When I was a first year medical student, I worked for a neuroanatomy professor 31 years my senior, who became a good friend.  He was still the professor, however.  When I once became upset, he became stern and calmed me down.  When I called a co-worker  “Little man,” (a college nickname), the professor, with the same last name as I, took me aside, told me my comment was demeaning and never to use it again.  I haven’t.

I offered suggestions in his research but never corrected him otherwise. Dr. Stuart Smith greatly influenced me, never knowing he was a big reason I became a neurologist. In 1981, I sent him a card announcing the opening of my practice.  His widow wrote me he had died two weeks earlier, at 63, from a ruptured aortic aneurysm. I wished I had written sooner. I can still hear his booming laugh.

I am now older than he lived to be and have had different experiences with those in their 20s.  One posted an article on Facebook about a scientist who had found a possible breakthrough that “might” help Alzheimer’s patients.  The individual wrote that the man deserved the Nobel Prize, hoping a grandmother, afflicted with the disease, would be helped.

I posted that the key word was “might,” and there was a long way from the lab to clinical practice.  I was measured in my response, not commenting, as I could have, that my grandmother also had Alzheimer’s, my mother died of a rapidly progressive dementia, and that doctors like the limelight, too, so any possible breakthrough is often taken directly to the press, rather than waiting to see whether it will work.  I didn’t add that I had evaluated thousands of Alzheimer’s patients and had seen many possible “cures” appear and disappear.  In short, I tried to inject a dose of needed reality into hope. Taking away hope is bad; giving false hope is worse.

The young person quickly retorted, “No, MIKE (caps added), the key word is hope.”

I am fairly informal about being called by my first name, but the Internet has allowed the young to call elders by their first name and slam them, because it is easier to write something nasty than to say it directly to somebody 40 years your senior.  On the bus, I am often called “Sir”; that is rare online.  I chose to remain silent, showing both restraint and wisdom.  I found the comment disrespectful and am not particularly eager to communicate again with the individual, whom I suspect would not notice.  I was once that age; the person has not been mine.

I never would have dreamt to correct Dr. Stuart Smith by using his first name and thinking I knew more than he did. He would have slammed me verbally, and he was one of the best English grammarians I ever met. Times have changed.

Many scientists want to report they have discovered a possibility that may lead to a possibility that possibly some day might possibly help somebody.  The use of the same base word here is deliberate, for new, safe, effective drug production is a long process.  There are few “miracle drugs” in medicine.  In my training, I learned an adage: “to write anything positive about treatment of multiple sclerosis is a good way to ruin your career.”  Forty years later, the adage is not far off the mark.  I have no doubt we will eventually prevent, stop, or cure MS, but that day is not yet visible to me.

The young person might feel I was too sensitive to take the comment as an insult. As both as a neurologist and as an older person who has seen and experienced far more, I was insulted.  Hope mattered a lot to the person, which I understand; realistic hope, however, based upon a great deal of experience, matters more to me.  Others in their 20s have said worse to me, but they were from other cultures, not familiar with mine, so I gave them more leeway when they said or did things I found appalling.

I can count on the fingers of both hands the numbers of patients in my practice I called by their first name.  I was formal.  I used “Mr.”, “Mrs.”, “Ms.” or “Dr.”    Thirty-five years after I met him, I still call the retired chairman of neurology where I trained, “Doctor.”  I always will. My parents resented being called by their first name.  I was furious when my dying father had a chest X-Ray performed by a technician, referring to Dad as “buddy.”  My father began his career as a science teacher and became superintendent of schools in three cities.  He wrote two science textbooks and could fix cars.  At 90, he was interested enough to see the Sandhill Crane migration; the following year, he explained to two young women why a lunar eclipse occurred and traveled alone to his 70th college reunion.

I think a key difference today is that the young have equal access to information that I have.  They don’t, however, have the same life experiences as I; many do not have critical thinking skills necessary to carefully analyze “breakthroughs.”  In my youth, every cashier could correctly make change, not now.  We learned grammar and how to hold a pen and write, uncommon today.  We called adults “Mr.” or “Mrs.”, less now.

Perhaps I should have apologized for being too old, sensitive and experienced to write what I considered a careful response.  I certainly know how to apologize, but felt then what I did was appropriate.  If not, I’ve had a lot of practice apologizing.  That comes from age, too.

Also from my parents, my wife, and Dr. Stuart Smith.


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