Learning about human relationships and the art of medical practice

Learning about human relationships and the art of medical practice

An excerpt from Pet Goats and Pap Smears.

After two decades of formal education, today I’m finally set loose with real patients. It’the actual moment I’ve been waiting for my entire life.

We’re each assigned to a family doc for the month. I scroll down the list of third-year medical students, place my right index finger beside my name, slide it across the page, then read aloud: E. Sinks McLarty, Jr., M.D., III.

The next morning I find his office—a small nondescript building with his name on the side—and enter the waiting room, which features 1970s-style wood paneling, faded and covered with the grime of decades of cigarette smoke. Centrally located is a large oil portrait of E. Sinks McLarty, Sr., M.D., who opened the place nearly 100 years ago. I pass rows of empty chairs to the front desk, where I meet three bouncy women—all relatives of Dr. McLarty. I introduce myself to the friendly, frenzied group of chatty chart finders, then the garrulous gang scurries me down a narrow, smoke-filled hallway where I meet Dr. McLarty’s nurse, affectionately nicknamed “Olive Oyl.”

A friendly, slender, snappy-tongued woman with a gravelly voice, Olive Oyl chain-smokes at her desk. Her deep red lipstick and nail polish are the color of freshly clotted blood. She escorts me into a dimly lit room where I’m not at all sure I’m safe. There, on the couch, I meet Dr. McLarty—a seventy-year-old cowboy eating Metamucil wafers while puffing on a pipe. He wears Wrangler corduroys and sports a crew cut with some gray hairs shooting through. With his thick Texas twang, he slurs his words together around southern slangisms and medical anecdotes.

With pen, paper, and stethoscope, I follow Dr. McLarty around to see what I can glean from him. I’m immediately struck by his speech with patients. He calls all the men “pahdna” and all the women “shuga.” Isn’t that sexual harassment?

Dr. McLarty has no tolerance for big-government rules. When a patient needs a triplicate form signed, he snaps, “Well, now, shuga, that’s a bunch of horseshit!” or “I don’t give a ram dam or a rat’s butt!” While cursing, he signs the forms, gives one to the patient, and throws the other two across the room in a wad. “Hell, I’ll make toilet paper out of it one day,” he rambles as he tramps out of the room.

Dr. McLarty makes even the common cold an event to remember. “Okay, now, pahdna, let’s look in that there snoot. Ah, a little redness, nothing to say grace over. Let’s listen to your ticker while I gotcha here.” Slamming down the chart, he exclaims, “You’ve prob’ly got some of that damn crud we’ve seen going around!”

In the next room, an elderly woman complains of joint pain. His diagnosis: “You’ve got arthritis! Well, hell, you can see that. No need to pay for that, shuga. Now hold that cane in your left hand and tell Byron to give ya a damn golf ball to carry around in the right.” He didn’t cure her arthritis, but she looked like an avid golfer when she left.

After seeing a few patients in the morning, Dr. McLarty closes down for a two-hour lunch. We all squeeze into his office on the couch to watch soap operas. During a romantic interracial scene, they shake their heads in unison. “Oh, no! We don’t believe in that!”

So I offer the clan some of my chocolate soy ice cream and one gal gasps, “Oh, no! My husband wouldn’t like that!” Dr. McLarty puts down his Metamucil wafer and grabs a spoonful. “That’s pretty darn good!”

After lunch we’re getting ready to see a man named “Sunshine.” Before entering the exam room, Dr. McLarty pulls me aside and says, “This family’s been shot in the damn butt with bad luck!”

“What’s going on?” I ask.

“He got cancer. I’ve known a week, but gonna break it to him now.”

“Why didn’t you tell him last week?” I ask.

“If he lived by himself, I’d a told ’im right away this is how the cow ate the cabbage, but his wife, Lordy, ya couldn’t scrape her off the wall last night,” he rants as he trudges down the hall.

I gathered that Sunshine’s wife was extremely anxious.

We enter the room. Doc pats the old fellow on the shoulder and says, “Sunshine, now I ain’t gonna pull any punches by tellin’ ya we got a drug.” After a few cryptic sentences, he asks, “Ya get what I’m sayin’?”

Sunshine replies, “Yep! Lights out.”

That was the entire office visit.

Most of Doc McLarty’s patients are old white guys who have aged right alongside him. But this afternoon, we jump into Doc’s old pickup to see a young gal in the hospital. On exam, he notices her breast implants and asks, “Hey now, shuga, how long ya had these damn things blown up that way?” She answers politely and the interview continues without a hitch.

We only saw one kid that month. As the boy raced around the exam room, Dr. McLarty quickly warned, “Hey now, pahdna, get back up there on that there table. We don’t want ya to bust your gazoo!”

I’ll always savor my month with E. Sinks McLarty, Jr., M.D., III. I didn’t learn much about diagnosing or treating disease, but I learned a lot about human relationships and the art of medical practice.

I sure miss him.

So, after fifteen years, I track him down to thank him.

He answers on the first ring.

With my heart pounding, I ask, “Is this really Dr. McLarty?”

“Yep, this is Doctor McLarty. Who the hell is this?” he shouts.

“I’m a medical student you mentored long ago, and I just want to say thank you.”

“Well, thank you, sweetie, but I got cancer of the bladder and just had therapy today, and I’m bleedin’ like hell!” Before I can express my sympathy, he quickly blurts out, “What comes around goes around. Thanks for calling on me, but I gotta go pee again!”

He hangs up on me.

That’s it.

I never even tell him my name—not sure he would have remembered me—but I do get to thank him before lights out.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears.

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  • Katherine Levine

    Please get add Pinterest to your shares. I wanted to pin this on my Stories of Strength Board. Did share on Facebooks.

  • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

    What a very special and inspiring story. Thank you for sharing this.

  • PamelaWibleMD

    Thank you. Feel free to share or repost. It is on Facebook on my page. Never been on Pinterest, but maybe Kevin Pho (our physician social media expert) can figure that one out. Kevin?

    • ninguem

      Did you bring your sniper rifle in with you?

  • ninguem

    One of my first rotation docs, the nurse smoked…while pregnant……the patients smoked…….and the doctor smoked.

    In the exam room.

    I was lucky to get out alive.

  • ninguem

    White belt and shoes?

    String tie with leisure suit?

    ’cause I think I’ve met this doc, northern version.

  • Suzi Q 38

    Smoke story #1:
    I once took a doctor to lunch.
    As we stopped the car, he pulled out a joint.
    He politely offered me one to smoke along with him, as he didn’t want to smoke alone. Isn’t smoking a joint similar to smoking 10 cigarettes?

    Smoke story#2:
    My MIL had a very good friend that was a physician.
    Fairly close, but sadly he was her physician.

    They would get together at least twice a week at lunchtime.
    she would have a sandwich ready for him, and he would make casual conversation.
    After lunch, they both would smoke until he had to get back to his office full of patients. His wife worked at the office, so I never understood that whole relationship.
    MIL was his “smoking buddy.”
    This arrangement went on for over 25 years, until my MIL was diagnosed with lung cancer in 1984. She died 3 months after that.

    I have another physician smoke story (#3), but it involved a blind date in 1980.
    Enough said.

    • ninguem

      My same doc that smoked, with the nurse and patient, and all that, had an admitted alcoholism history. He was very upfront about it, lectured to my med school class about alcoholism and used himself as an example.

      He ran AA meetings……..out of his office.

      That’s what I call being upfront.

      The result is, you get a……certain patient population.

      But sheesh………the state Medicaid paid five dollars for a medical office visit. This was the early 1980′s. He showed me the books. Some of these old-line GP practices, they’d take you in the back, they’d show you the books, when they showed you how to run a primary care practice, they meant it.

      • Suzi Q 38

        Interesting. Nice that he could be upfront and help others.

        I had a friend that was a nurse.
        She was an addict.
        She would steal drugs at the hospitals that she worked at.
        Once she got caught, and they fired her.
        She just started all over again at a different hospital.

        Now that would no happen, as the controlled drugs are locked up and accounted for.

        Also there are stricter rules about reporting this sort of behavior
        to the state boards.

        We could even talk about doctors and nurses that are obese and eat pizzas and hamburgers at lunch.

        I like to eat candy, but my pre diabetes sugar level doesn’t like it, so I try to limit the sugar.

        As far as the alcoholism, I could see that.
        Especially if your job, any job, had a lot of stress.
        I especially like the AA meetings out of the office.
        This is a very confident doctor that obviously had problems that he wanted to fix.
        Good for him that he wanted to help others.
        I would respect him and for that.

        • ninguem

          Do the math.

          Five bucks a visit, practice was mostly Medicaid.

          Say 30 patients a day, and that’s very busy.

          30 patient x $5 x 5 day week x 52 weeks =$39,000 gross income. That’s early 1980′s. That’s assuming no vacation at all. Take rent and malpractice and nurse salary and receptionist salary.

          He had gigs with shifts at urgent care clinics and the smaller ER’s in the area. He was a state medical examiner. So salary wasn’t quite as dismal as it seemed, but dismal enough.

          He was one of the original pioneers of the freestanding ER thing in the 1970′s, what evolved into urgent care clinics.

          But alcohol took it all, his practice, his boat, his house, more important, his wife and kids.

          So, that scraping by was better than the alternative, which was death.

          • Suzi Q 38

            I used to wonder how doctors like this could make it.
            i did not know that back then, medicaid paid only $5.00.
            What does it pay now?
            Sad that he lost it all.
            Thanks for the real story.

  • Wy Woods Harris

    I will never forget the Dr. who put his pipe on the charts as a sign that we nurses could not touch them until he was finished with rounds and the break room was a smoke room. Thank the Lord for getting me my 40 + nursing years into a smoke free hospital campus!

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