A Practice She Had Not Rehearsed For

Claire McCarthy is the kind of pediatrician any mother could love: impeccably trained, energetic, empathetic and unflappable. These qualities make her second book about being a doctor both readable and occasionally poignant.

A graduate of Princeton and Harvard Medical School, McCarthy trained at Boston’s venerable Children’s Hospital in the late 1980s, a process she described in her first and more compelling book, “Learning How the Heart Beats.” After finishing residency, McCarthy eschewed the lucrative path of private practice and took a job at the Martha Eliot Health Center, an inner-city clinic in Boston’s Jamaica Plain section.

The Martha Eliot, she writes in “Everyone’s Children,” is a world apart from the affluent one in which she grew up, the daughter of a lawyer and a history professor. Like all pediatric practices it is infused with an air of controlled chaos and outfitted with a complement of battered, brightly colored toys. But because the families are poor and the children often hungry, McCarthy says the doctors sometimes shared their lunches with their young patients.

“Compromises are a big part of practicing medicine at Martha Eliot,” she observes. She quickly learns to cadge free samples of medications for her patients and to make do in other ways. “Instead of designing the ideal medical treatment, I assessed what was possible and took it from there, making compromises I hadn’t been taught about making.”

McCarthy’s descriptions of the differences between her life as the middle-class mother of two small children and the lives of her impoverished patients, most of whom are on welfare, make up some of the best parts of the book.

One of the most memorable families McCarthy treats includes the young Molina children, who are being cared for by the woman she calls Sen~ora Gonzalez, a foster mother. Gonzalez first brings the children to Martha Eliot a week after they were taken away from their cocaine-addicted mother, who had beaten the youngest, a 6-month-old girl, so badly that she suffered bleeding on her brain.

The other children are 8-year-old Daisy, defiant and fiercely protective of her siblings; Sharina, a disturbingly thin 2-year-old who never speaks; Carlos, who is 6 and inappropriately stoic; and Eliana, a baby so deprived of normal human contact that she does not know how to cuddle.

McCarthy vividly describes her encounters with the hapless social-services system that failed to protect any of the children, especially Daisy, who at 4 was molested by her mother’s boyfriend. As the three younger children thrive under Sen~ora Gonzalez’s loving care, it becomes clear that she cannot help Daisy, who begins setting fires.

McCarthy is at her best when she discusses the ways in which her training--like that of all physicians--affects decisions she makes about how involved to become with certain patients.

“It felt odd to be asking the terribly personal questions we were taught to ask and then offering nothing of ourselves that was personal in return,” she writes. “And it seemed that often physicians used ‘therapeutic distance’ as an excuse to be brief, brusque and even unkind.”

McCarthy’s internal struggles to achieve the appropriate balance is revealing and her observations of the struggles and triumphs of her patients sometimes memorable. But her observations about life (“We are our brothers’ keepers. We need to be.”) fall flat and their triteness mars an otherwise-commendable book.