By Dr. Micaela Wexler
In 1997, I was the young mother of two daughters, an infant and a toddler. I was an unemployed playwright, with no marketable skills. I was married to a working actor who struggled to support our family so that I could be home with our daughters instead of working menial jobs. Central in this decision was our fervent wish that I breast feed our daughters “on demand.”
We had a pediatrician at the time who had not been supportive of me breast feeding my first daughter while pregnant with my second daughter. I had attempted to educate this pediatrician with research articles showing there was no harm in breast feeding while pregnant, but this had led to an acrimonious debate in her office during which she warned me my daughter could be removed from my home if I did not stop “harming her.”
I was aware that as a dark skinned minority woman without a college degree, I could not afford to fight with a pediatrician, that this could very well lead to my losing custody of my daughter. In my hormonal state, I began to have nightmares that I was sent to prison and my daughter soon forgot who I was.
I didn’t stop breast feeding. My husband and I simply lied to our pediatrician. We also lied to our obstetrician. I continued to breast feed throughout my pregnancy and then, when my second daughter was born, I started to “tandem feed,” all the time concealing my breast feeding practice from the person, who after my husband and me, was most responsible for my daughters’ health.
I shared all of this one day with my writing group. During the lively discussion that ensued, I was told about a pediatrician who was a champion of breast feeding, including tandem feeding. He was active in La Leche League, and did not turn anyone away, regardless of their ability to pay. His name was Dr. Paul Fleiss.
At that point in my life, I was still shy and timid. One of the women present surmised that I didn’t have the courage to call him, so she went to the phone and called him herself. It was late evening, but Dr. Fleiss answered his phone and listened as she told him my entire story. She got off the phone and told me I had an appointment the next day. When she gave me directions, I realized I had been walking by the cozy craftsman house he used for his practice the entire time I had been a mom.
During my initial appointment, Dr. Fleiss asked me questions in his soft voice, and as I gave my history of my daughters, he praised me, telling me what a great mother I was. He gently examined both my daughters, letting my toddler play with his stethoscope and place her finger on the end of the ophthalmoscope.
He was impressed I had found research articles about breast feeding while pregnant. He invited me to the La Leche League meeting held every other week in his office. He also invited me to join him and other people from the neighborhood in a morning hike in Griffith Park they took every morning at dawn. “Bring the babies,” he said. “They’ll love it. We’ll help you with them.”
Thus began a friendship that lasted until Paul died July 19, which happens to be my birthday. Paul became a friend, mentor and father figure to me.
I began hiking with the group, and developed several close friendships with other hikers. During one of our hikes, Paul shared that he did volunteer work in the Latino community, and could always use a fluent Spanish speaker. I accompanied him on one of these excursions, and my professional life began to take form.
For reasons that are no longer important I was not raised with the stability nor was I taught the skills one needs to pursue a career of any magnitude. During our many hikes I shared with Paul the story of my childhood and he took it upon himself to fill the paternal void in my life. He gave me advice as we climbed the hill in Griffith Park. He supported me in all my endeavors with the same enthusiasm he had for breastfeeding and pediatrics. Paul brought a group of friends to see each of the productions of my three plays.
One day I shared with him my desire to become a doctor, and my fears that I was too old. Whereas many well meaning friends advised me to consider nursing or physician assistant school, Paul never once said a discouraging or negative word about my desire to become a doctor. He gave me nothing but support in every way possible. He assured me that I was not too old, and then he said, “It’s better to be a good doctor for five years than a bad doctor for 20.” He gave me advice on where to take my pre-med classes, and how to make my resume more competitive. He allowed me to shadow him for countless hours in his office. He regaled me with stories about women who had become physicians after having children.
When I received my medical school acceptance letter, Paul was overflowing with pride. He then suggested a way for me to afford medical school: applying for the National Health Service Corp (NHSC) scholarship, a program that pays the entire cost of medical school (tuition plus a monthly stipend) in exchange for four years of service in a primary care specialty in an underserved community. “You’re exactly what they’re looking for,” he said.
During medical school, I did one of my pediatric rotations in his office. He risked our friendship for the greater good of pushing me hard as a medical student. He never passed up an opportunity to share one of his pearls of wisdom. A constant refrain was “always listen to your patient. If you listen long enough and carefully enough, the answer will come to you. The patient will tell you what you need to know.”
My second year of residency took me out of Los Angeles to Kansas City in 2007. The excitement of starting a new life was tempered by leaving Paul. Not only was I leaving an amazing pediatrician for my children, but I was leaving my mentor, father figure and close friend. Paul softened this blow by suggesting that I fly to Los Angeles with my daughters for their annual physicals. “Many people do it,” he said. For the first three years, that’s exactly what I did, and each time we saw him, he treated us as if we had never left.
My NHSC service obligation took me to a small town in Southwest Missouri where I was the only psychiatrist providing outpatient care. I also staffed the inpatient unit. The hours were long, and it was challenging to find coverage so I could take time off. My last trip to Los Angeles to see Paul was in 2011, for a short, impromptu weekend. Despite the short notice, Paul made time to see me. We went on a hike, and I had two of my three meals in town with him. I shared with Paul the challenge I faced in rural Missouri: the patients had come to expect doctors to write them multiple prescriptions for controlled substances. This expectation was especially high when patients saw a psychiatrist. My visit with Paul strengthened my resolve to “listen carefully to the patients,” and not just give out multiple medications.
My job in Southwest Missouri became more demanding as the months passed. The poverty there is brutal; the incidence of substance abuse is staggering. I was physically attacked on several occasions for various reasons: my dark skin, my refusal to dole out narcotics, my reluctance to place patients on disability until all avenues had been exhausted, and on two occasions, when parents became convinced I was the one who had called child protective services.
In the summer of 2012, I called Paul. “I can’t go on,” I told him. “I’m not going to make it through my contract.” We discussed the enormous financial penalties I would face if I didn’t complete the contract: 3 times what it had cost to attend medical school plus 18 percent accrued interest.
“I’m going to have to move to Mexico,” I concluded.
“That’s a wonderful idea!” Paul said. “my son went to school in Mexico. He loved it. You could teach in the medical school.” Always the dreamer, his mind was always brimming with possibilities. His reaction was perfect, it lifted my burden, giving me the freedom to think of other possibilities myself. I began to indulge my desire to treat children with developmental challenges, which became my plan to pursue a child and adolescent fellowship after completing my contract.
That plan fueled me for the rest of my service obligation. In September 2013, I got in touch with Paul to wish him a (late) happy birthday. When I expressed my fears that I would not be accepted into the program, he promised me he would hire me to do child psychiatry in his office. “In my eyes, you’re already a child psychiatrist.”
A month later I was accepted into the fellowship program at KU Medical Center, to start immediately upon completion of my NHSC service. I completed my service July 18, at midnight. Paul died the next day. My mentor and friend saw me through to the end.
There have been many moments since Paul died that I have been overcome with grief. It’s hard to believe I will never hike up the hill at Griffith Park with him, that I will never “talk shop” with him about my work with children. It’s difficult to accept that his seemingly endless energy really has stopped. To me, he will always be that thin man hiking next to me, his mind sparkling with ideas, showering me with flakes of hope and possibility. I get through these sad moments by taking comfort in the many gifts he gave me. Each time I think about Paul, I remember to “listen to the patient, and the answer will come to you.”
Dr. Micaela Wexler provides child, adolescent and adult pscyhiatric services in Kansas City.
Please visit Wexler Family Psychiatry to schedule an appointment.
Logo Copyright Debby Bloom
Appointment information for Dr. Micaela Wexler: wexlerpsych.com