Thursday, November 18, 2010

Review of "If I Get to Five: What Children Have Taught Me about Courage and Character " by Fred Epstein, M.D.

Let me say from the outset that "If I Get to Five" is one of the most moving, inspiring and challenging memoirs I have read. It is an unequivocal "must read" for anyone who is a regular reader of The White Rhino Report. Dr. Fred Epstein, in recounting his career as a pediatric neurosurgeon, tells a story about learning to humanize his approach to treatment and about his introducing holistic principles into a previously techno-centric world. After reading this remarkable little book, my first impulse was to want to meet "Dr. Fred," so I Googled him and learned that he had died of melanoma in 2006. But before his mortal life ended, he ensured a perpetuating legacy at the INN (Institute for Neurology and Neurosurgery) at New York's Beth Israel Hospital. He also has immortalized the lives and spirits of the dozens of young patients whose stories he so beautifully recounts in this book.

Several comments on the book's back flap concisely frame the achievement that Dr. Epstein has wrought in writing this book while he himself was recovering from neurosurgery and a 26-day coma following a bicycling accident.

"This book is a testament to the extraordinary depth, power, and resiliency of children's spirits."

"A magnificent tribute to human resiliency and hopefulness."

While Dr. Epstein wrote this book to pay tribute to the children he treated, and to their families, and to his stellar supporting staff, he inadvertently throws a warm light onto his own pilgrimage and transmogrification from a technically proficient automaton to a sensitive and caring physician who learned to treat the whole person rather than just to defeat the tumors that threatened these young and fragile lives.

I read several chapters of this book while sitting at a table in a Boston restaurant. I was grateful for the extra napkins that allowed me to dry my eyes several times during my season of digesting Dr. Fred's vignettes and anecdotes. They were not tears of sadness, but of empathy and appreciation for the poignancy of his journey and the lessons learned along the way that he was wise enough to impart to a broad readership.

I offer several samples of his words and thoughts and story-telling.

Dr. Fred's Rubicon of self-awareness was triggered by a poem that had been written by one of his patients, Chris Lambert. Chris died at the age of 17 of a particularly intransigent brain tumor. Shortly after Chris's death, his mother mailed the following poem to Dr. Fred.

I have for many useless hours contemplated eternity;
I have prayed in the night

By the cold and lonely side of the bed

For the peace and strength of our living God.

And I still wonder: Will I be saved?

I wait with hope in my heart.

I am struggling, O Lord, to stay alive

I am losing my sacred strength

I am living a life of confusion

And death is very near.

I ask you, reader, whoever you may be,

Take my trembling hand and warm it with care and sympathy.

I believe that love is the sole purpose of man's life

And without love life is sterile and without meaning

But with love life has wonder.

With love life has color and beauty.

Dr. Epstein responds: "Reading that poem devastated me. It still does when I read it today. I had failed him. I had done everything I could to save his life, but I had ignored the deepest emotional need - to feel loved. His words haunted me: 'I ask you, reader, whoever you may be, Take my trembling hand and warm it with care and sympathy.' I hadn't heard his plea until it was too late. How many other children had I turned a deaf ear to in their our of need?"
(Pages 14-15)

Dr. Epstein's personal revelation and gradual transformation of his practice lead him to a vision for a whole new way of practicing pediatric neurosurgery. He described the casting of the vision.

"You also need a vision if you want to lead, whether you're in politics, business, or even medicine. If you have a clear vision you can articulate, people will follow you - because everyone wants a piece of vision. We all do. Otherwise, we're just stumbling around in the dark, hoping not to collide with something hard and sharp. When I launched the INN, I didn't try to persuade anyone to come with me. I simply described what I envisioned - a healing environment built around human needs and human talent, rather than mere technology - and a lot of people decided it was a vision they wanted to help breathe life into. That's how fantasies become real: a group of people seize on the same vision and make it their own."
(Page 68)

Chapter 3 is particularly poignant, as Dr. Fred shares his thoughts about overcoming fear - lessons learned from his young patients and from his own struggles as a child and as a successful physician. The chapter opens with this quotation by Ambrose Redmoon:

"Courage is not the absence of fear, but rather the judgment that something else is more important than fear." (Page 75)

Dr. Epstein continues, in his transparent self-revelation diagnosing a universal set of symptoms: "Fear is an inescapable part of being alive. What counts is whether or not we let our fears keep us from engaging the toughest challenges or pursuing our most cherished goals. We each fight these battles every day - between our fear of failure and our desire for achievement, between our fear of intimacy and our desire for connection, between our fear of looking foolish and our drive to transcend our limits. We can all look back on our lives and see opportunities that we let get away - in work, in love, in friendships and families - because we lost our nerve." (Pages 75-6)

One of the most inspiring stories that Dr. Fred shares is that of Spenser, a thirteen year-old who has been fighting a recurring brain stem tumor for 11 years. On the heels of having celebrated his Bar Mitzvah, Spenser wrote to Dr. Epstein:

"Dear Dr. Fred,

Love is inside me and its keeps me going. This tumor has never stopped me and it never will. Even though I have a crazy life and I have mixed emotions about it everyday and think it sucks like hell, I also have all these nurses and doctors and machines that help me physical-wise and a huge enormous team of sweet loving and caring people including a brother, 2 dogs, a snake, 2 turtles and a suitcase full of cousins and friends that are like my best pals in the whole wide world.

This crappy tumor really sucks! I mean, like how many MRIs can a kid take? I still get angry and upset a lot, but I have the courage to get better whether it's next week or a year from now. No matter when it is that the day of the miracle in everyone's life comes, it will happen.

To miracles!

Spenser" (Pages 78-9)

Wow! Realism and hope in perfect harmony - as seen through the prescient eyes of a courageous 13 year-old man.

Dr. Epstein ends his musings with this memorable quotation - his way of suturing up the wounds that have been left exposed as the scalpel of his wit and wisdom have laid open the hearts of his readers:

"The question: 'Why do children suffer?' has no answer, unless it's simply. 'To break our hearts.' Once our hearts are broken, they never fully heal. They always ache. But perhaps a broken heart is a more loving instrument. Perhaps only after our hearts have cracked wide open, have finally and totally unclenched, can we truly know love without boundaries." (Page 183)


Read the book - and be prepared to have your heart broken - and softened.

I am thankful that while he walked among us, Dr. Epstein paused long enough to love his patients - and to pass along his hard-earned wisdom to those of us willing to listen and to learn.


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