A Country Doctor Writes:

Danny Ames was in for a Well Child Visit Friday, and I’ve been thinking about him all weekend. I had not seen him before; he used to see one of my partners, who retired last year. There are plenty of people named Ames in our community, but not all of them are related. 

Danny Ames turned out to be a very resolute young man, just about to enter the eighth grade. He told me he is living with his father in the next town, because that way he has a choice of High Schools. Danny wants to become a professional soccer player, and he wants to go to High School at a nearby private academy that tutors in students from towns without their own High School. 

He has spent the summer learning roofing. He told me with pride in his voice that his father has a roofing business. In the next breath he told me that since age seven he had lived with his mother, because his father went to prison. Now that Danny’s dad is out of prison, the two of them have become close again.

Danny is missing a big chunk of his left ear. He told me matter-of-factly that when he was four years old he happened to be standing behind is uncle, who was using a chain saw. The uncle swung the chainsaw behind him and cut into Danny’s ear. Danny remembered the whole incident vividly – the first two doctors he was taken to wouldn’t stitch him up, so he ended up at the hospital, the anesthesia didn’t take very well, and Danny screamed the whole time. 

Danny was alone in the exam room for his physical. His grandmother was in the waiting room with a younger child. As I went through the usual questions about alcohol, drugs, sex and peer pressure, Danny told me self-assuredly that he had been trusted to take care of himself since he was eight years old with his father in prison and his mother having to work two jobs to support herself and her two boys.

I rattled through the immunizations Danny might want to update, brought the grandmother in for signatures, but basically acknowledged that I was dealing with a very young adult. Danny had clearly not had an easy life up to this point, but he had the character to turn it all into something positive; he was proud of both his parents, he was learning a trade, and he had a dream. I know not many kids from around here become professional soccer players, but if anybody will, Danny Ames just might be the one.

Jeremy Doyle’s house is perched high on a knoll with peaceful meadows and a distant ocean view. I had been there a few times before, a dozen years ago, when our teenage daughters were friends. Tuesday evening I went there for my first house call.

Jeremy is a couple of years younger than I am and slowly dying from two forms of cancer. He has his family curse; I also tended to his brother, who died less than a year ago. Jeremy’s Hospice nurse had called earlier in the day and suggested it was time I went there.

The change in Jeremy since I saw him last was profound. He had been under the care of several specialists, so I hadn’t seen him for a few months. Now, with no further treatment options, Hospice nurses are going in several times a week. He is on a morphine drip for his pain, breathes through a tracheostomy and gets his nourishment through a feeding tube.

The last time I was there, we were on opposite sides of 40, he just under and I just over. Yesterday I was there to see for myself how we might change his medications to ease his final journey. Both Jeremy and his wife, Samantha, are rock solid. They have been through enough ups and downs in his cancer battle that they have learned to endure more than most people could imagine, and they have tackled each new obstacle slowly and methodically. Samantha has learned to do absolutely everything the Hospice nurses do.

Sitting in their kitchen in the bright early evening light with friends stopping in for a brief visit and a young dog at their feet, I clearly had the sense that Jeremy and Samantha were in the moment, accepting and appreciating each hour of life and relative comfort. The scene was peaceful, and somehow more significant as a sign of life than one of impending death. We went through his medications, checked on all the issues raised by the Hospice nurse, and I took care of his new medication orders.

As I patted Jeremy’s elbow when I left, I said “I’ll see you soon”. Both of us knew that “soon” might never happen.

Laura is about 25, a sweet kid with a doting husband, Mike. She was in the office yesterday to follow up on a weekend emergency room visit for vomiting and diarrhea. She wasn’t getting any better. Her liver tests were off the scale, but her pancreas numbers were pretty good. Her hepatitis profile was still pending. I got an urgent ultrasound on her to make sure she didn’t have her family curse – unusual and dramatic presentation of gallstones. This test was normal.

Today she was back for a follow-up visit. She wasn’t getting better. Her hepatitis profile from this weekend came back negative. Her liver tests from yesterday were unimproved from the ER visit. Overnight she had run a fever. She was vomiting more, her diarrhea was worse, and the pain was getting worse. She needed to go back to the hospital for some IV fluids and a CT scan.

Laura was alone in the room today. I asked if Mike was in the waiting room, which would have been unusual. No, her father had brought her, but he was waiting in the car. I must have looked puzzled. She said: “He’s a chiropractor, remember, and he has problems with doctors’ offices…”

I made the arrangements and Laura went back to the hospital with her father at the wheel.

I have had reason to think about physician-chiropractor relationships before; my brother-in-law is a chiropractor. We have never talked shop. I have always been a staunch allopath but have sometimes seen patients who were helped, dramatically, by chiropractic. Recently, Caleb, our horse with an unexplained limp, seemed to be very much improved after acupuncture and chiropractic treatments.

The practice of medicine in America is flavored by the malpractice climate. I have a form letter on my computer, stating that I as a patient’s primary care physician agree to authorize insurance payments to their chiropractor, but I don’t assume any responsibility for the chiropractor’s diagnosis or treatment.

When patients ask me if they should see a chiropractor, I usually answer their question this way:

“You wouldn’t ask your rabbi how often you should go to confession, would you? Chiropractic and allopathic medicine are like two religions. We don’t speak the same language and we use different tools. But even though our practices are different, we ultimately work for the same higher purpose, and it may be that our differences are smaller than we were taught. We don’t know enough about each other’s practices to make specific recommendations, but support you, our patients, in your pursuit of better health and wellbeing.” 

I wished Laura’s father had been more present as she sought allopathic care for a potentially serious, maybe even life threatening condition, and I wish my brother-in-law and I could sit down and talk about what it means to be in two different, yet similar healing professions…