It was a rainy day on the island of Kauai. Sunbathing was not an option, and neither was swimming or snorkeling. The ocean water’s typical clear blue color had been replaced by an unappealing shade of brown. Stranded away from the water we resigned ourselves to wandering through the stores in the Kukuiula Village shopping center near Poipu Beach.
After meandering through stores selling beach themed home goods we wandered into an art gallery that featured photos of scenic locations from around the Hawaiian Islands. I did not recognize many of the images in the pictures and asked the proprietor, a woman who appeared to be in her seventies, where some of them were taken. She answered my questions and then asked some of her own, the standard tourist questions of “Where are you from?” and “Where are you staying?”
After hearing our answers, she volunteered that she had moved to Kauai over 20 years earlier and still felt like she was new. She told us of the small town nature of the island (there are 27,000 permanent residents, only about 2000 of whom live in the Poipu area), and how everyone knew everybody else. She mentioned that there was only one department store on the island and that everyone wore the same outfits because they all shopped at the same Macys.
As there was no one else in the store and she seemed to be in the mood for conversation, I decided to ask her what life was like living on the island. In particular I asked her about the quality of medical care. “It isn’t very good,” she replied.
She told us that the only up to date mammogram machine was on the southwest side of the island, nearly an hour’s drive away from the hospital and over 2 hours away from the village of Hanalei. The hospital on Kauai was not very advanced. It was equipped to handle common conditions and emergencies but was not staffed for more complicated cases. Her husband had been diagnosed with pancreatic cancer a year earlier and had needed to travel by plane to Honolulu for treatment. Their medical care was comparable to that one would find in rural America.
The best part of their health care was their family doctor who had provided their care since they arrived. He was kind and compassionate. She shared that she was concerned about the future of their medical care because he would soon be retiring. She then told us a story of her doctor that helped us understand her fears.
A few years earlier her brother and his best friend had gone out fishing on her brother’s boat. They were about 8 miles off the coast when they hooked a massive fish that weighed over 200 pounds. The friend worked to reel it in while her brother went to get something with which to hit it in the head so they could pull it into the boat. Metal stick in hand her brother called to his friend to pull the fish in a little closer so he could reach it.
“I don’t feel very good,” the friend said. Then he dropped dead on the deck. Her shocked brother radioed the Coast Guard and started CPR. It took a while for the Coast Guard to arrive, too late to do anything for his friend. The Coast Guard took his body away. Her brother returned to the harbor alone. Waiting for him on the dock was his family doctor. The doctor had heard of the tragedy, and concerned for her brother’s state of mind had driven to the harbor to meet his grief-stricken patient.
As the woman told the story it was clear that she had not been surprised by the kindness of their physician. His caring act was what they had come to expect from him, standard practice from their small-town doctor. While this behavior was normal for her physician she knew that it was a level of kindness that could disappear now that he was retiring. She did not know if she would ever find a physician who cared for her that much, a physician she could trust to be there when she needed him.
Her story has stayed with me. I repeatedly find myself reflecting on the power of this small-town physician, the healing and comforting power of relationship and friendship, the importance of simply being “there” when needed.
I think of the times I have been able to care like that, the patients I have known over the last 25 years who have allowed me to be a part of their lives. The house calls made, the phone calls answered, the stories told and the tears that were shared. So often what mattered most were the moments shared, not the medications prescribed.
Our society is moving away from these relationships. Medicine is now practiced according to a set schedule. Interactions with primary physicians are often limited to the hours of 9-12 and 2-5, Monday through Friday, if scheduled in advance. After office hours and on weekends patients get the stranger in the Emergency Room or the Urgent Care Clinic. The feeling seems to be that people need a doctor, that seeing their doctor is not all that important.
The woman’s story, and my experience, suggest this is not true. There is more to good medical care than knowing medicine. Truly excellent care requires knowing the person who is receiving treatment, a truth small-town doctors know and the rest of us need to learn.