Monday, December 27, 2010


In the back-to-the-land days of forty years ago, I lived in a redwood forest hamlet east of San Francisco Bay. It was an untamed place, and its two hundred residents were people who welcomed challenges. They characteristically built their homes from seconds and from what they found in the forest.

I bought an old examining table from a funky movie studio whose owner told me it had been used as a prop in a film of dubious repute and then abandoned. I ordered supplies and common drugs and began seeing neighbors in a closet-sized micro-clinic. Most were on Medi-Cal, state medical assistance. It paid nada, and that hasn’t changed. (I treated two-year-old Starwater, submitted my remuneration paperwork, and received a rejection fourteen years later.) On the other hand, patients stopped by with a quart of soup or showed up to help me fix my plumbing, which led to a good deal of hanging-out time.

One sleety winter night a woman named Little Lulu roused me from my comfort to ask me to come see Butch the Rapper. I got my boots on, grabbed my little medical bag, and followed her over a hill and down a goat path to Butch’s place, a sheet-metal lean-to. Despite ice on the walls, Butch was undressed and sweating profusely. As a future nurse friend would have said, he was "looking puny." One of his lungs, it turned out, was packed with pneumonia. Since Butch refused hospitalization, I gave him a massive injection of penicillin then and again over the next three days. He survived, and the following summer delivered me an unsolicited cord of dry oak, followed, of course, by hanging-out time.

This was the way much of medicine was practiced a century ago, and even now in various crannies. A current best-selling book is Cutting for Stone by Abraham Verghese, born in India and trained as a physician there and in Ethiopia, and who now teaches at Stanford. It tells a fascinating story, but I think Verghese’s forte is memoirs. His previous book, My Own Country, describes his experience predominantly treating AIDS in Johnson City, Tennessee, beginning when the disease was a total mystery. Soon confronting a second pernicious condition, endemic homophobia, Verghese found that his practice required enhanced discretion, so many of his contacts with patients were in their homes, in more intimate encounters that afforded hanging-out time.

Hanging-out time isn’t idleness. It’s the vehicle of intimacy.

Today’s average medical consultation lasts, depending on which study you check, five to ten minutes—not exactly hanging-out time. I hear patients regularly complain that from the moment their doctor enters the room, it’s as though his or her hand is stuck on the doorknob. Ten minutes, I submit, isn’t enough time even for an accurate and comprehensive diagnosis, let alone genuine healing contact.

Face it: conventional healthcare is a factory. It short-changes patients and, over decades of practice, devastates doctors. Confided a colleague, “Here I thought I was entering this sacred calling, the path of Hippocrates, Galen and Osler, and I find myself drudging away on an assembly line. There’s gotta be more to medicine than this.”

She’s correct. There’s much more. Practice as though people matter, and you find yourself in their homes and their lives, entranced by the astonishing kaleidoscope of humanity and its inherent magic. Of course, you might not make as much money, but it’s worth remembering that while a certain amount of money is necessary, there are more important currencies.

1 comment:

  1. Add to this today's article in the Times about gamma knife surgery...

    Makes you want to forgo the hospital altogether...the lady with trigeminal neuralgia and three kids who is now in a nursing home...wonder if your tree dwellers could have cured her with the miracles of "medical" marijuana? Or even something as simple as morphine?

    Your story also reminded me of the doctor who visited our nursing school in 1998...he's famous, and a movie was made of him, but I can't for the life of me think of his name...he dressed as a clown...and lived in a hippie community, and worked for barter...he said he insisted on making house calls for all his patients, and checking the contents of every drawer in the house to really understand them, and thus the root causes of their illness....