Recently, I had the good fortune to attend the first Kienle Symposium in Medical Humanities at the Penn State Hershey College of Medicine.  Among the many fascinating seminars and activities planned was an early-morning grand rounds, “Lives and Life Stories,” with physician-writers Perri Klass and Danielle Ofri.  The insights into medical education, patient care, and the practice of medicine as narrated by these two practicing physicians are invaluable to students in the health professions. 

Dr. Perri Klass presents "Lives and Life Stories" at Grand Rounds, Penn State College of Medicine, May 27, 2014

Dr. Perri Klass presents “Lives and Life Stories” at Grand Rounds, Penn State College of Medicine, May 27, 2014

Upon returning to my university in South Texas, I visited the UTPA library and checked out copies of both Klass’s A Not Entirely Benign Procedure: Four Years as a Medical Student and Ofri’s What Doctors Feel: How Emotions Affect the Practice of Medicine.  While I was there, I browsed to see if there were any physician narratives that might be of particular interest to my students who are pursuing degrees in the health professions and minoring in Medical Spanish for Heritage Learners.  The two books that caught my attention were Oil Field Medico (1948) by Dr. George Parker and Harvest of Hope: The Pilgrimage of a Mexican-American Physician (1989) by Dr. Jorge Prieto.[1]  Although these autobiographical narratives detail the physician experience in the 20th-century, they complement Klass’s and Ofri’s contributions with focuses on the practice of medicine specifically in Texas and with the migrant and immigrant Latino patient population in the U.S.  Both of these texts detail the challenges and triumphs of providing medical care to underserved populations and offer advice and wisdom to aspiring physicians, especially Dr. Prieto’s book, which will be inspirational to any individuals who will be joining the first class of incoming medical students for the UTRGV College of Medicine in 2016.

The most useful lessons that aspiring physicians might take from Dr. Parker’s account of his early career in Texas involve managing one’s expectations and adapting to one’s environment.  Oil Field Medico opens with a letter from the publishers attesting to the veracity of the account given by Dr. Parker, describing how “the language is that of a physician, translating into the vernacular the experiences of a refined doctor among the raw and untamed.”  In stark contrast to Dr. Prieto’s calling of serving the poor, Dr. Parker’s motivation for establishing a medical practice in the “wilds” of early 20th-century Texas oil country appears to be purely financial; upon his arrival in Beaumont, Parker reports that “A wave of distaste and excitement swept over me as I viewed the scene.  But I had left my growing practice of medicine with all its bright prospects for the very thing I was looking at, and had set out with a high heart on this adventure, lured by the thrilling tales of the Croesus-like fortunes being made in the black gold flowing from Texas’ first oil gushers” (1).  Parker’s description of Beaumont will likely prove alien to the contemporary reader; much text is devoted to describing the mud and grime of the city and the difficulty with transportation due to the lack of paved roads and established paths.  The dirt and muddy roads are generally invoked as evidence of Parker’s discomfort in his new surroundings, yet at the same time they represent real obstacles to health and the delivery of healthcare in that specific time and place.  First, transportation to outlying areas for house-calls is complicated by the impassible roads, as Parker remarks in finding a cart “with horses that could get through the mud” (4).  Sanitation is also a barrier to public health, as is poverty; despite his best efforts to “instruct the women in sanitation, the care of themselves, the danger of mosquitos and flies,” Parker has to contend with the unhealthy living conditions of his patients’ dwellings.  When delivering a child, he notes that “sometimes the woman did not even have a shack to live in; many times it was a tent with a dirt floor in which she brought her young into the world.  So many of the men drank and gambled, that their wives and babies were often without enough to eat and wear, to say nothing of having anything ready or sanitary for the new-born life” (27).  Quickly, Parker has to learn to adapt to these challenges, finding new ways to educate his patients given the limited resources at their collective disposal.  What he had come to expect in terms of resources and comfort had to shift to align with his new circumstances.

Adapting to a new environment as a physician also means that Parker learns to treat diseases he had never seen previous to his arrival in Beaumont, many of which are related to both the physical environment and to occupational health and safety.  He recounts, “Malaria took a large toll of my patients” (27).  In a chapter titled “Poison Gas”, he enumerates the symptoms of the effects of toxic gases on an oil driller:

Arriving at the shack, I found the driller lying on a cot, to all appearances, dead, his eyes open, lips parted, swollen and dark as if burned with acid.  It was with difficulty that I could find a pulse or detect any respiration… I gave him the medicine that I had developed in Saratoga, but he showed very little sign of life until after daylight next morning.  I had been treating men in Saratoga for months and had seen them stay unconscious for a few hours and then recover, but this one was unconscious for more than twelve hours.  This case gave me a new idea on gas poisoning. (93)

Faced with this new occupational hazard, Parker researches medical journals and consults not only with fellow physicians—writing a letter to the Dean of his medical school—but also the “old-time oil men”.  His tenacity permits him to ameliorate the effects of this occupational hazard on his patients; after a time he writes, “I had developed a medicine for the eyes of those who were gassed so badly that they had to stay in a dark room for several days.  Also in my research work I had discovered something that eliminated the danger to the heart and lungs in gas cases” (93).  Parker continues to develop professionally through research by focusing on the most devastating medical conditions that affect his specific patient population.

One major difference between this early autobiographical physician experience writing and more contemporary writing is the lack of empathy or compassion for the patients.  Parker reflects on his perceptions of events but limits the accounts of specific patient problems and outcomes.  For example, he describes attending a particularly horrific industrial accident in the oil fields:

When I arrived at the scene of the accident, I found a man on a derrick floor almost torn to pieces.  He was bleeding from the head, arm, and leg…Blood was spurting from a severed artery, and his arm was broken in several places.  I stopped the blood, but I discovered that I had no splints with me.  Noticing some pieces of board lying on the floor, I had my helper make me some temporary ones so that I might set his broken arm.  When I had finally finished with him, I asked the boss of the rig to fix up a rude stretcher, and we sent him to his home. (22)

The boss of the oil rig then invites Parker to tour an oil field for the first time.  Parker describes in detail how impressed he is with the sight of his first oil well coming in.  In contrast to the lesson given in Perri Klass’s “Baby Poop”, that the patient is the central character in the physician’s narrative, Parker does not present himself as a peripheral character.  Oil Field Medico is valuable in detailing the physician’s experience in adapting to less-than-optimal living situations and learning to treat medical disorders stemming from industrial environments.

Dr. Jorge Prieto’s Harvest of Hope should be required reading for any aspiring healthcare professional interested in working with underserved populations.  A compelling read, Harvest of Hope contributes valuable lessons about empathy and vocation, including a narrative of “the physician as patient” and medical education from both the perspective of student and teacher.  After graduating from the UNAM, Prieto does his year of social service in a rural, isolated village in Northern Mexico, where he encounters complications due to malnutrition and many cases of tuberculosis.  Like Parker, while in the village of San Martín Prieto Prieto has to find ways to reach his patients in remote locations, eventually procuring a cart and donkey after testing his horsemanship.  Prieto also details his first cold winter in Chicago as a resident earning only $75/month and contending with discrimination against international physicians.  Prieto overcomes many obstacles in order to reach his goal of caring for migrant and immigrant Latinos in Chicago as a practicing physician and to establish clinics for underserved Latino and African American patient communities as Chair of the Family Practice Residency Program at Cook County Hospital.  In so doing, he also becomes involved in political advocacy and an active participant in the Civil Rights movement, with an understanding that ending health disparities is also a question of political will.

Dr. Prieto’s book presents the humanistic elements of the practice of medicine that distinguish a great physician.  He recounts how he is able to relate to his patients during his early years as a medical doctor, quickly learning skills that are not specifically taught as part of the curriculum:

As medical students we had been trained to look for infections, tumors, parasites, stones in the gallbladder or kidneys, sugar or albumin in the urine and abnormal blood pictures under the microscope.  All these we could feel, measure, or locate with tests.  Most we could ultimately remove or correct.  How then to locate, measure, or remove the cause when a woman, trying to explain her symptoms, suddenly had tears running down her cheeks?  This happened so often that I came to expect it when taking their histories and learned to see it as the most important clinical sign in many cases… At first I felt great dismay seeing so many of my women patients cry.  Dismay because I felt sorry for them but also not knowing what to do for them.  Gradually I came to realize that just hearing them out made them feel some relief.  It also taught me ‘clinical epidemiology’ by showing me how prevalent and intractable are the marital problems in a poor community.  Many had alcoholic husbands, and they were almost all expected to bear a child as soon as the previous one was weaned.  They were caught in a vicious cycle of poverty, isolation from friends and relatives, and marriages that were little short of permanent nightmares. (66-7).

As Prieto notes, this type of listening, especially to non-pathological complaints, was not a feature of his training.  In speaking of his rotation in pediatrics, he explains, “We learned how to monitor newborns; how to handle dehydration at all stages of childhood; how to do cut-downs on tiny veins, and even how to do a lumbar puncture in older children.  We did not, however, learn how to explain things to anxious parents.  This was, and still is, the most difficult and most neglected skill in a young physician’s training” (50).  So how did Dr. Prieto learn to communicate with his patients so effectively despite this lack of training?  He attributes much of his ability to empathize with his patients to his own experience as a patient.  He writes, “I had my own personal experience with the way our imaginations twist and exaggerate illness and this also helped to make me much more tolerant than I otherwise would probably have been.  At age fifteen I had suffered rheumatic heart disease and the memories, both of the illness and of the different ways I was treated, were too strong to be ever forgotten.  I recalled that overcoming cardiac invalidism was much more difficult than the rheumatic fever itself.  Fear and worry had been my worst enemies and I never forgot that” (65).  Later, when suffering from severe rheumatoid arthritis, his experience of pain gives him compassion for his patients.  He says, “my own pain was a good teacher.  It taught me that the physician’s attitude was the most important factor in his ability to bring relief to his patients with chronic pain” (153).  Harvest of Hope includes this important lesson in human understanding for aspiring healthcare professionals: all individuals, including doctors, will at some point experience illness, pain, and disability—either temporary or chronic—and will expect patience and understanding from those who care for them in their time of need.

These two narratives offer beneficial insights into the practice of medicine generally, as well as specific lessons about adapting to patient problems in Texas industry in Oil Field Medico and about working with underserved patient populations and empathizing with the patient experience in Harvest of Hope. Both complement the lessons contributed by contemporary physician-writers and offer a perspective from the past that is still valid today.

[1] Parker, George.  Oil Field Medico.  Dallas: Banks Upshaw and Company, 1948.

Prieto, Jorge. Harvest of Hope: The Pilgrimage of a Mexican-American Physician.  Notre Dame: University of Notre Dame Press, 1989.