Of chicken soup And Medication

Who Needs the Doctor? And Other Inherited Traits
By PERRI KLASS, M.D., and SHEILA SOLOMON KLASS
Among the many things a mother influences in a daughter’s life is her attitude toward health and doctors. Sheila Solomon Klass and her daughter, Dr. Perri Klass, were recently asked to trade thoughts on the topic.

PERRI Several years ago, I had a bad cold that wouldn’t go away. My voice sounded terrible and my mother was worried. It is my policy never to tell my mother very much about my health. I can’t stand solicitous inquiries, and I find that the loving concern of others often gets in the way of my own precious denial. But in this case, my mother could hear that I sounded lousy. And she wanted me to see a doctor.

I pointed out that I am, in fact, a doctor, and would know if something major was wrong. I pointed out that I hate going to doctors, and that I get that directly from her.

She still wanted me to go. So I offered her a deal – if she would go get the mammogram that was a couple of years overdue, I would get my cold checked out. And we kept the bargain – both of us. Though it is only fair to point out that we were both confirmed in our prejudices: my doctor told me I had a lingering bad cold, which I already knew, and my mother’s mammogram was negative and they told her she was healthy – which she already knew.

My mother, Sheila, is 77 years old. She believes, I think, that when a doctor finds something wrong, it is partly the doctor’s fault and partly your own for going to the doctor in the first place. My father, on the other hand, believed devoutly in preventive medical care. And every time the doctor found an abnormality, my mother was torn between gratitude that they had caught the problem early, and an accusatory impulse. “What do you expect if you keep letting them draw your blood?” I imagined her saying – or thinking. And then when my father died suddenly and unexpectedly, I know that part of her grief was a kind of frustrated anger that all his conscientiousness should have led to this.

SHEILA Doctors? Who needs them? I grew up in a home where there was a strong antagonism to doctors. They cost money and we were poor. They wanted to examine our bodies and we were modest. We never mentioned our unmentionable body parts – not even to one another, and certainly not to strange men. We pretended the dirty parts of our bodies weren’t there.

There was the abiding belief when someone was not well that if the illness wasn’t named, it might go away. It may have become a joke now, but in an orthodox Jewish home in Williamsburg, Brooklyn, during the 1930’s, chicken soup was an effective all-purpose medication.

In addition, we had hot baths and cold compresses and castor oil, and we could wish and pray to help drive the sickness away. But it was not naming the problem which protected us, which kept the illness from turning into something real.

In those days, there was no money for bread – so going to the doctor was a luxury – or maybe, better, a disaster. You went only if you absolutely had to. The sick person was blamed for draining the family coffers. I was a tomboy and often hurt myself playing rowdy games.

When I was 8, in a street game of kick the can, the can was kicked into my knee, tearing the skin badly. My mother, weeping with fear, ran downstairs and immediately carried me to the doctor. Tenderly, she held me in her arms while he stitched up the wound. Then she really let me have it, yelling at me, spanking me, raging to other family members about what I had done. “Whoever heard of a girl behaving this way?” she demanded, and she talked about that knee for years. I didn’t understand how she could love me and pick on me simultaneously. But I understand now when I think about my mother, bringing up three children in desperate poverty, with no health insurance of any kind.

The older women in the family whispered about “women’s troubles,” and various female relatives suffered from those vague illnesses. At my grandmother’s house, when someone was seriously ill, a mysterious woman would arrive to do “cupping,” a terrifying process in which little heated glass cups were applied to the patient to draw the poisons out. My grandmother also had various herbal medicinal teas. So private were illnesses kept that I have no idea what my older female relatives died of. Women’s bodies were our secrets, and they were not nice secrets.

When my older sister first menstruated, my mother slapped her. “To keep the color in your face,” Mama said. That scared me, rather than reassuring me, so I never mentioned my own menstruation to her. Oddly, my mother never asked.

I grew up distrusting doctors. I had a healthy body and I managed to wish away – or overcome – whatever minor ailments I had. I was lucky, I suppose. And I am inordinately fond of chicken soup.

PERRI I did not grow up poor – or religious – in Williamsburg in the 1930’s; I grew up middle class and secular in Manhattan and the New Jersey suburbs in the 60’s and 70’s. And my mother, by then, had learned to name the various parts of the body – of her children’s bodies, if not her own – without embarrassment. I did not get slapped when I reached puberty; I got the first edition of “Our Bodies, Ourselves,” with an inscription from my parents, as a birthday present. And my memory is that my mother treated our childhood illnesses with perfectly appropriate medical attention. No cupping, no castor oil, no desire to keep anything secret. My mother’s one big medical secret during this time, I suspect, was that she was not taking care of herself.

SHEILA It’s true, once I had children, I became a frantic doctor caller. The children were so small and helpless and they got so very sick. As soon as a child’s illness seemed threatening, I needed to consult authority. My husband had been a merchant marine ship’s purser, and therefore the medic on board his ship; he was calmer and sometimes he restrained me. He didn’t think that every little fever needed an emergency medical visit – but he did believe in regular checkups. He could talk me out of calling the doctor unnecessarily for our children, but he couldn’t talk me into medical care for myself.

I saw the doctor when I was pregnant, and I hated it for all the reasons I had learned growing up – the embarrassment, the concentration on the parts of my body I preferred to ignore, the risk that a problem would be identified, named and made real. After each child was born, I stopped going to the doctor – or even, really, having a doctor of my own. It drove my husband crazy.

However, we agreed about our grown-up daughter, Perri. She did not take good care of herself. She never got enough sleep. She undertook too much, her diet was haphazard. She was incredibly eagle-eyed and outspoken about our own illnesses or minor physical disabilities, but she neglected herself. And this from a doctor! She was supposed to be a model, an example. Wasn’t that in the Hippocratic oath?

PERRI For crying out loud, I was a medical student – then an intern, then a resident – and throughout, a mother of young children. Of course I didn’t get enough sleep, of course I was stressed out. But growing up, I had somehow acquired an invincible conviction of my own basic good health, and to this I added a very special kind of doctor’s denial: illnesses happen to patients, they don’t happen to me.

It’s kind of the opposite of the famous syndrome in which some medical students diagnose themselves with whichever obscure disease they happen to be studying; some of us just decide we’re immune to everything. And, like my mother, I got most of my medical care during my pregnancies. I was a cranky, if reasonably compliant, obstetrical patient. But as soon as each baby was born, I wanted nothing more than to be out of there – out of the bed, out of the hospital, out of the doctor’s supervision, out of the role of patient and back in the role of doctor, where I belonged. So sure, I could worry about my parents’ health – but where the hell did they get off, worrying about mine?

SHEILA Then, in middle age, my eyesight grew worse and worse, and my husband forced me to be examined. The diagnosis was glaucoma. A part of me hated that doctor for naming it and making it real. Though he treated me and arrested the disease, I never quite forgave him.

But these days I am humbled, reduced to dependence on doctors, who have taught me to name my body’s malefactors: cholesterol and high-blood pressure and macular degeneration. I am what my daughter the doctor calls a compliant patient; I take my medications every day, antioxidants and Lipitor and Hydrochlorothiazide and Toprol-XL. I resent them, but I take them. So my pharmaceutical list, which for so long included only chicken soup, has broadened, and I see my doctors regularly.

But deep in my heart I hold fast to the belief that the doctors are partly to blame for finding all these ailments – and that the rest of the blame is mine, for letting them look in the first place.

PERRI My mother may resent doctors and their authority, but she bows obediently to that authority. When the doctor first told her that her cholesterol was high, he gave her a list of foods that contained cholesterol, and immediately she cut them out of her diet. Just like that. (She had never heard anything about cholesterol before because she spent her life not going to the doctor and not having blood tests, and she never reads anything about health, either.) Then, a couple of weeks later, she called me up, very concerned, to tell me that she was mysteriously losing weight, and she was worried something might be wrong with her.

I, of course, don’t have the luxury of ignoring all medical information. My mother suspects me, with a certain justice, of manipulating my medical knowledge – which is, after all, my professional stock in trade – to make her go to the doctor more, while excusing myself. We have reached a somewhat uneasy détente in which both of us go – a little less often than is recommended – for routine health care checks, including those gynecologic visits she so dreads – and whenever I have a mammogram appointment, I use it to bludgeon her into making one of her own: “I won’t go unless you do.”

But I do try to avoid going to the doctor if I possibly can, and I do keep my medical problems secret if I possibly can. Earlier this year, my mother and I went on a trip together to India, and on the very first day, a bicycle rickshaw ran over my right little toe. I assured my mother that even if the toe was broken – which of course it wasn’t – there was no need for me to see a doctor; there’s no real treatment for a broken toe. You just buddy-tape it to the next toe with adhesive tape, and wait for it to heal.

So after I came back from India, a couple of months went by, and the toe didn’t feel completely better. It still looked red and swollen, and it still hurt at the end of the day, especially if I wore grown-up shoes. I didn’t mention this to my mother, of course, but I did begin to worry. Denial is all very well, I thought, but what if something is really wrong? So I got an X-ray done, and sure enough, the toe had a significant fracture – something I am only now this very minute revealing to my mother.

I went to see an orthopedist, carrying my X-ray. As he came into the exam room, he was reading the form I had filled out in the waiting room, giving my name and occupation and medical history and the details of my accident. “Hello, Doctor,” he said, with surgical firmness. “Bicycle rickshaw crush injury, huh? You don’t see that one every day.”

He looked at the X-ray and examined my toe. Then he told me that there’s no real treatment for a broken toe. Buddy-tape it to the next toe with adhesive tape, he advised, and wait for it to heal. His tone suggested that I should really have known that all along.

Perri Klass and Sheila Solomon Klass are the authors of “Every Mother Is a Daughter,” which will be published by Ballantine Books next spring.