SAN ANTONIO -- "I didn't start out to be a geriatrician. I
became one because my patients and I have grown old together,"
geriatrician Dr. Jerald Winakur wrote in his book "Memory
Lessons."
Winakur's new book on what he calls the "art" of doctoring, is
"part memoir, part manifesto."
In it, he probes and palpates, thoroughly examining our current
health-care system and its sometimes frightening predicted course
over the next couple of decades.
At the heart of the book is Winakur's glowing compassion, his
old-fashioned approach to medicine -- he is a country doctor in an
urban setting -- his strict, often anachronistic belief in the
patient/doctor relationship.
"I'm a 'Marcus Welby' doctor," he says, "not an 'ER' doctor
or a 'House' doctor."
For those too young to get the TV-series reference, he explains:
"I think that patients need to be treated as if they are your
family."
Finally, the book, immensely readable and thought-provoking,
chronicles his care of perhaps his most important patient, who is
not really his patient. That is his octogenarian father, Leonard
Winakur, a fine, if flawed, man who loved art and birding.
"There have been many wake-up calls about the state of elderly
care and their growing numbers, but I think it is only when we are
personally affected that the message becomes poignant and
critical," says Dr. Abraham Verghese, author and founding director
of the University of Texas Health Science Center's Center for
Medical Humanities and Ethics, who now teaches at Stanford
University. "Many of us can identify with Jerry because we have
either faced that, or will."
Along the way, Winakur, 60, tells the life story of a Jewish
pawn broker's son from Baltimore who finds solace and support in
what might seem a world away -- San Antonio.
All of us need health care. Or we will, someday. And many, many
of us are part of the largest group the health-care system will
ever have to accommodate:
The babyboomers. Just as we must try to figure out "What Are We
Going to Do With Dad?" -- the title of a 2005 essay by Winakur that
became "Memory Lessons" -- so will our children.
The numbers are staggering -- more than 75 million people older
than 65 by 2050, 20 percent of the population. (In 1900, only 4
percent of the population was older than 65.)
And the fastest-growing demographic is the "oldest old," those
older than 85. Once, families quietly assumed responsibility for
their old people, caring for them in the home. Today, we look for
outside solutions, nursing homes and specialized-care facilities.
Compounding the side effects of our societal evolution is the
direction medicine is heading, according to Winakur, who cites the
numbers: "There is a deficit of 7,000 doctors in geriatrics now,
and in another 20 to 30 years that deficit will be 35,000. So I
don't know who's going to take care of these elderly folks."
He surmises it will be physician's assistants and nurse
practitioners.
"Our medical organizations say, 'Well, the specialist will have
to take care of them.' But I know that's not going to happen.
That's wishful thinking.
"I think what will happen is that they'll be taken care of by
nurse practitioners and physician's assistants. And that might be
OK if they are overseen by doctors well-trained in geriatric care.
But if not, I don't think those folks, try as they may, have the
training to deal with the kind of people we're seeing now, who are
older and older, frailer and frailer, and are on more and more
medications. It's a complex task, and I really worry about what's
going to happen."
Consequently, Winakur long ago entered into what he calls "the
realm of advocacy" for his elderly patients, frequently presenting
his case to his colleagues and to his students at the Center for
Medical Humanities and Ethics, where he teaches a course called
Literature and Medicine with his second wife, Lee Robinson, an
attorney and published poet. In this class young doctors discuss
Nathaniel Hawthorne's "The Birthmark" and William Carlos
Williams'
"Complaint," rather than, say, "The Esophagus and Pharynx in
Action," to name just one of the titles on Winakur's office
bookshelves.
"He makes a true effort, through teaching, to inspire the
younger generation to value the patient/doctor relationship as
highly as the effort to strive for scientific competence," says
Dr. Ruth E. Berggren, the current director of the Center for
Medical Humanities and Ethics.
"Without role models like Dr. Winakur, students might tend to
opt for the more glamorous or materially rewarding disciplines of
medicine (emergency medicine, procedure-oriented specialties and
the like). His teaching, writing and role-modeling helps to
glamorize the primary-care doctor, the geriatrician, the doctor who
takes the time to listen and care."
"Memory Lessons" opens with one of Winakur's fondest memories:
The gift on his 12th birthday of a copy of Roger Tory Peterson's
"A Field Guide to the Birds of Eastern North America" from his
father, along with his dad's Army-issued binoculars.
Birding has been a lifelong passion of Winakur's. Once he was
"a lister" and states with pride today that he's seenmore than
500 species of American birds, from buntings to warblers.
He is more casual about ornithological pursuits these days,
although when asked about the best sighting he's had at his acreage
in Comfort, where he and his wife seek sanctuary and sanity,
Winakur responds without a second thought: "A Roseate Spoonbill.
There are very few Hill Country sightings of the roseate
spoonbill."
He writes in the first chapter of "Memory Lessons": "My
father has forgotten all he ever knew about birds."
Born in 1908 to immigrant parents, Leonard Winakur dreamed of
being an artist, but his mother removed him from junior high school
to work in the family pawn business. He suffered poor health later
in life, including prostate cancer and finally Alzheimer's disease.
The second chapter of the book chronicles another key event in
the Winakurs' lives: the destruction of the Baltimore pawn shop
during the 1968 rioting after Martin Luther King's assassination.
"My father, an average man caught up in these tumultuous times,
was . . . never able to recover from the losses he suffered in the
civil unrest of those days," Winakur writes.
The entire family, including brother Michael, an architect,
ended up in San
Antonio, where Winakur came in 1973 for his medical residency at
the UT Health Science Center after graduating from the University
of Pennsylvania medical school.
"The chamber of commerce should give me a medal for all the
people who followed me here," Winakur says.
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(E-mail: Sbennett@express-news.net)
c.2009 San Antonio Express-News