Medicine For People!

June 2007: The Long and Winding Road

The Long and Winding Road

Sometimes people ask me if I am going to retire soon. I always say no. I tried it once, and it didn't work out.

That would be back in the early 1970s. I had finished internship and one year of a pediatric residency and realized that I really didn't want to be a pediatrician. My teachers impressed me with their competence and sense of service, but I wasn't sure pediatrics was what I wanted to do. Plus I was feeling burnt out. I'd earned my undergraduate degree in three years, working nights in a research laboratory most of that time to help pay my college bills. Medical school, same thing; I worked in labs again every moment I could spare. With all that work and generous scholarships from Duke, I graduated with essentially no debt but with memories of too many 55 year old men, lying in the medical school wards surprised by some terminal illness, wishing they had taken more time to enjoy their lives.

Further, my dream had been of the old-fashioned Dr Welby type of doc, and while I had many fine teachers, Doctor Welby was nowhere among them. Our professors spoke of "managing patients" and "managing diseases." Young and full of drama, I cried, "They didn't teach me how to heal!" So I worked in an emergency department in Burien, saved up some money and decided to leave medicine behind. Young, rebellious and impressionable, I acquired some bell-bottom trousers, grew my hair long, and tried to imitate the apparently carefree hippies I saw around me.

The trouble was, I wasn't that great at it. When I tried to hitchhike into Canada, the border guard took one look at my get-up and slyly asked, "Ever tried marijuana?" "Sure," I naively replied. He threw me out. When I stopped into a free clinic one idle afternoon in Berkeley and offered to volunteer, they said, "Look, if you want to work here, you can't just walk in. You need to apply and wait for approval."

My most exciting dream had been to cruise to faraway places on a sailboat, so I bought a thirty foot trimaran sailboat. Over a two year period I explored Puget Sound, sailed around Vancouver Island, and then down to California. I saw many beautiful places and sea creatures. The sudden presence of an Orca appearing beside my boat in the still inland sea will live in my memory forever, as will the sandy shore of Cape Scott at the north end of Vancouver Island and landfall at the Golden Gate Bridge in a silent September dawn. I remember too all the work involved in maintaining a boat, and a bunch of time contemplating my navel, staring at a candle, and hoping to become enlightened. Didn't happen.

I ended up in Morro Bay, out of money. The only work to be had there was in the biologic research station, which was advertising for a janitor. That seemed appropriate for someone dropping out of society, so I applied. However, I lacked certain basic job-landing skills. Where the employment form asked for schooling, I continued right down the page and listed my undergraduate degree and medical school. On the address line I wrote, "Yacht Triphoon, Pier 3". For some reason, they never even invited me for an interview.

Really desperate now, I called the county medical society. They were glad to hear from me. A doctor in Pacific Grove had developed liver cancer and needed someone to cover his practice while he tried to sell it. I took that job for a month, but his practice was already minimal, and the few who were left did not regard bearded me as a satisfactory replacement for my dignified predecessor. At the end of the month his wife paid me $500 and closed the office doors.

Happily, there was other work for an itinerate doctor. A general practitioner named Percy Jonat in Watsonville had broken his leg skiing. He needed a replacement, so I covered his practice until he could hobble enough to get back to work. His associates needed time off as well, so I worked in that clinic for most of a year. I was actually fired by them, twice, but that's another story.

After about a month's work in Watsonville, I lay wearily at the end of the day on the lawn of my house overlooking Pinto Lake. In that quiet evening, the realization came that I was happy in a way I had not been on the boat. Though the work was demanding and my time never my own as it had been, I felt useful. The work challenged me as sailing the boat had not. As I rested content by the lake, I thought of Raskolnikov in Dostoevsky's "Crime and Punishment." Raskolnikov had been full of discontent until the end of the novel, when, exiled to Siberia, he rests by the riverbank and comes to accept his place in the world, no longer to judge or to struggle to prove his superiority. True it then seemed to me, that privilege and rest are without value when not nestled closely with productive work. Shortly after that I shaved my beard, put on my coat and tie, accepted the medical profession as it was, and undertook to make my contribution.

Now I understand Marge Piercy, who wrote:

The people I love the best
Jump into work head first
Without dallying in the shallows
And swim off with sure strokes almost out of sight.
They seem to become natives of that element,
The black sleek heads of seals
Bouncing like half-submerged balls.

I love people who harness themselves, an ox to a heavy cart,
Who pull like water buffalo, with massive patience,
Who strain in the mud and the muck to move things forward,
Who do what has to be done, again and again.
I want to be with people who submerge
In the task, who go into the fields to harvest
And work in a row and pass the bags along,
Who are not parlor generals and field deserters
But move in a common rhythm
When the food must come in or the fire be put out.

The work of the world is common as mud.
Botched, it smears the hands, crumbles to dust.
But the thing worth doing well done
Has a shape that satisfies, clean and evident.
Greek amphoras for wine or oil,
Hopi vases that held corn, are put in museums
But you know they were made to be used.
The pitcher cries for water to carry
And a person for work that is real.

Now I realize what a blessing work can be.

story: Coming to Comfort with Medical Practice


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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.