A long time ago when I was about to apply to medical school and struggling with college courses in organic chemistry and calculus and the like, a friend pointedly mocked my desire to become a physician.
He dismissed the idea that the profession of medicine could be "a calling" to serve humanity.
My friend specifically suggested that the notion that a doctor could play a modern role analogous to the village physicians of the agrarian past -- wise and indispensable servants of the community -- amounted to a stupid fantasy. In his view, as a profession, medicine, already overwhelmed by vanity and greed, had long since ceased to be a noble calling -- if it ever had been one, he added. To hear this kind of thing from a respected friend can fill a person with self-doubt.
A couple of years after that stinging assessment, and right at the start of my clinical training, all of my doubts were cleared. I was the student accompanying a family physician on a house call in the Schoharie Valley. My teacher had worked his way up, from manual laborer, to hospital orderly, to a wise and indispensable, and indeed beloved, physician for his rural community.
We sat at a kitchen table of a massive man in his senescence. Tethered to oxygen, short of breath with exertion, the man could not get his feet into his shoes because of edema, swelling. He braced himself on backs of chairs to cross the small kitchen to the sink and breathed through his mouth as he went. He suffered advanced lung disease as well as congestive heart failure.
My teacher spoke gently to his patient about salt intake, about watching his weight daily to guard against the danger of accumulating too much fluid. He was sympathetic about how difficult it was to use the scale and stern about how oxygen needed to be used always. The patient volunteered that he had given up pretzels.
The doctor pointed to a gallon-sized pickle jar that sat empty against the wall on the counter. "Did you eat many of those?" he asked.
"No," the patient replied, "I don't eat too many. But I do like to drink the pickle juice."
I could see from the twinkle in his eyes and a twitch at the corner of his mouth that my teacher wanted to laugh out loud. But out of respect for his patient the doctor remained cordial and easy, gently explaining that heavy salt intake would lead to retaining fluid and breathing problems too. The patient listened intently and pointed out that he needed his energy to make it out of the house to visit his wife at the nursing home.
Afterward, for my benefit, my teacher lingered over the lesson of how smoking-related illness had ruined the couple's "golden years."
"For decades the inside of that house has been a blue haze of cigarette smoke," he observed. "Cigarettes have just about killed them both," he explained in a way that illuminated the human tragedy of tobacco without putting the blame upon any one person.
My teacher later took me with him to the nursing home to visit the man's wife. I admired his dedication, his insight, his commitment to care for the whole family, the whole community. I could see that the patients and nurses did too.
Later on that year I was invited on a house call in Manhattan, in Inwood, about 30 blocks north of our medical school. An elderly matriarch, incapacitated by her illnesses and attended by a private- duty home health aide, greeted us from a wheelchair in her living room. My teacher, her doctor, carefully reviewed the patient's medications and how the aide helped give them, making minor adjustments. But most of all she encouraged the patient to live and make plans, cataloguing upcoming and recent family events, the Jewish holidays.
Like the upstate doctor, she knew every detail of the cultural and family life of her patient. She emphasized for me the the hardship of the patient's decline from the viewpoint of her family. This family counted upon this doctor in a profound way, to shepherd them through this painful chapter, with an emphasis upon living life to the fullest experience. I was especially privileged not only to witness this human interaction, but to be charged with studying and absorbing as much as I could.
As my education and training, and now my so-called career, have proceeded, I can testify that these role model physicians -- outstanding human beings and great teachers -- are NOT exceptional in the context of the profession of medicine. Yes, house calls may be rare, but they illustrate an impulse I find in so many of my colleagues. (And more of us do them than you might think.)
Vanity and greed do threaten to undermine the practice of medicine as the so-called medical industry can't help but introduce assembly-line management techniques. But the profession of medicine remains full of human beings striving to fulfill a noble calling, full of good doctors who know our patients, their culture, our communities.
Medicine as a profession remains full of potential to promote for the health of each and all. We have what it takes. We must rebuild our system to allow our caring, care-giving profession to live up to its calling.
Dr. Andrew Coates practices internal medicine in upstate New York. He is President of Physicians for a National Health Program.
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