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Notes from a Healer

After 28 Years

Yesterday my wife and I drove to Pennsylvania to meet a friend whom we had not seen in twenty-eight years.

The friend practices medicine in Arizona. He and I graduated from the same institution—I as a physician assistant, he as a physician. I stayed in the northeast; he elected to pursue a family practice residency in the southwest. I suppose that old adage about practicing where you train is true—at least it was for us.

We re-established contact a decade ago via the Internet. Since that time we’ve shared opinions, discussed patient care issues, voiced our frustrations and supported one another via cyberspace. When my friend told me that he and his family were coming east to visit his mother, I suggested that we get together; and he concurred.

We rendezvoused at noon in a small town at a greasy spoon diner. I was in process of calling his cell phone when he pulled up in a rental car. We recognized each other immediately after twenty-eight years.

There were hugs, kisses and introductions all round: my wife, his wife, his step-daughter, his new baby. We moved the cars to a shady spot and set off on foot to explore the town.

Because my wife is from Spain and his wife is of Mexican descent, we conversed in Spanish half the time as we wandered down the tree-lined streets, admiring the nineteenth century architecture of the homes and buildings. We talked about our families, our children, our struggles and former good times. For my friend and me, the talk invariably gravitated to medicine.

Over lunch on the veranda of the inn on the square, my friend confided in me that after twenty-eight years, medical practice had taken its toll on him. In the course of his career, he had been sued (the case went to trial, and he was acquitted), stopped practicing for a spell, then took a job at a clinic in a small border town. During the five years that he worked there he had seen sixteen doctors come and go.

The administration insisted that he see a patient every ten minutes during clinic hours. In addition my friend was expected to care for his own patients in the local hospital. Many of his patients were underinsured and in poor health with a myriad of medical problems. Managing their care was difficult enough; getting a specialist to see them when the need arose was nearly impossible.

And so my friend has decided to finish out the next two years of his contract and then get out of medicine altogether. The system has burned him out.

Two years ago, when I called for an appointment with my family doctor, I learned that he had quit practicing at fifty-one years of age. I was able to get in touch with him to find out the particulars. Much of his dissatisfaction stemmed from the same issues. In addition, he cited problems with the insurance industry and prescription drugs. Finally, he felt as though he couldn’t practice medicine any more.

For me personally, the upshot was that I lost a good family doctor. I’m certain that soon my friend’s patients will be saying the same thing.

A Hemingway quote comes to mind: “If people bring so much courage to this world the world has to kill them to break them, so of course it kills them. The world breaks every one and afterward many are strong at the broken places. But those that will not break it kills. It kills the very good and the very gentle and the very brave impartially. If you are none of these you can be sure it will kill you too but there will be no special hurry.”

We said our goodbyes in front of what had been an elegant old inn on the main street of the town. Over the years it had fallen into disrepair and was condemned, unfit for human habitation. Looking up at the sagging porch roof and the buckled flooring, we all agreed that it could be returned to its former state of elegance—with an influx of considerable cash and sweat equity. What would it take to overhaul our current healthcare system to make it more supportive of those practitioners who struggle to service their patients on the front lines every day?

As I pulled away from the curb and drove down Main Street, my eyes shifted to the rearview mirror. My friend and his family were fading from view. I wondered when we would see them again. Surely sooner than twenty-eight years, I thought, as I nudged the accelerator down with the sole of my shoe.

About the Author

Brian T. Maurer has practiced pediatric medicine as a Physician Assistant for the past three decades. As a clinician, he has always gravitated toward the humane aspect in patient care—what he calls the soul of medicine. Over the past decade, Mr. Maurer has explored the illness narrative as a tool to enhance the education of medical students and cultivate an appreciation for the delivery of humane medical care. His first book, Patients Are a Virtue, recently reviewed in The Yale Journal for Humanities in Medicine, is a collection of fifty-seven patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice.

Published: September 2, 2007