Month: June 2010
Bro’ Hippocrates
…”when religion was strong and science was weak, men mistook magic for medicine. Now, when religion is weak and science is strong, men mistake medicine for magic.” – Thomas Szasz
ISN’T IT CURIOUS how often, in an idle conversation with a complete stranger, you will be asked a clearly medical question? Your casual acquaintance has perceived that you can answer with some authority. I find this to be so even in other countries, languages, cultures. Physicians do look, speak and act like one another to a great degree. To become anonymous we must disguise our speech, appearance and actions. While there may be something faintly embarrassing in our transparency, I find that among the greatest pleasures of being a physician is my association with medical peers, those with whom I share much. Ours is a worldwide Family beyond nationality, race or gender. While recognizing both the philosophic and practical advantages of diversity in our culture as a whole, for an individual there is still great joy, great comfort, in shared personal experience, achievement and aspiration.
For if every man is my brother, who is My brother? As old Hippocrates knew, our professional family, our brothers, sisters, parents, are physicians. Of course the problems of living in the third millennium are not unique to physicians. In large part, we face overload. Most Americans have too many options, many of them illusory, yet we must choose among them. Too much information, much of it specious, but we must evaluate it. Too many demands on our energies, though we know that our strength, like our very existence, is limited.
Both our private and professional lives are affected. Medicine is a people profession. We are challenged and privileged to deal with the full measure of life around us, as revealed to us by patients. Yet the generalist can feel overloaded; may become selectively detached in order to survive; order more tests, over-medicate, over-refer. Patients expect advice, solutions. The specialist also, when unable to respond, may be tempted to deny he is a physician, and hide behind the ignorance of a limited scope of practice, or re-refer somewhere, anywhere. Patient, heal yourself, or find yourself a healer. That ain’t me, babe.
How can a physician deal effectively with every medical problem of Everyman? The psychopath, the suicidal, the abuser of substance, or of beloved, or of self? The sex-fixated, the asexual, transsexual? The worrier or the mentally or physically disabled? Like housekeepers, we do what we can, let it go, and come back tomorrow and do it again, and yet again, taking justifiable joy in our little accomplishments, and trying not to obsess over our limitations. The alternative is to be consumed by our profession, to become a physician machine. But life of the physician deus ex machina is self-imposed drudgery or, worse, self-delusion, even when high idealism is involved. It is as fake as the original character in Greek drama, who dropped down hanging from a rope to solve an insolvable problem.
To relieve the overload so characteristic of our time and our profession, we may find solace in simpler, more focused pleasures: the Farm, the Garden, the Gym, the Fish, the Bicycle, the Mountain, the Golf or Tennis Ball. Of a different order are the comforts of the Family, the Book, the Pen, the God, and even perhaps now the Internet. The list is endless. Leaving aside risky distractions like the Bottle, the Drug, the Sex, the Gamble, an escape from overload is often best shared with a colleague. Among all friends, that is the person with whom we share the most. At the risk of being parochial or small-minded, I consider physicians a select and accomplished set of people as any that can be found portrayed in literature, history or common experience. I must quarrel with some, like Voltaire, who would class us all clergy, physicians and lawyers as predators. We all have faults have merits not immediately visible to others. While physicians have all the failings of humanity, we have extraordinary attributes.
I recently went on two llama pack trips – the first with three adult physicians, the second with two wife/husband/child physician families. Even though we only slightly knew each other, we shared so much history and life experience that the trip was as smooth as if we had known one another for years, or had been on many such packs together. I have always been fascinated by the diversity among people, and have found great enjoyment in those very different from myself. But for sheer escape, and pleasure, it is highly rewarding to share an adventure with my own medical kin, and to take the time to know one another better; to know and be known and revel in that knowledge.
Be Still, Oliver
Be Still, Oliver
Oliver Twist is a found dog, an orphan of the universe, like all living souls. Someone rescued him on the freeway as a pup and left him at the pet store. Seeing him there 15 years ago, we could neither forget nor refuse the appeal in his shining golden eyes, and we brought him home. He became a best behaved, predictable, and affectionate member of the family. Now, with the children grown into young adults, he has become a child again who still retains his mongrel healthy appearance, Chesapeake- Shepard-whatever formation, and thick dogscented, rust gold coat. His only known illness was an exuberant hematuria following a delicious snack of rat poison. Though we live on a wooded creek, we have never given him heart worm prevention, and his blood tests have always been clean. He keeps his teeth sound and polished by chewing on pine cones, and by not eating table food. Except for a three-week outing when he followed an exquisitely compelling scent to its timeless source, he has lived in our one dog family in post-operative celibacy.
Oliver has always been timorous. He is deferential to strange dogs. When a puppy, he leaped into the pool and almost drowned because he couldn’t find the step to get out. Since then, the closest he gets to deep water is to delicately squat at the shallow end in three digit heat. He was always frightened by noise, but now the 4th of July explosions or the occasional thunderstorms inflict no terror on him because he is deafer than the average oak log. He probably sees well, yet his expressive yellow eyes are slightly milky; he guards the house from his bed by the sliding glass door, and his deep bark sounds only when sight arouses it. He has visible arthritic swelling of the wrists and ankles. A few years ago, he started to yelp occasionally while sprinting after a ball, and has gradually stopped fetching, even though it was once his chief remaining physical joy. He seems a bit confused at times, and has begun to scratch at his bed or the kitchen floor, as if to dig a hip hole.
In early summer this year, Oliver took to his bed and refused to eat. When I lifted him to his feet, he peered at me accusingly and walked reluctantly, unsteadily, his hind legs splaying and slipping on the smooth floor. The vet came, examined, tested, and opined:
“He is old. He has degenerative arthritis. It hurts. His heart, lungs, blood, and chemistries are fine. An NSAID may help, and if that doesn’t, try some prednisone.” He gave a shot of cortisone. And an antibiotic. (Why? “Just in case”. The small animal city DVM had apparently learned some economic and social tricks of sick medicine from MDs.) Nonetheless, after regular doses of Carprofen, Oliver improved physically.
But not animically. These days he has an uncreased need to never be alone. He often paces about anxiously, restlessly searching for…what? I wondered. Has he been around people too long, exposed to too much TV news, and human concerns? Has Oliver accreted from all these books and all this talk an inner existential burden, an undoglike need for answers to the unanswerable? A vague and oppressive awareness of age and decay and the unknown? An ineluctable doubt about doG, the immortal, the omnipotent creator bitch? Perhaps he needs to believe there is some marking of his passage, his territory in this limitless illusory plane of time.
Last night he wandered through the house complaining plaintively until I got up to speak with him. He was still troubled and couldn’t say why. After a while, we went outside and mutually confessed uncertain truths and lies in the summertime predawn air. I sang him some snatches of the song Peggy Lee did so well. “If that’s all there is my friend, let’s keep on dancing.” He told me of the fine dreams that cause sleep running. The sky began to announce a coming dawn.
“Good night Oliver; be still,” I said. “We are what we are, and this is our home, at least for now.”
We returned to our beds, and slept quietly, soundly, while the heedless earth raced purposefully round the sun turning toward a new day.
Northwest Almanac 