Among my projects for this past year has been ongoing research for my medical novel, set in the American West in the late 1800s. SHADOW is the tale of the doctors who have now become a rare breed in the medical profession. They were men of a certain stripe from a certain time -- before Medicare, before diagnostic tests, before studies filed and data compiled, before the lawyer class, before a physician became a statistician with a stethoscope or, for the manually dexterous, a scalpel.
Those doctors died off after they were driven out of their beloved profession by new technologies, new ways of dealing with medicine, new approaches to the patient. Patient-centered care was left in the dust and these doctors bit the dust.
The effects of this parting of the ways after the advent of “managed care” are still with us; indeed, medicine is currently on life-support. The doctor-patient relationship has become the Great Pumpkin, the Textbook Ideal over which the lawyers, the politicians and the bureaucrats fight and sue. The only people now left out of “health care” are the doctor and the patient.
The doctors of more than a few decades ago were driven out of their profession in ways that forever scarred them: the lawyers and bureaucrats shoved the exit door at the men who had pioneered medicine in a modern era. This era encompassed a time when the doctor and the patient could still know one another as people, individuals with lives and dreams and, yes, deaths that marked the end of their relationship, a bond that some have called second only to that between a man and his confessor. It was a time when the lawyers did not intrude upon that bond. The doctor was granted the autonomy and the freedom to ponder, to question, to guess, to use the intuitive skills that were gifted to him as part of the art of healing. He carried to his grave the secrets of his own scars, along with the secrets of the scars of others, the patients he had tried to heal and, often, did heal, while he ignored the pain that came with the sacrifice of healing, or not healing, diseased, sometimes, doomed patients. Through his dedication to the art of healing, he did himself many an injustice and he rarely spoke of them. When the era of injustices committed to the good doctors rudely dawned, many of them angrily left their profession, leaving it bereft of mentors, guides, teachers and inspiration for future doctors.
The lawyers can be blamed for this abysmal situation but the truth is that the doctor has overplayed his or her hand in believing that he is not replaceable. Ideally, a good doctor is not. In reality, he is. The gray areas in between those two positions are the shadow where modern medicine now exists. This shadow of medicine is the chasm into which doctors have fallen, and they cannot seem to climb out of it, at least not by themselves. They must ask for help. That simple request, for help, is too painful for too many doctors to even contemplate. Their silence is killing them; that silence might just kill a patient or two as well, but, shush! Don’t tell the lawyers! There are 3 reasons why any prospective Marine fails boot camp: (1) he is an egomaniac; (2) he joined the Marines for the wrong reasons; (3) he refuses to ask for help. This summary of advice applies to anyone attempting any endeavour. The physicians of the modern era would do well to at least contemplate his or her own humanity and fallibility, and to summon, at a minimum, the selfless surrender to a power higher than the medical licensing board.
It is this perversion of the field of medicine, as it has moved away from humility, that has altered it in ways that must be cured, or at least treated. Decades ago, many decades ago, mortality was more a certainty than a result to be avoided at any cost, and I mean “at any cost.” Medicine was palliative, not curative. A good doctor could cure many patients; some he could not. The fates of many patients were out of his hands. A wise doctor realized those fates were ultimately in the hands of God. The assembly line aspect of modern medicine has further dehumanized a profession that has long acknowledged the dehumanizing process of its own training. The making of a doctor is the ultimate irony of dehumanizing the student whilst he learns about the human body. The heart, soul and mind of the prospective patient and the prospective doctor are jettisoned in this boot camp of future physicians. The humility of humanity must be restored to the classroom and to the clinic. “Getting to know you” is not just a song from The King and I, although the current crisis of medicine pits the doctor, King, against the patient, I. It is time for physicians to join, or rejoin the human race, a race that, in their minds, has run them into the ground. Doctors must leave Perfectville and live real life again if they ever hope to come out of the shadows of living half-lives, quarter-lives, lives that do not matter. The most recent breed of modern physician not only hides behind the White Coat; he hides inside of it. Lacking a true sense of self, he, or she, uses the identity of Doctor as a way to derive meaning from life.
It’s a hideous condition, for any human being to become parasitic within a profession. And the profession of medicine has become host to all sorts of parasites. There are the wretched medi-crats, making decisions physicians used to make; and there are the ghoulish politicians, feeding off of misery as they create it. Consequently, there are the resultant wretched market forces, which deny true capitalism, formerly the engine of growth for any industry. To be a doctor today, anywhere, but above all, in litigation-happy America, is to work amidst the chaos that masquerades as Managed Care; and to wrap yourself in the false illusion of the security from lawsuits that is supposed to come from citing risk factors and statistics to the patient. The Warning Label mania has begun to extend to human anatomy. One day the percentage prophylactic will not work to protect a person with a medical degree. Maybe then Doctor and Patient will once again be able to develop a feeling of touch, instead of a risk-averse grazing of the trained fingers on potentially lawsuit-prone flesh.
“I wouldn’t treat a dog the way you treated me” is a hilarious line from a George Strait song from 1990, the last year that Health Care felt healthy and caring in this nation. Both Doctor and Patient can state that lyric, albeit for different reasons! Nowadays, vets get a lot more fun and bang and luck for their medical school buck. Living for the almighty dollar is no way to live life. Life cast a huge shadow over the world of medicine during the days of the late 1800s when doctors had not yet climbed onto their pedestals or hid behind the white coat. Those rugged individualists were mavericks who, one by one, blazed a trail toward modern medicine. Single-handedly, they crustily created and carved a profession out of grave-diggers and grave-robbers and barber-surgeons. SHADOW will reveal this world in all of its glory and all of its gore, along with some romance and self-inflicted murder. And I promise that it will one day, or one night, appear, unlike the Great Pumpkin!