Peter T. Pugliese, MD, a member of the Class of 1957 of what is now the Perelman School of Medicine, has had a varied career. Becoming a doctor was, he says, “a long and arduous trip.” Along the way, “I found God, lost him, and found him again. . . .”
As a youth, Pugliese believed he had a calling to the priesthood, until, while in the seminary, some spiritual doubts and questions led him to reconsider his plans. As he puts it in his recently published memoir, The Cookie Doctor: An American Physician’s Memoir of Life’s Obstacles and Miracles (The Topical Agent LLC): “I told my father of my decision to leave the seminary. He was furious with me. My grandmother never spoke to me again, and my uncle Joe the priest was upset with me. Basically, I was a pariah. What to do? The next day, I enlisted in the Marine Corps.” After discharge in 1948, he enrolled as a premedical student at Franklin and Marshall College in Lancaster -- the first step on the way to becoming a doctor. Then came another interruption: his Army Reserve unit was called to active duty, and Pugliese found himself in Camp Polk, Louisiana, in a tank battalion. Fortunately, however, he was eventually transferred to a medical detachment, where he picked up some useful training.
Even after being accepted into Penn’s medical school, Pugliese faced another setback. Despite being about to receive his undergraduate degree, he did not have a high school diploma required for medical school. His years in the seminary were not counted. But once again he was able to deal with an obstacle. He persuaded Mother Evangeline, the principal of Reading Catholic High School, which he attended only to tenth grade, to “create” a diploma for him. “The Lord had blessed me again.” The bulk of his book deals with the following two decades of his life after medical school. He became a family practitioner in rural Bernville, Pa., where many of his patients were part of the Pennsylvania Dutch community. Since retiring from clinical practice in 1978, Pugliese made another turn and became more involved in anti-aging research and skin care. Author of Advanced Professional Skin Care and Physiology of the Skin (3rd edition, 2011), he is the founder of Circadia by Dr. Pugliese, maker of skin-care products, and has been honored with the Maison G. de Navarre Medal Award, presented by the Society of Cosmetic Chemists.
A Doctor in the Country
The Cookie Doctor draws its name from the fact that Pugliese and other country doctors were often paid in commodities and received gifts of produce, meats, and sweets. But, as the author notes, that abundance was not always beneficial:
“Obesity and diabetes were two diseases I had to battle constantly in my patients. . . . At one farm, where I happened to be stuck in a snowdrift, the farmer invited me for breakfast before he pulled my car from the snow with his tractor. The breakfast consisted of fried eggs, fried potato, and sausage. This was followed by pancakes and scrapple, a butcher-scrap specialty whose ingredients are best left un-itemized. The mixture is ground up, formed into a loaf, dredged in flour, fried, and served covered with maple syrup. Finally, coffee was accompanied by coconut cake. I estimate that I had consumed close to three thousand calories that morning. No wonder I was facing an uphill battle against obesity in the Pennsylvania Dutch.”
Bernville, where Pugliese lived in a stone farmhouse, is about 50 miles northwest of Philadelphia. It sounds like a wonderful place to raise a family, but as The Cookie Doctor points out in vivid detail, it was also a place where husbands sometimes abused their wives, incest was more common than Pugliese ever expected, and the doctor even had to deal with a woman who was convinced she was hexed by an unfriendly neighbor. As recounted in the first few pages, a woman calls his office and says: “I am going to throw my children into the well.” The new doctor quickly determined that it is a case of post-partum psychosis, and he manages to rescue the children, calm the mother, and get her on a path to recovery.
Later in his career, Pugliese became involved in treating prisoners battling heroin addiction. As he writes, “I was thrown into an entirely new world, the murky, treacherous, and hazardous world of drug addicts.” Eventually, he decided to leave his clinical practice. (When he started, he paid $46 a year for malpractice insurance. Over the years, it had grown to nearly $18,000.) Instead, he chose to pursue his interest in “the root causes of aging.”
A Lesson Learned
Pugliese does not overlook his time as a medical student at Penn. He survives a high-pressure situation with I. S. Ravdin, then the celebrated chair of surgery, and learns a valuable lesson from Francis Wood, chairman of the Department of Medicine. Wood had a group of students examine the same patient, then suggest some diagnostic tests and a course of treatment. The patient was an 80-year-old woman who showed signs of cerebral insufficiency. Afterward, Wood heard their diagnostic procedures. “Most of us had suggested arteriograms, perhaps a pneumoencephalogram, and then one or two other arduous and painful tests. Then Wood asked what they would do if the woman was their mother or grandmother.
“Somewhat startled, we said that we would do none of those awful tests, but limit our test to the smallest number of painless procedures. . . . Dr. Wood said softly, ‘Do you not realize this lady is someone’s wife or mother or grandmother? As a physician, you must treat every patient as though that patient was your mother or your wife or sister or brother or father.’ . . . The class was dumbstruck. We had never heard this sentiment expressed by any other physician in the past three years. I recognized this advice was the single most important key to practicing good medicine.”