Irvin Yalom - The Schopenhauer Cure

Julius knew the life-and-death homilies as well as anyone. He agreed with the Stoics, who said, As soon as we are born we begin to die, and with Epicurus, who reasoned, Where I am, death is not and where death is, I am not. Hence why fear death? As a physician and a psychiatrist, he had murmured these very consolations into the ears of the dying.

Though he believed these somber reflections to be useful to his patients, he never considered that they might have anything to do with him. That is, until a terrible moment four weeks earlier which forever changed his life.

The moment occurred during his annual routine physical examination. His internist, Herb Katzan old friend and medical school classmatehad just completed his examination and, as always, told Julius to dress and come to his office for a debriefing.

Herb sat at his desk, rifling through Juliuss chart. On the whole, you look pretty good for an ugly sixty-five-year-old man. Prostate is getting a little swollen, but so is mine. Blood chemistries, cholesterol, and lipid levels are well-behavedthe meds and your diet are doing their job. Heres the prescription for your Lipitor, which, along with your jogging, has lowered your cholesterol enough. So you can give yourself a break: eat an egg once in a while. I eat two for breakfast every Sunday. And heres the prescription for your synthyroid. Im raising the dose a bit. Your thyroid gland is slowly closing downthe good thyroid cells are dying and being replaced by fibrotic material. Perfectly benign condition, as you know. Happens to us all; Im on thyroid meds myself.

Yes, Julius, no part of us escapes the destiny of aging. Along with your thyroid, your knee cartilage is wearing out, your hair follicles are dying, and your upper lumbar disks are not what they used to be. Whats more, your skin integrity is obviously deteriorating: your epithelial cells are just plain wearing outlook at all those senile keratoses on your cheeks, those brown flat lesions. He held up a small mirror for Julius to inspect himself. Must be a dozen more on you since I last saw you. How much time you spending in the sun? Are you wearing a broad-brimmed hat like I suggested? I want you to see a dermatologist about them. Bob Kings good. Hes just in the next building. Heres his number. Know him?

Julius nodded.

He can burn off the unseemly ones with a drop of liquid nitrogen. I had him remove several of mine last month. No big dealtakes five, ten, minutes. A lot of internists are doing it themselves now. Also theres one I want him to look at on your back: you cant see it; its just under the lateral part of your right scapula. It looks different from the otherspigmented unevenly and the borders arent sharp. Probably nothing, but lets have him check it. Okay, buddy?

Probably nothing, but lets have him check it. Julius heard the strain and forced casualness in Herbs voice. But, let there be no mistake, the phrase pigmented differently and borders arent sharp, spoken by one doc to another, was a cause for alarm. It was code for potential melanoma, and now, in retrospect, Julius identified that phrase, that singular moment, as the point when carefree life ended and death, his heretofore invisible enemy, materialized in all its awful reality. Death had come to stay, it never again left his side, and all the horrors that followed were predictable postscripts.

Bob King had been a patient of Juliuss years ago, as had a significant number of San Francisco physicians. Julius had reigned over the psychiatric community for thirty years. In his position as professor of psychiatry at the University of California he had trained scores of students and, five years before, had been president of the American Psychiatric Association.

His reputation? The no-bullshit doctors doctor. A therapist of last resort, a canny wizard willing to do anything he had to do to help his patient. And that was the reason why, ten years earlier, Bob King had consulted Julius for treatment of his long-standing addiction to Vicodan (the physician-addicts drug of choice because it is so easily accessible). At that time King was in serious trouble. His Vicodan needs had dramatically increased: his marriage was in jeopardy, his practice was suffering, and he had to drug himself to sleep every night.

Bob tried to enter therapy, but all doors were closed for him. Every therapist he consulted insisted that he enter an impaired physician recovery program, a plan which Bob resisted because he was loath to compromise his privacy by attending therapy groups with other physician-addicts. The therapists wouldnt budge. If they treated a practicing addicted physician without using the official recovery program, they would place themselves at risk of punitive action by the medical board or of personal litigation (if, for example, the patient made an error of judgment in clinical work).