An Easy Keeper

My last patient the day after Thanksgiving wasn’t happy with her two-pound weight loss. Everyone else who got weighed in that day had gained some weight, and each person had an excuse.

Cheyenne Mott is a striking young woman of twelve, going on seventeen. She has some of the features of her tall, reddish-blond father, yet seems like a spitting image of her dark, fiery-eyed mother. Like both of them, she is big-boned, but unlike her concrete-laboring father and her highly disciplined mother, Cheyenne has not been able to keep her weight under control.

Cheyenne has been on antidepressants for a couple of years. I have known her parents for years, but her for only a few months. It quickly became clear that her weight is her biggest issue. Last year her parents sent her to a camp for overweight girls, and during a few short weeks of strict dieting and rigorous exercise, she lost an impressive twelve pounds, yet gained it all back very quickly.

We talked about her efforts at self-discipline and her two-pound weight loss over the Thanksgiving week. She wasn’t able to see losing two pounds as a modest victory, but thought of it as a frustrating experience.

She pointed out that other girls eat more than she does, and are thinner. “It’s not fair,” she exclaimed. “I can’t even look at food without gaining weight,”

I tried to reach through her frustration.

“You are what we call an easy keeper,” I began. “You have a genetic ability to survive starvation, and that may have been a really great thing a thousand years ago, but now it means that if you eat like everybody else you will somehow gain more weight than they do on the same number of calories. And if you cut down your calorie intake, your body will slow down enough so you won’t lose as much weight as other people do when they go on a diet.”

She rolled her large, deep-set eyes.

“It’s like everybody else drives a Hummer with a 32 gallon tank and you drive a Toyota Prius that holds 12 gallons. What happens if you try to put 32 gallons of gas in a 12-gallon tank? It overflows, and when that happens it doesn’t matter if you think it’s fair or not, it’s just the way it is!”

She nodded with understanding, and I continued: “You’re just more fuel-efficient than your friends, and that can be a good thing in some ways, but it means you can’t keep comparing yourself with them,” I repeated.

She seemed to get it, and her mother acknowledged how hard she always had to work to keep her own weight in check, yet she threw in: “So you don’t think there is a medicine that could help Cheyenne?”

“No,” I answered, adding, “You already know you lost twelve pounds at camp. I know I sound like an old fuddy-duddy, but you don’t need a pill to do what you already proved you could do last year at camp. And look at what you just did; you are the only person I saw today that lost any weight over Thanksgiving!”

“I did lose two pounds,” she said with just a hint of a smile.

Local Firefighter Gives Doctor Thanksgiving Pie

“Biff” Mitchell at 6 foot four and 265 ponds is all muscle. He is a firefighter/EMT who drives the ambulance and regularly enters burning buildings to save lives. He teaches students at a nearby military college how to fight fires, and on the side, he repairs heavy equipment and also acts as our town’s Animal Control Officer.

I saw “Biff” this morning for an impromptu visit because of a finger laceration. I was curious, and asked what heroic act he had been performing when he cut himself.

He grinned, and answered: “I was making a chocolate cream pie for Thanksgiving.” He looked a bit uncomfortable, and added: “I haven’t told Debbie yet that I cut my hand on the broken pieces of her favorite glass bowl.”

“Biff” had rinsed out the cut thoroughly, and he was already up to date on his tetanus shots. I did a digital block with buffered lidocaine and stitched him up, dressed the wound and sent him home with my best wishes for dealing with the loss of his wife’s favorite bowl and “Happy Thanksgiving”.

Around four o’clock today a chocolate cream pie appeared at Autumn’s desk. It was from “Biff”, and I invited everyone to have a taste. Everybody politely declined, so I brought an intact pie home for our Thanksgiving dinner tomorrow.

I thought this was such a quaint little incident that after dinner I started to write it down, thinking it might make a post for my blog. I was interrupted by the telephone. The caller ID informed me that it was a local number belonging to “B. Mitchell”.

“Was there any left of that pie for you to taste?” he asked.

“The nurses left it all for me”, I told him. “It’ll be the crowning jewel at our Thanksgiving dinner tomorrow”.

I could almost see him beaming at the other end of the receiver.

He seemed more proud of this pie and more grateful for my squeezing him in the day before Thanksgiving than anything more glamorous either one of us has done all year.

Loss of Power

This country doctor lost power today in more ways than one.

During dinner tonight, with a hard rain beating against the windows and skylights of our family room and the wind howling outside, the lights flickered a couple of times and then went out. We always eat dinner with a kerosene lamp on the table, so we were not in complete darkness, and I quickly lit other kerosene lamps and the candelabra on the mantle of our Swedish ceramic tile stove.

Moments before this dramatic turn of events I had recounted for my wife this morning’s exchange with our clinic administrator, who had called me into his office to tell me that another physician at our clinic, five years my junior and with an internal medicine background, was vying for my role as Medical Director.

The way the administrator sees things, the future of our clinic depends on our ability to serve an aging population with increasingly complex medical problems. My colleague, the internist, prides himself in his ability to take complex internal medicine cases further before calling in specialists. Ironically, the way we get reimbursed is essentially at a flat rate, making longer visits a drain, while shorter visits are profitable for us.

The administrator told me in a roundabout way that my skills as a Family Physician in handling large numbers of acute visits involving pediatrics, GYN, minor trauma, orthopedics, ear-nose-and throat, ophthalmology and infectious diseases were needed to offset the costlier but less well reimbursed visits of the internist, but that I would be playing second fiddle to him because he deserves the title I’ve held for a dozen years.

My first reaction, I admit, had been one of anger. I helped build this clinic; in the first few years after I came here, our census doubled, and I created most of the programs and protocols in place today. After thinking about it some more, though, I admitted to myself that for any employed physician today, rural or urban, the non-medical people who run the clinics and medical offices we work in are free to bestow titles and “power” upon whomever they choose, and that is usually whoever serves the management’s purposes best.

I may not know what the ultimate purpose of our management is, and, as I was telling my wife just as we lost our electric power, the power I may have had as Medical Director was fickle, and subject to managerial whim, while my power as a physician and healer is something no administrator can take away from me; whether I see acute or chronic illnesses, I am following my calling in meeting my patients, one by one, where they are in their moment of need.

The one thing I will fight for isn’t the title, but my right to see my patients, the ones I have cared for almost a quarter of a century, as long as they choose to see me as their physician.