PEOPLE MEDICINE:
A Frugal Physician Prescribes
Common Sense and Enthusiasm

Dr. James (Red) Duke
Red Duke

Lip Service

A few generations ago, going into medicine, nursing and ancillary professions often required many years of real sacrifice. These were truly service careers. Physicians were paid sparingly if at all in training and earned little in the first years of practice. Medical men had to fight for specialized training, take what they could get, and work like the dickens. They were sure to be in debt for many years while getting their practices started and established. Big houses and long vacations often didn’t occur until late in careers. Physicians may not have been necessarily frugal in those days, but they certainly didn’t get well-heeled in a hurry.

Financial rewards have changed dramatically from era to era. Sacrifice is hardly an apt word in recent times. Physicians are handsomely paid from the get-go. Salaries start in the six figures range. Registered nurses and even CNAs garner substantial wages.

In the “olden days,” hospital workers barely made ends meet. I remember my maiden Aunt Elizabeth, a registered nurse for fifty years, bemoaning the long hours and low pay she accepted while working on hospital wards. I also recall her pulling out one of the many scraps which she kept in one drawer or another. A little article detailed the duties of a floor nurse in an era just before hers. “The Frugal Nurse” might have been a fitting title for that period. Among other parsimonious tasks, the nurse in training was directed to conserve her one pencil until it was little more than a nub.

Service like frugality has gone by the wayside to a large degree in medical practice and many other areas of daily life. (Consider for a moment the United States Postal Service. The writer is of the opinion that Americans got more SERVICE when it was the Post Office than since it became the USPS.) These days, it is the physician’s schedule, plan and protocol that are most important. The patients’ needs too frequently come second or farther down the order. The reader undoubtedly has stories which which support this thought.

Real service puts the customer-patient first when at all possible. It also points to the importance of care and compassion in medical practice. How often have you felt that you were really the most important person in your physician’s life - if only for a moment? How do you rate your physician’s bedside manner? Is s/he really with you - present - when entering the room? Or, just running from one obligation to another?

Compassion doesn’t cost a penny, but it can be invaluable. It can be as simple as taking one extra moment to show care and concern. I saw this demonstrated ONCE in my third year of medical school while I was on Dr. Red Duke’s Surgery Service. Duke was a hard-charging, no-nonsense cowboy who was also Director of the Hermann Hospital Emergency Center at the time. He eventually became famous by doing a syndicated Health Reports show and having his life played as Buck James by Dennis Weaver on television.

The wiry, redheaded, bespectacled Duke would careen through Hermann Hospital corridors with our entourage keeping close pace behind him. He was quick to make decisions and move on to the next task. But . . .

But, he wasn’t shy about spending time and getting close to patients, an unusual occurrence it seemed, especially for a surgeon. I remember our group standing behind him during morning rounds in a man’s hospital room as Duke traded questions and answers back and forth with his patient. Something caught his attention and caused him to move closer to the man’s bed. Then, he sat down on the edge. He motioned for us to leave the room as I heard him say to our patient, “Have you got time to talk?”

“Have you got time to talk?” Wow! Consider the implications of that simple remark to a patient.

Communication is so important in the present age that it is hard to imagine life without mouths flapping and words flowing from them. Yet, there must be times when we all wonder if our wind is worth the effort, especially when we remember it takes two to have a conversation.

Medical practitioners use clever and honed questioning in their desire to quickly get to “the bottom of the case.” However, these rote litanies often elicit flat, dull or meager responses. This causes physicians to find what they are looking for. “A person hears only what he understands.” (Goethe) But, will the result be good for their customers: patients with unique and personal problems?

As a medical student, I was at times intimidated by surgeons. They were larger than life in some respects. And, they seemed to like it that way. “We’re saving lives every day.” Especially trauma surgeons, like Dr. Duke.

Blood and guts never suited me much, even though I entered medical school thinking I wanted to become an emergency room physician. Having spent a tour as corpsman in Vietnam and worked in three other ERs before med school, I had been excited by the speed and drama of the Emergency Room. Patching people up and putting them back together seemed a magical formula. But, many things are not just as they appear to be.

Neither was Dr. Duke. He had that brash “cut him open and stop the bleeding” part to him. But, he also was a wise ol’ country boy. I suspect he had more than a little common sense and compassion in him. He was an enthusiastic cheerleader for his brand of medicine, for his trauma center, and for the medical school. He no doubt cheered for patients, too.

Enough to take time out from playing Chief of the Surgical Team to close the door and sit and converse with another soul.” I wish I could have been a fly on the wall of that hospital room,” as my mother might have said. I might have learned even more.

Of course, Duke might have just wanted to have a man-to-man conversation about the Texas Longhorn’s coming season. But, I have to believe he had more than football on his mind.

Healing comes in many forms and I am quite sure that Red Duke knew it. If a man needed the knife, so be it. If he needed some one to talk to and hear “the rest of the story,” Dr. Duke could surely handle that.

That episode stuck in my mind, like many others. I carried it with me until many years later after I had “taken down my shingle.” I was sitting close to another man’s bedside in a hospital room in Montana. I had shied away from medicine and hospitals for quite a few years when I “fell into” a job in the education department of Billings Deaconess Hospital. Drawing on my medical experience and computer interests, I did program development for hospital health and safety training.

During that time, I got it into my head to do some volunteer work on the wards. When asked how I would like to help, I said, “I would like to read to patients.”

For other volunteers that usually meant newspapers, but I wanted to read books. I did so with just three of four patients. But, one patient made it all worth the while and kept me reading for months.

Mr. Les Trafton had been in the hospital for many weeks by the time I arrived on the scene. A retirement-age man, Les had lung cancer which necessitated removal of one lung. He arrested on the table and a series of sad complications ensued.

Trafton had a tracheotomy, could not talk, but was clearly pleased to have new and regular company. His wife, Max, and sister-in-law were often in attendance when I appeared several times a week to read Louis L’Amour books to Les. We read a number of westerns, then a modern novel, Last of the Breed. I eventually got my fill of western novels and the Sackett family by the time months later when Les was finally transferred for a few weeks to his hometown hospital in Miles City.

Along the way, I became part of the family, so to speak. I’m sure Les appreciated the male company, but the two ladies did so as well. In future months, I made two visits to the Traftons at their home. Hospitality replaced hospital time.

I could only take so much Louis L’Amour and got agreement for me to read another classic western, Shane. Just before the Traftons left town, Max and I went out and rented the video. The three of us watched the movie in one sitting and drew even closer together.

I can’t help recalling moments when Trafton’s thoracic surgeon “peeked” his head into the room or stood at the foot of the bed and tried to carry on a conversation. In later weeks, Les’s tracheotomy had been repaired and he was able to speak. Still, the give and take between physician and patient seemed miniscule and distant. I wonder if Les’s surgeon ever sat at the edge of his bed and had a heart-to-heart talk with him. I wonder if he ever did that with any patient, if he ever read a western to anybody.

Many people wish that old-time country doctors were still in business. The search may not be in vain when there are old-time country patients on the lookout for that supposedly dying breed.

Hard-charging Dr. Red Duke took time to sit on the edge of his patient’s bed to visit with him. To be a friend as well as a physician. Both undoubtedly gained something from the spontaneous exchange. There seems to be many reasons to believe that more physicians, frugal and otherwise, can do much the same.


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