Out Of The Old Black Bag

Out Of The Old Black Bag




Designed To Break Your Heart (Part 1)


By Anthony Kovatch, M.D.

AHN Pediatrics — Pediatric Alliance Arcadia


Musical Accompaniment: “In My Life” (The Beatles)


“It breaks your heart. It is designed to break your heart. The game begins in the spring, when everything else begins again, and it blossoms in the summer, filling the afternoons and evenings, and then as soon as the chill rains come, it stops and leaves you to face the fall alone. You count on it, rely on it to buffer the passage of time, to keep the memory of sunshine and high skies alive, and then just when the days are all twilight it stops–just when you need it the most.”

— A. Bartlett Giamatti, professor of English literature, president of Yale University, and seventh Commissioner of Major League Baseball.  He was renowned for his insatiable love of the game, but died of a heart attack only five months after taking office. In spite of this, his legacy endures and the quote has become part of baseball lore.


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I think they all were intuitively correct: I was born to be a pediatrician. A cross physically between an ectomorph (my nickname in medical school was the “Thin Man”) and a mouse (sometimes referred to as a shrimp). But more the personality of a mouse:  non-confrontational, non-judgmental, a pushover. “Not a mean bone in his body.”  Nothing more than “a nice guy”! The prototypical “baby doctor.” So in the spring of my career, the self-fulfilling prophesy began and I would never flounder.

“How many years have you been a pediatrician?” one is frequently asked by parents when the autumn leaves start falling and you start changing color, too — the hair turns grey (if you have any), the skin becomes laden with “liver spots,” and the gleam in the eyes takes on rain clouds. One is bolstered by those many summers of sharing the lives of your patients and their parents in their prime, as they gradually over the years become your second family and you become their surrogate parent, confidant, and tamer. (Thus spoke the Little Prince to the Fox: “What does it mean to be tamed?”)

“I think I have been a pediatrician since I was born,” I would want to say. “Since I had any capability of understanding devotion and love.” That would be 70 years, or 71, depending if psychologists believe that fetuses understand love. I learned just about everything I ever needed to know about the science of being a pediatrician in the spring of my career, and spent all those summer months learning the art of being a “good” doctor from my patients and their parents. I was especially educated in the most essential skills of patience, compassion, and undying devotion by sharing in the experience of managing the patients I call “Lazarus” — those unfortunate, disabled children loved intensely by the long-suffering caretakers who grant dignity to our profession of “healing.” Unlike the rich man of the biblical story, I hope to be alongside them in paradise after the Judgement Day that restores equity to all the universe.

“All I really need to know I learned in Kindergarten,” wrote Robert Fulghum in his landmark poem. The same might be true of what a pediatrician needs to know to practice.

Of course, the science is learned in medical school and residency, but the true art is learned during those painstaking years of cleaning out ear wax from an obstreperous toddler; or reassuring an anxious, first-time mother that the fever or the diaper rash is of a benign nature; or convincing a depressed adolescent that we can restore the mood back to normalcy; or salvage the souls of parents who have had their loving child abruptly stolen from them by SIDS.

A good pediatrician is in essence what Holden Caulfield, the protagonist of J.D. Salinger’s 1951 (ironically I was born that year) bellwether novel, “The Catcher in the Rye,” envisions himself to become to escape the realities of a seemingly antagonistic world:


“I’m standing on the edge of some crazy cliff. What I have to do, I have to catch everybody if they start to go over the cliff — I mean if they’re running and they don’t look where they’re going I have to come out from somewhere and catch them. That’s all I’d do all day. I’d just be the catcher in the rye and all.”


We repeat these same seemingly meaningless tasks year after bloody year during the summer of our careers, resent how the monotony and meaningless stress sometimes displace the joy of raising our own families, but solemnly hope that these warm memories will sustain us in the cold, barren winter of our lives.

Sadly, but expectantly, the hair turns completely grey, the vision weakens, and the memory starts to falter (as they say, the mind’s the first thing to go!), and we know beyond a doubt that we must “pass on the torch” to a new generation of pediatricians that strongly reminds us of ourselves in the spring of our careers. And we realize that songwriter Joni Mitchell was well ahead of her time when she balanced the scales in “Both Sides Now”: “Well, something’s lost and something’s gained in living every day.” In retirement, we starkly convince ourselves that in these years of winter we will have to face the world alone. However, unlike the spectator sport of baseball, our memories of the patients we served are so powerful and real that they will be part of our being until the end of days.


To be continued…

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