The medical textbook depository

I’ve come to the conclusion that the only people interested in reading old medical textbooks are old medical doctors. I long ago abandoned my basic science textbooks from undergrad days. In 1963, “basic” was the operative word. Physics, chemistry, zoology, geology, anthropology were at the core of the curriculum. The textbooks, today but anachronistic reminders of scientific evolution, have long since served their academic utility. They were recycled years ago in curb-side blue boxes left to the discretion of waste managers who turned a page and took on the responsibility of environmental protection. Medical School in 1966 began with two more years of “basic sciences,” supported by more textbooks inclusive of histology, pathology, anatomy, physiology, pharmacology and biochemistry. These weighty tomes were our ersatz “google” resources before googling became the soup du jour, instinctive, instructive and intuitive. We scribbled notes in the margins, highlighted, and dog-eared pages as we consumed the content only to be regurgitated on demand. The onion-skinned, pseudo-transparent pages with minuscule font made for challenging reading and study, but those were the days before cataracts and macular degeneration clouded both vision and perspective. These texts were frequent fliers, travelling well through academic and clinical pursuits for years, despite bulk and heft. They often served as the supportive infrastructure for bookshelves. They could have been ballast for a large sailing vessel. When I ultimately returned to Toronto from my medical school sojourn in Ottawa, so did the textbooks. They took up residence in my parents’ basement until years later when I acquired my own. Married with children, the old books were lost in the frenzied world of young family life and the cultivation of a medical practice. As my children grew, so did the practice, sometimes equally stressful and challenging. Time management became an essential ingredient to work-life balance. Books were always included in our children’s’ daily routines, especially at bedtime. My kids’ childhood books were preserved and treasured keepsakes, not so the medical texts that gathered dust or were forgotten in a subterranean corrugated container. The children's books travelled well with subsequent housing moves, the medical books broke the backs of many a mover. In time, the kids moved out as they are want to do. They left behind their cherished literary possessions. We became the custodians of Cat in the Hat, Goodnight Moon and Where the Wild Things Are. Admittedly, my wife and I loved these books as much as our kids did. When our kids had their own kids, their book collection succession went to their kids, repatriating and perpetuating old bedtime routines. The plight of my old medical books was less purposeful. When my wife and I decided to downsize almost 20 years ago, we bought a townhouse. The process of purging and culling can be cathartic, a therapeutic exercise that releases endorphins and elicits positive feedback loops of suppressed or forgotten memories. There is something cathartic about placing years of collectibles on the front lawn, curb-side, and then waking up the following morning to find everything vanished, like the work of an illusionist. Under the cover of darkness, someone had taken up the mantle of responsibility for my discarded stuff and filled a perceived void in their own lives. I recall placing a well-scuffed wooden bookshelf of Encyclopaedia Brittanica at the curb. My father had bought the collection from a door-to-door salesman along with the annual ‘book of the year’ subscription many years earlier. As proverbial bookends, I placed a box of my ageing medical texts on either side of the Brittanica collection. The following morning, as you probably have already surmised, the Brittanica had a new owner and the medical texts, abandoned, to be reluctantly moved to the townhouse where they would take up residence in a dank corner of an unfinished room in the basement. I started a solo medical practice in 1973. My personal office was inclusive of a dark pine bookcase which I populated over the years with medical texts specific to general practice and my ancillary practice interests. Primary Care Today, Harrison’s umpteenth edition, Textbook of Occupational Medicine, The Principles and Practice of Medicine and a plethora of Pharmaceutical Industry-supported publications. I loved having my books at hand in the office, that is until I realized I could have the same information and data literally in my hand. With computer and handheld devices insinuating themselves into the practice of medicine, the ‘device’ became the preferred information delivery system. There was no longer any need to buy books, expensive and cumbersome and rapidly outdated, valueless icons. I was a reluctant and late adapter to the computer-driven world of medicine. I steadfastly remained committed to the humanity and patient-centred principles I learned at the bedside 60 years earlier in the old Ottawa General Hospital in the ByWard Market district. There is no more sacred nor meaningful approach to patient care than the laying on of hands. There are no textbooks at the bedside, although today, there are tablets and iPhones and portable ultrasound devices. In September 2020, I retired from my GP practice after 49 years. I packed up the charts and the books and the memories. The charts were off-loaded to a medical storage facility, the books were packed up to take residence in yet another basement and the memories were secured in the most personal of vaults. I recently inventoried my basement collectibles. As you may have guessed, the books are still safely stowed. Keeping in mind that there is possibly another move in the future, another downsizing, I began exploring possible resource receptacles for the preservation of my cherished medical textbooks. I went online and googled “medical textbook disposal.” The general consensus is that “old” medical textbooks have a relatively short life expectancy. They are of little use today unless you are a collector, however, these are neither first editions nor signed copies by Osler or Hippocrates. “Recycle and dispose” are the frequent directives. I called Habitat For Humanity, spoke to Gary who was very engaging, apparently not having a very busy afternoon in his cluttered habitat. They “don’t do books,” he advised. He had some suggestions but none were practical or realistic. My initial intention was to do something for ‘humanity’ but I was thwarted in my efforts. Where was the Goodwill of mankind in my time of need.And then imagination took flight, to a special place where us old docs with old medical books could insure that the knowledge and resources we cut our teeth on so many decades before could be secured and preserved, a depository for posterity. No membership fees; we had all paid our dues over the years. We could visit our old books any time, have a collegial conversation in comfortable, time-eroded chairs and talk about what life was like “when I was an intern” or “back in the day.” The books, peripherally shelved and systematically organized by girth and colour, would serve as flash cards, conjuring a kaleidoscope of vivid recall. Even today as I write this story, the images and personalities of the cast of characters, academic and clinical influencers of my past, have a clarity I thought had long ago faded into the oblivion of time. The depository of medical textbooks would be like a doctor’s lounge, only with bookshelves of outdated tomes, the very foundation of our professional lives. And, of course, there would be institutional-grade coffee for authenticity, prompting memories of where we’ve been and what we’ve left behind.

The medical textbook depository

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HOWARD GOLDSTEIN

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