The Doctor in Town
by Dennis Sinar
Fate, the mother of us all, guided me here in 1957. I drove a dusty 1950 Powerglide Chevy into town looking for a job. Cars parked at angles studded the four blocks of Main Street and shoppers crowded both sides of the street. Eventually, I found a vacant two-story building at the north end of town, a block beyond the established stores. Negotiations were quick. The owner needed a tenant, and the combination first floor office and second floor apartment were suitable for a businessman tenant who didn’t mind being on the edge of town. Location was not a problem because I knew people would come. It took a day to find a sign maker and hang my shingle above the door. Carl Jordan, M.D. was open for business. I was the only doctor in this small town.
In the late 1950s, a general practitioner was expected to be a caring, gentle, knowledgeable person who listened to his patients and most importantly, was willing to work hard. On the first day, people started coming with the usual illnesses, and in that first year, my practice grew steadily as I established trust. My patients were my neighbors and it was easy to remember all of their illnesses. I treated mostly common diseases in families and sat with other families for comfort when their people died.
My patients were black or white, rich or poor, ornery or not, and I made house calls. If a drunk wandered onto my porch on a Saturday night, he sat there until he was sober, then I saw him first when the office opened. My posted office hours were eight to five, five days a week, but that was only a guideline. If a sick patient knocked after hours, I yelled out the upstairs window for them to sit on the porch and I’d be down shortly.
I learned that the interview was the most important part of the encounter, a time to observe all the clues about what was troubling them. People needed to tell their story on their own terms and it was best to smile, nod, and listen as they talked. I remember a wife who was nervously waiting for my diagnosis of her husband’s illness. As she sat silently beside her husband, looking between us, rubbing her trembling index finger across the hair of her eyebrow and then repeating the motion on the other eyebrow. To hide his embarrassment, he looked straight ahead at the sunset print on the wall, studying the print and the color of the sunset. He was used to facing the setting sun in tobacco fields and his face was lined with crow’s feet. His right foot tapped, tapped on the floor to some rhythm in his head. The wife looked at her husband and then back to me, willing him to talk about his symptoms, to be truthful about his weight loss, lack of appetite, and the pains in his stomach. He was silent, not ready, so she told the story. I watched her hands and her eyes for clues as to what she needed. It was obvious that he had a cancer of some kind, likely terminal. He never looked at me. Before I said the words, she knew her suspicions were true, and her eyes asked what could be done. She wanted my guidance on the path from here to there, but he never stopped looking at the sunset print. Diagnosing cancer was terrible, but not difficult. Someone with a wasting disease, steady pain, or jaundice had the bad disease. Finding where the cancer was located was not important back then. People did not want to know the kind of cancer; they just accepted that it was cancer, an untreatable condition in their mind. Every day they stayed above ground was a blessing, a day to be used to work and provide for their family for as long as they were able.
In those early days, my hands were my greatest asset, warm, smooth, and neatly groomed. Someone told me that people didn’t trust a doctor with dirty hands and so I washed my hands after coming into the room so the patients knew they were clean. In the beginning, it was difficult for me to examine patients because I disliked physical contact, but when people complimented my gentle touch, I became more comfortable.
Examining a patient was like playing a fine instrument, my warm hands started well away from the tender area and slowly worked toward their particular area of discomfort. During the exam, I nodded often to encourage patients to add details to their story. If someone complained of pain in their chest, I’d gently palpate the back and front, feeling for tender spots. If I found tenderness, it was the end of my search and I knew what to do; if not, I’d listen with my scope and decide on something different. If their chest rattled, they went home with pills dispensed by the nurse from our back office supply; if their chest was quiet, they went home with the same pills, but a different colour. The results were the same—patients most often got better. Each of my capsules looked different, large, or medium sized and coloured blue, white, or bright yellow. It was easy to buy coloured double 0 wax capsules out of town and fill them with sugar. Placebo pills were common at the time, and as the nurse handed the patient their envelope of pills, she instructed them to swallow them whole, so they never tasted the sugar. I used simple medicines because they worked.
The mechanics of laboratory testing did not interest me; I was concerned only with the mystery and the manifestations of disease. My medical knowledge was refined by trial and error. On a back office shelf was my single reference, the Merck Manual. I consulted it with difficult cases and the pages became worn over the years. In most cases, the manual proved adequate. Most days I was able to puzzle out a patient’s problem using common sense. My treatments reinforced the placebo principle— examine carefully, treat with confidence, and expect a cure.
Surprisingly, their confidence in me was the most effective medicine – if a patient believed I knew how to treat their problem, their belief was enough; patients tried to get better because it was expected. When people heard my diagnosis, they nodded understanding, and symptoms that were unbearable before the visit, with my reassurance, became bearable. I had a nervous tic, rubbing my knuckles back and forth across my lips and teeth as I thought about a difficult case. The tic initially gave patients a start, but then eventually instilled confidence in my diagnostic skills. The tic helped solve a surprising number of vexing problems.
Vaccination of children was not widespread in the South. I learned that childhood diseases, whether in a rich child or a poor child, mostly improved in a day or two, and if the child did not improve, I sent them on to a specialist in the big city. In children, what looked like a cold might actually be a serious disease like polio or meningitis that could get much worse in more than a few days. Those were the times of the most severe cases of polio, widespread tuberculosis, and the worst of a handful of other severe childhood illnesses. Thankfully, those times have passed. When I sent the child to the city, the specialists appreciated the prompt referral and always let me know how things turned out.
Payment for my services was a challenge because few people had readily available cash. Most offered trades or asked for credit until their crops came in. I collected food, dressed farm animals, or canned preserves. Patients saved their best harvest for the doctor. If I took care of all three kids in a family for their colds, I might get a smoked ham; if a farmer’s wife had the vapours, the husband brought a few thick steaks. When I had enough food, I took handmade clothing.
In the practice of general medicine, people came during regular office hours with common ailments: colds, scrapes, arthritis, and fevers. Emergencies and house calls always came in the middle of the night for patients too sick to leave their bed. An emergency for a farmer had the same importance whether it was a cow in labor or his wife’s spells. Often I would see the wife and the cow on the same house call. In both cases, I prescribed the same pills, and more often than not, the wife and the cow got better. I saw joy, grief, and the loss of life, often in the same week.
Toward the end of a long day, I was exhausted and failed in my caring. The best I could do at those times was to follow the thread of their history, but no diagnosis came into my head. I saw the person in front of me as a skeleton stripped of skin or a blob of muscles that talked. When that happened, I asked them to come back in the morning for a fresh look. People saw my foibles and believed my words, either in the office, or when they saw me on the street and stopped to ask about some medical problem.
One morning, a car weaving down Main Street hit a man, and the patrons of the Starlight Grill had an excellent view of the accident. I was sitting at a table in the front window, looked out at the splattered man, and then resumed my breakfast, knowing the man was already dead and beyond my services. None of the patrons questioned my decision.
Through weeks, then years, I learned to appreciate the strength of the human body—the oldest to the youngest bodies—and how they adapted as they aged. It was common to see an old granny and then a newborn baby, one after the other in a morning, and the diversity of life amazed me.
There were many times when I went to a person’s home, often in the middle of the night. On one visit, the spouse opened the front door, nodded, and led me upstairs to their bedroom. It was a clean room, but infused with the smell of sickness. On the wall opposite the window, there was a huge poster bed with a white lace canopy. The patient, a man I had seen only rarely, was propped up in the bed, leaning against large feather pillows, his breathing so laboured that he could barely get more than a few words out without pausing. There was an odour of urine from the bed and damp washed sheets hung out the window to dry. By way of decoration in the room, hanging on a nail in the middle of the wall across from the bed was a crayon drawing of a man. Underneath the drawing in a child’s handwriting was: “To Dear Papa.” This man was Papa.
One hot summer afternoon, a woman sat in the office and told me about her husband: “That man is disturbed, sick you know. He’s never been all there, what with staring into space rather than looking me in the eye like a normal person, talking crazy sentences about the devil or someone following him or trying to poison him. He never tells normal things anymore, and people stay well away from him. I’ve never known for him to hurt anybody, but with crazy people, you never know when they’re just going to snap and go for your throat.” She went on in that vein for some time, and I found that letting her get it out was the best tonic, nodding, looking at her face, and listening with my hands crossed in my lap. Eventually, her tape ran out and she went back into herself. Our conversation continued, but she avoided my eyes and looked down at my hands, as if they would give the diagnosis and tell what she should do.
Then, one week, my routine changed. Odd feelings stirred in me, and I felt something alive moving deep inside my abdomen, tightening and squeezing, not yet pain but becoming pain. The feeling became worse and changed to pain in another week. I had examined enough patients to know the diagnosis, but not how long the disease would take. I knew there was no treatment, even in the big city. My nurse and I decided to close the office gradually over the next two months.
At home, I turned to thoughts of God and an afterlife. I became philosophical about the extremes of life, knowing that the boundary between life and death could be measured like the narrow path of a tornado, and like the tornado, my disease was unstoppable. My ego hoped that perhaps medicine might hold back that boundary, and that my will alone could determine the path enough for the storm to miss me. With each day as the pain increased, the division between life and death became more narrow, making me wonder about the next adventure. A week after the office closed, I sat in the sun on the front porch and looked at my hands. I was surprised at how bony they had become, how the flesh had stripped away. The knuckles were prominent, and the skin was stretched tight around every joint, yet my grip was still strong and my gentle touch was the same touch that so many patients recalled.
I had seen life end in suddenness, a merciful transition between living and then not, and I had seen the opposite—a slow, painful process of ending that fostered replaying, regret, and only a few pleasant memories. Which path would I prefer if it were in my power? My preference didn’t matter because the choice was made for me.
Perhaps my legacy will live on, but I doubt it. After I’ve gone, people will forget the good and only remember the bad in their dealings with me. My greatest secret would go with me into the grave. On my scout drive into town in 1957, I was looking for easy money, but instead found my destiny on a path that was irreversible. In the end, if people thought I was a doctor and helped them, then I was their doctor.