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Defense of the Tribe

When do you teach a kid to put up his dukes?

My patient was a nebbish: bespectacled, socially inept, and as articulate as an adult. A sixth grader, he carried a Gucci briefcase and a Portabella umbrella with an ivory grip. He was a character out of a Somerset Maugham story; I could see him playing bridge and sipping gin fizzes in Singapore. And just like a Maugham character, he suffered great angst. He had early-onset Crohn’s disease.

I had removed a part of his colon and small bowel, operated on him three times, put feeding tubes in his veins, and had watched him writhe in pain that no kid deserves. We do try to keep our professional distance from our patients, but there was something about this boy that made me smile, made me want to help him enjoy life with zest and vigor.

As he was about to enter the seventh grade, his father, a titan of industry, made a career move that took the family from their wealthy neighborhood in Newton, Massachusetts, to a town in West Texas. His new schoolmates had never seen a kid like him. He wore a tie, carried that briefcase, spoke the King’s English—was polite, well-groomed, and hated. His folks noted that he stopped eating, and feared his Crohn’s disease was about to flare up. He was ill, and they flew him back to Boston on a private jet. He slumped into my office, gray in color, worn looking and sagging and beaten.

I examined him, ran labs, and then he, when his mom went to the restroom, told me the diagnosis: punches to his belly. Kids in school were beating him up every day. They would grab his briefcase, pull his tie, and call him “nerd,” “Jew boy,” and “Yankee.” And punch away, they would, at his belly, where I had three incisions to my credit. They hurt him, but the hurt was as much psychic as physical—he felt alone, different, forlorn. I instantly realized that this was not a case where civilized discussions or parental interventions were going to get those bullies off his back. Somebody had to teach the boy how to defend himself. And because his dad wasn’t around much, and his mom was a gentle person, I knew it had to be me.

I walked out of my little office into the atrium, where two secretaries sat, along with a trauma coordinator and assorted residents. I pushed all the chairs up against the walls, drew the curtains, and cleared the rug of debris. I shed my white coat, tucked my scrubs into my socks, and brought my nebbish patient out into the middle of the improvised ring. As a kid in Springfield, Massachusetts, I had fought a thousand fights, and boxing was my strength. So for thirty minutes, while those around us—including his mom—watched with rapt attention, I showed him how to bob and weave, jab, uppercut, shift, shuffle, and move his head. I showed him how to hold his hands, how to make a fist, and how to breathe as he circled. He was so eager, and he was, I knew, in his heart a true Maccabee, a descendant of the ancient Hebrew warriors. A bright smile came to the boy’s face and to his mother’s.

As we parted that day, he shook my hand and said “jab, jab, uppercut,” my mantra to him, and we both grinned knowingly. He flew to West Texas and, like young Henry V at Agincourt, won the day when he arrived on his battlefield. His mother called to tell me that the very next school day they came at him as she dropped him off in her BMW. He dropped his bag, took off his tie, and put up his dukes, like a young Ali. One boy ventured into his zone, and my nebbish remembered his mantra. Three punches—jab, jab, uppercut—and it was over. They never messed with him again.

I’m sure there are those who will tut-tut when they hear this story and say, “A doctor? Teaching violence? Outrageous!” But I say one of my patients needed protecting. As Sebastian Junger writes in his book War, “defense of the tribe is an insanely compelling idea, and once you’ve been exposed to it, there’s almost nothing else you’d rather do.” I did not make a killer out of that boy; I defended him by teaching him how to defend himself. My nebbish is a proud man today, and well.

BRIAN GILCHRIST, A77, M84, is chief of pediatric surgery at Elliot Hospital in Manchester, New Hampshire, and was formerly surgeon-in-chief at the Floating Hospital for Children at Tufts Medical Center.
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