A Frugal Physician Prescribes
Common Sense and Enthusiasm

(scene from Shakespeare in Love)

Is There a Doctor in the House?

Shakespeare said long ago that,
“All the world’s a stage and all the men and women merely its players.”
Others think life is just about power, or all about love or pleasure.
What’s your take?

Being a teacher at heart, I look at the world as being a great school.
Wherever we go we meet teachers and students.
Sometimes, we teach and other times we hopefully learn.
And others, maybe we do both.

Teaching and learning is surely happening in hospitals and clinics and medical offices.
Whether they realize it or not, physicians and medical providers are about that business, every day.
Even though much of those processes may be quite unconscious.

Doctor coming from the Latin word meaning Teacher
should give physicians and patients alike pause to consider what lessons may be learnt in medical moments.

Continue on to read stories about physicians
and some of the hidden things they may be learning in the course of practicing medicine.

Chapter: Teaching and Learning

The importance of patients’ faith in their physicians brings many intangibles - demeanor and attitudes, interests and aptitudes, hopes and aspiration - to the fore. Know it or not, physicians are constantly expressing their talents and prejudices, ideals and struggles while the ply their trade and practice medicine.

Medicine surely has components of teaching and education, unconscious as well as conscious. The term DOCTOR comes from the Latin word for teacher. The best of doctors are teachers and practice the premise: “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.” Unfortunately, the present system makes it difficult to squeeze in teaching time during brief consultations.

A Real Physician is not just an attendant of the physical form, but a teacher in word, deed and presence to the minds and hearts and sometimes souls of his/her patients. When that is the case, true healing among those patients may be stimulated from time to time. 

Whenever we are really about healing others, we are drawing forth the best (one definition of education) in them and reinforcing that in ourselves. The author, featuring himself to be a teacher, has had the chance to view and experience many varied teaching and learning opportunities in the course of 20 years passing through the medical profession. And, many more in after years. Here are some which come to mind.

• First off, I am reminded of my brother, the Salesman, who once said to the family minister, “You know, we are both in the sales business. I sell signs and you sell God.”

The minister wasn’t flattered, but certainly Brother had a point. We are all selling something; ourselves if naught else. Teaching and selling have a lot in common.

Physicians sell themselves as well as their products (pills and operations) and services (tests and procedures) and beliefs (based on medical knowledge). The better the physician’s skills at teaching and selling, the better his patient is likely to respond.

• I remember meeting physicians whose name tags told reams about what they were teaching and learning - consciously or otherwise.

I was still a medical student when I got into conversation with a short brash, bulky, red-haired man in a business suit on a hospital elevator. He acted more like a salesman than a physician as he told stories and yucked it up. Actually, he was a surgeon.

Before his sales pitch was over and we got out of the elevator, he handed me his card which read Donald Butts, MD, Proctologist. I suspect he is still in practice and selling his service. I wonder what he is “up to now.”

• Then, there was the cardiologist named Dr. Heart (maybe Hart). I didn’t know him personally. I just heard bits of his story secondhand. He must have needed more heart than some. His theme song could have been “You Gotta Have Heart.”

You must have heard of Dr. Cutter. Of course, he was a general surgeon. And, Dr. Blood. The hematologist. And, Dr. Crabb who worked in oncology. (The crab is the astrological sign for Cancer and cancer itself is frequently called the “crab” in medical parlance.)

How about Dr. Child, the pediatrician.

• Emma Jordan was a nurse practitioner who worked at the ARE Clinic. She was past 60 at the time. I can see her now. Thick hyperopic glasses, permed and dyed short gray hair, a lilt to her voice and an often seeming frustrated air. She waddled a bit like she had arthritis. It can be hard to get old even for a medical person.

Emma had the consolation of working with patients who were a lot like her. Or certainly became that way by the time they been on her “panel” for a while.

Emma was obviously post-menopausal and on hormones. So were a swath of her patients. She was hypothyroid and taking some form of thyroxin. As were many of her patients.

Emma was always setting up patients for glucose tolerance tests looking for hypoglycemia which she had. There were a few other recurring ailments like sinusitis and candidiasis on her personal and on those in her patient panel. Emma had companions on the way with her dis-ease. Like attracts like. Which certainly creates learning opportunities.

• Medicine has other ways of teaching, some very mystical and removed from regular eyes and common thinking. Nonetheless, mythic guardians such as Asclepius and Chiron must watch over the comings and goings of its practitioners. They certainly looked after me.

You say, “I don’t believe in that! You’re pulling my leg, now.” Not so. Let me give you something we might both agree on which may also cause you to rethink your disbelief in medical guardians.

You must have driven in heavy big city highway traffic and wondered more than a few times, “How can all of these lethal vehicles charging around at high rates of speed keep from regular accidents, injuries and fatalities? With all the oblivious drivers, texting, phoning, lunching, radio listening and map readnig, how do people keep from harming each other every day?”

Well, my answer is “Surely, there are invisible Lords of Traffic which keep us safe most of the time. When our number is up, They keep those whose aren’t out of our way. Think about it!”

Similarly, there must be Teachers - Angels - Spirits - Guardians who watch over us in our health and in our disease. They only permit that which is our due to come to us. For, “As we sow, so shall we reap.”

Asclepius is the patron of healing who carries medics through the trials and tribulations of the profession and guides them according to their effort and motive. Chiron has the special task of coming sooner or later to every physician to teach him/her about mortality, pain, and humanity. Personally and not just in the guise of his/her patients.

Chiron is the sign of the healer and wounded one. Like Gus Wood (see below), we all have wounds and weaknesses. Until physicians grapple with them and learn from them, their abilities to aid and heal others is surely limited. The lessons of Chiron some day will return to the medical curriuclum as they were centuries ago. (Patients of Job)

• All of us, including physicians, are constantly drawing the experiences we need to enrich our path through life. We thus meet ourselves coming and going. MEETING SELF. Eventually - it may take a very long time - we learn the course of instruction ordained for us.

One needy learner in my Family Practice residency was Dr. Gus Wood. Gus was “a hell of a guy,” but had a “hell of a problem,” as well. Everyone smiled at and bantered with Gus. Everyone was glad he was in the program and in the hospital.

But, Gus wasn’t so sure about being there. Gus wasn’t sure about anything. He lacked self-confidence and self-esteem. He was always telling or demonstrating his weaknesses to staff and fellow residents alike.

Wood was tall - well over six feet - and stocky, and filled out his uniform so he looked like the aging military officer he was. Gus had a large round face, lined forehead, and a scalp that was bald except for a few whisps over the ears and around the back. Tiny bubbles of sweat often oozed out his pores. Gus always has a hanky handy.

His big face always wore a broad grin - except when it didn’t. Like when he was worried or fretting over something or someone. Gus was the Teddy Bear of the resident bunch. He had a heart of gold and was truly concerned about his patients,. He worried about them and cried over them when they hurt or died. He cried on other occasions.

Dr. Wood was the oldest resident in the program. He was in his late forties while the rest of us were in our mid to late 20s. Gus had been practicing medicine here and there within the military and government service for many years. Gus had traveled the world far and wide looking for fulfillment and for himself. He had drunk heavily at times along the way and “taken the cure.” He had long abused his body, but at the time limited his vices to chainsmoking and coffee guzzling. Altogether, the years told on him.

On occasion, fellow residents would drop in on Gus when he was on call and staying in the doctor’s quarters. If we found him stretched out with his shoes off, we would be overwhelmed by the pungent and fetid aroma emanating from his feet. No amount of foot powder or Odor Eaters could ever neutralize the toxins and miasms which radiated from the soles of his poor feet. Gus’s feet became the center of puns and jokes, smirks and smiles. We all knew that we were in imminent olfactory danger when we found Gus crashed in the call room. Regardless, we all thought Gus was great and would never avoid a chance to spend a moment with him.

Gus suffered not just over patients, but also over himself. Working in the government service since medical school, Dr. Wood had neglected to take a medical board exam and was therefore unlicensed to practice in any state. He was not legitimized to do a civilian practice and he didn’t plan to stay in the military forever.

So, Gus decided to go back into formal training and brush up for medical boards. He joined us as a second-year family practice resident. But, Wood was forever carrying his perceived lack of knowledge and obvious lack of confidence almost literally on his sleeve. I can see him now shuffling down the hospital hallway, worrying about something and looking for a colleague to lean on. He usually had his hands full of charts and papers. The pockets of his long white coat overflowed with notebooks and cheat sheets, pens and pencils, instruments and dosage calculators.

At one time, I suggested that we sew a large pocket on the back of his coat so that he might carry for “easy reference” a copy of Harrison’s thousand-page, ten-pound Principles of Internal Medicine. The funny thing was that if such a pocket had been feasible, Gus would have sewn it himself. It might have eased a bit of his anxiety about not knowing enough.

How much was enough? Gus didn’t know. He just had the everpresent sense of inadequacy and continued to tell anyone who would listen how much he didn’t know. Eventually, the Family Practice staff heard his refrain one time too many. At the end of the year, they told Gus, “We’ve decided you don’t know enough medicine, Dr. Wood, to be advanced in the program. You also lack sufficient confidence in the abilities you do have. You must repeat the second year of the training.”

Gus’s two-year residency turned into a three-year program. I suppose that he was ultimately relieved when the decision was made. I assume that somehow the extra year made some difference. For, Gus completed the program. The last I heard from him, he was practicing at Fort Polk, Louisiana, and preparing anxiously to take the medical licensing exam in Texas.

We all learn the hard way, at least in some areas of our life. No one has a “free ride.” If Gus had perceived the world as we did him, his battle would have been greatly eased. He already had qualities of heart and compassion that some physicians never get close to. Instead of carrying a medical textbook on his back, he actually carried an invisible shining heart which touched many people. That is a gift which a Frugal Physician gradually develops and shares quite freely.

• Another physician named George Hart (not related to the cardiologist) comes to mind. When I met Dr. Hart, he was working as a psychiatrist at the Yellowstone Boys and Girls Ranch west of Billings, MT. We sat across from each other for lunch at a downtown cafe with a mutual friend in between. George’s story - or parts of it - unfolded quickly. He was obviously a sensitive and caring health professional. A soft-spoken, graying little man in his early 60s, Hart had recently relocated from the East with his second family.

As opposed to many psychiatrists who seem to hide behind desks and beards and pipes, George was more than willing to share his story and expose himself. The most poignant part of his life up to the present time concerned an experiment in the 60s and 70s when he purchased Great Duck Island (off the coast of Maine) to treat and nurture psychotic patients without drugs. He apparently had some successes, but he also took on a large burden which modern psychiatry pretty much avoids by prescribing high powered drugs. That was the tipping point. He helped people without drugs, but seemingly to his own detriment. But then, the result followed his own lead.

In the midst of his storytelling, George recalled the beauty of the island and the variety of animals which roamed its open spaces. Then, he got absorbed in tell of a striking experience which occurred to him. He was walking the land by himself in a meditative state, I suspect. He turned a corner and encountered a lone deer. He stood within feet of it. Their eyes met and he had some sort of ecstatic moment of other-worldly communication. Hart began to cry in the midst of lunch. He practically sobbed. Which was fine with me, but may have startled our mutual friend who was a rather interiorized computer geek.

This moment was quite obviously a profound healing experience for him, though he didn’t seem to recognize it as such. I spent occasional moments with George in coming weeks and months and, on occasion, sought to get him to revisit the moment and draw out more meaning from it.

That especially became more imperative when I met his new family and visited their rural property. The Harts lived quite a few miles southwest towards Red Lodge Mountain. George had a young wife, Martha, and two little children, a boy and a girl. George seemed to have found family success later in life as well as a retreat in the Montana countryside.

When he was not occupied with his professional work at the Boys and Girls Ranch, he could relax and enjoy his own ranch. The ranch had no cows or pigs or sheep or even horses, but it did have dozens of DEER.

That seemed to be a fantastic and poetic sequel to the Duck Island story. Martha spoke of George going out to spend time with the deer in the evening. Sometimes, he took a portable radio and tuned in classical music for them.

There was a flip side to the idyllic picture, though. Mrs. Hart told how difficult it was for George to do veterinary tasks with the animals. Vaccination, tagging, de-horning and minor surgeries on them created pains as well as chores for him. He seemed to feel what his animals felt.

What was even more disturbing for George was his intention to eventually slaughter the animals and sell their meat to area restaurants. But, he didn’t seem to be consciously aware of the conflict. He was an extraordinarily sensitive helping person who worked with disturbed youth and cared for some of God’s equally sensitive creatures. Deer are gentle, inquisitive, and acute creatures. Just like George.

On more than one occasion, I tried to suggest that there might be an alternative to slaughtering the animals. “If these deer can nurture and heal you, maybe they can do the same for young people like those who are struggling at the Boys and Girls Ranch.”

The idea seemed to go nowhere. George thought his ranch had to pay. Although I don’t think Geroge got very far along in his plan to make his ranch venison available to local eateries. Life has a way of getting in the way of plans.

One day out of the blue, Bill, our mutual friend, told me, “George is in rehab at St. Vincent’s Hospital.” I went up to see him. It was never quite clear whether he had had a stroke or a heart attack. George was a psychiatrist, not an internist. In any case, the episode gave him a jolt and laid him up in the hospital for quite a period.

He recovered and was able to return for a time to work at the Boys and Girls Ranch. He later told me that it was in this time period that he had an epiphany of sorts. It came to him that he had been dealing with Attention Deficit Disorder his whole life without realizing it. And, he needed to do something about it.

This psychiatrist, past 60 years of age, decided after all those years that he had his own mental problem. George determined to do something about it. And, he did. He convinced the family practitioner at the Ranch to prescribe Ritalin for him.

George was lost from sight for some time. I eventually heard he was living at the Sage Apartments in Billings. I went for a visit and found him spread around a dinky flat. His place was cluttered and in disarray. His mattress was spread on the floor without frame or accessories.

He made no apologies but was glad for the visit. Then, he recited the update of his life since our last meeting.

Apparently, Ritalin pushed George over the edge and into a psychotic breakdown. His psychosis had played out in full view of his wife and children. After Dr. Hart was sent as a patient to the State Hospital in Warm Springs, his wife initiated divorce proceedings. He eventually was released and returnedto  a totally empty life.

I don’t know the final chapters of George’s story. I do see that he died in 1997 (I last saw him in 1993) in Butte as noted in a small obituary in a Harvard University bulletin.

At least two recurring thoughts come to my mind when George Hart appears there. One concerns whether or not Dr. Hart had Attention Deficit Disorder. That was his belief and caused him to act accordingly at a critically passage. Then, Life really got his Attention and he had the rest of his few years to consider the consequences.

More benevolently, I have always wondered whether George had the capacity to learn the lesson of his meeting with the deer on Duck Island. If there was a lession? Had he learned it, could his life have ended differently?

The Deer definitely got his attention in that poignant moment. Could he have retrieved the essence behind it? Or, was he fated to end his days so sadly, from this observer’s view.

• One of the major lessons of medicine as well as life is suggested in the Golden Rule which is part of practically every religious tradition on Earth. “Do unto others.”

No, religion and spirituality aren’t part of the medical curriculum. Like so many other key aspects of practically every person’s (and patient’s) life. A Frugal Physician has so many of the deepest and most important things to learn after s/he leaves the corridors of his/her medical school.

“Love your neighbor (patient), as your self.” But, how often is the cart put before the horse? Physicians are constantly about the work of helping, repairing, fixing others. Or, intending so.

How can a physician truly love-help-aid-heal a patient until s/he has developed the love of self? Self respect, esteem and love must arise within a doctor, or s/he is just a technician. And, not necessarily a useful one.

We all must develop self love. So that we have some real love to give away. Whether in the context of main street or office, neighborhood or home. The physician is not alone in this department of life. But, has a special calling to find the key to open the heart.

You wonder: “A doctor is supposed to keep a distance from his patients. Be a professional and do his job. Now, he is supposed to be spending more time loving him/her self and others than addressing his/her occupation?”

Maybe the quickest way to answer that one is to point out the obvious fact that many, many people find their way to the doctor’s office because they are in need of attention, reassurance, some form of love. The shortest route to addressing those patients’ problems is to listen to them and to BE with them.

It seems more than likely that the vast majority of clinic patients would do better with a listening ear than another prescription. For many people, a trip to see the doctor at the clinic is a way to get out of the house, have company and conversation, and to experience more than the four walls and the television.

• A next step in medical practice will then be such that patients become brothers, family, parts of the self. Doctor and patient, patient and doctor are really no different.

Standing face to face, the patient should be a mirror for the physician. The patient is most truly part of the physician’s larger self. He or she only appears to be separate from the physician. Appearances can be deceiving, as we well know.

I assume that it is still common for patients to be treated as less than - needy, sick, helpless, etc. Even distasteful patients deserve more than being called names which place them somewhere in Outer Darkness.

Health care providers must learn to do unto others (their patients) as they would have done unto themselves. “As ye do unto the least of these ...”

• The practice of medicine and the life of patients is often of one of “hurry up and wait.” Patients can handle that. They have no choice. But, physicians don’t manage well under that scheme of things. They like to be in control and make things happen. “It needs to be done and as soon as possible.”

Ah but, “Rome wasn’t built in a day,” and neither was the patient’s body nor the practitioner’s. Patients need patience and so do physicians.

Patience is a great virtue and worthy of efforts to bring it into a physician’s armamentarium. “In patience, possess ye your souls.”

Time is one of the great healers. One that doctors use to their benefit more often than they realize. And, might utilize even more consciously.

How long does it take to make a human being or a body part the first time around? How long did it take for the patient to get into his/her condition? Is it reasonable to expect that illness and injury should be reversed more quickly than it took for them to develop?

There is much for all of us to experience and learn. Hopefully, we can better teach and learn more gently from each other in the coming times.

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