What Real Medicine Looks Like
The young doctor, a very slim, attractive man in his thirties, gently rolled me over on the big bed and began palpating my kidneys, spine and lower back. In one corner of my hotel room here in Sanur, Indonesia, stood the hotel manager and two female staff members, worriedly watching as he worked. It had taken the doctor half an hour to respond to their emergency call after I had been dropped off by motorcycle from my original hotel. They weren’t equipped to deal with my emergency.
Dr. Semara Putra spent nearly an hour checking absolutely everything, then plied me with a multitude of questions. What had I eaten recently? What were my activities? How long had I been sick? Where had I been? What could I have been exposed to in the last 48 hours?
This gentle, thorough man spent fully two hours with me before we identified the problem.
Three hours earlier I had been standing in another hotel a block up the street when suddenly my lower gut was gripped with unimaginable pain. In seconds I was bent over, grabbing my stomach, barely able to breathe. The two young men promptly found me a more upscale spot, then loaded me and my gear onto two motorcycles for the quick ride to the homestay where they nearly carried me to my room. I was in so much pain I was crying out in agony.
Seconds later two women were on either side of me, one working and massaging my back and the other holding my head with a clean towel, wiping the tears and sweat off my face. The cramps were so severe that I was sobbing, snot dripping on the pristine floor. It felt as though I was being stabbed repeatedly.
These kind women continued to work on me, with one of them rolling me on my side to rub my spasming belly with oil. There was no nausea or diarrhea, so I knew it wasn’t food poisoning.
24 Hour On Call Home Visits
By the time Dr. Putra had arrived, most of the pain had passed. I was able to make some weak-assed jokes with the staff whose hands I squeezed in thanks. Now these good people attended while the doctor looked me over.
For those of us old enough to remember, doctors used to make house calls. They’d show up with a big black leather bag, conduct a thorough inspection, provide medicines that they had on hand and make a return visit or call the next day. This Indonesian doctor not only had a full array of scripts, modern technology also allowed him to consult his resources by phone to double check his diagnoses.
What Ails You
We sorted out what had happened. After catching an evil flu from a fellow airline passenger two weeks ago, I had spent the entire fourteen days coughing non-stop. Despite the fact that my abs are rock hard from thousands of sit-ups, that kind of constant stress on the lower abdomen takes its toll. My belly muscles were spasming in protest- for nearly an hour- but the pain had been much relieved by the swift, effective ministrations of the two women. Dr. Putra left me with a new array of scripts design to help put a final end to the coughing and promised to return the next day.
Circling Back Around
That kind of extreme pain is exhausting no matter what shape you’re in. As soon as he left and my hosts closed the door by late afternoon, I went to sleep. In fact I slept until noon the next day when I awoke with a mean headache to the gentle knock indicating Dr. Putra was back.
Again he did a full exam, and decided that I desperately needed food. After giving instructions to the staff to make me some rice and bring fruit, he settled down to wait until he had watched me finish eating to see if I improved.
I did almost immediately. I had developed more symptoms, which we discussed and for which he provided an additional script. That was another two hours, part of which he simply sat at the edge of my bed and watched me doze, waiting for me to demonstrate that the food had done its job.
The Financial Toll
When Dr. Putra tallied up the bill, the damage was $230.00. That might cover the first five minutes of an ER visit in America, after the ambulance gouges you for five grand or more. Along the way I got to know that this good man had gotten married last July and his young wife was expecting their first child, a boy. He was beaming. We exchanged cards, as by now I was up and moving around. We took selfies. He admonished me to call should anything else arise.
Later, when I ventured out to find a mini mart for a yogurt supply, I ran into one of the women who had so kindly attended to me. She was beside herself that I was better, and I got gifts for all involved.
What We Have Lost
This episode, while painful, was a reminder of what so-called “modern medicine” has lost over the years. Medicine is a hands-on business. Healing involves touch, a lot of it. In a world where doctors are justifiably terrified of lawsuits, they err on the side of extreme caution. This has caused our caregivers to stop touching and start prescribing ( I won’t begin to address the big pharma issue here) rather than listening with their hands. The great intuitive wisdom of a pair of trained hands, eyes, ears, and heart has been sterilized and compartmenalized not only out of fear but also by a predatory system that rewards speed rather than actual doctoring.
Having people- complete strangers- rush to your aid when you are in extremis has an immediate healing effect. Being cared for by a truly hands-on doctor who takes however long it takes to get you well is a prescription that few medicines can surpass.
In some unknowable future, long after my death, someone is likely to revive the practice of home visits by doctors, not just attendants who change the sheets and help with baths. How that will look is hard to imagine. Given the extraordinarily high rate of suicides among medical professionals (300 to 400 per year, higher among women, afsp.org), I strongly believe that something has to change. Most docs want to be in the business of healing, at least starting out, and our current system doesn’t allow them to do so. Add to that the predatory nature of unscrupulous patients with a bank of ambulance-chasing lawyers, it’s no wonder that the system has produced hands- off automatons more at ease with pill pushing than the intimate nature of real healing work.
I have had my share of run-ins with bad doctors, lazy specialists and incompetent care providers. That has made me suspicious, as well as determined to know as much as possible going in the door. But before blaming everything on the physicians themselves, we also need to question the forces that created the Frankenstein’s monster that is our health care system. Greedy patients eager for an easy payout, greedy lawyers only too happy to sue, greedy pharmaceutical companies eager to get us addicted, greedy insurance companies that feed off both physicians and patients, a system incentivized steadily worsening health vs, prevention and an all-too-easily purchased greedy Congress which changed the laws to allow all this to happen.
My doctor here in Sanur was a stark reminder of what real doctoring looks like, as well as the power of caring human touch offered selflessly by members of the cooking and cleaning staff. I was graced by this experience, as I most always am when I periodically have difficulties overseas.
My boyfriend wrote asking me if I had a “proper doctor.” While I know what he meant, the truth is that I often get better care overseas than at home. Real doctoring is underscored by tenderness, care, a loving concern. Those are telegraphed through touch, words, and the sheer presence of the healer. We as a society have in too many ways robbed our caregivers of their ability to heal. And that is in part why we are losing them.
America doesn’t fare well by comparison in the world (see www.Medicaresupplement.com, Healthcare Across the Hemispheres, Analyzing Healthcare Resources and Utilization Around the World). Our infant mortality rates are appalling for a country with our knowledge (Washington Post, September 29, 2014, by Christopher Ingraham). We lag behind 27 of the other wealthy countries in this category alone. Some 440,000 thousand die each year in hospitals for reasons ranging from gross incompetence to overmedication to misdiagnosis to benign neglect.
We don’t know how to doctor any more. We primarily medicate and push often unnecessary and expensive procedures. And we are an increasingly sick population, desperately in need of caring care.
And One More Thing…
When Dr. Putra left today, he got right in my face.
“Eat,” he said, wagging a finger in my nose. “Lots of water. Get up and move around.” Then he smiled, like the sun rising.
That’s good doctoring. I’m already much, much better.