florence. My office is adjacent to Francis Marion University.
There is some resemblance to Dr. Ceriani-fedora, jacket, medical bag (you can see just the top in my right hand). My style of dress is more reflective of my father and grandfather. I didn’t set out to dress like Ceriani, but it is interesting how our careers and even our appearances have lined up.
You can post this as a comment if you like. I couldn’t figure out how to include the photo.
I would have liked to dress as my father did when I was a kid, but I couldn’t. He was a naval officer.
So I dressed as a newspaperman most of my adult life. Coat and tie and all that.
Now I dress like a guy who’s lounging around the house on vacation — even when working. I only put on the coat and tie for very rare work conditions that involve an important meeting with or for a client, and I’ve done that maybe once in the last month or two.
Other than that, just for weddings, funerals and the symphony about once a month during the season…
Speaking of dressing to go out into the world for a work thing…
Right now, I’m about to go to the Cayce-West Columbia library to emcee a lecture about the Battle of Camden. Therefore, I’m in compromise attire: One of my nicer pairs of knaki cargo pants, a dress shirt (well, a button-down sport shirt — not something you wear with a tux, but with an everyday tie), and one of my pairs of Salomon trail shoes (solid black ones, of course; bright, colorful ones would be completely insupportable for a public appearance).
I’m debating whether to change from white sweat socks to black socks. Just to have that slight sign of dressiness. I do that these days when I’m going to Mass…
And yikes! I’d better run…