The Old Bastard

His name was John. Granted, I never called him that. I always called him "doctor."

Every residency program has one on staff. An old, semi-retired physician who's rumored to have trained under Osler or Charcot. Brusque, rude, and brilliant.

John was all of that. Came to work in a suit and tie every day. He always sat in the same seat in every meeting and lecture. One of the few docs old enough to have literally seen every neurological disease. He'd started in the era where top-of-the-line brain imaging was the pneumoencephalogram and ventriculogram. The number on his American Academy of Neurology certificate was 2 digits long.

We were terrified of him. He wasn't mean, but intimidating none the less. If you were answering a question, you knew you were on the wrong track if you heard him starting to chuckle softly in the back of the room, and when he took his unlit pipe out of his pocket and began puffing on it... you'd really screwed up.

At the same time, you'd go to him for help. Due to his long experience he could explain things sometimes no one else could. Occasionally you'd get invited into his office (it had been his for over 30 years) which reeked of tobacco. The hospital was no-smoking everywhere, but he didn't care. He smoked a pack of cigarettes a day, and a pipe on top of that. The little room was packed with bookcases, creaking under the weight of neurological tomes going back to the 1930's. Although it was a chaotic mess to everyone else, John would always go to a specific spot in the room, pull out and blow the dust off a book, and open it to exactly where the answer was.

John was a widower, and his only son and he had a tenuous relationship at best. He was a workaholic, and the neurology department was his life. He'd come in on weekend mornings to read the paper and have his pipe and coffee in his office. For dinner each night he dined alone at the same table in the same Michelin 3 star restaurant. Only once did I know him to have a dinner companion, when an old acquaintance of his was in town: Sir Roger Bannister, the world's fastest neurologist.

Shortly after I completed residency, John was diagnosed with metastatic cancer. He didn't even bother with treatment. Nor did he miss a day of work. Once he told others about it, it was no longer to be discussed. No one was to bring it up with him. He and his pipe continued to teach and lecture and glare at us until he no longer could. I, and many others, including his son, visited him in his last days.

His office was still locked and untouched when I left the area a few months later. No one dared go in or move his books or pictures. They were, for better or worse, all that was left of him.

A friend of mine from the department and I were talking about John's solitary life, with nothing but his work left. He commented that "it's a lesson in how not to live."

But... John never really died.

He's at my office every day, and follows me to the hospital. When writing a note I'll sometimes hear his chuckle and realize I'm not thinking the patient through correctly. He sits across my desk from me and argues about cases. When doing an EMG/NCV he'll chew me out if I do the wrong muscle, or tell me to do it over if it didn't sound right. If I forgot to check something on exam he'll make me go back and do it over.

There are many lessons to be drawn from John, both good and bad. I'll try to learn from all of them.