In Jamie Passaro’s interview “Who Will Heal the Healers?” [November 2009] Pamela Wible elegantly expresses what is wrong, and what could be right, with our medical system. I have been a registered nurse for more than twenty-five years. Before I became an RN I was a certified nurse’s assistant and worked for a physician with his own practice. He charged patients whatever they could afford, sometimes as little as a dollar, and also accepted trade. All his patients loved him, and no one ever sued him, because he took good care of them, was honest, and listened to their problems. This was in 1973, before the insurance and pharmaceutical companies had a stranglehold on physicians, a time when doctors were actually free to practice medicine.
I have followed Dr. Pamela Wible’s work over the last few years and have been inspired by her. As a primary-care doctor, I know the struggles she describes. I will be taking my own leap away from treadmill-style medicine in the coming year, a decision that’s been a long time coming.
Pamela Wible’s vision for practicing medicine is noble, idealistic, and dear. Eugene, Oregon, must be an enlightened community where patients take more responsibility for their health than they do in the America that I know. Maybe obesity is not an epidemic there. Perhaps everyone exercises regularly, eats a vegetarian diet, refrains from smoking and using recreational drugs, and avoids other risky behaviors.
Here in New Jersey my patients are not so conscientious. I wish that I, too, could center my medical practice on “delivering a human relationship,” but when I see new patients, they have often been obese and diabetic for years. They already have damage to their eyes, their kidneys, and their hearts and other vital organs. Wible describes her wariness of technology and her preference for being “low tech,” but when patients have diseases like diabetes, laboratory technologies are an essential aspect of care.
I believe there are few doctors who wouldn’t want to get off the merry-go-round of what Wible calls “assembly-line medicine,” but most of us do not live in that golden city on the hill. We are forced to deal with the wreckage of our patients’ poor life choices, and with a broken healthcare system that continues to exert rationing and arbitrariness on our medical decisions. Just like Wible, we strive to be true to ourselves, to our ideals, and to our patients in an imperfect world.
Pamela Wible responds:
Like my colleagues, I’m challenged to remain present for patients in dire and desperate circumstances. Most new patients to my office have seen multiple physicians but are still looking for a doctor they can “connect with.” On reviewing their medical records, I find their prior physicians to be competent. They did everything right.
I, too, could just follow guidelines, place patients on textbook treatment regimens, order quarterly laboratory tests, and remain professionally distant to protect myself from their sad lives. And at the end of the day I’d receive a gold star as a top physician delivering quality care. If I played the game and submitted my data set to the right government agency, I’d even be awarded a “pay-for-performance” bonus.
The real epidemic in America is not diabetes or obesity, but the despair, hopelessness, and cynicism that feeds both patients’ self-destructive behaviors and physicians’ resistance to creating new ways to practice medicine. If we want our patients to stop abusing themselves with alcohol, tobacco, and food, maybe we should stop abusing ourselves by scheduling unmanageable numbers of patients per day, submitting to unfunded administrative trivia, and signing unfair contracts with third parties that destabilize our medical practices.
Innovative physicians across the country are leaving production-driven medicine and developing successful relationship-driven models. Let’s help each other recapture our sacred covenant with patients.
Reading Poe Ballantine’s essay “They Dream by the River” [November 2009], I marveled once again at how many Americans are unable to pay for medical care.
I’ve lived in British Columbia most of my life. In the early fifties my dad got polio and was in the hospital for two years. My mom had plenty to struggle with, but the cost of his care was not an issue, because we had provincial hospital insurance.
Twenty-five years later my second son was born premature. I’d been helicoptered to a large hospital, and he was in the intensive-care nursery for six weeks. The doctors and nurses were top notch. Our total costs were about three hundred dollars.
That son had many visits to specialists over the years, including two major surgical procedures — all at little or no cost to us. My husband was so impressed with the care our son received that he decided, in midlife, to become a nurse. After fifteen years he now works in palliative care. His patients have access to free drugs, home care, and a team of professionals to help them die at home, if that is their wish.
As part of his work my husband helps people negotiate our far-from-perfect medical system and determine what treatment is best for them. None of the difficult decisions involve discussions with insurance companies. Never are people told that they can’t see a doctor of their choosing. We don’t have “euthanasia boards” in Canada. A friend of ours, American by birth, could not go home to the U.S. to die because she could not afford it. Instead her family had to travel thousands of miles to be with her at the end.
I’m sure most of your readers support more-equitable access to medical care for Americans. Canadians do too — not just because we think everyone deserves such care but because your medical corporations are working hard to undercut our system. Privatized healthcare is like an abusive relationship: once you find the courage to leave it behind, you’ll wonder why you stuck with it all those years.
Imagine you’ve been traveling down a backcountry road. The journey has been bleak and rough. You see a farmhouse in the distance and hope for a straw bed, perhaps a hot meal. When you get there, the owner invites you to eat with him. He is a gracious host and a master chef who takes the earthiest of ingredients and turns them into one of the best meals you have ever had.
This is how Poe Ballantine’s writing affects me. He takes raw emotions, no matter how painful, and makes them beautiful.
I have been moved by your magazine from the moment I discovered it in our local bookstore, so my heart skipped a beat when I read of your financial troubles [“Friend of The Sun,” November 2009]. That I felt real fear at the possible loss of this magazine proves you have created something much more than a few bound pages.
As a single working mom, I’m unfortunately in no position to send you a donation. What I will do is share The Sun with as many people as I can, whether it’s as a gift, an e-mail message to friends, or a link on my Facebook page. I hope I can add to this community that you have so diligently tended and nurtured over the years.
I have in the past found the tuneful ruminations of Sparrow quite welcome and often profound in their simplicity, but his essay “Spring Comes to New Jersey” [October 2009] is close to mere “twittering.” To the editors (you do still have editors there, I presume): by all means, keep the Sparrow coming, but sift out just the gold nuggets, please.
Thank you for publishing Doug Crandell’s essay about his sister who died shortly after birth [“The Sister in Our Dreams,” October 2009]. My mother lost a baby girl three years before I was born. It wasn’t until I became a mother myself that I understood her loss. But I never really thought about that baby girl being my sister until I read Crandell’s account of visiting his own sister’s grave. I cried then for the sister I never knew.
The October 2009 Readers Write on “Rain” reminded me of a spiritual experience that involved thunder. On April 23, 1995, I sat at a table in a prison cell and wrote in my journal about my determination to kick my drug-and-alcohol habit so that I could help others fight their addictions. I wrote that I would do what I think I am here to do: “fight monsters.” It thundered at that moment. I added, “It just thundered, and I believe it was someone assuring me that I have correctly chosen the direction of my life.” I laid my pen down, closed my eyes, and prayed. As I opened my eyes, a flash of lightning lit up the cell, and thunder rumbled in the distance. There was no more lightning or thunder for the rest of the day, only rain. Almost fifteen years later, I remain clean and sober and have helped numerous others defeat the monsters that once tormented them.
We made a mistake in Lisa Bellamy’s contributor note in our February 2010 issue. She lives with her husband in Brooklyn, New York, not her daughter. We regret the error.