Lifting the topmost clipping from the cardboard shoebox, he read it twice while scribbling notes on scraps of paper. For over 60 years the New York Times earned his respect; its editorials always carefully reasoned and informative, but . . . this one strongly offended him, insulted all physicians in practice . . . and his long-gone colleagues and Bellevue mentors. It begs for a strong rebuttal, he thought. I have to respond and set things right.  Now.  No putting it off. I’ll try to be more careful this time, he cautioned himself; no more churlish rants or accusatory epithets that might detract from my argument. He opened the top drawer, took stationery and envelopes out, and placed them next to the bottle of black ink and jelly jar of pens.

*          *          *

Dr. Abelman’s letter writing had begun, over 30 years ago, with fiercely contentious volleys, almost daily, to Nixon and Kissinger. Sarah, his late wife, frequently looked out the front window worried that the F.B.I. was coming for him. “Sam,” she said, “be careful, Hoover reads everything. You’ll get into big trouble. You don’t have to be the conscience of this meshuggeneh world.” Colleagues, friends and family tolerated his cantankerous nature. It annoyed them that he didn’t listen, even to reason. Unassailed by doubt, he knew he was right. After Nixon’s resignation and the end of the Viet Nam war, he stopped for a few weeks, as if catching his breath. Soon he was once again sitting up late, after evening office hours, writing scolding diatribes to the White House—to Republicans and Democrats alike, it didn’t matter—local and national politicians, newspapers and magazines.

That was thousands of letters ago.

Abelman lived alone since Sarah’s death two years ago. After her funeral he spent the next month with his children and grandchildren in Miami and Cleveland. He declined all offers of assistance. They had busy lives to lead, he reasoned. I would only be a burden, and besides, I’ll be more comfortable back home in Brooklyn.

Overwhelmed by sadness, he grieved for several months. Consumed by the weight of shared happy memories, and the frightening bleakness of what might lay ahead, he felt confused and adrift; uncertain of what to do. He and Sarah had planned retirement years ago, hoped to move south. But . . . he had procrastinated. Abelman couldn’t stomach the thought of sitting by a swimming pool alongside old geezers smoking cigars, gabbing about stocks and bonds, playing gin rummy. He couldn’t see himself in pastel terry-cloth outfits learning the silly game of golf. There were still important things to do with his life.

For over 40 years Sarah had run the office; her gracious diplomacy balancing his crusty disposition. The last several years he sat at his desk reading or napping, waiting for the doorbell or telephone to ring. His once-busy practice now consisted of refilling longstanding prescriptions, and conversing with the few old patients.

He couldn’t bear continuing to practice medicine without Sarah. He had just turned 80. It had been a half-century of going downstairs to the office, driving to the hospital, making middle-of-the-night house calls. Now it was time to retire.

He telephoned the remaining patients and suggested other doctors. Abelman knew he would miss being their doctor, in spite of whatever past aggravation they had caused him. It was useless trying to sell his practice; no young doctor would want to live or work in that now run-down part of the city. He paid neighborhood boys to move the office furniture and medical library upstairs to the guest room, now his study. The small office laboratory: its monocular microscope, slide collection, chemical reagents, racks of test tubes, autoclave and centrifuge were a dusty medical museum that no modern clinic had use for, even as donations. He carried his medical bag, framed diplomas and photographs and a few mementos himself.

Abelman began visiting friends—fellow survivors—in nursing homes and assisted living developments. There wasn’t much to talk about other than illnesses, medications, and a distant shared past. He read the Times obituary section, and dutifully attended funerals of old patients and friends. The Brighton Beach Chess Club was filled with young Russian emigres whose accents eluded him, and foul smoke. He tried going to the Public Library to read favorite authors of his youth, but often dozed off, awoke disoriented, having forgotten what he’d read.

One morning a Times headline caught his attention. Abelman felt his dormant sense of injustice reawaken. “Bush Pushing Privatization of Social Security.” He read the article twice, making notes in the margins. Social Security and Medicare are too important to leave to sleazy politicians and greedy businessmen, he grumbled. What’s Bush set to dismantle next – medical insurance for the elderly and the poor? All of the safety nets? Energized, he wiped the dust off his desk and began to write. An hour later the letter was completed. Over the years he had sent hundreds of letters to the White House, and reckoned they had a thick file with his name on it. What could they do to me now? he wondered. Honor me, an octogenarian, with a jail term? He leaned back, smiling.  

Almost daily thereafter, during what once were office hours, he wrote argumentative letters to scores of national and local politicians, editors and newspaper columnists. He never expected a reply. It didn’t matter. While writing he felt alive. His mind focused on the task, life’s juices flowed once again. For a short time he was able to ignore his aching bones, failing eyesight, labored breathing and put aside sadness. Outrage sustained and invigorated him.

*          *          *

“Enough  ruminating. Get to work, the morning’s half over,” he admonished himself. A computer and printer—surprise birthday presents from his daughter—remained in boxes on the floor. “My hand is still steady,” he explained, “and besides, I don’t want to learn anything new.” Abelman sat a moment sipping tea, formulating in his mind what he wanted to say. He began slowly. Like an ancient steam engine, fires lit, he knew pressure would build rapidly and he would soon be at full speed.  

                        Dear Editor of the New York Times,

“The Growing Pains of managed Care” (editorial, Nov. 11)  refers to patients as “customers, consumers, and clients” and doctors as “providers.” Let me quote from the last paragraph: “Medical providers have to view their services as a commodity, and compete for consumers by introducing more pleasing and innovative forms of care.

I am an 80-year-old physician, retired after 50 years of caring for patients. I know what I am talking about, and strongly resent the tone of your recent editorial. It is more than just an issue of semantics. Much more. Let me explain. These terms reflect a business mentality that has become routine in the press, health insurance companies, HMO’s and even hospitals and university medical centers. It is a dangerously misguided choice of words. I am dismayed that you didn’t spot this grave error. Sloppy thinking does not become you. Your newspaper should be a leader of public discourse, not a reflector, a timid follower.

A patient is not a client; (lawyers and social workers have clients).

A patient is not a customer or consumer; (Shopping malls and fast-food stores have customers and consumers) . . .

“Customers!  My God, what has happened to the practice of medicine?” he wondered.

Abelman stared at his dusty black medical bag sitting atop the bookcase. Leather peeling, handles taped on, it had accompanied him on thousands of house calls. Inside were ether bottles and forceps for home deliveries, scalpels and sutures for lancing boils and performing tonsillectomies, carbolic acid and rubbing alcohol for sterilization, glass syringes and needles for vaccinations during epidemics, rubber gloves and Vaseline for disimpacting the elderly, wads of cotton and rolls of gauze and tape for wounds and sores.

He got up and moved closer. “Ah, the Siczjak parrot,” he mused. Sitting stolidly atop the bookcase, the gaudy plaster statue glistened in the morning sun; flaming red, fluorescent yellow and orange. Like a prize won at Coney Island. He was able to remember much of the 30 years of doctoring the Ukranian butcher’s family of Pitkin Avenue, treating their good-for-nothing sons, and late one night losing the battle with Stanislaw’s weak heart. He hadn’t forgotten that house call. “Tenk you docta, “ Anastasia said at the door. “He no breathe good. I open window. Help him.” Old Stanislaw was sitting up in bed, gasping, gurgling. Quickly checking pulse and blood pressure, he listened to the faint irregular heartbeat and stertorous breath sounds, while noting the dusky, cool fingertips. When he took a syringe and vial of Morphine from his bag, Siczjak suddenly collapsed, breathing stopped, eyes wide open. Anastasia shook her head, and wept.

Years later, after he retired, the widow brought a large present wrapped in newspaper, nodded and quickly left. The garish bird was placed in a position of honor in his office.

“Were the Siczjaks customers, consumers or clients?” he asked the statue, as if expecting a reply.

Abelman remembered other battles; few won, many lost. On a high shelf was a capped jar of kidney and gallstones preserved in formaldehyde, saved for him by the surgeons. Each stone had its personal history. On the bottom was the tiny gray kidney stone of Rose Bagnoli, the grocer’s wife. He recalled the night she came crying to the office holding a jar of bloody urine. No staff urologists would see her because she was on public welfare. Finally, Professor Chamberlain, his former teacher, removed the stone. Gratis.

He recognized Feinlieb the tailor’s mottled brown gall stone. The frail old man had endured three days of pain and vomiting before timidly knocking on the office door. It had been and easy diagnosis, even in Yiddish. Feinlieb never talked about the numbers on his left forearm. The tailor paid in service; altering Sarah’s dresses and his suits and pants for years.

There was the tan stone of Claflin, the policeman. Screaming “Gimme a shot, you old phony, like you’re supposed to, Goddamnya!” his huge body feverishly thrashing around in bed, the yellowish hue of biliary obstruction was evident in the light of the bedside lamp.

Franny Claflin whispered, “That damn fools’ been like this for two days. The stubborn mule won’t go to the hospital. That’s where his father died. He wants to ride this out.”

“It’s an emergency, dammit,” Abelman hissed. “He needs surgery now. In a second I’ll call an ambulance and alert the hospital. First I’ll have to knock the lummox out with a shot.”

Of course that gonif never paid his bill.

. . . your thoughtless use of business terms is insulting. It contributes to the erosion of a noble, learned profession. A physician is not a “provider.” Medical schools do not graduate “providers.” They educate doctors who treat and care for sick people – once known as patients. Don’t you remember?? Were you ever sick as a child and taken to a “provider?” Were your parents ever ill? Did their doctor “provide” goods and service, or treat and care for them?

We are physicians, not businessmen!

It is an important distinction. Think about it. Please be more careful in the future. Don’t worry, I will still buy your newspaper.

                                                            An aggrieved but loyal reader,

                                                            Samuel Y. Abelman, MD

He read the letter out loud, an old habit. “Irrefutable logic. Plain language. Handwriting legible. No words misspelled. Good.” He checked punctuation (after all, it is The Times), addressed the envelope and put it aside. It was 1 o’clock. The tea was cold. Any appetite for lunch had disappeared. He felt too riled for a nap. He turned to the wall behind him, stared at the faded photo of his graduating class and faculty on the steps of the old hospital, and shook his head.

“Fifty years of easing the suffering of thousands of patients, and now I am put in the same class as a McDonalds—as if I dispensed French fries and fast service with a smile to customers. Outrageous!” he said to his long-gone classmates.

Abelman grumbled a moment, then reached into the shoebox for another clipping.