Steven Berk tells a story that most of us encounter only in the newspapers or on the evening news. It is the true story of his kidnapping. The story has a happy ending; otherwise, Dr. Berk would not be telling it. But it is a harrowing tale that began with his innocently leaving a garage door open and ended with a fear-filled run down a deserted country road. There were many unexpected twists and turns between. To Dr. Berk, what was “only” a 4-hour experience undoubtedly seemed a lifetime, in which he had to make many decisions to protect his life and the lives of his family. The story of the kidnapping is narrated in the present tense, which gives the experience an immediacy for the reader—while at the same time establishing an atmosphere of agonizing eternity.
Events of the kidnapping, described in detail, are interlaced with dry transcripts from the courtroom. This contrast highlights the vividness of our memories and the ease with which different recollections and assertions emerge during a trial. The reader experiences the “subjectivity of perception upon recollection” (the so-called Rashomon effect) that he or she might get from the classic Japanese movie Rashomon or a Pirandello play.
Since the kidnapping, Dr. Berk has been able to reflect on the wisdom of his decisions during the ordeal, as well as to consider what personal strengths and experiences forged those decisions. For the most part, he attributes his ability to reason under pressure to his training as a physician, in particular to the state of “aequanimitas” that Sir William Osler advocated over a century ago.
Sometime during medical school, physicians my age all received a copy of a small brown volume as a gift from one of the pharmaceutical companies. The book was a collection of addresses delivered by Sir William Osler, the great internist of the late 19th and early 20th centuries. The title of the book was Aequanimitas and the first chapter, of the same title, marked Dr. Osler's departure from the University of Pennsylvania in 1889 to the newly organized Johns Hopkins Hospital. In that chapter, Osler tells his listeners “… in the physician or surgeon no quality takes rank with imperturbability….”
Steve Berk has adopted that as one of the guiding principles of his distinguished medical career, and it serves as the focus of this fascinating true story of his kidnapping at gunpoint from his own home on a seemingly quiet Sunday morning.
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The kidnapping is startling, but in itself it is too short to make an entire book. So Dr. Berk develops a memoir of the patients and experiences that helped to shape his perspective on life and to provide the framework for his aequanimitas in the face of possible death. All physicians who have cared for patients for any length of time have accumulated memories of patients who have taught them lessons of life and lessons about decisions—both right and wrong—which have influenced their care-giving, as well as their personal lives. Dr. Berk's stories are often touching, sometimes profound, and always interesting. Particularly moving is the account of his astute and possibly life-saving diagnosis of diphtheria in a young boy at the Keams Canyon hospital on the Hopi Reservation. These recollections, merged with the telling of the kidnapping, provide insight into Dr. Berk's personality, together with an understanding of why he made some of those decisions during 4 hours of terrible stress. Even so, the reader is left wondering. While it is hard to argue that the decisions were wrong (Dr. Berk, after all, is here to tell the story), he conveys his own uncertainty about his conclusions. Perhaps this book is a way for him to come to grips with that uncertainty.
Strengths: The core story of the kidnapping is engaging and provides an excellent platform upon which to consider the split-second decisions that must often be made in times of danger. Similarly, the clinical vignettes are powerful. They remind the physician reader of his or her own past—lessons learned from clinical triumphs and errors. They also remind us of the lessons that our sickest patients have taught us about living.
Weaknesses: Dr. Berk is obviously a very accomplished and respected individual with numerous honors. Many of the details of the book make that clear. To this reader, some of that focus is an unnecessary distraction from the story and could have been omitted. The book would also have benefited from tighter editing to eliminate inconsistent shifts in tense, as we move between the abduction and the recollections. Then too, the photographic images (street scenes) add little of interest; a map of the kidnapping route would perhaps have been more useful.
Recommendation: This is a worthwhile book to add to the shelves of pre-medical and medical students, as well as residents. Other books in that group include Osler's Aequanimitas, even with its rather antiquated language; Ferrol Sams's autobiographical series of novels, including Run with the Horseman; Sherwin B. Nuland's The Soul of Medicine: Tales from the Bedside; and of course Abraham Verghese's My Own Country. A good dose of inspiration and encouragement is helpful to the tired or discouraged aspirant, or for that matter the older clinician.
Darryl M. Williams, MD, MPH
Professor Emeritus, Internal Medicine, Paul L. Foster School of Medicine, The Texas Tech University Health Sciences Center, El Paso, Texas