Practice Diary

 

Fam Pract Manag. 1999 Oct;6(9):44.

Julia's tree

The highlight of my summer vacation this year was visiting Julia Butterfly Hill's tree. Who is Julia Butterfly Hill, you ask? She's a 25-year-old woman who, for nearly two years, has been sitting atop an ancient redwood, which she has named Luna, to save it from being felled. She has braved chain saws, sirens, helicopter logging, torrential rains and gale-force winds. If I hadn't heard Julia give interviews from her 6×8-foot platform 180 feet above the forest floor, or seen pictures on her Web site, I wouldn't have credited the accounts. But she is stirring to hear and inspiring to contemplate, so I convinced my family to make the journey. After all, aren't we physicians supposed to have a spiritual side?

The tree is visible from the highway at Stafford, Calif., but it took a local to point it out to us and give us directions. The route to it isn't marked, since it's on timber company land, and no one tells you it's an arduous climb (nothing like visiting Thoreau's Walden Pond, a short walk from Concord, N.H.). We hiked for an hour and a half, until finally we were there.

Nothing prepared me for the majesty of this tree. She was easily 16 feet in diameter and over 200 feet tall. In awe, we spoke in whispers, feeling that we were in a hallowed place. Then, we heard a soft voice from somewhere up in the tree. “Hello,” she said.

“Hello, Julia,” I replied. And then, I thought, what do you say to someone like Julia Butterfly Hill? We spoke for only a few minutes, during which I learned that she has a support team that brings her everything she needs (she even has an exercise bike, cell phone and laptop computer in her perch) and that the surrounding trees had been cut down the second day she was there, Dec. 11, 1997.

“It was good talking with you,” I said, and we began the trek back to our car, seeing no one else along the way, which made it seem quite special, almost surreal.

As I began my workweek and got back into my routines, I couldn't help but wonder what we physicians might do for a patient who told us she intended to conduct a vigil in a redwood tree and that her feet wouldn't touch the ground until she had done everything in her power to make the world aware of the destruction of our old-growth forests. Call mental health, or make a pilgrimage?

Horses vs. zebras

There's an old adage in medicine that goes, “When you hear the hoofbeats, think horses, not zebras.” Translation: Think of what's common, not of what's rare. But what makes things rare (vs. nonexistent) is that they do, occasionally, happen.

I was recently called to attend a 70- year-old unassigned patient admitted with pneumonia. Mr. LaRue had journeyed to my town for a family reunion and, while here, began to exhibit fever, chills and a cough. He remained stable but unimproved for two days and then experienced severe chest pain and abruptly developed pulmonary edema in the middle of the night. For a number of reasons, I thought he might be having cardiac ischemia, so I transferred him to a tertiary care center for coronary angiography.

The cardiologist found normal coronary arteries and normal left ventricular function. However, Mr. LaRue's edema worsened, and he had to be put on a ventilator. Pulmonary and infectious disease specialists were called in and surmised that the patient may have been exposed to hantavirus; a more detailed narrative disclosed that he had spent time in a cabin in the Four Corners area the week before and had even handled several dead mice! He survived his respiratory failure and was able to be weaned off the ventilator five days later.

For a few days I felt remiss as another medical aphorism came to mind: 95 percent of diagnoses can be made from taking a thorough history. But then I got a call from the attending pulmonologist, saying the serologies were negative for hanta and he was signing the case out as a viral pneumonitis. Horses again!

Starting early

I begin my office hours at 8 a.m., an act which goes against the commandment many of my colleagues seem to follow: Thou shalt reserve the 8 a.m. to 10 a.m. hours for rounding. But I seldom have patients in the hospital, so following that rule would leave me with very little to do except eat danish.

I used to begin office hours at 9 a.m., but I always had patients wanting to come in earlier. So I tried it and was surprised at the response; the 8 to 9 a.m. time slots are often the ones that fill first. My patients appreciate not having to take time off from work to come in, and the ones who've been up all night sick are grateful not having to wait all day to be seen.

I think the only person who dislikes the early office hours is Isabel, my office manager. She's hardly a morning person, so it's not unusual for me to arrive first, turn on the lights and computers, and then give her a hard time for coming in at 8:15, scrambling to get her makeup on before “that cute Merck rep” comes through the door. But it's not all work and no play. We take an hour-and-a-half lunch break at noon.

Dr. Brown is a family physician in solo practice. He lives in Mendocino, Calif. These excerpts from his journal illustrate the many characters, stories and lessons family practice has to offer.

 

Copyright © 1999 by the American Academy of Family Physicians.
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