Anatomy of a Kidnapping

Dr. Steven Berk’s book Anatomy of a Kidnapping is a memoir discussing his kidnapping experience within the context of his many medical experiences and lessons drawn from the late Sir William Osler. Unlike other kidnapping accounts, Dr. Berk focuses much of his book on his medical career and experiences dealing with the daily struggles and hardships faced by clinicians and patients alike with a collected composure, or aequanimitas. As Dr. Berk writes,

The practice of medicine is intimately wound up in the most emotionally charged moments of life and death. At times, it can be chaotic, stressful, and dramatic, and the only way to perform such conditions is to remain composed and rational, and often emotionally detached from situations that call for controlled, decisive actions. Throughout my career as a doctor, developing and maintaining Aequanimitas has been one of my greatest challenges. I have been called upon many times to act skillfully under pressure, and these have been some of the most memorable and educational experiences of my career.

Sir William Osler similarly wrote,

Throughout my career as a doctor, developing and maintaining Aequanimitas has been one of my greatest challenges. I have been called upon many times to act skillfully under pressure, and these have been some of the most memorable and educational experiences of my career.¹

Although Dr. Berk’s kidnapping lasted for a few hours, its dramatic retelling is a direct testament to years of discipline practicing Osler’s aequanimitas in his daily life.

Dr. Berk’s stories of being a young medical student were a reminder of what drew me into medicine. Furthermore, Dr. Berk’s practice of aequanimitas in his medical career and kidnapping experience were important lessons of handling the vast unknowns and uncertainties facing medicine in an era of political upheaval and stark divides. Specifically, Dr. Berk’s account of a patient’s successful recovery from alcoholism but ultimate demise from malignant lymphoma illustrated the twists and turns that clinicians and patients experience throughout their relationship. In many of Dr. Berk’s stories, he emphasized the importance of not only building rapport with a patient but taking a thorough and clear physical exam and history.

Much of Dr. Berk’s philosophy was inspired by Sir William Osler. As Dr. Berk wrote, Osler provided

deep insight into the fundamentals of practicing medicine. He taught about the importance of the careful physical examination and wrote about how various findings from a physical examination should be used in diagnosis. He emphasized the importance of the most basic bedside skill: carefully listening to patients about their complaints. This is important not only as a way of developing the proper physician-patient relationship but of learning the facts about the medical problem so that the right diagnosis can be made. Today, many physicians rely too much on expensive lab tests and diagnostic technology and forget the fundamental value of a close physical examination. For this reason, Osler’s teachings are still vital and relevant today.

In this manner, Dr. Berk’s stories illustrate the importance of combining a clinician’s intuition, scientific training, and humanism in each patient encounter.

This reflection of Osler’s teachings is littered throughout the underlying narrative of Dr. Berk’s kidnapping in Amarillo, Texas. Dr. Berk’s kidnapper, who we discover had a troubled history with alcohol, drugs, and violence, attempted to steal money from Dr. Berk and threatened him multiple times. At one point, Dr. Berk’s family became central to the story as the kidnapper forced him back to his home. At the end of the ordeal, Dr. Berk escaped from his kidnapper, who was eventually caught and convicted. Interesting, as the kidnapping is described through Dr. Berk’s memoir and court transcripts of the subsequent trial, we gain perspective on the culminating social factors influencing the kidnapper. As Dr. Berk reflects, many patients over his medical career faced similar struggles with addiction, abuse, and other social issues. As clinicians, our work often becomes entrenched in the hospitals and clinics we work and train in. As Dr. Berk reflected, our jobs truly influence the larger scope of the society we practice and serve.

Dr. Berk’s Anatomy of a Kidnapping was one of the first books I received as a first-year MD/PhD student. I first met Dr. Berk at my white coat ceremony but knew little of his reputation or infamous kidnapping experience. At the time, my focus was on navigating through the preclinical years of my medical training. It was only later that I took time to read and appreciate Dr. Berk’s story and insightful medical experiences. Unlike most readers, I had the opportunity to hear Dr. Berk discuss his kidnapping experience; he also taught several of my infectious disease courses. Dr. Berk was very approachable and encouraged me to pursue my own writings on Sir William Osler, lending me a copy of The Quotable Osler during my research. As I’ve continued my training, I’ve come to appreciate Dr. Berk’s reflection on the many lessons in life “to live each day to its fullest; to celebrate the joys of family, work, and good health; and to appreciate our every moment as precious.”

Overall, Dr. Berk’s book is a unique blend of storytelling and reflection on the challenges and difficulties of being a physician. The medical field is facing several challenges, ranging from new resident work hour restrictions, mounting burnout, and incorporating electronic health records into clinical practice—all of which threaten to erode the physician-patient relationship. As Dr. David Rakel explained,

There are lots of times when I find it a struggle to stay in a room with the patient and give them the full empathic presence along with bringing to bear all of my evidence-based, medical and scientific knowledge. Of course, patients expect that we do this in every visit, but anyone who has been faced with a full waiting room, a couple of emergency walk-in visits, and a few talkative or dependent patients knows differently. Despite our best intentions to be caring, compassionate, and competent physicians, our daily reality may intrude and leave us (and our patients) feeling that we have not achieved those noble and lofty goals.²

But despite the enormous challenges, we are not alone in this struggle. As Dr. Berk wrote to his son at his darkest hour, “If you choose medicine, there will be hundreds around the country eager to assist you. It is part of the Hippocratic Oath—to teach the sons and daughters of those who have taught you the art of medicine.”

The reviewer, Jonathan Kopel jonathan.kopel@ttuhsc.edu, is an MD/PhD student at Texas Tech University Health Sciences Center, Lubbock, Texas.