“Notes from a Healer” — Once a Year

Harry was a typical adolescent in the practice. Although I would see him now and again for the occasional minor illness, for the most part he came but once a year for a check up. But Harry was atypical in one respect. more»

My latest installment of Notes from a HealerOnce a Year — is now online, newly published in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine is an online journal fostering discussion about the culture of medicine, medical care, and experiences of illness. Interested readers can access a list of editorial board members and regular contributors here.

Board feet

With the proliferation of commercial home improvement supply centers in our area I had no idea if the small lumber yard I remembered from years ago was still in operation.

I checked the telephone directory. To my surprise not only were they still in business, they even had a simple web site.

After my morning cup of coffee I pulled on a fleece and cap and stepped outside with the tape measure to check the length and width of the boards I would need to fix the front porch. I wrote the measurements down in pencil on the back of an old envelope, grabbed a hank of rope from the garage and slid behind the wheel of my SUV. It was a short drive to the Riley Lumber Company.

The structure had changed little over the years. The parking area had been paved, but the old barn-like building was still there. I peered through the expansive doorway into the wide central bay. A man silhouetted against the light from the rear of the building was working on the upper level, passing boards down to another man below. The whole place exuded the pleasant smell of aged milled lumber.

I entered through the unmarked office door to find a grey-haired man with a short grey beard standing behind the counter. In front of the counter stood an older woman smiling, and on the counter sat a redheaded youngster, perhaps two years old. The man was showing the boy how to make the register ring.

“What can I do for you?” he asked.

I pulled the envelope from my pocket and produced a short piece of tongue and groove flooring that I had found in the back corner of my garage.

“I’m redoing my front porch,” I said. “I need a couple of boards—three pieces of T&G, as well as some ¾-inch pine for the skirting.”

I handed the man the list. He pulled a tape measure from his belt and checked the width of the piece of wood I had brought. The woman lifted the boy down from the counter and walked him out the side door into the big bay.

“I wasn’t sure of the standard width of the pine, or the standard length for that matter. It’s been a while since I bought lumber.”

“Not a problem,” the man said.

I followed him out through the side door into the bay. The redheaded boy had toddled down to the far end with the woman following closely behind.

“Wait here,” the man said. “I’ll go up top and hand a couple of pieces down to you.”

He ascended the wooden stairs to the second level and began sorting through a stack of tongue and groove fir, eyeing each piece for straightness. He set several aside before handing one down to me. Soon I had three pieces—one 10-footer and two 12-footers.

The man descended the stairs and began sorting through the pine. “You plan on cutting them in the field, or do you want me to cut them here?” he asked.

“I’ll do the final cuts at home,” I said. “I just need them in lengths short enough to carry them on top of the SUV.”

The man picked out several boards and took them to the other side of the bay. He laid them on the table saw and made the cuts. Then he returned to get another 8-foot board. “We can rip this into two 4-inch widths,” he said. He disappeared into the shop and returned shortly with another man at his heels. The other man held the board as the old man pushed it through the rip saw. “You want the trim?” he asked. “We’ll just throw it away.”

“Sure,” I said. “I’ll take it.”

The old man stacked the boards and shrink wrapped the stack near the ends. He carried them on his shoulders out to where I had parked the SUV. “You got some cord to tie them down?” he asked.

“I brought some old clothesline,” I said.

“That should do nicely,” he said.

He laid the boards on top of the roof rack and walked back inside the office. I tied the boards onto the rack, taking care to tighten the knots so they wouldn’t slip. Afterwards, I walked back into the building.

The old man was standing next to a cat that was lying in a basket on the back counter, stroking her head. A porcelain figurine of Louis Armstrong rested on a desk nearby.

“How long has she been part of the firm?” I asked, handing the old man a credit card.

“Eight years,” he said. “She wandered in one day and decided to stay. We had her spayed. Before that we had another stray show up shortly before she had her kittens. We gave the kittens away, and the cat was hit by a car. I can’t tell you how much money we’ve spent on veterinary bills over the years. The animals give you a lot more in return, though.”

He handed me my credit card and a pen. I signed the slip, and he stapled it to the invoice. I offered him my hand. “Thanks for your attentiveness,” I said. “I’d much rather patronize a place like this than one of the big home improvement stores. At least you didn’t run the other way when you saw me coming in.”

We both laughed. The cat in the basket yawned and stroked an ear with one of her paws.

“Barn Doors” 2011©Emily B. Maurer

The bridge at Langlois

Although we have not yet reached the autumnal equinox, my mind has already down-shifted into fall. Lately, the days have been clear and crisp; the nights cool, but not enough to dampen those nocturnal insect serenades. Sounds of crickets still pulsate through the screened windows of our house at eventide, albeit without the intensity of their warm summer night cacophonies.

The hummingbirds have departed. I have not seen them at the front porch feeder since Labor Day. These days only sparrows, titmice and chickadees frequent the firebushes. While immersed in painting the balustrade this afternoon, I chanced to look up and glimpse a high-flying hawk soaring across the blue sky in a southern direction.

The leaves from the poplar trees on Winthrop Street lie brown and fallen, wafting rusty hints of autumn when crushed underfoot.

After my evening shower I donned my day clothes and stepped out for a walk. Many of the neighborhood houses lay in darkness. Tops of tall pines stood silhouetted against the last light of evening.

As I approached our house, I caught a brief chill in the night air.

Summer is behind us, and autumn is not quite here; the day’s work now done, but not yet time to retire.

I glance at the calendar on the closet door. September — this month that houses the equinox — carries a reprint of Van Gogh’s “Pont de Langlois.” Washerwomen work at riverside below the stone abutments as a covered horsecart crosses the drawbridge. At some point the weights will shift, the ropes will groan and the central span will separate as it rises beneath the overarching blue sky.

The equinox is not a moment in time, but rather a process. We humans carve up the year into seasons, as though our calendars could pinpoint these transitions in time.

Ultimately, such events remain elusive, although we persist in attempting to convince ourselves otherwise.

“Pont de Langlois” by Vincent Van Gogh, 1888

The problem with primary care

Where does our job satisfaction come from? Money has been put forth as a likely determinant.

Over the course of my clinical career I’ve felt most satisfied when I’ve been able to focus on the needs of the patients entrusted to my care.

Money is a great motivator, but in my book only compassion carries the day. more»

“Notes from a Healer” — Those We Carry With Us

Some of us need more time to grow up than others. Some of us never seem to make that transition. more»

My latest installment of Notes from a Healer — Those We Carry With Us — is now online, newly published in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine is an online journal fostering discussion about the culture of medicine, medical care, and experiences of illness. Interested readers can access a list of editorial board members and regular contributors here.

Clinician burnout: A hot topic

Lately, clinician burnout has become a hot topic.

Judging by the speed at which Shanafelt et. al.’s study “Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population” has seared through cyberspace, the problem of professional burnout seems to be resonating with large numbers of practicing clinicians, especially those who work in the front lines of primary care medicine.

Why the surge in interest? Because the problem appears to be widespread, perhaps much more so than anyone in the business of medicine realized. And it seems to be most prevalent in specialties involving front line access to care.

Compared with a cohort of 3,442 US adult workers, doctors were more likely to manifest symptoms of burnout and to express dissatisfaction with work-life balance.

Professional burnout negatively influences the quality of medical care and increases the likelihood for medical errors. On a personal level burnout contributes to severed relationships, alcohol abuse and thoughts of suicide. And burned out clinicians are more likely to opt for early retirement.

In a career path that has the potential for meaningful and fulfilling work, why do nearly half of all clinicians report symptoms of burnout? Has this always been the case among medical professionals, or are these latest data straws in the wind?

Perhaps a relative loss of autonomy might be a contributing factor. Fifty years ago most physicians set up private solo practices. As individual entrepreneurs, they set their own hours, charged their own fees and took no orders from third-party payers. All that has changed dramatically. Nowadays, the majority of physicians work as employees in hospitals, clinics or large group practices. Administrators determine their salaries, daily patient load, hours worked, benefits accrued. In short, modern clinicians have experienced a loss of autonomy, a factor which contributes to lack of work satisfaction.

But there might be more to it than that.

Physicians are highly educated workers. Yet compared with high school graduates, individuals with an MD or DO degree have a greater risk for burnout. Interestingly, individuals possessing undergraduate or graduate degrees (including doctorates) other than an MD or DO degree are at lower risk for burnout. Perhaps the relative lack of respect afforded to doctors as a group by society at large might be a contributing factor.

(Lest you think this observation a bit far-fetched, in my defense I offer a bumper sticker which I chanced to encounter just the other day: “Be Kind to a Nurse: After all, someone has to intervene on your behalf to make sure doctors don’t kill you!”)

Most highly educated professionals are not employees in a service-based industry. Clinicians work in stressful environments, caring for folks who are vulnerable, sick and depressed. When problems arise (as they inevitably do), doctors are expected to take things in stride and roll with the punches. Many times they find themselves in precarious situations where the likelihood of getting sued is high. I don’t imagine that tenured university professors fall into the same category.

A more important question is how to deal with the problem of physician burnout. After all, the healthcare system itself stands to suffer immensely with the loss of significant numbers of practicing clinicians already in short supply.

Dr Richard Gunderman offers some wise words to this end:

Only by keeping what matters most at the forefront can we reap a full harvest of professional fulfillment. Burnout is not a disease. It is a symptom. To combat it, we must focus primarily on what underlies it. And here the key is not eradicating the disease but promoting professional wholeness, which flows from a full understanding of the real sources of fulfillment.

In Dr Gunderman’s words: “Medicine represents one of life’s greatest opportunities to become fully human through service to others.”

On that score I think that William Osler and Albert Schweitzer would agree.

Albert Schweitzer in Aspen, Colorado (Life Magazine)