Confessions of a Cayce Doctor
“Watch your step and
be careful how you share your gstudies and interests ...”
Hugh Lynn Cayce
§ I mentioned at the opening of the book that (Kathy and) I had made the rounds of the US Army hospitals in the Southeast interviewing for a place in a Family Practice Residency in 1977. Following our interview at Fort Belvoir, Virginia, and a quick swing through our Capital City, we drove down to Virginia Beach.
After staring at the ocean and walking the beach for a time, we scouted ARE Headquarters and the Library. We completed our tour by scanning selections in the bookstore and then repaired to the foyer to look at some of the Cayce memorabilia spread around the spacious room. As we milled about, Hugh Lynn walked by and settled into a couch near the front window. Kathy sidled up to me and asked, “Who is that distinguished, white-haired gentleman over there?”
“Why that’s Hugh Lynn Cayce, Edgar’s elder son,” I said.
Kathy, timid in one moment but bold in the next, immediately took me by the hand and escorted me toward Mr. Cayce. He came to his feet as Kathy said, “You are Mr. Cayce. Is that right? I’d like you to meet my husband, Dr. McNary.”
Hugh Lynn was cordial and made Kathy and me feel very comfortable. After preliminaries about my looking for a residency opening and a brief warning about sharing my beliefs too freely, we talked about a variety of topics – mostly about medicine, the ARE Clinic, and the Cayce readings. Along the way, something prompted me to ask, “Do you ever sense your father’s presence here or in other parts of your life.”
Hugh Lynn considered the query for but a moment and responded: “Oh, yes! Dad has been with me on several occasions. Let me tell you about the most powerful experience I had of him which came many years ago. It was during the second pregnancy of my wife, Sally. Carrying our first baby was very difficult for her. We were fortunate that mother and child both survived. It took Sally a long time to recuperate from the pregnancy and the complicated delivery. Her physician told us that having another baby was out of the question, ‘Much too dangerous.’
“Yet, we prayed long and hard about it. We wanted another child and Sally dared to go against the doctor’s proclamation. Still, we both fretted and prayed, prayed and fretted through most of the pregnancy. Our fears became acute in the latter days and weeks when we were told that the baby was lying in a breech position.
“I came home one evening after work to find Sally napping on her bed. I knelt at her side and began to pray silently. Before long, a vision of Dad came before my inner eye. He was smiling, almost laughing, but also radiant. He spoke to me but without words, ‘You have nothing to fear. The delivery is in order. All will be well. All will be well. You will soon see.’
“Immediately, Dad and Sally and the baby and I were joined as one and engulfed in a tremendously brilliant and overwhelming light. The sensation was as a thousand orgasms. We were held in that state for I don’t know how long. It could have been a moment or an hour. I had no desire to let go, but the feeling and glow eventually faded.
“When I opened my eyes, Sally sat up at once and said, ’Oh, Hugh Lynn! I’ve just had the most wonderful dream of your father being with us. He wanted us to know that there is nothing to worry about with regard to the baby. That all will be well.’
“That same evening, Sally went into labor. We raced to hospital. Amazingly, the baby’s position had been righted. Our second boy was delivered by an intern fresh from medical school before Sally’s obstetrician could make it to the hospital.”
Kathy and I were deeply touched by Hugh Lynn’s willingness to share the details of such a meaningful and intimate experience with us. §
Neither the wise words of Dean Tuttle nor Mr. Cayce nor Mr. David got through to me deeply enough to temper my actions in the early days of my residency at Martin Army Hospital in Ft. Benning, Georgia. In my psyche, I simply acted like a man with a medical diploma. I had passed the medical board exam in Austin, Texas. So, I was licensed to practice in that state. I was also accepted to train in Family Practice in the United States Army. I pictured myself with sufficient qualifications to practice some of my own brand of medicine. The Cayce kind.
I thought I knew a few things, even though I wished to know much more. Regular medicine left big gaps in life and healing for me. Even before I took that senior elective with the Kirksville osteopathic community, I was trying to get additional hands-on training. I thought I should have a whole year of osteopathic studies. Paul Kimberly was willing to help make it happen. I put in a special request to the Office of the Surgeon General at the Pentagon as I was indentured to the United States Army for paying my way through medical school. Uncle Sam’s approval was required before I could take such an unusual step. It was only a few weeks to find out that the powers-that-be nixed my request believing my regular medical school program “to sufficiently qualify you to fulfill your duties as a medical officer in the United States Army.” I was a little bummed, but not surprised.
I felt a kinship with osteopathy, but I was “at home” with Cayce’s brand of holistic medicine. I somehow figured I was then, although I certainly didn’t say it out loud, a Cayce Doctor. I didn’t say so but I acted it out right out of the starting blocks in that first year of graduate medical training.
Immediately upon starting the residency, I made a holistic medical connection outside the Army training program. I found the Staff of Life health food store and restaurant in Columbus owned and run by a Seventh Day Adventist group. Across the river in Phenix City, Alabama, lay its major outreach called the Uchee Pines Institute. The latter had been developed a number of years earlier out of the personal, professional, and financial resources of Drs. Calvin and Agatha Thrash.
Agatha and Calvin Thrash
The Drs. Thrash had apparently practiced orthodox medicine for a number of years before dedicating themselves to their Seventh Day Adventist roots and the health teachings of the church matriarch, Ellen White. Mrs. White had left numerous writings – revelations – with regard to health and healing practices to the Adventists. Many spas, sanitaria, and health centers spread around the United States, as well as the Loma Linda Medical School and School of Health located in California, exist because of her teachings.
Uchee Pines was composed of a central church structure, a nearby health center, several permanent dwellings as well as a variety of mobile homes, and large acreages of gardens and fruit trees. The residents followed White’s – and the Thrashes – admonitions rather strictly and most of them were expecting “The Rapture” before too long. I didn’t think much of that belief, but was generally comfortable with the Uchee Pines lifestyle and gentle manners, low-tech medical therapies and basic health philosophy.
Kathy and I visited Uchee Pines one Sabbath (Saturday for them) and joined the Thrashes and neighbors after services for their second meal of the day. The UPers followed a strict vegetarian diet and ate only two meals daily. The buffet table was filled with salads and breads, tomatoes and all sorts of greens, sweet melons and juicy peaches. We sat at table eating for a good hour and a half, Kathy and I being finished long before the heartier Adventist eaters were done.
The Uchee Pines health center was set up particularly for visitors who wished to stay on an extended basis. However, the Thrashes did see people on an outpatient basis and taught scheduled classes at the Staff of Life centers. The fees were quite modest and the Thrashes donated a great deal in personal and medical attention to the patients and the program. The health program focused upon Bible study and prayer, diet, and exercise. The Doctors compared their work to that of Nathan Pritikin who was becoming popular at the time.
The therapies were quite comparable and compatible with the Cayce teachings and included herbal mixtures, charcoal infusions and compresses, massages, etc. The Thrashes were proud of their successes, but also admitted to failures and “the need to learn more,” which was quite refreshing. Refreshing too, was the air and space and green life of the Yuchi Pines land.
A stimulating program of walking and gardening was undertaken by most every resident and visitor on the land. Young and old, strong and ill alike could be seen at different times of the day, tramping, hiking or just strolling the various paths laid out over the rural landscape. During the warm weather months, many residents slept “outside.” A number of wood-framed cabins furnished solely with a few Army-style bunk beds had been built around the property. The frames were covered with tin roofs and surrounded by screens to keep the mosquitoes out. So many times, I have wished to have such a summer “dwelling” of my own.
My contact with the Thrashes, Uchee Pines, and the Staff of Life was helpful and hopeful. It was also eventually pain-producing because it drew my attention away from the reality of Army internship while reinforcing my beliefs in “natural methods” which were so antithetical to my mandated environment of military hierarchy, medical orthodoxy, and cookbook practice.
Martin Army Hospital
Martin Army Hospital was like a small community. The few hundred employees knew each other by face, if not by name. The medical retinue numbered around fifty or so and more than a third of the physicians were assigned to the Family Practice department.
All of the Family Practice staff were relatively young. The acting chief was only in his mid-thirties though his hair was thoroughly grayed and he had his share of wrinkles. Dr. Jimmy Varnado was Louisianan with a happy drawl, a friendly smile, and a bagful of stories. Dr. V. was relatively easygoing. Yet, being Chief of Family Practice was not his idea of fun. He just wanted to fulfill his military obligation and get back to Louisiana. But, his position of authority gave him more headaches than he cared to suffer. Many of them were caused by his young residents and I was painfully prominent among that group for several months.
Dr. Baumgartner and Dr. Thomas were the other two staff men with whom I had most contact. Dark-haired Dr. B. was relatively laid back, soft spoken, and radiated a subdued, but genuine warmth. The sophomoric Dr. T., on the other hand, was strident, anxious, and nit-picky. He grated on most everyone’s nerves and mine in particular.
I assume that my name must have come up quickly as a topic of discussion at Family Practice leadership meetings. Early on, I attended one of Baumgartner’s patients with a complaint which is now long forgotten complaint. I gave her no medications but instead some suggestion on things which she might do to help herself. I even did some gentle manipulative therapy to her sore neck. She seemed relatively pleased and comforted when she left, but patients don’t always tell doctors what they’re really thinking. The circuit was closed, however, when the patient talked to Dr. Baumgartner about the unusual therapy and suggestions she had received at my hands in the emergency room. Dr. B. was affable and kind when he told me to “keep with the regular methods and don’t stick your neck out.”
Yet, I was so deeply involved in my alternative beliefs and interests at that time that I could not see what I needed to do to survive in the medical training program. I was then a graduate physician and wanted to be a Cayce-style physician. I, however, overlooked much of Cayce’s valuable advice. A major component to the art of healing comes in respecting and treating the patient’s consciousness. I too often tried to treat patients according to my own consciousness rather than theirs or that of the prevailing paradigm. In retrospect, the level of consciousness of most patients reflected much more closely that of military medicine than of my own brand.
Pediatrics was the first two-month assignment of my internship. It was a slow service for the most part. There were only three or four pediatricians on the hospital staff. With the abundance of Family Practice staff and residents, more weren’t needed. Jim Kaye, a second-year resident, and I worked as a team with a different staff man who rotated on and off the hospital service each week. Jim or I were expected to see pediatric patients in the Emergency Room and all children who might possibly be admitted before consulting the staffer.
Dr. Kaye and I shared a number of things over the course of the rotation. Kaye was a D.O. and used his manipulative skills occasionally. I was interested and tried to learn a bit from him about osteopathy. But, he was mostly interested in “getting by and getting out.” He had been through several battles with the FP staff during his first year. Apparently, his performance did not always meet standards and his shortcomings continued to pop up from time to time. Before long, we were commiserating and counseling with each other. On his frequent turns to advise, Jim would say, “McNary, keep low and out of sight. You know me, I am about as low as I can go now – lower than a snake’s belly.”
Jim was a funny-looking, anxious, and clutzy kind of guy. He was always biting his nails – close to the quick – and muttering about who was on his tail. I soon caught some of the latter attitude and carried it for a long time. Jim had big, buggy eyes, bushy eyebrows, and a broad, gaping smile. When he put on his act, he did a great Groucho Marx – raising his eyebrows, accentuating his grin, and sliding around the ward elbows akimbo with his white coat trailing like a cape in the wind.
I have Jim to “thank” for introducing me to Lydia – I don’t suppose I will ever forget Lydia Newton – during one of her ER visits. Whenever they met, Jim would teasingly sing à la Groucho, “Lydia, Oh, Lydia, the tattooed lady.” It was only a tease, though. Lydia was a bit young for such things and had no place for tattoos, besides. Lydia was a child of color. She was a skinny, eleven-year old girl who literally frequented the Emergency Room for the first few months of my internship. She visited regularly because of her many asthmatic attacks.
I soon saw Lydia by myself one evening when I was on call – I can almost see her now – panting, grunting, and wheezing in the Emergency Room. On our first meetings, I followed the typical medical protocols and suggestions from other physicians in the ER who knew a bit about Lydia. Of course, those suggestions were all part of the medical routine. Lydia was hooked up to an intravenous line carrying a big dose of aminophylline. Sometimes, she was given a blast of cortisone – quite a gift for an eleven-year old – also by IV. Depending on how congested she was, she might get a breathing treatment or two. If she was laboring hard or seemed to be turning a shade of blue – not easy to tell in a black child – she got stuck with another needle in her radial (wrist) artery so that her blood gases – oxygen and carbon dioxide values – could be tested.
Lydia was admitted to the hospital a time or two, staying for a few days. Her sisters and mother would visit regularly. Her parents were divorced and I always wondered what the absence of her father had anything to do with Lydia’s frequent attacks. Sometimes, I got the impression that Lydia could turn her wheezing on and off as she willed. I remember working with her in the ER a couple different times, talking to her, coaxing her to slow down her breathing – I lent her my watch on those occasions – to calm herself and let her breathing passages open up more widely. It worked a couple of times – or seemed to. But, Lydia would be back for another “visit” in the ER soon, almost always in the evening.
I got wrapped up in her symptoms and situation. The more I worked with Lydia, the greater became my distaste for the typical medical management of asthma – not that I ever discovered or demonstrated any effective alternative. Still, there must be a better way. I particularly disliked the shock which her body had to take each time she received a jolt of IV cortisone in the hospital and a prescription for prednisone to carry home. I was painfully aware of the many and sometimes severe side effects of that potent drug. The more I saw Lydia, the more I identified with her.
I can still see Lydia sitting on a hospital stretcher with a needle in one arm and an oxygen cannula in her nostrils. She sat cross-legged – Indian style, wheezing and panting. She even slept in that position. When exhausted by symptoms or fatigue, Lydia literally fell asleep – her head and torso leaned against the stretcher mattress while her legs remained crossed under. She looked like an infant fresh from the womb.
§ It makes me blush to think of some of my passionate missteps in medicine and in other places at that time of my life. One of them comes to mind unavoidably when I think of Lydia. Lydia made another appearance in the middle of an asthmatic attack at the ER. I was on duty. She seemed to “know” the times when I was on call. No kidding! That evening, I worked with her using the standard treatments – which I could not avoid – plus my words of encouragement and my supportive presence. As the evening wore into night and then morning, Lydia made little progress. I hadn’t given her any cortisone, yet. But if daylight arrived with her unimproved, she would have to be admitted and given another bolus of cortisone.
I wasn’t ready to give up. What possessed me to make the telephone call, I don not know. But, I did call Dr. Agatha Thrash and ask her advice. That action was way out of line according to SOP (Standard Operating Procedure) and a downright dumb thing for an underling to do. I admit it and am embarrassed at the remembrance. Although Dr. Thrash probably had more experience with asthmatics than any of our young medical staff, she was not an Army physician and my consultation with her was definitely inappropriate.
Nonetheless, I spoke with her about Lydia and her present situation. Dr. Thrash suggested that garlic taken by mouth might help open Lydia’s respiratory passages.
I grasped at that slim, wispy straw and wandered around the hospital kitchen early ﬁn the morning asking for a clove of garlic. I hadn’t even considered how I would get a youngster to consume such a thing. Well, there were no garlic cloves in the whole hospital, only some powdered preparation fit for institutional cooking.
When I returned to the ER, it was moving toward three a.m. I was stuck with the task of getting some garlic powder through Lydia’s lips. My success, as you might imagine, was quite limited. I suspect that she swallowed only a few grains of powder in water all tolled. Much of that, she spit or vomited up. However, as the ordeal and night concluded, Lydia was somehow breathing better. I happily, but anxiously sent her home – to return again, who knew when. Lydia became such a part of me that I eventually signed her family onto my Family Practice panel. Responsibility for their care was no longer spread through the hospital, but laid in the hands of the FP group with me as primary physician. §
Strangely, I never heard any comment about my innovative, but borrowed, approach to acute asthma. Nor id any direct repercussions come from it. But, it didn’t take long for another opportunity to arrive for me to try one more unorthodox remedy. That time I pricked the system too much and too directly.
I was on pediatric call again and was summoned to the ER to see a young boy. Gerald, aged seven, had been ill with nausea, vomiting, and diarrhea for 48 hours. He was dehydrated, lethargic, and had a low-grade fever. I decided to admit him for observation and hydration – intravenous fluids. I also decided to order a castor oil pack for Gerald. I believed that it would help to settle his intestinal system. Castor oil packs in that instance seemed the simple and quite natural thing to do.
The nursing staff seemed accommodating. With my instructions, a pack was prepared for Gerald right away. The medical staff was quite another thing. During the day, the staff pediatrician for the week, came by to review charts and check on patients admitted during the previous 16 hours. He saw the order for a “castor oil pack” and quickly countermanded it. Without even thinking to speak with him about the order, I rewrote it. The showdown was set to begin and I was outnumbered and outgunned.
First, the Chief of Pediatrics called me in and told me of my arrogance and insubordination. He made a few threats. Shortly thereafter, I was counseled by Dr. Varnado and his new supervisor. They were a bit more sympathetic to my cause, but told me in no uncertain terms that if I wanted to stay in the program, “You will have to practice standard medicine.”
Before long, there was call for a psychiatric evaluation. I do recall that we had a psychiatrist at Fort Benning, but maybe they wanted me to have a break as well as a consultation. So, I was directed to see the “head doctor” at Fort Gordon. Kathy rode along for the one-day visit in which I took an MMPI (Minnesota Multiphasic Personality Inventory) and had an extended interview with a psychiatrist. I only remember one interaction from the sitting. After discussing my situation, the interviewer told me about a neighbor who had broken his ankle and was trying to heal it by passing his hands rhythmically over his leg. “Do you believe in that sort of thing?”
“Oh, certainly not?” Which was not a totally honest answer. But, we are not allowed to be totally honest in the modern world. At least it seems so based on my years of viewing civilization as it presently exists. I may have been brash, impetuous, even impudent, but I wasn’t stupid enough to answer “Yes” to such a loaded question.
The upshot of the trip and intervention of the psychiatrist was that, “This man is not crazy. He is just opinionated and has his own views, some rather unorthodox, of medicine and medical practice.”
I was placed on probation for six months and enjoined again quite firmly “to follow standard practice.” At the same time, I was supposed to be assigned a mentor who might listen and counsel me on my beliefs on some regular basis. The first two parts of decree were met. But, the assignment of a mentor never occurred.
I had to buckle down. Dr. Kaye, the Groucho Marx look-alike, reminded me, “Get down there as long as you can. Slither around and try to be invisible.” Even while “slithering,” I was not only in pain, but downright depressed for the first time in my life. At moments, I was ready to give up.
The weight of the first two months – I hadn’t even completed the first two when the conflict boiled up – hung heavily upon me. Still, I was able to do the work and get through the day. While mulling and brooding over the problem I had created for myself, I seemed to gather some sustenance in listening to classical music in the evenings. Beethoven and Wagner and Tchaikovsky would have understood some of my feelings.
Still, I struggled to see my way through the problems staring me in the face. One thing was quite clear. I could not practice Cayce medicine – or any facsimile thereof – in my inferior situation. I continued to harbor strong feelings about the grotesqueries of surgery as well as the destructive effects of such drugs as cortisone which I was expected to prescribe. My negative feelings overwhelmed my ability to determine the best action to take. I was the one who got me into the situation. I had already shot myself in the leg and was close to committing medical suicide. I was my own worst enemy, yet blamed much of the dilemma on “Medicine.” I needed to become my own ally again.
For a time, I looked at the only apparent options: get back in and play the game, keep my mouth shut and lie low, or give up the internship and become a general medical officer. Should I have followed the latter direction, my lot would have been doing physical exams day in and day out for four years. (I inevitably did quite a share of them as it was and learned to have quite a distaste for the routine examination.) There was a kicker though, of one year of postgraduate medical training to be eligible to practice in good proportion of American states. I already had my medical license for the State of Texas. Yet, without completing my internship, I might not have been able to practice in a place of my choosing.
Some time after my probation began, I took a trip to Atlanta remembering a recommendation Mr. David had once made. I visited with Lynn Buess, counselor-numerologist. Lynn was a fine fellow who spent an hour with me. One simple statement, that I should “Go with the flow,” hit home. While I didn’t immediately learn to get into the full flow of the river, I caught some of the rhythm of the current from time to time. The river was deep and wide and the paddler relatively inept.
Learning to flow with the times and the seasons of our lives is so important, yet often so difficult to accomplish until we take stock and realize our place. If we could but learn and live the wonderful prayer: “God grant me the serenity to accept the things I can't change, the courage to change what I can.” There is so much for us to learn and that is how we find ourselves embodied again and again and again. We humans seem to learn rather slowly as individuals and as a whole human race. I do, anyway.
For most of the next ten months, I tried to flow and make no waves. Using standard medicine. Or if I strayed from such, I would have current literature to back me up and ask permission in advance. Even so, I was often looking over my shoulder – so to speak. Wondering if I might have slipped up somehow. When my number appeared in the paging system, I was wont to think, “What did I do now?” Which was not a good way to spend most of a year.
Thankfully, the next rotation was on Internal Medicine and I had a cracker jack second-year resident for a partner. Danny McAvoy was a smooth, charming southern gentleman. Dan was a short, sandy-haired Georgia boy. He had a sweet disposition and a double-dimple smile. The women patients adored him. McAvoy was kind and caring but still a take-charge type.
Danny told me to, “Forget the pediatrics experience and start fresh.” He took me under his wing and was a big help at a rough moment. He knew I was in a difficult place and went out of his way to help me through our two months together. McAvoy and McNary did okay. Actually, I think we handled our load splendidly.
Work on the medical service went by rapidly as I learned a relative lot and made up a bit for my offensive beginning in postgraduate medicine. All the while gaining confidence in handling acutely ill adults, and diabetics, heart attack victims and even crazies who got into their sickly way, in part, through too much booze. Many alcoholics are practiced at hiding their “sins,” but they often take over the body and appear as illness.
Only rarely are patients forthcoming about their habits and addictions. But, some do. I remember admitting an active duty staff sergeant in his forties who had an acute heart attack. When he was stabilized, Sergeant Jasper freely acknowledged that he drank two cases of beer a day. Now, I was sure that he was bragging or simply overstating the case. I just couldn’t imagine anyone – I still have trouble imagining this one – drinking that much of anything in one day and especially someone who held a full-time job running a concession stand. I never sat down to calculate the numbers on two cases of beer – ounces per hour, etc. – but, it seemed like he was doing not pints but gallons of beer. All I could think of was Jasper’s endless trips from the refrigerator to the toilet. Amazingly, Jasper’s wife confirmed his taste for beer and his ability to put down TWO cases a day.
Sgt. Jasper is the only person I’ve ever met who claimed to drink gallons of beer per day. I have, however, encountered a few people who happily maintained that they drank tea or coffee in similar quantities. I’ve consulted with numbers of smokers who puffed on 3 or 4 packs of cigarettes each day, but I have to give the record to retired Sergeant Willem Boudreaux. I met SGT. Boudreaux in the intensive care unit at Martin Army Hospital shortly after he too was admitted for a heart attack. Willem was an aged WWI veteran who was blind and showed the effects of a previous stroke. Despite his multiple medical problems and recurrent counsel to give up the habit, Willem persisted to smoke. SGT. Boudreaux smoked and smoked and smoked – SIX packs of Picayune cigarettes each day. I’ve never seen a Picayune cigarette, but I imagine it must be on the order of a Camel – potent and nasty.
Human beings seem to find means to punish their bodies in a wide variety of ways. Some of them even set unofficial records, along the way tearing down the bodily houses which they inhabit. It is hard for me to think of such bodies as “temples.” People who misuse and abuse their bodies in these ways theoretically have little reserve to fight disease when it arises. Yet, some still hang on with fierce and tenacious wills. As in the story of the centenarian who drank and smoked and caroused for most of his life. Passing the hundred year mark, he told, “If I knew I was going to live this long, I would have taken better care of myself.
Surgeons who work on such patients sometimes throw their hands up in disgust complaining of the 3P Syndrome: “Piss Poor Protoplasm.” While the epithet may be crude, the point can be useful. It is hard to repair a poorly built and maintained shack. It is equally difficult to rebuild a human structure which has been neglected and mistreated. Yet, there is the other hand. For, it is quite amazing that some humans can long exist on little and poor food, inadequate shelter, and insufficient human attention. It is obvious that, “Man does not live by bread alone.”
So, there came the Surgery rotation. I wasn’t looking forward to surgery again. But, I spent a week following a senior surgeon, Dr. Antipol. He mentored and I quietly did what he expected. Then, I got turned over to Major Owens. I listened, assisted, followed, and listened more to Dr. Elwood Owens. Owens was a large man and looked bigger when he briskly toured the wards in his white, flowing coat. He had dark hair, a round face, and wore spectacles. The glasses weren’t Army issue. Owens had no intention of looking or acting military any more than required. Elwood was a blunt, talkative, proud Southerner. He really thought himself a “good ol’ boy,” an enthusiastic operator with eyes on advanced training in cardio-thoracic surgery at Emory University in Atlanta.
He couldn’t tell me often enough in his Georgian accent about his plans: “I’m gettin’ outa here as soon as I can. I’m gonna do hots (meaning hearts).” Arrogant and obnoxious though he could be, it was hard not to like Owens and get a guffaw from his stories – or at least his telling of them. One of his favorite ditties went like this: “When the Army drafted me, they made me a Major doing General Surgery. I tried to tell them, ‘I would much rather you make me a General doing Major Surgery.’”
Although Dr. Owens tried to maintain an aura of superiority, his impression of himself was not universally shared. Prior to my arrival at Martin Army Hospital, the staff had included another surgeon named Haywood Owens, Elwood’s brother. I gathered that Haywood was more productive and less verbal than his younger brother. Tall, red-haired, and good-looking, Haywood favorably impressed many hospital workers. From time to time, the two surgeon-brothers would be seen walking the hospital hallways. A common refrain heard at the time was, “There they go: Redwood and Deadwood.”
Elwood was convinced that surgeons were not only the real elite of the medical profession but also God’s greatest gifts to humanity. To become a cardiac surgeon would place him in the most exalted state. Elwood didn’t think much of internists or most other non-surgeons. Speaking with his round, pompous drawl he used to say, “They just play with their tests and pills. Tests and pills. When they get stuck, they have to call on us. We can do anything an internist can do and cut besides. You know that surgery is the only permanent way to cure. We surgeons cut to cure. Yes, we do. Cut to cure.”
Surgery is warranted in many situations, especially in the event of trauma in our present state of knowledge. Yet, it may be interesting for the reader to know that Tibetan medical practice abandoned surgery centuries ago. In the modern west, surgical procedures like medical prescriptions are much overdone. “My feeling is that somewhere around ninety percent of surgery is a waste of time, energy, money and life.” (Robert Mendelsohn)
By the time retired SFC Henry Baxter appeared on the Surgical ward, he and I were almost friends from our time together on Internal Medicine. But, I got to know him much better while I was under tow with Dr. Owens. For a time, it seemed like Baxter followed me or I followed him around the hospital until his last days.
During my surgical rotation, Sergeant Baxter was admitted for care of an ulcer on the heel of his left leg. Having already encountered Baxter before gave me a leg up, so to speak, when working with him. Still, Owens clearly “took charge” of the situation – at least for a time. He “prescribed pills” (antibiotics) and proceeded to debride the patient’s wound in a rough and hurried manner. Elwood carved away tissue – some dead and some quite vital – on the edge of the wound without, to my view, the benefit of sufficient anesthetic or explanation to the patient.
Mr. Baxter rebelled. (I called him Sergeant B. or Mister B., generally. He liked that.) Dr. O. became angry and defensive. Mr. B. wouldn’t bow to Dr. O.’s surgical “care.” I was forced, but not unhappily, in between the two, the surgeon handing over main responsibility for Mr. B.’s treatment. Owens tried to forget about “that distasteful old man.” While on the “heels” of our previous contact, Mr. B. and I got along chummily.
Our chummy relations helped out dramatically as did “cutting” back on debridement of his wound. Instead, Mr. B. and I began to work with the Physical Therapy department in a novel way to encourage the healing of his ulcer. We procured a TNS (Transcutaneous Neuro Stimulator) and placed its electrodes around his sore. I hoped that its low-amperage current would stimulate wound healing. In addition, Henry went twice daily to PT for whirlpool treatments. At first, there was an obvious and rapid response to the new regime, but later the benefits were less dramatic and slowed considerably. Yet, by Christmastime his wound was sufficiently reduced in size to allow him to be discharged. He carried the TNS home with him and Mrs. Baxter drove him back to the hospital each day for a whirlpool and a dressing change.
Things seemed to turn out for the best – at least for the time being. Dr. O. was relieved of his trying patient. Mr. B. received some special attention and benefit for his wound. Mrs. B. got a break from her dependent and often trying husband. Dr. M. had a chance to learn about the broader implications involved in the care of a challenging person like Henry B.
In retrospect, it is hard to reckon what most helped with Mr. Baxter as his ulcers did recede and heal. Was it the electrical stimulation or trying something different or caring, human contact or the passage of time or God’s grace? To put things in perspective: the vast majority of physicians and surgeons (including Dr. Owens) have specific knowledge and valuable technical skills. But, the nuances of life, the differences in human beings, the factor of time and the flow of body energies make for a host of forces with which we all must deal. Wise physicians create ways to cooperate with their patients in practical and sympathetic as well as competent ways.
By the time we came together, Mr. Baxter had accumulated a long list of problems – most of resulting from medical or surgical interventions which followed on his diagnosis of prostatic cancer. The surgeons first tried to remedy that with a prostatectomy. When his disease showed signs of spreading, they castrated him and later on removed his pituitary gland. The latter rearranged his whole internal chemistry and required him to take daily adrenal and thyroid hormones. How effective that replacement therapy was subject to debate.
The extraction of person’s master gland is surely a major intrusion into a person’s head, glandular system and consciousness. Not surprisingly, his general health deteriorated rapidly. Mr. B.’s metabolism was subject to large and mysterious swings. When I first saw Henry while working with Dr. McAvoy, he was comatose and thought to be in a critical state due to insufficient adrenal hormones. The presumptive diagnosis proved to be inaccurate and Mr. B. came around rapidly with hospital attention and intravenous fluids. We never did figure out the cause of Mr. B.’s short-lived coma.
The more time I spent with Henry, the more I got to know the many aspects of his case, his personality, and his life. Some parts were appealing and others were not, but I did like Mr. B. and enjoyed spending time with him and learning from him. I can see his bent, but solid figure now. I remember his face and his unique manner. Mr. B. was often childlike, but could become hostile as a bulldog. He related to his surroundings and people, but only on his own terms. He had a number of faces to project to the world, but two usually predominated. The first was a cherubic, smiling, wispy grin. It gave the impression that he knew a “secret” that the rest of us could never discover. The other was a distant, wondering, and wandering look which might coincide with an idea like: “I think we should drive up to Clinton, CT, today.”
Henry Baxter was crazy at times, in part, because of medication. But, he certainly had a funny side. He was mostly bald and had a face bloated from cortisone. With all his ills, he still could put on a show. He spoke when feeling playful with an almost British accent and reminded me of Winston Churchill. He only needed a cigar dangling from his mouth for full effect.
Henry B.’s mental state was erratic to be sure. He hallucinated at times, became belligerent at one moment and was quite docile at the next. One evening on the ward, he pointed out a contingent of Marine sentinels standing guard outside Sergeant Warren’s room. He told me to be careful of them because, “One of those Marines is a spy!” The next evening, he wanted me to purchase a popcorn popper at the Post Exchange for him. His intention was to make some festive, colored popcorn balls to sell to the nurses and aides on the floor. As a gesture of Christmas spirit, Mr. B. thought he would give a few away to fellow patients.
A couple of days later, Henry made an attempt on the Post Exchange. Clad only in his robe and pajamas, Mr. B. managed to slip out of the hospital, but was soon picked up by the MPs on the road to the PX. Quite a few of the hospital staff were embarrassed by the incident.
I sat with Henry and listened to his stories and some of his hallucinations. I even drove him over to the PX on my next opportunity. We had a short and uneventful excursion. Henry made a couple of small purchases. The popcorn popper was not one of them.
Before our time was over, I took myself to visit the Baxters at their home in Alabama. I cared for Mr. B. in his last days on the medical ward. I remember the Sunday of his death and being called to the hospital upon his sudden passing. I consoled Mrs. B., signed forms, and closed his chart. When I drove back home, I sensed Mr. B. seated next to me projecting his enigmatic grin as if he knew he was leaving that old hospital for the last time.
Paula Baxter and granddaughter
His wife Paula (Leopoldine), Henry’s Austrian war bride, mailed me cards and pecan cookies at Christmas for many years. When I left for my next duty station, she sent me off with a Red White and Blue afghan which still covers my couch.
Working with the Baxters and others really helped to put Family into Family Practice for me. That didn’t happen often. But when it did, it made medicine seem much more real, human and down-to-earth. I developed a comparable relationship with a woman patient named Pinky Brown. Pinky made for “a very curious case.” First of all, she was as small woman in height, but hardly pink. She was a black, African-American woman married to a retired serviceman. We became friends and I eventually received a dinner invitation for Kathy and me to join Pinky and her husband. We had a fun and laughing evening.
Pinky had multiple medical problems including high blood pressure and diabetes. But at first glance, her weight seemed to be of major concern. Pinky was almost a wide as tall. I don’t remember whence the impetus came, but the medical people – including myself – worried about Pinky’s weight. Worried to the extent that we eventually hospitalized her for most of two weeks trying to find a way to reduce her weight.
Well, our supposed interventions were for nought. Her measurements and weight were almost the same leaving the hospital and when she went in. That didn’t seem to phase Pinky. She just trundled on. But, some of the medics seemed to figure, “She must have been snitching food on the side. Must have.” I thought not and still think not. Some people just don’t fit the norm and work by the same rules, however we try to make them.
After the surgical rotation, I was assigned to the OB-GYN service and found it a generally pleasant and happy place to work. The chief responsibility of interns was the handling of routine deliveries. Actually, the nursing staff did the vast majority of that work and could quite easily have accomplished most of the tasks we residents performed. Like my medical school experience, obstetrics was on the whole a very positive period.
My internship occurred during a time when many changes were taking place in obstetrics. Fetal monitoring was in vogue – still is, and probably more so. Caesarean sections were more and more common – and still are. At the same time, birthing classes were being offered – even in the military setting. Husbands were invited into the delivery room, if they had attended birthing classes. We tried to bring fathers and family into the delivery room as often as possible. I made several exceptions for husbands to take part in the delivery even if they had missed classes. My only wonder was whether the husband would be a help or a hindrance in the delivery suite. I was not disappointed in any of them. None ever interfered or passed out.
Scenes come to mind of the hard work and real LABOR which women went through, of the confused interest and genuine concern of husbands, and of the skilled, dedicated nursing staff. Sometimes, the nurses were too efficient. I once assisted a staff obstetrician on a seemingly normal delivery of a Latino woman. In all previous deliveries, I had followed the pattern of waiting for the expulsion of the placenta before repairing the episiotomy. But, after the delivery of the infant, the obstetrician told me, “Go ahead and do the episiotomy. By the time you are finished, the placenta will be free.”
I was uncomfortable changing my pattern and even as I did as told, I sensed something was amiss. I proceeded with the episiotomy slowly and methodically. Completing the repair, I gently tugged on the cord expecting the placenta to slide into my hands. I tried again without success and was perplexed. I told the assisting nurse of the situation and she became agitated, “I asked you, doctor, if I could give her the Pitocin and you said, ‘Okay.’”
Well, I hadn’t heard any such question and didn’t even remember opening my mouth during the whole of the episiotomy repair. Regardless, when the Pitocin started to run through the woman’s IV, her uterus clamped down on the placenta and wouldn’t let go. The obstetrician had to be called back to sort the situation out. He seemed quite unperturbed and quickly gowned and gloved up to manually extract the placenta. He tore the placenta from the wall of the uterus – one piece at a time. The new mother handled the procedure amazingly well with only a little sedation. It hurt me just to watch and imagine having my insides scraped out by hand.
A simple, natural process – the delivery of a normal infant – can become a complex one. Even the relatively bright and happy area of obstetrics is basically an unnatural intervention into one of nature’s two most common phenomena, the other being death. Physicians pretend to go to the greatest lengths to insure the health and welfare of mother and child. Yet, how much better off might they be without the excesses of electronic fetal monitoring, analgesia and anesthesia, C-sections and episiotomies, pubic shaving and pre-delivery enemas. Fortunately, the care of women and children is slowly passing out of the hands of men. The Women’s Movement has had some positive effects on a wide range of modern life – obstetrics, gynecology, and pediatrics included.
It was on that the obstetrical unit of Martin Army Hospital that I made my one “life-saving effort.” I had just delivered the infant son of an unmarried woman. There had been no particular problems during her pregnancy nor during the course of her labor. If there had, the staff man would have likely done the honors or been standing over the shoulder of his intern.
The child arrived and gave a brief, but forceful cry. His color was good and everything else seemed fine. But, within seconds the infant stopped breathing. A potential catastrophe was on my hands. However, from that moment everything moved as if planned and choreographed. One nurse attended the mother and another carried the infant to the warming table in the corner of the delivery suite. A third nurse prepared a laryngoscope and an endotracheal tube. In a trice, I positioned the child’s head, inserted the laryngoscope blade through his vocal cords, and placed the tube into his trachea. A nurse connected an airbag to the tube and gave the baby a few puffs of air. By the time the staff man arrived, the infant was breathing and bellering on his own.
That instant reinforced an element of my growing medical philosophy. It seemed to me that despite the scare, that child was meant to live. I remember running through the motions of intubating the newborn as if someone or something was working through me. I seemed to perform the procedure as an accomplished technician. I had had only two previous experiences of intubation under my belt, both of them were under controlled circumstances in the operating room. I had been guided through the process on two anesthetized adult patients during medical school. An anesthesiologist had directed my eyes and hands in both instances. In the real life emergency, I also felt myself guided, almost pushed through the procedure, by a quite invisible mentor.
I feel comfortable with my conclusion, based on that and other medical moments, that physicians don’t really save or heal anyone. We are not doing the REAL work. We can at best be channels – important and necessary though they may be – for the true healing forces which are inapparent to our usual awareness. Furthermore, it is my distinct sense that physicians and nurses can’t cause the shortening of a person’s life simply by accident – the patient’s time must have arrived. It must be his or her karma. There is, however, the possibility of a “helper” deliberately harming a patient and creating new karma. How that works, I have no idea.
I firmly believe that we are protected from pain, injury and death which does not rightfully belong to us. On the other hand, health and welfare are also karmically determined unless they come to us as gifts of grace through the hands of our compassionate fellows.
A final incident on the OB Service worth retelling involved Dr. Sutherland who passed through the doctor’s lounge one day. At the time, I was trying to read a book on astrology even while the TV was blaring away for others to watch. The tall, stocky, imposing obstetrician instantly seemed to come apart at the seams. “Astrology! The Bible refers to astrologers as idolaters. You’re just studying ignorant witchcraft! How can you, a doctor, read such trash!”
For a moment, I thought to defend astrology. Based on my quite limited exposure at the time, I was sure to have gotten nowhere. Fortunately, another physician in the lounge came to my rescue suggesting that I had the right to read and study anything that I wanted. He also remarked that it’s hard for anyone to be sure what is true, not true, or only half true. That seemed to meet Sutherland right between the eyes. I heard no more on the subject.
Interestingly, the wife of the hospital neurologist was a budding astrologer. Anne Marks drew up and interpreted a horoscope for me during my time at Fort Benning. But, I never had the gumption to ask Dr. Marks what he thought of astrology. Nor did I have the nerve to read my astrology book in the obstetrical lounge again. And, I was equally shy at visibly studying any of my favorite “Night School” materials while on duty.
During the spring I was back on the Internal Medicine Service with Dr. Ed Friedler. Ed introduced me to totally unexpected things almost every day when we walked the hospital hallways. Friedler would have a story to tell trying to support some point he wanted to make. Quite interestingly, Winnie the Pooh, the Bear of Little Brain, was one of his main authorities. Long before the publication of the Tao of Pooh and similar books, Ed sang the praises of Pooh and quoted him frequently. Having never read or been read Winnie the Pooh books, I got a bit of an alternative education regarding children’s literature in the midst of my medical training. Thanks to Dr. Ed.
Dr. Ed Friedler
I will thank him again for the painting and books he gave me on my 30th birthday. I received two Pooh books and a childlike but original painting of the Pooh characters by Friedler entitled “Consider All the Possibilities.” That was one of Friedler’s mottoes and became one of my own. But, we each created different layers of meaning for that particular slogan.
In a similar vein, Ed’s most common refrain as we walked hospital hallways was one drawn from “western lore.” He would regularly remind me, “Now Bob, what do we look for when we hear hoofbeats off in the distance?”
You might suspect that the answer was not the obvious one: “Horses.” Ed’s reminder and a recurring one implied in modern medical practice is to “Look for zebras when you hear hoofbeats in the distance.” A physician – especially a novice – is supposed to consider ALL the possibilities. That causes him/her to often focus on some of the least likely ones in medical practice.
Really? Dr. Ed was making a sarcastic but pertinent remark about how we young investigating physicians had to spend so much time chasing after the unusual and scouring for the unique. Too often, Ed and I were ordering tests in the search of exotic diseases rather than tending to what seemed most obvious or at least likely. The pattern, which was around in the 70s, is much more common in the present day. That is why we have so many tests and have them done more often even than in Tinsley Harrison’s day or in Cheves Smythe’s.
§ Fear and anxiety over a person’s bodily being are surely the most common problems human beings face. Thus, it is hard for me to understand the huge gap in our training – except where psychiatric patients was concerned – in how to work with the fearful emotions which are so pervasive. Whatever the diagnosis, fear and anxiety and other emotions of wide variety depending on the patient are almost certain to be involved. I don’t remember such being much of any concern in our list of patient problems.
Nor do I recall ever having a medical school lecture on how anxiety affects patients, precipitates illness, gets them to doctors, magnifies their problems. It seems in many instances, anxiety was separated out as an individual psychiatric disorder with many pseudonyms which elicited prescription for anti-anxiety drugs.
But the plain and simple fact is that FEAR is the chief reason which brings people to the doctor. No doubt about it.
Fear of disease and pain open the gates to the medical system routines and subsequent outcomes. Most patients appear in front of their physicians firstly because of discomfort in their lives – emotional, social, spiritual, financial – and secondarily bodily illness. The latter is most often the result of the former dis-ease, as Mr. Cayce would say. Very often patients are quite unconscious of the influences of the former on the latter.
It is easy to focus on the body, worry and fret about it. Which often takes one’s mind off the “bigger issues.” Some patients are just feeling bad and want to feel better which quite naturally causes them to worry about their bodily functions. But, a high percentage are afraid something serious or deadly is going to happen to them.
Our medical system and the mainstream media often add to our common worries. How often does the physician augment health worries rather than addressing them and helping patients look at how much health they really have. Even in major illnesses, the vast majority of cells, tissues, organs and systems are working more efficiently than the most sophisticated systems that humans can produce.
Well, Ed and I weren’t taught about such ways to look at our patients and find out the deeper things going on with them. And, we were young, relatively healthy bucks who really knew personally very little about illness. Nor had we yet recognized the full truth of Ed’s comparison of Horses vs. Zebras and how physicians too often search for the latter in patient problems rather than the former.
We looked and tested repeatedly for rheumatoid arthritis rather the common old rheumatism aka osteoarthritis. [Interestingly, the title of rheumatism is out of vogue even though it seems to be a much better name for many ailments we suffer.] We worried and fretted over melanoma versus plain old skin cancers, the dreaded “strep throat” rather generic sore throat.
You may not have noticed but people do not faint or swoon in the modern day as in previous historical periods. Why? Maybe because it is simply too expensive. If anyone faints or gets whoozy or has a fit of any kind, it is off to the emergency for a costly workup.
Diarrhea and gastric discomfort require studies looking for one germ or another, while the bowel is loaded with them – trillions – without which we would never complete digestion of our meals. Germs are on us and in us. Creeping and crawling and doing their necessary business in a symbiotic relationship with their human counterparts, lest the interior milieu as per Claude Bernard gets dissembled and disordered. Then, doctors do their tests and point to microbes as causes of illnesses. When more often than not, they are just innocent bystanders. §
There was so much to learn and theoretically know. To be a real physician requires so much beyond the perceived knowledge of a young – or even older – person who has spent almost his/her whole life in schools. How could we really KNOW what was right and best and true for anyone. Experiences upon experiences hinted that to be the case.
Despite our shortcomings, Dr. Ed and I worked together well, helped and backed each other up, and maintained good relations with most sectors. We dealt with a reasonably wide spectrum of patients and physicians alike. The medical ward was such a great place to relate to people even in our limited ways and times. Learning to deal with people and personalities, faces and forces, is important to many jobs. In medicine, the talents of a practical psychologist are sorely needed – talents which take long times to develop. And, talents hardly recognized by the medical system.
I remember arriving a few minutes late for MOD (Medical Officer of the Day) duty with Friedler one Saturday morning. I found him in the ER hard at work already. He was doing an admission workup on a retired black sergeant. The man had high blood pressure and had just been admitted because of a paralyzing stroke. Ed slipped out from behind the curtain of the patient’s cubicle and pointed, “This one’s mine. Yours is in the next bed.” In a few moments, I discovered what Friedler meant. I picked up the patient’s chart and entered his cubicle to find a retired black sergeant with the obvious signs of a recent stroke. My patient’s medical history was prominently marked by hypertension. It seemed to me that the two men could have been twins, for all their apparent similarities.
Such “coincidences” in the hospital setting are exceedingly common: two old black men suffer strokes and are admitted within minutes of each other, two heart attack victims in the ICU develop abnormal heart rhythms within the same hour, two young women enter the hospital, one after the other, because of the same complication of pregnancy.
Such events happen quite often in small as well as large hospitals. But, what do they mean? Most hospital personnel think of them as curious phenomena. Others don’t even consider them at all. “They are unimportant – irrelevant!” An astrologer might have had some valid comment, however unwelcome to most physicians. When I first noticed those “coincidences,” I thought of lunar or astrological influences being implicated. Now, I think of a few other possiblilities, all of them hidden from direct apprehension, but nonetheless reasonable to the deep thinker.
The Emergency Room was an active, exciting, interesting place. I met curious people, anxious and acutely ill people there. But, I only began to get to know them on the wards when more time was available. When the pace slowed, I could listen and converse with them, learn from their lives, and think and consider possibilities. While many of the residents and staff men spent great amounts of their time with charts and lab reports and xrays, I found that I could learn and share most by spending time at close proximity to my patients.
It takes personality as well as brains to become a real physician. But there are all kinds of personalities who pass in and through the medical school gates. I must say that Family Practice seemed to attract a “better sort.” Humans who were interested in caring and helping others even though the modern system often fails them and their patients.
While Friedler and many others in medicine try to figure and think problems out, medical school squeezed through their doors a very few feelers who might bring other dimensions to the profession. Those types seem to find fitting in as hard as I did. Maybe harder.
However we see and experience the world, we can’t help but meet ourselves coming and going. MEETING SELF is our major course of study, as noted early on. All of us, including physicians, are constantly drawing the experiences we need to enrich our path through life. Eventually – it may take a very long time – we learn the course of instruction ordained for us.
My favorite resident in the residency was Dr. Augustus Wood. Gus was “a hell of a guy,” but had a “hell of a problem,” as well. Practically everyone smiled at and bantered with Gus, listening to him and his stories. Everyone was glad he was in the program and in the hospital. But, Gus wasn’t so sure about being there. Gus wasn’t sure about most anything. He lacked self-confidence and self-esteem. He was always telling or demonstrating his weaknesses to staff and fellow residents alike. Maybe to his patients as well.
Wood was tall – well over six feet – and stocky. He filled out his uniform so he looked the part of an aging military officer, as he was at least ten years older than the rest of us. Gus had a large round face, lined forehead, and a scalp that was bald except for a few wisps over the ears and around the back. Tiny bubbles of sweat often oozed out his pores. Dr. Wood always has a hanky handy to absorb trickles of errant perspiration. His big face generally wore a broad grin – except when it didn’t. Like when he was worried or fretting over something or someone. Gus was the Teddy Bear of the resident bunch. He had a heart of gold and was truly concerned about his patients. He worried about them and cried over them when they hurt or died. He cried on other occasions.
Dr. Wood, the eldest resident in the program, was older than most of our supervisors. Gus had been practicing medicine here and there within the military for several years. He had traveled the world far and wide looking for fulfillment and for himself. He had drunk heavily at times along the way and eventually “took the cure.” Wood had long abused his body, but at the time limited his vices to chain smoking and coffee guzzling. Altogether, the years told on him.
On occasion, fellow residents would drop in on Gus when he was on call and staying in the doctor’s quarters. If we found him stretched out with his shoes off, we would be overwhelmed by the pungent and fetid aroma emanating from his feet. No amount of foot powder or Odor Eaters could ever neutralize the fumes and miasms which radiated from the soles of his poor feet. Gus’s feet became the center of puns and jokes, smirks and smiles. We all knew that we were in imminent olfactory danger when we found Gus crashed in the call room. Regardless, we all thought Wood was great and would never avoid a chance to spend a moment with him.
Gus suffered not just over patients, but also over himself. Working in the government service since medical school, Dr. Wood had neglected to take a medical board exam and was therefore unlicensed to practice in any state. He was not legitimized to do a civilian practice and he didn’t plan to stay in the military forever. So, Gus forced himself to go back into formal training to help him brush up for medical boards and the rest of his career. He joined us as a second-year family practice resident.
But, Dr. Wood was forever carrying his perceived lack of knowledge and obvious lack of confidence almost literally on his sleeve. I can see him now shuffling down the hospital hallway, worrying about something and looking for a colleague to lean on. He usually had his hands full of charts and papers. The pockets of his long white coat overflowed with notebooks and cheat sheets, pens and pencils, instruments and dosage calculators.
At one time, I suggested that we sew a large pocket on the back of his white jacket so that he might carry for “easy reference” a copy of Harrison’s thousand-page, ten-pound Principles of Internal Medicine. The funny thing was that if such a pocket had been feasible, Gus would have sewn it himself. It might have eased a bit of his anxiety about not knowing enough.
Recent version - It was not so large 40 years ago
How much was enough? Gus didn’t know. He just had the ever-present sense of inadequacy and continued to tell anyone who would listen how much he didn’t know. Eventually, the residency staff heard his refrain one time too many. At the end of the year, they told Gus, “We’ve decided you don’t know enough medicine, Dr. Wood, to be advanced in the program. You also lack sufficient confidence in the abilities you do have. You must repeat the second year of the training.”
Gus’s two-year residency turned into a three-year program. I suppose that he was ultimately relieved when the decision was made. The extra year may have made some difference. For, Gus completed the program. He was then assigned in Family Practice at Fort Polk, Louisiana, and prepared anxiously to take the medical licensing exam in Texas. He passed. Eventually electing to leave the military before retirement, he went to work in small-town emergency rooms – of all places.
We all learn the hard way, at least in some areas of our life. No one has a “free ride.” If Gus had perceived himself as we did, his battle would have been greatly eased. He already had qualities of heart and compassion that some physicians never get close to. Instead of carrying a medical textbook on his back, he actually carried an invisible shining heart which touched many people, patients and otherwise. To me, he held unknowingly within himself one of the finest remedies available to human beings.
On at least one occasion in the residency we were encouraged to do some creative thinking. That was when we were required to do a research paper to be presented in the last weeks of the year. Since it was research, I figured that was safe for me to do my paper on an unusual remedy and even got the okay from the committee. I chose to work with a subject dear to me: Castor Oil Packs. My non-standard study of Minimal Brain Dysfunction (ADD) used castor oil packs and dietary suggestions as key components following on the work of Drs. Ernest Pecci and Ben Feingold.
Interestingly, just the ADD diagnosis gives big clues to how little medics know about the “syndrome.” Around forty (20 by Organic Terminology and 21 by Symptomatic Terminology) different diagnoses were used for this condition at the time. The number has undoubtedly grown over the past 40 years. The study, facilitated by the Occupational Therapy Department, was of brief duration and quite incomplete because of my leaving the residency after the first year. But, the “preliminary findings” showed that the eight “subject children were found to have increased attention span, fewer temper tantrums, decreased activity level, improved speech patterns and school grades, and decreased number of abdominal complaints ...”
I didn’t get to “present” my paper with the rest of the group because I was convalescing at my garden [explained below]. Dr. Thomas was the only person who ever commented on my paper. He was not impressed with my “research,” didn’t believe in any of the concepts, and suggested that I had probably wasted my time. I might have asked Dr. Thomas, “What is waste?”
There was one thing I didn’t put in my paper which seemed clearly important to the beneficial results which were noticed early on in the study. That was the positive input by parents which came about with them taking the time and energy to assemble and apply castor oil packs to their children three times a week. They didn’t just drop a pill into their hands. They had to attend to the children, spend some quality time with them and even touch them. How novel and nice!
My internship year in Family Practice at Martin Army Hospital was surely the most stressful in this life. Much more so than the one I spent in Vietnam. It was the only period in my life in which I recognized being depressed. My wife knew all about anxiety and depression. Maybe it was my turn.
Besides meeting major obstacles while trying to act as a Cayce Doctor, I also dealt with marital issues. Again, those were mostly of my own making. In any case, they certainly fit my being and my nature. Kathy wanted conversation and comfort, reassurance and security. I wanted study, challenge, and growth. Kathy wanted status and title, I wanted to learn and to “find my purpose.” Kathy was ever so proud to be the wife of a Doctor. while I never felt fully comfortable saying, “I am a doctor.” When asked what kind of work I did, I would usually respond, “I practice medicine.” That answer seemed to confuse some questioners. I remember only once using the my “DR.” credential to get some special benefit. My identity was as a human being who worked as a doctor. When the time came to part from active medical practice, I was fortunate to have that sense about my “self.”
CONFESSION§ I have to admit that by that time in marriage, I had developed a roving eye. While I never broke my marriage vow literally, I certainly must have at an energetic and spiritual level. Regardless, I was smitten by the head nurse on one of the medical wars. Leslie was slim and pert, bright and cheery. She seemed to have it together, while Kathy was constantly battling depression. Leslie was involved in medicine, curious about deeper health issues, and interested in exercise physiology. She ran road races (and influenced me to start running), did health foods, and read widely. I desperately wanted to spend time with her. Yet, I had no thought to get divorced despite the discomfort of my marriage. For the longest time, I thought, “Kathy can’t stand on her own. When she can, I will let go.”
Another embarrassed confession arises. I made a dinner date with Leslie when who should appear for a visit but Kathy’s father, Bob Wilson. He remonstrated with me but to no effect. I made the appointment and enjoyed the evening.
But, I knew not how to proceed. I needed someone to hear out my feelings – to say it was okay to feel the way I did. I decided to take another trip to Atlanta and talk with Lynn Buess. He perceived that I had lightened up in some ways with regard to my professional situation. Lynn suggested that the marriage could very likely weather the turmoil at hand. “Why not ask Kathy for space and time to get to know this person? Share what you came together to share. Then move on with rest of your life.”
Lynn perceived that Leslie and I were like two trains which cross paths in the same terminal, share the same space for a short time, and then pull out for distant destinations. He said my situation would be resolved by May. Kathy and I discussed my dilemma and Lynn’s suggestions amicably – or relatively so. Kathy backed off and gave me some room. Rather than commuting to West Georgia College where she had recently started a Master’s program, she decided to live temporarily on campus.
In days, Leslie saw through the whole situation. After that one dinner date, she told me that she would not get entwined in any way with a man’s marriage. I continued to see her on the hospital ward and always enjoyed our conversations. Eventually we lost contact as we went our separate ways, Leslie to Washington, D.C., and I to Kansas. §
It was only a few weeks before Kathy decided she wanted and needed to be back home. Kathy called in an anxious state one evening concerned about her physical health. She claimed that she had had a gynecological exam, that her Pap smear came back positive, and that she was recommended to have a biopsy. Within a few days of her returning home, the truth came out. There was no positive Pap smear and no physical disease – just a pain and a hurt precipitated by me. But, I was unwilling to walk back into our unfulfilling relationship at the time. I and moved in with another intern. Then, I bought a car to replace the awful Honda 50 that K had convinced me was a prudent and frugal thing to do. “We don’t need two cars.” She was probably right when she said it, but I was the one who had to drive the “little beast.”
Kathy and I kept in touch mostly via the telephone for some weeks. Late in the residency year, a couples’ retreat was scheduled by the leaders of the program. That seemed to be a fitting moment for us to try to reconcile and get back together. Well, it seemed so. And, I returned to our quadriplex in officers’ housing at Fort Benning.
At least two other factors besides hospital probation and marital separation seemed to impinge on my being at the time. I had been invited to a residence for an evening discussion of some new age topics. The home belonged to a civilian physician and his wife. Gena Romani was much more the metaphysical student than her husband, but he also had some interest. Ronald was an Argentinian trained as a thoracic surgeon. He worked evenings and weekends in the army hospital Emergency Room because he was having unexplained problems getting into a civilian practice.
While I felt almost comfortable with Gena, I was always uneasy around Ronald. He was reasonably pleasant and cordial, yet his bodily movements and manner seemed strange and affected. To top it off, Gena called Ronald, “Poopie.” That name must have been more than symbolic.
The evening of the gathering, Gena and Ronald and I waited for some time for others to appear. But, no one else arrived to join us for the meeting. Instead of starting the intended discussion, we gravitated to topics of some mutual interest. The whole evening was passed by the threesome without a call or contact from any of the other invited persons. After more than an hour waiting, Gena suggested that we scrap the discussion, share a short meditation, and call it an evening. I have never rejected an opportunity to meditate regardless of the situation, place or participants. Yet, I remained uncomfortable throughout the whole episode. When we sat on the floor in a triangle and joined hands during the meditation, I was even more wary. But, what could I do?
The meditation was relatively brief as was the rest of the evening. As the week and month began, I also started my next to last internship rotation. I was placed on the Ear Nose and Throat Service under another surgeon whom I soon came to detest. I thought him arrogant and distasteful to patients and others alike. I chafed at the idea of spending a whole month under his thumb.
But, there I was, a few months out from probation still looking and worrying over my shoulder, working under a “jerk” drawn into my proximity, and recently returned to my wife while yet carrying ambivalent feelings about our relationship. The month had barely begun when I turned shades of yellow. Medically, it was called non-A, non-B Hepatitis then. Simply put I turned yellow like a canary because my liver was acting up.
Over time, I came to understand – that at least in my case – as the Chinese say, “The liver is the seat of smoldering anger [and fear].” I was holding onto so much frustration and resentment and fear instead of accepting things as they were and getting on with life. Whenever I was in the hospital I was always looking over my shoulder. Still, the flow ultimately took charge.
My colleagues surely believed I had picked up the hepatitis from a patient, a needle, etc. But, I say, “I created it meeting myself coming and going.” However, I must add that all things work together in some extraordinary way. Once I returned to duty, I ran into Dr. Romani in the ER while I was doing my last month of internship. Ronald and I passed the amenities of the day between us. I asked after his efforts to find a thoracic surgery position. He inquired as to my bout with hepatitis. I told him about my three week “vacation.” Ronald came back to me saying, “Oh, you were lucky, then. You know, I had hepatitis a little over two years ago and it almost killed me.”
I’ve wondered ever since how “lucky” I was. How did that uncomfortable evening and meditation at the Romanis relate to my turning yellow a few days later? Was there some synchronous, causal relationship there? What kind of karmic connection did I have with Ronald? Did he “give me” something, or “pay me back” on that evening years ago?
However that meditative moment contributed to my turning yellow, I believe that the stresses and strains, fears and frustrations of a whole year – with lifetimes behind it – were culminated in the onset of the disease. For long, I had suppressed my feelings, maintained my self, accepted humiliations, and stifled my sensitivities. The angers and animosities as well as the yearnings to give and serve creatively came to a head in May. They vented through my liver, spread through my blood, and oozed through my skin. My whole being was demonstrating the inner crisis through which I had been and was passing. There was a “Big Picture.”
Yet, nobody really noticed. Nobody knew. I was just “one sick puppy” who had mysteriously and unfortunately contracted hepatitis. Even I was relatively unknowing at the time. It took me many months to pull most of the threads of the episode together. While the moment was not one I would wish to relive, I am thankful for the experience and the learning which came from it. From that instant, I was pointed toward an even broader perspective of health and disease. The many forces – external and internal, physical and psychic, objective and subjective, material and spiritual – which make up human nature as well as human disease came more and more clearly to my awareness. I was also helped to recognize that opportunities for learning can be found everywhere and in every moment.
Fortunately, we get respite and relief for periods of time whether we learn our lessons or not. I got most of my 11th month to recuperate at home and work at a small garden thanks to turning yellow. You know, there are always consolations.
One other benefit of my bout with jaundice was an opportunity to test castor oil on myself. During the early days of my discoloration and lethargy, discomfort and insomnia, it was Kathy who said, “Bob, why don’t you try the castor oil packs. Maybe they will help you sleep.” So, I did. And, so they did. Almost immediately upon application of the packs, I was able to rest and sleep easier. Thus, I had and have other personal testimonials for the use of castor oil packs.
I could have returned to work in a week or ten days, but did not want to go back to the ENT Service. After almost three weeks convalescence, I returned to the wards as physician not patient again to the Internal Medicine Service. It was by choice that time.
I bid my goodbyes to Henry Baxter during that last rotation as well as to another old-timer, retired SFC Nathan Stevenson. Ed and I had initially worked with him because of a cardiac abnormality which demanded the placement of a pacemaker. But, Mr. Stevenson’s main problem was cirrhosis of the liver related to many years of heavy drinking. His skin was a dark, dark bronze color and his eyes were muddy yellow. Although Nathan was at the time shrunken to little guy size, his belly was swollen like Santa Claus’s. His liver was partly inflamed and partly dead and his activity was quite limited due to his multiple system disease.
Yet, we kept “patching” him up and sending him home – one more time. Mr. S.’s family, despite the rigors which his alcoholism must have put them through, were loyal and solicitous of his welfare. Unfortunately, the quality of their loved one’s life became poorer with time and aggressive medical care. Finally, there came a point during a hospitalization when I took a wider view and confronted that angle of the situation.
I conferred with the family to discuss his disease, his life, and his prognosis. I was candid and so were his wife and grown children. We considered that Mr. Stevenson was spending all of his life in a bed or in a chair. He was frequently in a stuporous state, unaware of his surroundings, and dependent on the whims of his disease.
I told the Stevensons that we could continue as we had with our involved interventions or we might back off medically. The family might also ponder whether, by their loyalty and concern, they were merely delaying Mr. Stevenson's departure. The family clearly understood my words and intent. One of them said, “Yes, we have been holding on to him. We don’t want to let him go, but we know he really has no life here in his tortured body. Is it really all right to let go?”
Nathan left two nights later. The family was teary-eyed, yet relieved and grateful. It seemed that once we were ready, SFC Stevenson didn’t wait long to take his leave.
That last month on Internal Medicine gave me one more real Family Practice experience thanks to Bill and Edith Feeback. Bill was another retired Army sergeant in his late fifties. He had been a cook or mess steward. His stout, obese build made me imagine that he could have fit that role quite well. Feeback was blustery, talkative, and anxious. He was in and out of the hospital many times with angina and heart attack, stroke, and hyperventilation episodes. His manner offended or at least irritated most everyone. I seemed to be an exception. I listened. I let him talk and tried to respond to his worries and queries.
Most of the time his requests were beyond my abilities to fill. And, too often they were quite unrealistic. He wanted the hospital, nurses, and doctors to do things for him and his wife which were rightly his own responsibility. Still, I listened. Bill was rather an albatross and no one wanted Feeback tied to him or his ward. Staffers were always more than glad to see him discharged from the ward or the emergency room. Yet, if Bill wasn’t a patient, his wife was, and the hospital workers seemed to have even more trouble with his demands as a family member than as a patient.
Edith was diagnosed with an inoperable tumor in her chest which had spread to her brain. Her cancer was only recognized after she was admitted for work-up of her suddenly appearing seizures. By the time I met Edith, she had received maximum chemotherapy and radiation to both her chest and head. She had been sent home some days previously with a personal attendant to help Bill care for her until her death.
Her cancer doctor had shuffled her out of the hospital in part because the staff couldn’t deal comfortably with her husband. Then, Mrs. Feeback showed up at the Emergency Room one evening when I was on duty. She was brought in by ambulance and I found her lying in a near-comatose state on an ER gurney. I did a terse exam and got some basic information from Bill despite his tense and agitated state. I then made a phone call to her attending physician. Dr. Hermann made it quite clear to me that he had “done everything possible for this woman. There is nothing more that can be done for her. She was sent home to die.”
Edith and Bill hadn’t cooperated with that expectation. And, we couldn’t very well send her home as she was. Hermann moaned and groaned about how overloaded he was, but said, “Go ahead and admit her for me, please.” With his unspoken, yet obvious hint, I volunteered to take over Mrs. Feeback’s care. Hermann was undoubtedly relieved and was quite cooperative when I consulted him later on about her case. Even while I was on the phone with Dr. Hermann, the idea was brewing in my mind to try some unorthodox methods in Edith’s care.
The potential for using alternatives was now opened for several reasons. By the time I encountered Mrs. Feeback, my internship was well nigh over – I was almost home free. I was in relatively good standing in the training program after early conflicts which put me on the short end of the stick for a time. I had even been “invited” to complete the final two years of the Family Practice Residency. I declined.
There was little to lose in trying “something different” with Edith Feeback. I had been allowed to do my innovative research study on the use of castor oil packs in the treatment of minimal brain dysfunction. Not long after, Dr. Hermann had given up on Mrs. Feeback in more ways than one and had handed over her care to me – with blessings. So, possibilities presented themselves.
I admitted her and wrote initial orders to approximate the regime she was given on her previous hospitalization. The next day I called Hermann again and asked for his okay in treating Edith with vitamins as per the work of Nobel Laureate Linus Pauling and British cancer surgeon Ewan Cameron. I intended to place her on megadoses of ascorbic acid (Vitamin C) as part of her therapy.
Hermann readily agreed and even suggested adding a good dose of Vitamin E to her new plan. With his go-ahead, I ordered C and E plus multivitamins and folic acid as soon as she could swallow pills. I added castor oil packs and mild natural laxatives to her treatment. At the same time, I gradually reduced her “real drugs” – cortisone and anticonvulsants.
I involved Bill in her care by getting him to go to the commissary each day for fresh fruits – papayas, pineapples, melons – which became the mainstay of her diet. The Feebacks had been stationed for some years in Hawaii and the fresh fruit fare suited them.
SFC Feeback fed and tended his wife carefully and comfortingly. It was great therapy for her and maybe even better for him. Bill was helpful and generally cooperative. He was still demanding, but reasonably pacified because his wife was being cared for and he was doing his part. However, there were bumps on the road of her treatment. And Bill felt them. He reacted and ended up in the ER a time or two because of angina and hyperventilation attacks.
Our “experiment” was successful not only from a human standpoint but also from a medical one. Edith perked up, sat up, and even started physical and occupational therapy. Her color and appetite returned. Her blood counts revived and her seizures diminished. Her bowels even worked. But, alas! Her tumor became active again. A lump appeared at the angle of her jaw and the once “frozen” mass in her chest started to grow again.
Fortunately or unfortunately by the time these developments occurred, my final internal medicine rotation ended and I left the program entirely. Edith Feeback’s care was assumed by a new intern. Immediate changes were made. Mrs. Feeback’s diet went from light fare – mainly fruits and vegetables – to standard hospital menu. Her once supposedly maximum therapy was topped off with more radiation and more anticancer drugs. The tumors again responded, but the patient lapsed into a weakened and depressed state. Edith’s seizures returned. And Bill resumed his very anxious and difficult postures.
Mrs. Feeback lingered for some weeks with her latter days spent on IVs and no food intake at all. One of the residents let me know, as I was moving to my next duty station, that she lived that long because of the regime we had undertaken in the spring. I don’t know what happened to Bill after his wife died. Her passing must have been extremely hard on him. He was then faced with the supreme task of caring for himself and living alone.
In retrospect, I’m not sure what I would have done if I had continued as Mrs. Feebacks’s physician when her tumor reasserted itself. At this point, all I can think is that it must always be better to treat people than diseases. If I had it to do all over again, I would have spent more time with Edith and Bill, broached sensitive topics of family and life, and even joined the fruit fest.
My latter days in the residency brought the announcement that I was selected to continue into the second year. That was a bit of a surprise considering how much trouble I had caused for myself and the program with my unique behavior. I remember attending a gathering of residents who were applauded by the Commander of Martin Army Hospital. Colonel Schmidt made me cringe at one point when he said something to the effect that, “At Martin Army Hospital, we pride ourselves on teaching and practicing the highest brand of medicine. There is no place for the unorthodox or unproven here. We only offer and provide that which is best for our patients. I warmly congratulate you on your achievements. I thank all of you for sharing your medical talents and for representing the United States Army Medical Corps in its highest tradition.”
There were “Amens” voiced in various ways to the Commander’s words. If he only knew the honest truth, he would not have been so proud and proper. I played the game pretty well after being squelched into probation albeit suffering frustration, depression and jaundice. I did not, however, stifle beliefs. I only funneled my efforts into working with patients and not diseases.
It didn’t take me long to decide that one year of the Family Practice residency was enough for me. I looked around and saw that second and third year residents were for the most part repeating what they had done in the first year. They got more time to spend on favorite wards and services – and even go golfing. But, it just seemed like they were being recycled rather than learning more medicine if not healing.
So, I refused the invitation to do another year and made room for Dr. Friedler to take my place. At this juncture, I have to assume that the reason they passed Friedler over and gave me first chance to continue the residency was because of my prior military service. In any case, Friedler was happy with the turn of events.
On the one hand I was relieved to flee from the web of karma in which I had embroiled myself for the past year at Fort Benning. On the other, there were some pangs of regret at leaving friends and co-workers neighbors. Those were heightened when Kathy organized a small celebration for my thirtieth birthday. All of my group, the then second-year residents, joined the party. Jovial Gus Wood, second-year resident for the second time, arrived with a bit of heartfelt philosophy for the group member departing to do “field duty.” Dr. Friedler presented me with his Winnie the Pooh presents and a few stories for the road. We wished each other well and bade our good-byes.
Consider All the Posibilities by Dr. Ed Friedler
Over the previous several weeks, Kathy had been trying to decide how to proceed with her own life. She had two courses, a thesis, and some odds and ends to manage prior to fulfilling requirements for her Master’s degree in counseling at West Georgia College. She eventually decided to join me on the road to Kansas, do her thesis there, and travel back to Georgia as needed to finish her program.
Our relationship was tenuous at best, but Kathy was insecure and hung on. I hung on, too. I felt responsible to her and for her. I thought, “I can wait until she’s able to stand up for herself, handle a job, and be independent. Then, we can decide if we should stay together or part ways.”
Taking Flight: Chapter 8