A Vow of Connectedness–part 1

–David Loxterkamp

 I have known Beaver for a dozen years. He is a member of my parish, a patient in our practice, the host of our son’s summer camp excursions, and a grandfather figure for my daughter, who helps with the summer milking. His daughter-in-law once worked in our medical office. He and Dr. Hughes forged their friendship years ago in Tim’s two-man racing shell. One of Beaver’s sons married the next door neighbor (she had been among my children’s favorite babysitters).

 One can be seduced into politics by the notion that popularity, moral righteousness, and a good grasp of the playing field are a guarantee for success. So, soon after establishing myself in medical practice, I joined the parish council, spoke up at hospital staff meetings, and ran for the school board. Mine was a voice for family practice values. I helped children become more involved in church worship, opposed screening programs that reduced health care to a commodity, and supported neighborhood schools that fostered strong relationships between teachers and the wider community. In these and other debates, I was frequently on the losing side. You might have thought that medicine—where the patient’s struggle against mortality is conceded from the start—would have prepared me for poor outcomes. Even in victory, the politician is left with a compromised and transitory gain. He must cherish the political process more than the final vote—likewise, the doctor’s reward, which lies in a love of his or her patients and the provision of good care rather than in any false hope of transforming the misery that parades past his or her door.

 Change

Is the family doctor an agent of social or political change? Perhaps some of us will shape and leverage the national debate. More will run for elected office in our home state or municipality. The rest will do their part by maintaining the connections that are severed in patients’ lives during the course of their disease, despair, addiction, or aging. For them, the doctor holds the flicker of hope, the reassuring hand, a mirror of their self-worth, and sense of dignity. Through our own lives, we model the possibility of change.

 I have saved only a few of my patients. I have seen alcoholics give up the bottle, wives flee the battering hand, the morbidly obese shed an elephant riding on their backs. But most of what the doctor accomplishes is infinitesimally small, barely a quiver, broad and trickling like the St. John’s River for those who are succored in the watershed of our care. We are stewards of a human ecology. Our practices are strengthened by diversity, interdependence, and the desire for our mutual long-term survival. We are caretakers of what Robert Putnam calls “social capital.” The wife of a patient of mine, home dying of lung cancer, recently said to me, “Dr. Loxterkamp, I just feel better knowing that you drive by my house every morning.”

 (Excerpted from A Vow of Connectedness: Views from the Road to Beaver’s Farm, The Country Doctor Revisited (KSU, 2010) and Family Medicine (2001) used with the permission of the author)

Read the entire selection

 Dr. Loxterkamp reflects on how intertwined our lives are with those of our patients in rural communities—babysitters, role-models, etc. In other selections, we have talked about how our patients are often our friends and the importance of figuring out how to create boundaries. Post January 2nd. Here Dr. Loxterkamp explores the big fish in a little pond phenomenon of the local doctor.  For some physicians this may be a “fish bowl” experience where everyone knows his or her business in a way that is unpleasant. For other physicians this may be a one of the benefits of a small community where he or she can be a leader and a role model in the community, a mover and shaker, even politically involved. Others look up to him/her for his/her opinions, ask for money, support, etc. Some personalities may be better suited to the ‘big fish in a small pond’ experience. Think about the health professionals in the community where you are rotating—where do they fall on this continuum??

 This being elevated to a pedestal, the accumulation of power and prestige can go to one’s head.  The national media is filled with the stories of celebrities and politicians who “have fallen from grace, ” who think they can live by different rules. Dr. Loxterkamp does not use the word humility, but he hints at it when he warns about: “false hope of transforming the misery that parades past his or her door” and “I have saved only a few of my patients.”

We are reminded that although others may look up to us, we still live by the same rules as anyone else.  Like anyone else in the community we are human, we each have our strengths and weaknesses, and our challenges– we each must live by the same rules.

 Finally, Dr. Loxterkamp reminds us that as healers we have the opportunity and privilege of giving others support and comfort during the journey of life. This is a privilege. During the years of practice in a community one sees births, health, illnesses and deaths and all the ups and downs in between. He reminds us to appreciate the gift of the intimate view into the human struggle of our patients.

 Reflect on the role of the physicians or health professionals (nurse, pharmacist, health care administrator, chiropractor) in your community. What have you noticed about the respect they do or do not garner from others? How do they respond to the privilege of walking with others? Please do not share identifying characteristics.

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