American College of Physicians: Internal Medicine — Doctors for Adults ®

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President’s Column

Internal medicine: healers for adults

From the April 2001 ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.

Most patients believe
Dying is something they do.
Not their physician,
That white-coated sage,
Never to be imagined
Naked or married.
Begotten by one,
I should know better. “Healing,”
Papa would tell me,
“is not a science,
but the intuitive art
of wooing Nature.”

—“The Art of Healing,” W.H. Auden

A special friend of mine, Paul C. Grider Jr., FACP, died recently, just at the brink of retiring from a lifetime of internal medicine practice. Loved by his family and thousands of patients, he needs no further eulogy from me. Yet my relationship with Paul has so shaped my values as an internist and my view of the College that I would like to share some memories.

Paul and I saw each other only once a year during brief summer vacations on a lake in northern Michigan. After a week or less of vacation, he would return to his busy general internal medicine practice and I to my hospital-based position.

In retrospect, a lot can be said in a week, especially if the dialogue recurs annually for more than 30 years. The long hiatus between contact didn’t seem to matter. We picked up the conversation where we had left it.

Our conversations gradually became predictable. I would seek him out on the dock, where I would find him carrying a favorite book of poetry.

The ritual would begin with a catharsis of the mutual uncertainties about our personal lives—worries that we were not the husbands and fathers our families deserved. After those requisite apologias, we moved on to the real business of our friendship. Unashamedly, we committed the cardinal sin of vacationers: We talked shop, discussing problem patients with the enthusiasm of medical students.

Wooing nature

Over the years, these conversations became chronicles of two very different lives in internal medicine, but we were always linked by a mutual sense of our personal struggles and growth in caring for patients. At least in that pristine relaxed environment, we agreed on our good fortune of being part of this profession at this time in history.

I am not sure if Paul learned anything from me, but I remember almost every one of his patients he chose to talk about, some over the course of 20 years.

Paul spoke of his patients in warm, sometimes venerable tones. He cared so much, and he often worried that he was not up to meeting their needs. Perhaps that explains why during his entire professional life, Paul always made house calls to see his more frail patients.

I soon realized that he crafted an individualized approach to each patient, combining knowledge in therapeutics with a tempered regard for the limits of that therapy when his patients’ quality of life might be affected. But there was something else. Paul had the ability to weave his way through the intricacies of chronic disease in a way that changed the lives of his patients.

At some point, I realized that this hard-working College Fellow had acquired a wisdom that was not taught—or even teachable—in medical school, one that was certainly not measurable by billing codes or audits. By intuitively combining an understanding of the natural history of disease with a perspective into his patients’ strengths and weaknesses, Paul coaxed health from disease. Although I intuitively recognized this skill, I struggled with how to define and characterize it.

As I prepared to say a few words at his interment, high on a hill above our beloved lake, I remembered some lines from W.H. Auden that Paul had often recited at our annual reunions. In those verses, cited above, Auden recollected his own physician-father’s words: “Healing is the intuitive art of wooing nature.”

I began to think more about this view of healing. According to the Oxford English Dictionary, the word “heal” is derived from the Middle English word “hael.” This word evolved into the concept of freedom from defect or infirmity.

Heal, however, also has shared roots with the word “whole,” perhaps because healers make people whole. Here was my definitional answer. I realized that Paul had figured out this wooing process years ago and had been patiently (if unwittingly) tutoring me all those years.

Searching for healers

Since that realization, I have searched around the country for other healers among my internist colleagues. I have skirted the periphery of this secret society for long enough that I think I can finally recognize healers from their demeanor.

They are wise, kind men and women who patiently deal with the vagaries of chronic illness, rarely “curing” but always bargaining with nature to improve the quality of their patients’ lives in ways that are not interpretable by billing codes. They view things a little differently, as can be demonstrated even by their conversations and observations at chapter meetings and Annual Session. The opportunity to engage so many of these special internists has been the highlight of my involvement with ACP–ASIM.

I am referring not to the speakers at these meetings, but to the internists in the audience who share their wisdom and kindness in conversation. They have taught me that you cannot “heal” from the pulpit, but only from the pew. Perhaps it is no surprise that many of these internists eventually become College Fellows, as these are the very attri­butes that Fellowship recognizes and celebrates.

To be sure, we internists have no exclusive franchise on healing. However, we as a group may have more opportunities to develop the requisite skills due to our compunction to understand the scientific basis of what we do and our self-selected predilection to care for complex patients.

Some of us, like Paul Grider, can perform a form of alchemy, blending science and caring into a very precious product that to me represents the peak of our profession. How do the rest of us strive for this form of rejuvenation and become the wooers of nature?

That’s where the College comes in. In order to heal—to make things whole—we need to start with ourselves. We all need to find a professional refuge, much like the dock I shared with my friend. There we will find an opportunity for precious dialogue with our colleagues. There we will edu­cate and define ourselves and encourage our profession’s youngest members to become better than we could ever be.

At times, this refuge might be Annual Session or chapter meetings. We need to engage each other, share our stories, find the hidden healers in our midst and celebrate this calling. Wherever it takes place, the message will be the same: healing is the intuitive art of wooing nature.

William J. Hall, FACP

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