A Country Doctor Writes:

It is the evening of Christmas Day. The day did not turn out the way I had planned. But I made it work. Those who follow me on Facebook know that I was one of the quarter million people in Maine who lost power Friday night.

Because I follow the weather, like most Mainers, I pulled my large, portable $1,300 generator out of my walk-in basement early Friday evening and connected it to the outlet outside. When, after several blips, the house finally turned dark, I just turned it on and manually switched from utility power to generator power for my little house and my Amish minibarn, infrared heater and all.

Christmas Eve, generator humming in the back yard, I fed the generator gasoline a few times, stashed more hay and water in the horse barn, made sure to replenish any water the horses drank, and went to town for a few extra groceries and to refill my gasoline tanks.

Some friends and neighbors didn’t fare as well as I did. Many don’t have generators. I could have installed a more permanent whole house germerator for $6,000 or more, but my portable unit runs everything electric on my little farm; I just have to fill’er up now and then. It is dual fuel, so maybe I’ll get a honking propane tank some day.

Feeling a little smug, I cherish the fact that for way under $2,000 I have what it takes to weather a storm like this without jeopardizing my horses or myself and my dogs. People around here spend much more than that on snowmobiles, ATVs and other toys. And then they freeze or have to check into a motel in situations like this one.

As Christmas Eve turned into night, it was obvious that I could not go to Bangor to celebrate Christmas Day with my children and grandchildren. I had to stay home with the animals and feed the generator. We were already planning for everyone to come up here for New Year’s so we will do another Christmas then.

Because I always think about Medicine, this incident made me again reflect on how, on the front lines, the practice of medicine is never predictable or straightforward. It is always full of surprises and obstacles that have to be creatively approached or circumvented. It always bothers me that the people who evaluate us have little or no understanding of the fact that primary care medicine is never predictable, that no two patients are ever the same, and the same patient may seem different on two different occasions.

Cookbooks are great learning tools, but show me a master chef who always follows a recipe.

I thought of watching a Christmas movie tonight, but I’m not yet feeling quite in the Christmas mood. Sitting by the fire, I instead decided to read from Pulitzer Prize winning Maine writer Richard Russo’s book, The Destiny Chief – Essays on Writing, Writers and Life.

In Getting Good, he writes:

Indeed, a good hint that you’ve entered the realm of art is that you immediately feel like giving up. You become overwhelmed by the astonishing complexity of the task, the sheer number of moving parts over which you have less – than – perfect control, the perversity of happenstance, the impossibility of predicting outcomes. In Life on the Mississippi, Twain describes learning to pilot a steamboat as an art because the river you steam up this week isn’t the same one you’ll navigate after a week of rains on your return trip. It’s still the Mississippi and eventually you’ll end up in New Orleans, not some unexpected city, but each trip is different because the river is. You have to know everything about it, know it without having to think, and be certain of your judgments, which will have to be made quickly on the basis of incomplete information, and at night you’ll have to do all this and more by feel. It would be nice if the river were a science because in the sciences there are controls, and if you’ve been careful your results can be replicated. What worked on Tuesday will work on Thursday, a claim that cannot always be made when what you hold in your hand is a paint brush or a camera or a pen. What was exactly right for your last painting will be completely wrong for this one. Creative people love to claim they know what works but in reality all they know is what worked. Fortunes are lost and hearts broken in that shift of tense.

Medicine, perhaps mostly in the muddy waters of primary care, is at least as much art as science. The number of variables is beyond at least today’s artificial intelligence to consider. Only a well educated and seasoned clinician has a fighting chance to do well by patients with messy histories, messy lives, multiple comorbidities and unclear genetic and epigenetic predictors of outcomes.

Once again, I find myself learning and borrowing from other disciplines as I muddle my way forward in the practice of primary care medicine.