The Enemy Within
By Michael J. Katin, MD
"How sharper than a serpent's tooth it is to have a thankless child."
Shakespeare, King Lear, Act I, Scene iv.
It has now been just over 12 years since the failure of the "August coup"
in which residual hard-line believers in the Soviet system tried to take
over control of the government from Mikhail Gorbachev, and the fallout from
this event led to the dismantling of the power of the Communist Party. Almost
overnight the balance of terror under which we had lived for over 40 years
had vanished, and the opportunity for world peace suddenly presented itself
as a realistic possibility.
Fortunately, humanity came to its senses and we are now overwhelmed by
multiple varieties of internecine strife, with danger from nationality/ethnic/religious
groups that had not been known to exist prior to 1991. To make matters even
worse, we in the medical profession are now threatened by an insatiable,
cunning, and merciless hoarde: our offspring.
There is a tradition in businesses to hand over the family enterprise to
the next generation (G.P.
Putnam's Sons, the Von
Trapp Family, Sanford
and Son, the British
Empire, etc.) but this is a vanishing tradition in medicine. Handing
over of the family practice (even if it isn't Family Practice) is impossible
if the next generation doesn't think it's a good idea to go into the medical
profession. For the past six years, applications to medical schools have
decreased, with stablization finally this year. That would be bad enough,
but applications to law school have gone up
21% in one year and MBA degrees are being pursued in record numbers.
Traditionally, the medical field was seen as a respectable profession reflecting
accomplishment in our society, and medical schools were filled by children
of immigrants and also by scions of established families who had wanted
to leave the sterile world of business and work with flesh and blood (e.g.,
Howard Dean). The 1954 book Not
As a Stranger, by Morton Thompson (published, interestingly, by Charles
Scribner's Sons, indicating that publishers are much more successful
in controlling their children), described a medical school class made up
of this variety; imagine that in the 1955 motion
picture (the first directed by Stanley Kramer)
some of these students were played by Robert Mitchum, Frank Sinatra, and
Lee Marvin. I don't know who played Howard Dean.
There are at least three reasons why our children don't want to go into
- Fear of SARS
- Fear of working hard
- Fear of poverty
Once they get past these restrictions, there's also the example of their
contemporaries getting out into the real world years earlier, although at
least now the guarantee of outrageous salaries is temporarily on hold. It
will probably be at least 3 more years before the investing public is willing
to pour zillions of dollars into fly-by-night tech companies with no products.
Although most of us would prefer to see our children go into medicine because
of the example we have set for them, they've also heard us complain incessantly
about how businesspersons and lawyers have ruined our ability to practice.
It's therefore somewhat ironic that every day I hear one of my colleagues
speaking of his daughter or son who just got accepted to law school or business
Mythology has it that the pelican feeds its young by piercing its breast
to release its own blood to them. This is depicted on the official state
seal of Louisiana, although there is no official state pelican that depicts
a seal as doing the same thing. Regardless, this was thought to be fact
by the ancient Romans, who also believed that flies came out of rotten meat,
that Iraq had weapons of mass destruction, and that the earth was the center
of the universe.
In other words, we work endless hours at our profession to try to create
a secure and nurturing environment for our children, at which point they
turn on us and go into the professions that plague us the most. Is there
a self-destructive mindset in our families that creates this? Are we planting
the seeds of our own destruction, so to speak? This makes King
Lear look like Ward
Cleaver in comparison to our situation.
Maybe this is part of the circle of life, and the next generation beyond
will consist entirely of orthopedists and nephrologists. In the meantime,
we'll continue to support our children, maybe not as dramatically as the
mythological pelican. Regardless, even if we don't give them our blood,
they'll be giving us their bills.