Declining Professionalism in Healthcare or What Happened to All the Good Magazines?

 It dawned on me. I was an adult. Here I was sitting in the lobby of a medical office without my mother.  At age sixteen I had driven myself to the appointment. There was no pageantry, no ceremony, and no announcements or gifts. Adulthood just happened.  It came about in the most unceremonious way:  My first physical examination by an internal medicine doctor, not a pediatrician. I think that’s why I remember it so well. It’s like a slow motion movie in my head.  Is my memory correct?  The movie in my head seems idealized, like an episode of Marcus Welby, MD. I had been apprehensive about going.  My brothers had warned me of the gloved examination ahead of me. Or should I say “behind” me?  And the Internist’s name was Doctor Payne! (I heard Pain)

But the apprehension was fading fast. The Lady at the front counter had been really nice. She had noted that I was a Franklin. She had talked about my family and how much she liked my parents. She smiled as she talked. It was a comfortable place to be. I sat on the cushy sofa and looked at Yachting magazines. 

It wasn’t long before a friendly Nurse called my name.

My first name. 

She had me weigh in and then took me immediately back to a patient room.  She chatted away about how many years my family had been coming to see Dr. Payne and reminisced about when my mother had worked there as a Medical Assistant. After taking my vitals and a vial of blood she said that Dr. Payne would be just a minute.  I barely had time to get changed into the exam robe before he knocked on the door.

After a thorough exam, Dr. Payne said that I should get dressed and then come down the hall to his office. I did as I was told.  When I peered into his office he was sitting back, relaxed and smiling.  He said, “Sit, please have a seat” motioning to the chair in front of his desk.  We looked across the desk at each other. He was clearly sitting in the seat of authority, but I was seated directly across from him. Equal as a man.  And then we had a conversation.  He asked me what I liked to do.  Was I going to be a photographer like my Dad? He told me that he liked to fish. He asked if I was dating. He seemed… no… he was genuinely interested.  The Nurse knocked at the door and leaned in and handed him some paperwork.  Dr. Payne looked it over and then looked at me. He said, “Your blood sugar is really high, did you follow the fasting instructions we sent you?” I nodded and he rubbed his chin. Then I said, “Well, I did get thirsty and I drank a Mountain Dew on my way up here.” His face relaxed into a smile, “Well, that would explain that.” He stood up and said that everything else looked good. He said he would see me next year and held out his hand to shake mine.  I stood and gave a firm shake like dad had taught me.

And I was on my way.

This pattern repeated itself year after year. Always the trip back to his office to wait on blood results. I remembered not to drink a soda until after the appointment. There was always the same friendly staff and nice conversations. Plenty of yachting magazines to peruse. And each visit ended with a firm handshake. Shortly after I finished college, Dr. Payne retired. He told my family about a young Doctor who had just joined the practice. He said that he had all the latest education and was a nice guy to boot.  You see, in those days, the nice guy part was just as important as the latest education part.

The new Doctor practiced the same kind of medicine as Dr. Payne.  He was young, but everything else stayed the same. Dr. Marshall took his time and patiently listened to my questions.  We had great conversations year after year.  The staff would change from time to time, but were always nice.  The office had Life magazines, Time Magazines, and Boating magazines.  The occasional Yachting magazines with turned up corners were still in the mix as well. And each visit ended with a man to man chat in the Doctor’s private office followed by a firm handshake.

  One day an announcement arrived in the mail.  

 I hardly payed attention to it, but apparently the practice that Dr. Payne and now Dr. Marshall worked for had been sold to the hospital. 

It said nothing else would change, so I chunked it in the trash and forgot about it.  Were things different at my next appointment?  I can’t say. I just can’t remember.  It was at the least so similar that it didn’t matter enough to stick in my brain.

  Except…that maybe the lady at the counter had been just a little less friendly….  I’m not sure… but I don’t think she knew who my family was. And maybe… just maybe… the Yachting magazines had been hauled away.

Soon the Life magazines and the Time magazines gave way to celebrity rags like People and Us.  I’d have to go on an archeological dig to find a Boating magazine.  The counter staff had grown to two or three ladies.  They were happy enough chatting with each other, but seemed slightly put out when they had to check a patient in.  The Nurse was stern. All business, no chit-chat. She called out my name. My last name. 

The respite would come when Dr. Marshall would make his casual entrance, lean against the counter, smile and ask questions. He asked about my family and my work. But at some point I noticed that the conversations were no longer two-way.  If I started to go into much detail about a non-medical issue he would get antsy. The private office visits had stopped. But at the end of the exam he would give a nice firm handshake.

As each year passed it seemed like the visits were getting shorter and shorter. I often found myself leaving, on the elevator, when I would remember something that I had meant to ask him.  He was the same Dr. Marshall, always pleasant, but now he seemed distracted. He would even forget to do the dreaded gloved examination sometimes.  On one of my last visits to him, I swear that he kept one hand on the door knob the whole time, including while he listened to my heart. 

He was being rushed!  How could this happen?  He was a Doctor!  Who could be more important than a Doctor?  Who could be making him feel the need to race to the next patient?  I was confused. And dammit, the Boating magazines were gone too.

And that’s when it ended.  After the boating magazines left, so did Dr. Marshall.  When he retired, he seemed too tired to even make a wholehearted recommendation of any other Doctor on the staff. Now I know why.

I randomly picked a new Doctor. I wanted someone young. Someone who could be my physician for the rest of my life. 

The office had been completely remodeled, sanitized even.  The men and women at the counter were no longer happy at all.  They didn’t chat it up with each other.  They barely made eye contact with the patients as they checked in.  They made us show our insurance card at every visit.  They made us scan our palms. The nurses were different at every visit. 

They would call my name. Last name, First name. 

The nurse had stopped drawing blood long before.  They had a lab.  Apparently having a lab meant that instead of getting the results at your appointment you could look them up a week later, on the patient portal, if you could remember your password.

The Doctor did not have a private office.  He had a cart in the hallway.  There was no time for pleasant conversation.  All the questions were designed for efficiency.  The visits were quick and procedural.  He never forgot the dreaded glove exam.  The waiting area had institutional style chairs.   And wait we did.  

Someone had decided that patients should not look at magazines while they waited.

Long waits with the only thing to read being slick brochures about cancer and diabetes. 

Apparently Doctors no longer had the time to boat, let alone yacht.

This place that had been so comfortable.  This place where my adulthood had dawned had been wiped clean. It had been transformed. It had vanished. 

And I can’t remember the last time a Doctor ended the visit with a good firm handshake.

Simply Hope

Hope is strength.

Hope is enduring.

Hope handles the tough jobs.

Cleaning out your deceased mother’s house.

Comforting your father during

your mother’s funeral.

Hope survives struggles.

Like losing a child.

Hope thrives in the face of adversity.

Like raising and caring for a

disabled child.

Hope is able to see that

even people with damaged brains

have beautiful souls

and experience moments of pure joy.

Hope is the first to call

when a brother needs support

or just a word of encouragement.

Hope stands in the wings and cheers

for the people she loves

when they take the stage.

Hope survives crashes

and grueling years of rehab.

Hope is a presence in your youth.

Hope is there from the 

moment you are born.

Hope is strong and enduring.

Hope is beautiful.

Hope is love.

Hope is my sister’s name.

Arrowheads and magic Eyes or How to Grow Up to Be What You Want to Be

I wasn’t very good at spotting arrowheads. I lived at the lake with my parents. Each winter the water would recede in preparation for spring rains. The power company had decided that it was better to open the dam and let the next lake down the chain deal with spring flooding.  In front of our house a large shoal would reveal itself. It reached out from the shore at the top corner of the cove and extended straight out a good 200 yards. Muddy, red clay covered in gravel sized rocks.

A neighbor three doors down had a huge collection of arrowheads that the water would churn up from the sticky mud each year. He said that they were really easy to spot. They just stood out.

So sporting rubber pull-over-your-shoes snow boots I made my away along the shoreline to the mucky red sandbar (or claybar, in reality. But that doesn’t sound quite right). Spluck, spluck, splucking my way to the plethora of arrowheads and Native American artifacts waiting to be discovered by me.  This was going to be great. Newspapers would be calling.  The elders of the Catawba tribe would probably want to shake my hand and personally thank me for recovering long lost spiritual relics. I’d be an honorary medicine man!

I was a hundred yards out into the stretch of mud when I stopped and took a good look around. My neighbor had said “they just stand out”. I scanned the thousands of arrowhead sized clay coated rocks. Nothing stood out.  I must not have been at the good spot yet.  I looked across the water back toward my house.  My neighbor must have spotted me because he was making his way out to join me. I kept moving.  I had to beat him to the treasure.  He already had about a million.

Another fifty yards. Nothing.  Feeling like Yukon Cornelius, I squatted down to get a closer look. Red gravel. That’s what I saw.  My competitor was gaining on me.  He had real hiking boots.  It seemed like an unfair advantage.  I stood up and started out again, only my boot stayed where I had been squatting. Stuck. Next, I planted the bootless foot straight down into the soppy, sinky sludge. Now my tennis shoe along with the foot in it were stuck as well. Ugh. And here he comes. Practically gliding over the stickiness in his fancy hiking boots!

“Hey”, He said. “Found anything?”  I was half standing/half squatting and stuck in my tracks. Literally. He popped my rubber boot out of the mud and held his hand out for me. He pulled me back to full standing position and handed my boot back to me. “You should get some hiking boots”, he told me. Ha! Exactly.

And right then and right there, he said,” What did I tell you? They just stand out”. Without moving a step, he bent down and picked up a perfectly shaped arrowhead. “Yeh”, I said. “I was just about to pick that one up."  He smiled and held it out to me.  I took it and looked at it. 

It's beautiful. It's really old.

And someone a long time ago had carefully crafted it. Had used it to hunt. To feed his family.

I took off the other boot and started following my new best buddy around.  Every few feet he stopped and picked something up.  Sometimes it was nothing. Sometimes it was a broken piece of pottery. Sometimes it was an arrowhead.  Some perfect like mine.  Some with broken tips. Some worn smooth from the water lapping over them for a couple hundred years. But in every case, before he leaned down to pick them up, they still looked like clay covered gravel to me. He had magic eyes, I decided.  Nothing “stood out”.  He kept saying it over and over. He said, “I told you”, he was giddy now. “It’s only your first time out here and you spotted one right away.” He glanced down at the beauty in my hand.

I thought about Indians. American Indians. I thought about how I had admired them as far back as I  could remember. 

As a kindergartner, when people asked me what I wanted to be when I grew up, I said, “An Indian.” This used to send my brother into fits of laughter.  I didn’t get what was so funny. Indians are noble.  Indians use strong words like honor. Indians tear up on TV when they see all the garbage left lying around by white people. 

Indians tell the truth.

Could my friend with the magic eyes see the guilt I was feeling?  I started to say that…

“Hey” he interrupted. “I think we are in the middle of a good spot. Look around you.  They just stand out.” He guided me with his eyes.  I followed his gaze and Bing!  It just stood out. An arrowhead.  I grabbed it up and examined it.  He looked at it over my shoulder, going on about how cool it is and how easy it is to spot them. It is cool. Not as perfect as the first one that was actually his find, but I had found this one. Sort of.

We kept looking. He found a few more. I found a couple of pieces of broken pottery. I didn't find any more arrowheads. I had two in my pocket. I really couldn't claim either one of them as true finds of my own.  But I did. I took them home with me and never looked back.

I showed them to people over the years always telling them that I had found them. I kept them in a box of special stuff. A polished rock that seems to magically stay frigid cold to the touch, a piece of petrified wood someone gave me. I showed these things to my own children and told them how I had found them. Magic Eyes never got credit.

Right in that same box with the arrowheads is a square tile of wood.  Back when I would say I wanted to be an Indian when I grew up, an older kid down the street had listened.  When he was away at camp he painted this wooden tile for me. The painting was of a noble looking Native American Chief in full headdress. On the back my name had been inscribed with a wood-burning tool. I treasured it. But I had not lived up to it.

So now I am saying to the world that my friend had magic eyes. He could spot beautiful ancient tools in the midst of a vast red field of gravel. I had no such talent. I’m coming clean.  I’m making an attempt at nobility and honor.

I want to still have a chance to grow up to be an Indian.