Category Archives: Reflections

Coming of age

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I started medical school in 1975, around the time the image of physician as a kind, wise, helpful, infallible, and exclusively white male—mythologized by James Kildare, Marcus Welby, and the brooding Ben Casey—was becoming tarnished, replaced by a far more realistic but much less comforting version. In subsequent years, disappointment would turn to anger and cynicism, expressed in mutual distrust and an explosion of malpractice litigation.

My attending physicians in medical school and residency reflected that reality, varying widely in age, temperament and clinical competence. Some of them still embodied those traits patients held dear—compassion and genuine concern—but others had become short-tempered, sarcastic and condescending towards their patients, their colleagues, and those of us in training.

Those physicians reserved a special scorn for the latter-day Inquisition known as the Morbidity and Mortality Conference, during which the care of a physician whose patient suffered a bad outcome was scrutinized. The Grand Inquisitor presented the case piecemeal, pausing to offer up tidbits from the chart—lab results, x-rays, nurses notes—while sometimes occasionally professing amazement that the offending physician had missed something intuitively obvious to the most casual observer. Some of this may have been defensive; the fear of being in the hot seat one day. “There but for the grace of God go I.”

New physicians are invariably young, naïve and idealistic and I was no exception. I’d witnessed bad behavior first hand and swore I would be different. I would listen to my patients and wouldn’t rush them. I wouldn’t become an arrogant asshole. I wouldn’t be afraid to admit, “I don’t know.” Above all, I would make fixing all their problems my personal mission, instead of blithely dismissing their complaints as psychosomatic.

This delusion is comparable to your teenager telling you he or she will be a MUCH better parent than you were, with a similar rude awakening. It’s not as simple when your own butt is on the line and you’re the one making difficult decisions.

My most liberating experience was learning what I could NOT do. I couldn’t solve everyone’s problems, because many of them were rooted in psychosocial and economic realities that were beyond anyone’s power to affect, including mine. I could be empathetic and listen; I could offer suggestions. I could lead the horse to water but not force it to drink.

Some of my contemporaries drifted to the dark side, seduced by the golden handcuffs. The price one pays for the illusion of financial security includes exhaustion, substance abuse, divorce, and alienated children. Others later denounced their early altruism as “liberal naiveté,” wondering how they ever could have believed health care was a right and not a privilege. Two of them refuse to speak to me anymore because I thought our current health care system needed an overhaul.

I’m more comfortable treating the middle class and poor folk than with Yuppies, and I prefer small-town hospitals to the large and often predatory health care systems. My loyalties lie with the nurses and staff who make doing my job much easier, not with other physicians.

I lost a few battles but I think I ultimately won the war. I just did my best.

Clip Art: CanStock Photo

 

Good Bye, Old Paint

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He was the medical director of an Ob/Gyn clinic for the indigent in a southwestern town near the Mexican border. In its heyday, eight midwives and three physicians—including a near-deaf Catholic nun whose car sported an “Ordain Women!” bumper sticker—handled thousands of patient visits a year and delivered more than 130 babies each month.

Poor folk are never a priority for the health care system, even less so if they are black, Hispanic or worse a border-jumper. Many of the patients gave the same rural mailbox number for an address, having paid the “coyotes” thousands of dollars to be smuggled into the US. I can’t say I blame them, because I’d had to deal with the consequences of poor obstetrical care some of them had gotten across the border.

I first met him in 2000 when I worked as a locum tenens physician at the clinic for seven months. At that time he was in his late 50’s, a slight man with thick brown hair and glasses whose quiet demeanor sometimes produced a wry joke that both surprised and amused. I thought he was a kind and decent man, even after I found out he was a staunch Republican and had his picture taken with George W. Bush at an inaugural ball. I’m not sure he ever acknowledged the irony of devoting his life’s work to people the Republican Party despised.

But a sadness always surrounded him as if he recognized the futility of the task while refusing to give in. The hospital expected the clinic to be profitable but funding was always a problem. Private physicians in other specialties never wanted to see the patients in consultation. Some of the hospital staff treated them as vermin. He did his best but most of the time, unlike Sisyphus, the stone never got anywhere near the top of the mountain before falling back.

As often happens, he was pushed out in favor of younger (and less expensive) physicians. He retired a little farther north where he lived before taking his own life the day after Christmas, 2012. His ashes were buried on a ranch in the western state where he’d first practiced—a fitting repose for an old hand.

“Why?” will forever remain unanswered. Was it being discarded like an old pair of shoes? Was being a physician his entire identity and, lacking that, his raison d’être had evaporated? Or had he just reached the end of his trail, tired and dispirited?

He may never have realized to how many people’s lives he brought comfort and healing, but those of us who bore witness will never forget.

Photo credit: CanStock Photo

Slow Dancing

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Nothing in my life – even my oral Board exam – was as terrifying as the first time I slow danced with her.

I was not one of the cool and popular kids in high school (even though one of my best friends recently admitted she thought I was a “player”). I rarely got asked to a gathering at someone’s house. I was more likely to get a “Happy New Year” phone call at home while I drank hot Dr. Pepper and watched Johnny Carson. So, when the Eckstein brothers invited me over one summer evening, I gratefully accepted. And I knew she would be there; she usually was.

Parties were fairly simple affairs back then. We gathered on their lawn and played Frisbee or Jarts—lawn darts with heavy steel points that were banned after several accidental trephinations and deaths. A portable phonograph, relocated outside and plugged into a couple of extension cords, was loaded with 45s or an occasional LP. The parents supplied munchies and drinks and then disappeared into the house but ever mindful of our presence.

When the sun went down and the bowl of chips was down to crumbs, the music shifted from Top 40 rock to stuff meant for slow dancing. Songs like The Turtles’ You Showed Me, The Cryan’ Shames’ Up On the Roof/It Could Be We’re in Love, Tommy James and the Shondells’ Crimson and Clover, and, of course, Bread’s I Want To Make It With You, the fantasy of every horny teenaged boy.

But there was one song that will always remind me of her. Three ascending guitar notes then a drop to two chords:

You ask me if there’ll come a time
When I grow tired of you
Never my love

Suddenly, it was now or never. I screwed up every ounce of courage, walked over to her and, with a look that was both asking and pleading, held out my hand which, to my surprise, she took. No words passed between us.

She was a beauty. Shoulder length chestnut brown hair; deep brown eyes I could never hope to read, and skin as soft as…well, any comparison would be superfluous at that point. She wore a sleeveless white blouse, turquoise shorts and white tennis shoes. I wasn’t sure what I’d done to be rewarded this way, but I wasn’t about to argue.

Now, I didn’t know how to dance. My attempts to teach myself ended abruptly when my mother walked into my room while I was practicing the Twist—a dance that was already a decade out of date. I knew that my job was to slowly spin in a circle while not stepping on her feet until the music stopped. So I just put my arm gently around her back and prayed for the best.

I wasn’t sure how to hold her hand: up and out like our parents danced, or close in, by our shoulders. I wanted to pull her close enough to me to feel her breasts against my chest, but I was afraid of impaling her on the embarrassing erection that popped up the minute we touched. We gently swayed back and forth, around and around. I would never forget the warmth of her breath on my neck and the scent of her skin.

And then it was over.

I thought about kissing her softly, gently before we parted but I wasn’t about to press my luck. We went back to where we had been sitting, like boxers to their respective corners at the bell. I had no idea why she danced with me. I was too shy and insecure to even talk with her, let alone carry on an extended conversation about something other than “my life sucks.” But it didn’t really matter. I’d had a glimpse of heaven and that was enough.

Sometimes I’d have dreams at night, the two of us slowly dancing alone, feeling loved, hoping it would never end.

Never, my love.

Where the Heart Lives

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I went to the wake for the mother of a high school friend on a butt-ugly, stinking hot September in 2011, back in a town I’d learned to hate decades earlier. I left with something more.

Susan and I weren’t close enough to be confidants, but she was close enough to be more than just a face I used to know, staring out at me from a yearbook page. We lived about a block from each other, rode the same bus to school and a group of us would hang out at her house on occasions. Sue’s mom, like the mothers of my other friends—Margee and Betsy—were kind, lovely women whose houses provided sanctuaries from my tumultuous existence. I went to honor her memory, not to fulfill any obligation.

Rosemary or “Rosie”, as we all knew her, died a few weeks after she’d began having difficulty breathing which progressed to gasping for every breath. The doctors diagnosed primary peritoneal cancer and started chemotherapy, but one morning she woke up unsteady on her feet. She fell into a coma a short time later; a CAT scan showed a massive stroke from which she’d never return. She was 81.

Rosie’s life had been well-lived. She married her husband in 1949 and they were together for 55 years, until he passed away in 2004. They raised five children who have all done their parents proud. Sue became a veterinarian, something she’d wanted to do since high school.

Rosie was a friendly woman with a smart sense of humor. A few of us had gathered at Sue’s house one evening during our high school years and the talk inevitably turned to sex and Vaseline. Without missing a beat, Rosie said, “After five kids, who needs Vaseline?” We were astounded someone’s mother would say something like that because it sure embarrassed us. (Years later I would discover the joys of annoying my own kids with “TMI.”)

There was already a line of people when I arrived at the funeral home. By the time I left it was out the door and down to the sidewalk. Rosie had many people in her life who loved her and would miss her dearly.

A collage of pictures from Rosie’s life stood on an easel in the corner, summarizing eight decades in a brief moment. The most poignant picture was one I’ll never forget: Rosie standing behind her oldest daughter, preparing for her wedding.

I talked briefly with Sue’s sister-in-law, Mary Jean, and Mary Jean’s mother; then I sat next to Margee. We chatted for a while and tried to identify people we knew from high school as they joined the line, but some of their names eluded us. They had all stayed in town and, as far as I could tell, they were happy with their lives.

I reflected on Rosie’s life and then on my own. I drove around town and took pictures of my past: the bowling alley and the hospital where I had worked; the school where I attended eighth grade and had my first girlfriend; the empty lot where our house once stood. I rode along the rural roads where I used to bike, remembering the relative peace of being alone and the chaos that waited at home.

Forty years have healed the wounds of adolescence. The ugly scars from then have faded into those of fine leather. I hated the place when I left and couldn’t get away fast enough. Years of living in the suburbs, however, has made me yearn for a small town in which to retire, the ultimate irony.   One person’s godforsaken acre is another’s paradise and, while I wouldn’t move back—there are far too many painful memories of my past life—I’m no longer inclined to disparage the places others call home.

We spend our lives looking for the place where we belong. Some find it early; some have to search for years or decades. Others never find it because home is more of a feeling within than a physical location.

I found my home when I stopped looking so hard.

The Long Way Home

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I’ve sewn up several vaginal lacerations women have acquired during a far too vigorous session of Feely Meely. Rings, fingernails and improvised sex toys can slice through the vaginal wall and, like scalp wounds, vaginal lacerations can make a woman bleed like a stuck pig.

The reasons I hear for the injury are rarely truthful but often entertaining. One woman, sporting an impressive rip in her vagina, claimed neither she nor her husband could retrieve her contraceptive sponge after intercourse. They called the neighbor, another man, over to help and he tore her trying to get it out. That was their story and they were sticking with it.

Lust and alcohol often lead to calamity. I got a call at 5 a.m. on a Sunday morning from the emergency room about a university co-ed who was bleeding rather steadily from her vagina. The ER physician told me she had a long tear that was bleeding steadily and he didn’t feel comfortable trying to repair it. I told him I’d have a look.

One of the nurses followed me into the examination room which smelled of fresh blood, stale cigarettes and beer breath. The young woman, an attractive blond who might have been a cheerleader, was sitting on the table sobbing, because the boyfriend had dropped her off and disappeared. I asked her what happened.

“Well, he had his fingers in me and all of a sudden I felt this sharp pain and I started bleeding.” I thought to myself Yeah and his knuckles drag on the ground when he walks.

When I put the speculum into her vagina I saw a small artery pumping blood from a 3-inch gash in the right vaginal wall. Most times I can fix these in the ER but sometimes it’s much easier to take someone to the operating room where the lights are better, the instruments are plentiful and accessible, and the patient isn’t squirming.

I did a quick history and physical examination, asking the usual questions. Have you ever had surgery? No. Are you allergic to any medicine? No. Have you had anything to eat or drink in the past few hours? No, not since about midnight. I called surgery to set up a room and talked briefly with the anethesiologist. However, when he asked about recent oral intake, she said, “Does the six-pack I drank at 4 a.m. count?” Yes, it does, because general anesthesia increases the risk of vomiting, aspiration and pneumonia, making a spinal the preferred anesthetic.

We took her to the operating room and got her onto the table. I stood in front of her holding her steady while the anesthesiologist did her spinal and she blubbered about her useless boyfriend. When she was numb, the anesthesiologist gave her intravenous medicine to make her sleepy and the sobbing ceased. It took about 30 minutes to fix the tear and I made sure there was no bleeding before we left the room. She would likely be sore for a week or so but there would be no lasting damage.

But her troubles were just beginning. I walked out to the desk and the OR secretary said, “Her father is in the waiting room and wants to talk with you.”

Father? Uh oh…

I walked out to find a man who looked a lot like Dick Cheney but far more unpleasant. “So what happened and why did my daughter need surgery?”

I fudged a little and said, “Well, sometimes women can have really heavy bleeding and we need to do a quick surgical procedure to get it under control.” I think he knew there was more to the story than I was telling him, but he just grumbled and appeared to be as satisfied as any father would be under the circumstances.

It turned out he’d driven 700 miles to take his darling daughter home for spring break. I surmised that was one very long car ride home. If I was her, I might have opted to ride in the trunk rather than submit to an inquisition or, more likely, her dad’s stony silence.

 

Image credit: (C) Can Stock Photo