Chapter 9
A Bit of Philosophy
There are many young men who enter the field of medicine strictly because of their love of people and with a definite altruistic outlook. They are going to be medical missionaries or work in clinics where the pay is low and the service is high. However, it is surprising how many of them become so involved and so fascinated with making money that they soon forget the humanitarian aspect of medicine.
I knew one young fellow who was very enthused about the good he could do when he had saved $100,000. He planned to return to his childhood home and let the folks know how successful he was, and become a philanthropist. That was when $100,000 was quite a lot of money.
His success was phenomenal. He entered a neighborhood where there was a shortage of doctors, and he worked every day of the week plus Sundays and holidays. Soon he was earning $100,000 a year. He delivered many babies, did quite a lot of surgery, some of it unnecessary, and saved his money. Finally money became a primary matter and the good of the patients a secondary one. He died one Sunday in his office of a coronary condition and didn’t live to enjoy himself.
However, there are some very wonderful doctors who are in reality unsung heroes. They have the welfare of the patients in mind, a heart full of love for their fellow men and never refuse to make calls on patients who cannot pay the entire bill. They even supply them with medicines free from their stock of pharmaceuticals.
Now that our Uncle Sam is obligating himself to pay all medical expense for the poor, it in a way breaks into the good that doctors do. The era of medical philanthropy is passing. The elderly poor have been such a pleasure to care for, yet the privilege is quickly passing.
Such controversy now arises about presenting patients before seminars and classes in medical school. Previously these patients were in for free care and they eagerly appeared as teaching patients. I don’t recall any of them objecting, for it was for teaching purposes and medical students had an opportunity to see cases that would not otherwise be seen.
Now, with Medicare and Medicaid, which makes teaching hospitals pay patients, there are some objections to appearing before a class. There is likewise a hassle over who shall treat the patient, and who shall get the fees.
Unfortunately there are patients who do not tell the doctor the whole truth, but try to make him guess. Some do not wish to divulge secrets, which are not important to the doctor, but are important in making the diagnosis. Others think it is a game to lead the doctor astray and make him guess. Still others are great at acting out their role. It is their only opportunity to make a great to do about themselves, for the doctor does give them his undivided attention for a while. Still, one cannot measure the meaning of any one life, no matter how humble it may be. Each life has a definite purpose, we know, and each purpose has a hidden quality.
The man in the family usually dies first. It is interesting in that we call women the weaker sex, but they most often outlive their men. There was an elderly woman telling me that one day that earlier she had belonged to a group of six couples in Long Beach. Every Saturday evening they would meet at the home of one of the couples for a social event of bridge, and refreshments. When she told me, all six of the men were gone. All the women were widows.
Since men are more helpless when left alone, that is probably a good thing that they go first. When left alone, either man or woman should marry again, not only for companionship when one needs it most, hut to prove he or she was happy in the first marriage.
The unhappiness we see in a doctor’s office is astounding. There is unhappiness with the work, unhappiness with the mate, unhappiness about financial affairs, and many children make their parents unhappy. This state of affairs leads many men to cocktail bars, and in turn, to more problems. Any man who intends to make a foo1 of himself has only to go to a cocktail bar to find a woman who will help him do so.
Insecurity among children whose parents do not get along leads to many frustrations which result in inability to do their school work and in many instances, to crime. We all have problems, certainly, but some of us handle the problems better than others. If children have help and advice in coping with their problems they learn to solve them in a mature fashion. Others turn to narcotics, alcohol, and to crime to keep up the habit. Parents do not spend enough time with their youngsters. No one has a bed of roses with continuous happiness. We would be poor, weak creatures if there were no obstacles to surmount and nothing to thwart our purpose, but we must learn to overcome our hardships maturely.
People who consult physicians. and ministers for advice sometimes have to reveal more than they care to. However, once the ice is broken and they begin to talk, the speech flows freely and they bare their entire souls. This outlet is good for them, usually. By getting the problem off their chest they can feel relieved and start all over again. After an honest confession the problem sometimes adjusts itself. Another thing such people can do is to write it all down in letter form, and then tear it up. This is the next best thing to baring one’s soul, and it is a great deal safer.
Many people require a listener, however. In the thirties there was a column of ads in the paper day after day by individuals who would listen to someone recite their woes and troubles, for one dollar an hour. I don’t know how these folks were patronized, but it seemed to last for quite a number of months.
Some people want sympathy rather than advice. They have their minds already made up. But sympathy does not help their cause. In fact, too much sympathy can aggravate their condition and create a cycle of self condolence.
Loneliness and unhappiness are the usual motives which cause a patient to search out a doctor as a good listener. Sometimes a woman has an ulterior motive. For example, the woman who said, “I’m no nymphomaniac, but I sure do like my loving” and eyes the doctor very cagily. Then there is the one who says, “I wrap my arms around my pillow and pretend it is a man.”
The way a woman dresses to go to her doctor may not seem important to her, but the doctor notices the way it shows her pride and self-respect. Some are so meticulous, paying attention to every detail, while others are careless and seem to care not a whit.
The most interesting things are people, and the greatest assets are life and time. Couple these with health and you have the greatest wealth in the world. One of the secrets of a great musician is health. He has concerts scheduled months in advance, and his health is of paramount importance. If he disappoints his audience his name is “Mudd.” He must be dependable, and the majority of successful ones are very dependable. We seldom hear of an artist’s program cancelled because of his health.
Older people vary a great deal. Some are very belligerent, always finding an excuse for complaints. There are “crackpots,” fighting for a cause and blaming frustrations of childhood for their present mental conditions, yet there were thousands of people who grew up in poor surroundings, and their lives were continual frustrations. They didn’t realize they were “creatures of injustice” because all the neighbors were in the same fix. We do know that early childhood treatment and frustrations can have a great deal to do with one’s adult life, but as a rule the poor are just as happy, or more so, as the wealthy, as children. If we depended on those who were wealthy as children, to keep our country going, we would be hard up for good citizens.
Then there are the dignified, older people who are making plans for travel, for helping others, who are optimistic and always looking forward. Their enthusiasm is revealed in their faces, and they radiate a glow of verve and success which is infectious. We also can learn a lesson from the foreigners among us. Almost without fail, they express far more enthusiasm about living in America that our American-born. Some of them have been through so much that they appreciate things about our country that we take for granted. They are hard workers, honest, patriotic and sincere and really make good citizens.
I have noticed that the older a fellow becomes, the more proud he is of projects he has participated in, like the Civil War veterans who enjoy telling and retelling of their exploits. Age seems to level people, too. Judges, doctors, machinists, and truck drivers seem so much more equal than when younger and following their individual pursuits. Put a fishing rod in their hands and they are of a common brotherhood.
There was an eighty-five year old man who came in one day and very seriously requested a low-cholesterol diet so he could live to a ripe old age. Then there was a ninety- three year old came in with a rose thorn in his finger. He had no other complaint, and had seen no doctor for many years.
It is surprising how many people have small differences among themselves, which seem to intensify with time. There was the man who was ashamed of his wife because he felt himself above her. He seldom went out with her because of his intense feelings. There was the woman who resented having her husband dress up when he went anywhere. She called him a dude, and vowed he was trying to attract the attention of younger women.
Most people enjoy retirement after they become accustomed to it. Sometimes it is difficult during the first six months to break the habit of getting up, getting ready and going to work, but soon they love the change in routine. One patient looked forward to his retirement for months. The time finally came, he had his party, watch, and the works. After about four months he was in the office and I asked.
“How is your retirement going?”
“These women at home are driving me crazy,” he said. “I wish I could go back to work.”
Older folks, outside of being lonely, are mentally honest, fair, kindly and grateful. They usually obligate themselves only for what they can afford and they pay their bills. Their budget is really lived up to.
Many go to a doctor just to have someone to talk to, because they are so lonely. There are now 17,500,000 people in the United States over sixty-five years of age, and the figure is increasing constantly; and they all have complaints, some so very trivial to us, bit to them they are monstrosities. Some have such a terrible fear of cancer that they wake up at night thinking about it. I had a man patient who came in time after time with an expression of fear of cancer, always of some different kind. The first time he was in was for cancer of the stomach and we disproved it by a gastrointestinal series (X-ray of stomach and upper bowel). Next time he thought he had cancer of the bladder, so we had a thorough examination, including the necessary X-rays. After every annual physical examination he always asked, “Do you find any evidence of cancer anywhere?” This went on for thirteen years and he is just as healthy now as earlier.
Patients are people, after all. They are the most interesting phenomena of all, and the variety is infinite. I have noticed that, as a rule, the better educated one is, the more he realizes what a huge field of knowledge there is and the more humble he is. The individuals who know little are frequently more aggressive and more brazen, which is probably the reason for their success, for not all successful men are well educated. The ones who brag the loudest usually have the least to brag about. We cannot all be good speakers, poets, millionaires, or musicians, but we can employ what talents we have and fill our lives with success in our own mild way.
At any given time, about one fourth of the people of the world are sick, or not feeling well. If we can keep happy and busy, we will not be among that fourth. Lack of love and attention probably are responsible for a great deal of illness among both the elderly and the young. This results in emotional disturbances, depression and loss of appetite. Not all old people we consider senile, are so. Many allow themselves to slip back into the immaturity they experienced in earlier days, so when the magic time comes to retire they assume a very dependent attitude. The result is that their children, who have enough guilt feelings, allow themselves to be used. These old folks, instead of being senile, are simply being immature and cagey. In order to grow old gracefully, one must start in his younger years. How old must a person be to be considered old? Many are the excited, interested, happy people in their eighties who are much younger at heart than some solemn, disgruntled men or women in their fifties.
Each day there are new decisions to make, and new problems to solve. The manner in which we make these decisions and solve the problems confronting us denotes the amount of maturity we have. Frequently a person can grow old but not mature. If we learn early that the two most expensive things we can buy are ignorance and leisure time, we shall live our lives more fully.
We say that all men are created equal, but the truth is there is a lot of inequality in the world. Look at India, China, parts of Africa, and East Asia. There are those who are born to starve, others to grow up in a stage of malnutrition which becomes chronic, with no possibility of enjoying good health and achieving happiness. It is very unscientific to assume that all are born equal. What a difference there is in the genes and chromosomes. Some people have something within which impels them forward, even in the face of obstacles, to invent, to lead, to become huge successes in life, while others are satisfied to be in a rut all their 1ives.
Some people are born to be doctors. They have a compassion that makes them superior to those lacking it. They can talk to patients, soothe them in terminal illnesses, and give the patients an opportunity to talk things over, which is sometimes better than any treatment he can give. This shows the doctor really cares for the patient’s welfare. The good doctor is the humblest servant of the person who needs his help. He should have an agape love (concern) for each and everyone he cares for and should show sincere happiness in the patient’s recovery. Sometimes, now, with the shortage of doctors, there is so much hurry and impersonal care that one really defeats one’s purpose and misses out on the real joy of medical practice. How fortunate we are to live in this generation of great scientific discoveries. At least ninety percent of the very effective drugs we use today were not available in the 1930’s.
Primarily the doctor was taught to do an excellent physical examination, and to use the laboratory to confirm his diagnosis. Now the first thing is to prescribe laboratory work galore, and then X-rays. These are frequently allowed to make the diagnosis now, instead of the doctor relying on his own judgment.
Each doctor has his own perspective and a different way of approaching a patient. Many are gruff, bossy and even insolent. Many want the patient to “know who is boss,” and some develop a very independent manner, which is accepted by some patients and is resented by others. Some, however, are compassionate, showing a great deal of empathy with the patient, who after all came to see the doctor because there is trouble, real or imagined, in the first place.
There was a man patient who had a slight stroke, and was directed to one of the well known specialists in the neighborhood. His blood pressure was around 190/140 which is high enough to be dangerous. This specialist said to him:
“This blood pressure is at a very dangerous level, and you may die anytime. You must go into the hospital. Otherwise I can give you no hope. In fact, I can’t give you much hope anyway.”
While there is life, there is hope, and this doctor practically took all hope away. This patient needed consolation instead of fear, and I’m happy to say he is still alive today, fourteen years later, because he didn’t allow himself to be frightened by the specialist.
Goethe said, “It is the property of true genius to disturb all settled issues. It may take even greater genius to settle the disturbance.”
Many issues are disturbed. There is frequently a group of dissidents creating a disturbance about some governmental or political idea, and they become so involved in creating their disturbance that they forget what the goal is that they are trying to reach.
Growing old gracefully really starts in youth. Very few individuals make a complete change of personality when they reach a ripe old age, except in the case of senility, in which case we must overlook them. They really can’t help it. Other individuals become so crabby and hard to please that the best thing all around is to put them in a “home” where they can be cared for.
We notice that there are many homes for the older people. Very few are kept with the younger folks growing up, but it really is a defensive mechanism. There is a saying that no house is big enough for two women, and women being so much more liberal and independent do not want their lives interfered with by someone else. In the days past, before Social Security and welfare, the old folks lived with the young married folks, but there was probably more unhappiness than we realized. The situation has now changed, so the young folks let someone else take care of the oldsters. In case the oldsters have become hard to live with, that certainly is best, but if they have grown old gracefully, they could be a great help to the younger ones. Still each case has to be determined on its own merits. Some old peop1e much prefer to be alone, but they all need love and attention.