R. Wieder, M.D.
is strange how over 26-years practicing general medicine in Spartanburg
County, South Carolina, just a few office visits that were so meaningful
for me from my patients will remain as very precious memories that I
will carry to my grave. The names will remain confidential but if they
ever read this essay, I trust that they will come to know how very dear
to me those visits were to me and still are.
A physician in the United States is trained in anatomy, physiology,
biochemistry, pathology and the etiology, diagnosis and treatment of
disease processes. The modern physician learns to appropriately provide
certain chemicals, medicines, to combat these diseases to cure the patient's
illness. Thank God the outcomes are usually positive. There is very
little, if any, importance given to learning to bond with, or more aptly
learning to love one's patients. This has led many to see their doctors
as aloof, uncaring and viewing the patient merely as a disease process
to be probed, poked, prodded and cured. In reality the patient is a
living, breathing, evolving creation of the Creator. They - all patients
- bring to the examining room an entire lifetime of differing circumstances,
beginning with genetic inheritance, or course, and overlaid with childhood
memories, both good and bad, relationships with others involving love
and hate, differing levels of education, differing levels of understanding
of just how their bodies function, personalities that differ in temperament
from complacent to pathological ambition, from grouchy to compliant
and alertness to dementia. It is one of life's greatest experiences
to be a physician and meet so many of my fellow men who differ so much,
yet, are all human beings in the end. It makes me realize more than
any scripture or sermon that surely a benevolent God does exist, and
believe me, I have felt His presence in my examining rooms on many occasions.
For many years I was agnostic in my views but science has brought me
closer to that ultimate creative force - the Star- Maker - than any
religious service I ever attended.
Fortunately, my training at the Medical University of South Carolina
in the most beautiful of American cities, Charleston, did its very best
to instill in all its' students to remember to treat the whole patient
- not just his or her disease - but the whole patient as a unique and
beautiful living being. In fact, all of us students heard that term
"the whole patient" so much that it almost became a weather
beaten phrase - almost I said, not quite. I am still truly amazed at
medical meetings when I run into my old school mates at how caring they
all seemed toward their patients. For example, and I believe he will
not mind me telling you of the experience and name the names, Dr. Robert
(Bob) Scarpato, a classmate of mine and a man whom I hold in the highest
esteem, related a house call that he made to those of us sitting around
a table. Bob is a vascular surgeon/cardiologist in Hyannis Port, Massachusetts.
He was taking calls for another physician when his beeper went off and
he answered it. He was stunned to learn that he was requested to come
to the Kennedy compound in Hyannis Port, Massachusetts. Arriving at
the compound, he was met by a guard and asked to identify himself. After
the establishment of who he was and why he was there, entrance was allowed
and he drove up to the mansion itself. Knocking on the door, he received
no answer. The door was slightly ajar, so he pushed it open slowly.
Upon entering the foyer he noticed a large array of photographs, some
recent and some of the distant past of the Kennedy clan. One thing caught
his eye - a framed letter from a young school-age child to his mother,
Rose, and was signed in childlike letters, Jack.
Bob said that his skin became goose fleshed and a swelling of tears
came to his eyes. He was literally awestruck, by the history surrounding
him and it struck him how fortunate he was as a physician to experience
such a house call. Composing himself, he wandered through the house
and heard noises coming from the kitchen. There he startled several
cooks going about their duties. After introducing himself, he was taken
to a bedroom to examine the patient. At that point in telling me the
story, Bob choked up again. In retrospect, to the best of my memory,
he said, "Dick, you cannot believe the feeling that came over me
when I entered the room and there, sitting on her bed, was this woman
of such great beauty, intelligence and grace that I was totally overwhelmed."
He was in the presence of Rose Kennedy.
He did not say, nor did I ask, of the nature of her problems that evening,
for I know how much Bob respects patient confidentiality. I wish now
that I had given him a hug, for I could see the feeling of awe on his
face to have been privy to such an experience that he would never have
had, had be not been a physician. Dr. Robert A. Scarpato is a man of
great knowledge and humor, equaled only by his great love and compassion
for humanity. He can best be described as a loving old country doctor
in surgeon's garb. It is a privilege to be called his friend and colleague.
I, on the other hand, have never in my years had the privilege to treat
such a famous and gracious human being as Mrs. Rose Kennedy, but I do
have some marvelous memories of my own.
The first visit was quite embarrassing to me, my nurse and the patient
herself. In Enoree, South Carolina, a small mill village in southern
Spartanburg County, I had a solo general practice for eight and one-half
years fro 1975 to 1983. My office was a small building owned by Inman
Mills, who literally had built the town over the years. One examining
room was about eighth feet long by four feet wide. Between the examining
table and the medical cabinet, on an opposing wall, an area of about
18 to 20 inches was allowed for me to stand at a table and examine my
patients. A very attractive young lady had come back for a recheck,
for which I had treated her ten days earlier. My nurse, Mrs. Virginia
Sakalaris, escorted her into the room, took her vital signs and prepared
her for my recheck exam. Virginia informed me that the young lady seemed
to be very upset. I entered the room, followed by my nurse and stepped
in front of the patient - remember that this was a tiny room. The patient
has her blouse pulled out and unbuttoned but held closed by the tail
of her blouse. I asked how she was feeling. At that moment, her lower
lip began to quiver and her eyes began to water. She reached high on
her blouse, flung it open, thrust her bare breasts in my face and screamed
"That antibiotic you put me on shrunk my tits!" Startled,
I fell back against the metal cabinet rattling speculums and glass jars
so much that it sounded like a tornado had hit the building. My nurse
fell back against the light switch pitching the room into total darkness.
In a brief second or two - that seemed like an hour - Virginia turned
the light switch back on. I was read as a beet, the patient was crying
and Virginia lost it completely. Then we all broke out laughing so hard
that we were all tearing. "Honey," I said, "There is
no antibiotic that will shrink your tits." I tried to convince
her, but to this very day, I do not think that the young lady believed
In order to understand one of my most memorable office visits, one must
be aware of what the practice of medicine has become. There was a time
when a doctor left his training to go into private practice with the
ability to decide how and with what to diagnose and treat his or her
patient. I pity the newer physicians coming into his field, for they
will never know the joy of making one's own decisions. The insurance
companies and especially HOMs want the public to think that they are
based on the idea that all doctors and all hospitals are out to bankrupt
patients by greedily over-medicating, over-testing and performing needless
surgeries. I merely ask you to trust me when I say that 98% of all doctors,
nurses and hospitals have always done their best to give good, competent
and reasonable care to the American public. Yes, some
doctors seem aloof and at times uncaring, but
hospitals and allied health professionals must give their very best,
because, if they do not, some lawyer will sue their ass off. HMOs developed
formularies; lists of drugs that they will pay for and ones they will
not pay for. In other words, businessmen fresh from the business colleges,
aided by salaried physicians on their payroll, decide what is best for
the patient. I have known many of my patients for 26 years. Based on
their particular needs, I may pick a given medicine to treat their needs.
But those businessmen and women, in cahoots with certain physicians
- Who have never met my patients and would not know them if they walked
up and spit in their face - decide decide what is best for them. This
really sticks in my crawl! All amoxicillins are not the same. All ACE
inhibitors are not the same. The HMOs prefer generic drugs in all cases.
The difference in medications largely lie in their release mechanisms.
An antibiotic and ACE inhibitor may be touted as once a day medicines.
But in a patients system, some, but not all, generic drugs may release
all of their substances too quickly, or too slowly and thus not give
the patient the degree of required. It does a patient no good at all
to use substandard medication. The HMOs tout generics to save the patient
from paying higher co-payments, to save the patient money, to keep costs
down. Name brand drugs are more expensive, but the pharmaceutical companies
spend millions of dollars over many years to develop any given name
brand product. When medical patents are granted, the research facility
is given a chance to make up their cost and make a profit. After all,
our economy is a capitalistic one. But, in the long run, this process
has brought the vast majority of our populous a better standard of living
than any other nation on earth since the dawn of history. Almost every
time I order a test, scan or an MRI, I need permission from businessmen
and women, who live hundreds, maybe thousands of miles away. In nearly
every case my decision is denied by these people. They want me to use
a less accurate, cheaper test. There is no test for a specific purpose
that can tell me more about my patient's condition in certain cases
than a CT or an MRI. The HMOs do not care about diagnostic accuracy!
They are trying to save money, at times,maybe at the expense of my patient's
life. In fact, HMOs use as their basis: keep costs down. Quality medical
care is not cheap. It never has been, and it never will be.
Most HMOs require that a doctor, desiring to admit his patient, must
first call the home office to obtain permission to admit their policyholder.
Remember, these people making the decisions are not in the emergency
room, looking at and touching the patient. They are not reviewing the
lab work. They are not reviewing x-rays. They are off in some other
city or state counting their profits. They are not seeing the fearful
look in the patient's eyes who does not know what is happening to them.
They have no idea how maddening it is for the physician to tell his
patient, "you need to be in the hospital, but some SOB in New York
or some other home office does not think so; now, I can go ahead and
admit you, but the insurance company will not pay anything on your bill."
The patient is left to figure out if it is worth a huge hospital bill
for them to go into the hospital, or go home and possibly die. The patient
may also be thinking that, "my doctor must be a jackass and does
not know what he is doing if my insurance company will not let him admit
me." Whoosh, there goes all of the trust that a doctor has built
with his patient.
Please understand that these restrictions are absolutely maddening to
the doctors in America. It is frustrating, stress inducing and cripples
the thinking of all American doctors.
Here is the hooker: Here is the kick in the butt! The CEOs of the HMOs
in this country receive salaries and compensation ranging from $3,000,000
to $54,000,000 a year! This is a matter of record. It make me think
that a white collar mafia is in charge of American medicine.
If the companies do decide that the doctor can admit a patient, each
diagnosis that they approve for admission is granted "X" number
of day to get them in, get them well and get them out!
Keeping all of this in mind, I go to work each day to try my damnedest
to give my patients the best care I can and still stay in the mafioso's
guidelines. One particular day I was in a terrible mood, overworked,
p.o.'ed at several letters of denial recently received regarding procedures
I needed on some of my patients and ready to bite the next person's
head off that even spoke to me. I reached up to grab the chart from
my examining room door. Glancing quickly at it, I could see that a five-year-old
boy named Jonathan had a fever and sore throat. With furrowed brow,
clenching jaw and heart racing, I entered the room. There on the examining
table was an adorable boy, sandy blonde hair, blue eyes, and perched
on the end of the table leaning forward, on his hands. Now, I had seen
this boy several times before and he is a very sweet little kid. I quickly
perused the progress note sheet to check his vital signs and review
the nurse's notes. Then I glanced over at his face, He was grinning
up at me. Then from his lips he said, "Dr. Wieder, I just love
you." For a split second I froze, , then unable to control it,
broke into uncontrollable sobbing and ears dripped down my face. I dropped
the chart and put my arms around him and kissed him on top of his blonde,
fluffy head. I turned to his mother and through my embarrassing sobs,
told her of the absolutely horrible day that I was having - of wanting
to kick butt, throw my office chair through the window, stomp out and
never come back. Then from the heart of a five-year-old boy, God let
me know that I was performing the dream that I had always dreamed- being
a doctor. Through all of the crap governing medicine today, it is still
the most rewarding profession a human being can enter. The reward is
not money, status or a big fancy car. The reward is the thanks and love
of a grateful child or an older patient who may say as he or she leaves
the room, "thanks, Doc."
Two other visits that I will recall are very similar in their content
and happened within days of each other.
A woman whom I had known for nearly 25 years as a patient came to my
office because she was having problems adjusting to her father's death.
He died of metastatic cancer at home with her at his bedside. She had
been very close to her father throughout her life. When his cancer had
been found, there was still a lot of hope that he would beat this thing
and recover. Time proved otherwise. When it became clear that he was
not to survive, she went through a period of denial; Thank God he was
going to make it! Her father was not going to die! Then his physician
referred him to Hospice. Now, if there are angels in human form, it
is the nurses of the ancillary staff that make up Hospice. They are
called in at the end of life, not only to care for the dying patient,
but especially to assist the family of the patient. They are, in a word,
wonderful! Now this woman's mother was in the early stages of alzheimer's
so it befell Sandy, as I will call her, to be the strong one in dealing
with her father's death.
Sandy said that her father had once told her never to put her mother
in a nursing home and to look after her until she passed away. This
was causing Sandy a great deal of grief as she knew, to well, what alzheimer's
will lead to. Well, Sandy was told by Hospice that sometimes the death
of a person can be hampered and even made harder for the dying patient
by the family constantly reassuring the person that everything is going
to be okay, you are going to be all right, when in fact I believe very
strongly many dying patients are well aware of the impending end. They
can be uncomfortable because they do not want to upset the family members
that seem so confident that recovery is just around the corner. I also
think that many dying patients would love to say "look, I am dying,
help me with it, be there for me." It is far more beneficial to
that patient to let them know that the family is aware, though saddened,
and it is all right to let go. Sandy's father had an old dog that slept
on his bed every night. Now that he was home from the hospital surrounded
by all of this strange equipment, the dog stayed true to his master
and remained in his spot every day and night at the foot of the bed,
nestled against his master's leg.
One evening Sandy was sitting at the side of her father's bed, talking
quietly with him even when his eyes were closed. He would pass in and
out of a fretful and painful sleep, perhaps a sleep induced by his medication,
but she kept talking in a quite voice relating memories. Suddenly, the
dog arose and began furiously running around the room. Her father opened
his eyes, staring past her toward the foot of the bed. Sandy was puzzled
by the dog's behavior and when she looked back at her father, he had
raised a diseased weakened arm and was pointing to the foot of the bed.
"Do you need something, Dad," she asked? She Looked in the
direction that he was staring and saw nothing. "Do you want mother,"
she queried? He shook his head no and pointed again. "Is it the
dog?" Again, he whispered no. Suddenly, without thinking, she asked,
"Dad, is there an angel in the room?" He answered with an
affirmative nod of his head. His arm slipped back onto the bed. She
took his hand and whispered, "Day, it is okay, you can go,"
and with that he peacefully breathed his last; he was gone. Sandy then
slipped her face down into her hands and wept. I felt in a sense that
her tears of sadness that he was gone, mingled with tears of grateful
joy that she had been able to share this last precious moment with him.
It was truly a beautiful moment for me and I arose and crossed the room,
knelt down beside her and put my arms around her shoulders and whispered
to her. All I could say was to thank her for sharing with me, her doctor,
this divine moment in her life. I knew at that second that this was
an office visit I would never forget and I told her so.
Karen, as I will call her, came to me in March of 2001 stating that
she was depressed. She was not eating well. She was not eating well.
She was not sleeping well. She was losing interest in life and having
crying spells. Her menstrual periods were becoming holy hell for her.
After a brief discussion of depression and a cursory exam, I started
her on Sarafem 10mg. a day. This is a remarkable new product marketed
by the Eli Lily Company for PMDD. PMDD is an emotionally trying condition
for some women related to estrogen changes in their cycle among other
things. I instructed her to go to 20mg. a day after the first week.
She returned to my office in mid-June 2001, crying and telling me that
nothing was working. She did not know what to do. She was at the end
of her rope. I discussed other alternatives to Sarafem, trying to bolster
her with the fact that it was not right for her. Her marriage was sound,
her job was stressful, but then what job isn't? Then she really cut
loose with huge sobs, so much so that she could barely speak. Then,
she blurted out that her father had not eaten in two weeks. I asked
what was the problem? She finally calmed down at least to the point
that she could speak. Her father had been diagnosed some time ago with
prostate cancer. He had been doing well. Just a few weeks ago his urologist
had been hopeful that things would be better. The family was overjoyed.
Then, only a few days before her visit to me, she was at work when she
received a phone call that her father was bleeding out of his mouth
and was being rushed to the hospital. She rushed to his side. Later
that day, the family learned that his cancer had returned with a vengeance.
It has metastasized to his liver, lung and brain. He did not even know
who Karen was at times. She was devastated.
I suddenly realized how wrong I had been last March. Here was a woman
trying to understand the great changes that were taking place in her
life. Everything was happening so fast. She was not depressed, she was
grieving horribly and I had not been astute enough to be there for her.
Depression is one thing. Grief is another thing entirely. There is no
medicine for grief, only time, and I had missed the boat. For several
seconds I did not know what to say. The doctors and nurses had told
her and her family that there was just no hope. He was in the final
death throws of his life, and a brief one at that, being in his late
Thirty something years ago her father laid down in an intimate moment
of bliss and made love to her mother and brought Karen into her own
world and life. She carries half of his genetic pool in every cell of
her being. She could feel down, even to the chromosome level that something
in her too, was dying. I believe that some mechanism not yet known to
medical science, something occurs to us at the cellular level when a
parent, sibling, child or even any blood relative dies. And to a slightly
different sense, if the death occurs in a spouse, in a special friend
or even in a stranger, for all human beings are connected together by
the human gene pool. We are all truly one. Anyway, maybe that is the
difference between depression and grief.
And with Karen, as I do with nearly every one of my patients who has
lost or is about to loose a relative or very close friend, I recommend
a book entitled " Life After Life", by a psychiatrist named
Dr. Moody, who did the first true investigations into the near death
experience. It was a book, which I read 25 years ago, that led me out
of my misty world of agnosticism towards the light of my creator. In
telling Karen about this book and describing some of the cases related
there, her entire mood changed. She began to smile, her tears stopped,
then she related to me the story of her friend Dawn. She and Dawn were
the closest of friends, sharing their innermost secrets with each other.
In fact, they both had vowed that if anything should happen to either
one of them and if either one of them would bear any children the survivor
would promise to look after any of those children. Oddly enough, both
Karen and Dawn shared a very similar dream on one occasion. Dawn had
confessed to Karen that she had a horrible dream that someone had died
tragically. She had gone to the hospital emergency room. As she approached
the body she was unable to discern the face and so she could not identify
Karen eventually gave birth to a daughter. One evening Dawn and her
boyfriend were visiting at Karen's home and saw the baby for the first
time. As the evening progressed, Dawn and her friend left in his car.
Moments later, Karen heard what she thought was an automobile crash.
As it turned out, two blocks from Karen's home, Dawn was killed.
Karen's daughter is now 6 years old. Not too long ago, Karen put out
a framed picture of Dawn onto a table. Seeing it, her daughter rushed
up and said, "Mama, Who is that?" Karen responded by saying
that was a picture of Dawn, a very dear friend. Her daughter's eyes
widened and she turned to Karen and said, "She is my friend too,
she is always with me and says that she will always look out for me."
Karen said that this just absolutely flabbergasted her. One evening
later they were passing a cemetery while driving through town. Her daughter
looked out the window and said, "That is where Dawn lives, but
she is here with me now." Both of us just stared at each other.
It was obvious at this point that the office visit was drawing to an
end. Both Karen and I had dried our tears and we were both...just kind
of giddy, and we were giggling. It had been a catharsis for both of
us. I wrote down the name of the book and author and Karen promised
to buy it and read it. This visit was on Friday morning, June 22, 2001.
I was off that Friday afternoon and weekend. I can honestly say, as
God is my witness, that was the most joyful weekend off I have ever
had. I was ecstatic. I was walking six inches off the ground. It was
the very afternoon that I felt compelled to begin this essay. It is
a day that I know that I will never forget.
I have just stopped and read what I have written so far, making a few
corrections. I was adding in words I had forgotten when it struck me
like a bolt of lightning! Why these three office visits in particular
(there are so many beautiful moments that I have shared with patients)
but these three...why?
I believe is is because that in these visits, I too had received a healing.
A cure. I had never thought of my patients healing me! After all, I
am the trained healer. And yet, I now understand the full import of
something said a long time ago. It has a whole new meaning for me now...Physician,
heal thyself. For in some metaphysical way, when we reach out to help
another, we receive help ourselves. When we can uplift another, we uplift
ourselves. Do unto others, as you would have them do unto you. Whatsoever
a man soweth, so shall he reap. These patients had unknowingly reached
out and touched me by their situations. When in a moment of extreme
frustration, resentment and anger, an adorable five-year-old boy told
men that he loved me. He made me realize how petty I was being. He made
me realize again what a marvelous life I had in realizing my childhood
dream of becoming a doctor. The two women trying to come to terms with
the losing of their fathers had finally brought closure to me. My grandfather
John "Cap" Wieder died in June of 1947. That was my first
experience at losing a loved one. I remember it as if it were yesterday
when my sister, Libby, came running outside to the sidewalk where I
was watching cars go by at 1507 Spring St. in Parkersburg, West Virginia,
"Grandpa Cap's dead," she kept screaming it over and over.
I turned to run back into the house where we lived. The entire scene
remains blurry in my memory because my eyes were full of tears. I did
not understand at the time just what "dead" was, but somehow
I knew that I would never see Grandpa "Cap" again.
My father, Maj. John M. Wieder, whose death hit me harder than any death
I have ever experienced, died in the wee hours of January 27, 1997,
at approximately 12:30 a.m.. My dear stepmother Dotty, called to tell
me of his passing. At that moment I felt as if an eight-pound cannon
ball had been fired through my chest, leaving a hole that would never
be filled. My father served his entire adult life in the Military. He
enlisted in the United States Army in 1939. He joined the U.S. Air Corps
at the end of WWII and took his flight training at Randolph Field in
San Antonio, Texas. I have quite a few memories of that time, 1946,
because after that he never really lived with us again as a family.
My growing up was largely without him. Memories that should have filled
my heart where that cannon ball hole was now never to be filled. And
until that Friday afternoon, June 22, 2001, when two of my patients
who had lost or were losing their own fathers, that date I swore I heard
my dad say, "See Dick, I told you that everything would work out
well." He died a noble death, strong and unafraid. My brother,
Steve, who was with dad at his death, told me later that he had never
known anyone in his life that had faced death so nobly and so strongly
as my father. Totally unafraid, dad had turned to Steve that night,
saying that he had lived a full life, he had loved a lot of people and
he hoped that a lot of people had loved him. He could not understand
why God had yet to call him home. His only hope was that God would take
him soon. Shortly after those words, my father died.
Libby, Steve and I are now the old guys of our family. At future reunions
of our clan, we will be those old gray haired people who slip quarters
to nieces, nephews and grandchildren. Hand out wet sloppy kisses. Have
to be helped to our feet. And talk of folks passed on that none of the
children there will ever know. It will be a wonderful feeling to be
at that stage of life.
Those three patients have healed me of my fears, helped me to come to
terms with the death of my father, and allowed me to re-attain my dream.
I have but only one wish- only one dream- only one hope in my life and
that is, like my father before me, as did the quarry slave in the poem
"Thanatopsis" at my death be..."soothed and sustained
by an unfaltering trust approach thy grave like one who wraps the drapery
of his couch about him and lies down to pleasant dreams."