Thursday, December 24, 2009

Fixing Trucks and People

The days grow short and the nights long at this time of the year, and in this northern location the sun is down shortly after 3 p.m. and it is near dark an hour later. It is an indoor time for most, but it's important to get out into the natural world, always, and it's always here at the door. Birds are coming now to the feeder, the usual chickadees and nuthatches and goldfinches. There've been a few snowfalls but so far nothing to get the tractor with the snowblower out for. They'd predicted a big storm earlier this week, so I spent an hour removing the sickle bar from the tractor and attaching the snowblower. But the snowstorm inundated the northern third of the state only, and nothing fell here. And today it warmed above freezing for the first time in ten days or so. The snow melted back to a few inches of cover at most, with many bare spots. 

This morning I drove my truck into the local garage for repairs. It had been jittery at speeds of about 35 mph and above. At first I thought it was the tires out of alignment or balance, but as it went away when I would ease off on the throttle, it had to be the engine, I thought, so I expected a tuneup. But it turned out to be the universal joint that needed replacing, and fortunately the garage was able to get the part and the mechanic do the job in about an hour, for seventy-five dollars including labor. This mechanic has worked on my trucks for twenty years, and I've come to appreciate his diagnostic skills, his ingenuity and abilities with wrench and torch. The garage is less than ten minutes' drive from the house, and usually I can get an appointment within a day or two of my phone call. In an emergency they work on a vehicle right away. 

Fixing cars and trucks on this island is a lot easier than delivering medical care, apparently. I sometimes wonder that it's easier to get your truck fixed up than to get yourself fixed up. Who has a doctor these days for twenty years, when doctors are moving about so often? A mechanic is a vital part of the local economy, but also a part of the community: relationships with customers matter, reputations are important. A person who is a failure as a mechanic does not leave the community but finds another job; a doctor who is a failure is covered by malpractice insurance and moves elsewhere. A doctor's kindly bedside manner is a thing of the past--no doctors make house calls anymore, and if they are brusque with their patients as they shuffle in and out of several waiting rooms, they justify it in the name of efficiency and the economics of health care. In the office for medical care, a patient feels like a part moving down the assembly line.

When I was growing up, my family was close to another family whose head was a country doctor. His name was Fred Zipser. I didn't know much about his practice then. But now I recall that he was a family practitioner in a small town, he made house calls, his office where he saw patients was a part of his home, and his wife kept the books. Does this kind of doctor exist today? Only in the world of alternative medicine.

I was lucky for the past five years and was taken care of by a local doctor who was willing to spend time talking with me, not just about my physical condition but also about my life and what was on my mind. I know she was unhappy with the way modern economies in medicine translated into a loss of facilities at the hospital where she practiced--obstetrics for example--and also the way they translated into bean-counter productivity, seeing more and more patients for shorter and shorter periods of time. She is moving to a different part of the state, and soon I'll have to choose another doctor. I'll be lucky if I can find someone who shares her medical philosophy and who is curious not only about my health but about my life.

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