Monday, June 27, 2011

Seven Is a Natural

      
                                           MY DOCTORS
                   Therein the patient must minister to himself
                                                        Macbeth  V.iii

    I have fully seven of them, a consortium of Boulder physicians, minding me in my old age. Seven excellent men dedicated to the care and repair of my human body. The most respected of men along with the clergy, the postman, and the man from Prudential-- and, dare I add, teachers-- even if, in the end, they can no longer deliver the goods. 
 
    I sit here at my keyboard only a few yards above the old family home down on Bluff Street. I allow myself to think back over eight decades to see, in my child’s excited eye, Doctor Fitz-Henry Farrington, a pioneer in his profession, looking for all the world exactly like Louis Pasteur, arrive at the house in his Model T Ford. He had given up the horse and buggy that took him all over, even into the mountains, not many years earlier.
    The good doctor greeted my grandmother in style and was shown to whomever it was who was sick, and for whom he could not do a whole lot by our measure today. Yet his presence, his listening, and his touching were an immense comfort and helped to heal and to cure. He possessed the spirit of the healer, and things were better when he left-- after his cup of coffee, warm conversation with my grandmother, and his five-dollar bill from her hand. As a little boy, I was looking at greatness.
    Today, much disabused in my advanced age, I wait upon my doctors. I have no hope that they can save me. On the other hand, I know full well that they have saved me already-- over the years of my life, more than once. They saved me from being dumped in my youth. Now they watch over me as I head toward that big dump in the skies, allowing me to sink or swim-- a horrible and badly mixed metaphor for life and death. But, to their credit, I think I can trust them, when the time comes, to let me die as best I can.
    And therefore, I wait upon them still; I keep my appointments with less and less to hope for beyond a few pleasant minutes of their company.
   Poor devils, everyone expecting everything of them, as they burst smilingly into their horrid little examination rooms, shake our hands with the broadest of smiles. And there we sit, compromised, ashamed, cold, and mostly naked, in our ugly old skins, stretched over the loss of our muscles, on our broken frames. How do they stand it? The spectacle of our ugliness!  Where is their aesthetic sense, for God’s sake? They must leave it at home when they come to the office every morning. I should be paying them double just for having to “witness” me.
   But I listen to them tell me how well I look, how great I am doing at my age. We banter, and laugh, and, like the Walrus and the Carpenter, speak of many things, on this and that about the world. We are fellow professionals, after all. I, too, am a doctor and decently proud of it.  But, after a bit, they peremptorily dismiss me. They can’t figure me out. No idea what’s wrong. I get dressed and go the hell home, trying to remember what they said.
    I have always tried not to bore my doctors: I think they must get bored. They need support. They need relief from all the bad lungs and plugged up hearts. Inside this mortal frame we are all pretty much alike, real democracy in there. Our doctors need respite from the sameness of our guts by way of the variety of our peculiar psychic lives.
    I feel responsible for them, what must be the intense worry over their profession, the complications of a modern practice-- and its expenses, all the write-offs with which they honor Medicare. Their endless paperwork.  The forms to fill out. Their distrust of government planning and programs saddens me a lot.
    I fear that most of my Seven would disagree with my politics; so we avoid that. I wonder how they can stay interested in us, or me, as long as they do. I feel a need to care for them. I want them to rejoice in a national plan for health care, but fear that they do not.
    I’m no help to them. Medical care has grown so hideously expensive and complex. Technology has given the medical profession the ability to extend human life significantly, and there seems to be no end in sight. Who should get this care?  How old and why? And how? Is it a right or a privilege? And to what extent ought I to want it?
    I think of all those in the past who had to be content with the art of medicine instead of its science-- back in the days when medicine was more literary than scientific. I think of the suffering of the great progenitor of this very essay, Montaigne, with his kidney stones. Today he would have been relieved of his stones instead of dying, as he most likely did, under the literary ministrations of a physician who knew only his Galen.
    The moral issue of a society in possession of all this advanced and proven technology for the care and repair our bodies on the one hand and a tea party frame of mind to deny it to the many who cannot pay, on the other…. Well…  It's too much.
    I wonder at the myriad poor folks, barely making ends meet, who are the most ardent champions of those who already have so much and seem to live only to get more. There’s a social, political, and economic deformation for you. It’s what can happen when freedom is made synonymous with the accumulation and protection of private wealth.
   When In Henry Fielding’s great novel Joseph Andrews, gentle Parson Adams is set upon by brigands and left in a ditch, beaten and robbed, he doesn’t know what to do, how to save himself. There is a splendid country home within sight, but the stricken parson tells us that he dare not appeal to the people of that fine house for help because as he says, “… They will think that because I have no money, I am no Christian.”
    There you have it. What more do we need to know about our situation than that! If we can’t pay, we are at our own risk and, what’s more, do not deserve rescue. So let us hear no more about Medicare.
   Though the workman shall be worthy of his hire, my physicians, whom I so admire, are not receiving their fair hire. The insurance companies want it all. The doctors are forced to work at cut-rate.
    I say, let us all, every man woman and child, go to a single-payer and cleanse the money-changers from the temple of our good health!
    Yes, my lucky Seven tell me I am doing fine. Notwithstanding my funny-beating heart, my immense prostate, my poor lungs, my cataracts, all those barnacles all over me, my neuropathy, my gut that wants to choke me with GERDish gorge: all these I live with in comparatively good cheer-- and have every expectation of out-living them in favor of being run down by a Boulder bicycle. But these attacks of morbid fatigue that bring me low, my seven excellent men cannot fathom. “Nothing to be done”, they say.
   I should be their model “Idiopath” -- after writing down in my huge file, that I have the joints of a young man and have survived the very heights of cholesterol from the day of its first measuring, and of which I boast at every turn. And I appear to be alert enough…My doctors urge me to believe in my good health as it is written down in that file-- my really and truly “book of life”.
     My seven men must yearn to see some fine, strapping, young body-in-its-prime with some specific ailment to which they can apply something quickly sovereign, doctor and patient both ending up refreshed. But no, they face daily the procession of an ever older, more decrepit, more grotesque, unsavory parade of bodies-- of those who have lived too long.
    Seven --come Eleven…. I muse on the possibility that I have taught a substantial Shakespeare course to as many-- or more-- pre-meds than anyone in my profession. Poor dear sweet kids. I told them that in Shakespeare’s plays, doctors are all good men, that they are all healers in the larger sense and know when they are in over their heads as in Macbeth. I tell them of Shakespeare’s son in law, the distinguished Dr. John Hall, whom Shakespeare so admired, and how they must have spent many a good evening at the fire talking together of the greater human condition.
   Then a generation or two later, over in France , there came the great Moliere to his theatre, despising his physicians as killers. He hated them and their profession.
    Nearer to our time, George Bernard Shaw, in his plays, excoriated the fashionable physicians of London for their vanities and vacuities. They made, Shaw insisted, their reputations on the degree of distinction of the people who died under their care, not who were cured. Charlatans, the lot of them!
   And now my kids, my students of times past, are the doctors of whom I am so fond. They can really deliver the goods; they can make us better; they can preserve us (for a bit); they can feed us pills by the handful; they can cut on us in endless and fascinating ways that work. All but….
    I taught so many of them….
   I recall conferences with worried parents who beseeched me not to allow “their son the doctor” to become a drama major.  I always assured them that I would do my best on their behalf. And I did. I don’t believe that I ever consciously encouraged a student to take up the theatre. Still, my own daughter slipped by me and did it, as did her husband, himself one of those students of mine. They might have gone and made money instead….
   Our crazy lives!
   Somewhere, between Shakespeare and Shaw, doctors are practicing their medicine.
   Somewhere out there, one of those many doctors knows what’s wrong with this old school teacher and can relieve this bloody fatigue…. But until she shows up, I must carry on with the task that I have set myself: to be expert at being old.
                                                      ~~~

4 comments:

Victoria T. said...

Before anything, let me pause and just breathe the pleasure of this discourse; then send my heartfelt blessing to you, Gordon, and hope that blessing can be the energizing cure. Perhaps this could be the great belated birthday offering from your many students, that we all join to send blessing together in one huge, rhythmic wave. For all that good energy you expended on us, it seems only fitting.

I had a moment with my surgeon some months ago. It was in one of those horrid little rooms you mention. He sat with his shoulders slumped and announced, "It's all so broken. The system is broken and no one knows how to fix it."

I leaned forward from the exam table where I was sitting cross-legged, "Isn't it incredible to be living in this time when no matter where we look - medicine, education, politics, you name it - we see things in such disarray that it's hard to imagine healing them, and yet imagination is exactly what we're being called to muster. I suppose it's what we came for."

He seemed almost grateful that I had said this as if it were not the end of the world, but some kind of interesting re-formation.

This surgeon was my lucky draw on the night an ambulance delivered me to the hospital and I still cannot get over the fortune in it - because of his quality of heart and the fact that he is the single best listener I have ever met in my life (unheard of in a surgeon, the nurses, who also loved him, all told me).

There was an article in the Chronicle about an Ethiopian physician who teaches "The Lost Art of the Physical Exam" at Stanford's Medical School. He teaches young doctors the many things you can diagnose from observing a person's gait and how to read the whole room and everyone in it when doing rounds... and the importance of touching your patient, of letting the patient judge your touch - something that now often goes horribly lacking, what with all the useful machines.

When I mentioned this article to the surgeon that day when I was part of his rounds, he sighed, "It *is* a lost art," and then he recited a poem that was new to me.

Wonder if he teetered as a possible English major some years ago...

John Holderegger said...

Gordon,

I lived across the street in Powell, Wyoming in the early 50's. Your daughter Linea was my best friend and childhood sweetheart. She brought me a May Day present each 1st of May, leaving it secretly at my door.

I married her at 5 year old at a "Tom Thumb" wedding. I in tux and her in a beautiful gown. You took your family to England that year and she got a year ahead of me in school. I never recovered.

John from Bernard Street in Powell, Wyoming.

MaryC said...

Oh Gordon, I'm joining Victoria in that wave... and sharing this with a few of those doctors to be who are now doctors that are. I think they'll enjoy it as much as I did!

My parents didn't dissuade me from my drama major (well, combined with an English major - did that make it more palatable, I wonder?). And I didn't try to steer my own son away from the same major, at the same school. I think I've done all right with it, and I suspect he'll do the same!

batoutofjersey said...

My dear Gordon,

I think their aesthetic sense probably went out the window about the same time as a fair national health care plan became the victim of post-Gingrich partisanship.... But that is another story entirely!

How delightful to find your blog! Great reading and so happy to see you out here in this strange new world.

You can catch up with my latest doings at www.JeromeElliott.com, my little webpage of self-aggrandizement, and my increasingly sparse blog "Batoutofjersey" here on WordPress.

Ever your faithful Fool,
Jerome Elliott Moskowitz

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