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.
