HOW I FOUND MY RHYTHM WHEN THE MUSIC STOPPED

At a time in everyone’s life, we come to find ourselves in a situation where the music stops, and we must go on.  The unfortunate truth about life is that the unexpected will happen. Some of us learn from it, some of us change because of it and some of us find our life’s calling because of it. The latter was the case for me.  After our dad picked us up from middle school, we spent that afternoon like we had every afternoon that month. We went to the oncology unit at the hospital, where my brother was admitted.

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THE MAN IN A BLUE SARONG

I remember him. I remember the man in the dark blue sarong the same way I remember the lines on back of my own hand. He was hunched over next to a column on a dirty platform at a railway station in Calcutta, India in the middle of the harsh summer sun. His hands were withered, his fingers and toes looked like tiny nubs, and he was completely malnourished and alone. He had opaque blue eyes, as if fog had taken place of his irises and pupils.

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PATIENT “OWNERSHIP”

I studied insects in college; my favorite insects were the bees (I found them diligent and so helpful to humankind).  One of my favorite classes was about medical diseases caused by insects. My professors noticed my interest in the medical side of things and connected me with a professor who did clinical research. Our work focused on a clinical trial for children with intractable epilepsy and exposed me early on to patient care and patients.

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pleasures, or even obtaining a virtue. It was the exercise of virtue. Basically, it was habitually doing the right thing.”


My son eyes me seriously. “Dad, I’ve wanted to ask you, have you been happy being a doctor? I mean, were the sacrifices worth it? My friends are going to grad school and getting big jobs at consulting firms. When I mention medicine, they groan and say it used to be a good gig, but not anymore.”


“Why do you suppose they say that?”


“Because everyone knows medicine is a long and punishing journey, with countless exams in med school, then years of residency training, and way too much debt. And in the end, even the veteran docs complain about most everything.” Then he scowls, “Did you put cranberry sauce on this turkey sandwich?”


I raise my sandwich as if to acknowledge its intrinsic worth. “Nothing like sweet cranberry and a hoppy IPA in the morning,” I emphasize with a swig. “So that’s what your friends think about medicine. What do you think?”


“I know you don’t like to fish the rhetorical surface water, but you really didn’t answer MY question either. I remember Mom saying when you were a med student you arrived two days before your wedding ceremony, scruffy and exhausted with $20 in your pocket.”


“Not exactly a knight in shining armor, but it was during my surgery rotation and the eighties so scruffy and disheveled was a thing.”


“WHAT I AM ASKING IS… was it all worth it?” he bellows.


“Truthfully, I never really considered anything else. Well, I contemplated being a cowboy after my dude ranch gig in Wyoming, but that was youthful myopia. I loved science and people, and medicine was part of my heritage: my great grandfather, uncle, and father were all respected physicians. I never worried about the sacrifices.”


“Interesting but a little unexpected, like this sandwich,” he says.


“Your buddies are probably reminiscing about the Golden Age of medicine when fee-for-service allowed docs to do and charge whatever they wanted. It was unsustainable.”


“So,” he says sarcastically, “Are you suggesting there might be more to happiness than ‘show me the money’?”


“I think Aristotle would say that wealth without generosity is not very virtuous. He probably said it first, better, and more clearly than anyone has since. Happiness comes from finding your purpose, realizing your potential, and working to be the best version of you. Then sharing it.”


“So we are in control of our own happiness. Like landing that trophy Brown.”


“A virtuous fish indeed,” I say. “And yes, there were sacrifices. Many. Thank God for your mother. Life was hectic, particularly when babies started coming in duplicate. Raising children is always an odyssey, but doing it early in both marriage and career is an epic challenge. I missed family dinners, Sunday Masses, and tournament weekends. I missed my wife. Worst of all, I wasn’t always present even when home. I had to learn to carry the burdens of others.” I pause to watch the Aspen leaves wriggling in the breeze. They color the water with copper-yellow reflections. “Your classmates may worry that their future income won’t justify the effort, which is a legitimate question. But more importantly, you need to decide for which journey you are intended. Whichever you choose, ask yourself will it be enough?”


I notice the sun is low on the horizon casting long, lean shadows. It is why autumn afternoons feel so melancholy. “As a healer, I feel our purpose is centered on human life and its relationships, but also preserving, prolonging, and celebrating it. Frankly, loss hasn’t gotten any easier for me. But these thoughts are mine. It is my journey.”


My son doesn’t answer immediately, weighing what he heard. Then he says, “That’s some powerful river philosophy. So what’s your take on the future of medicine?”


“As a profession, medicine is honorable and timeless. For me, being a healer has been truly fulfilling, and even exhausting days end with systemic contentment. I would do it forever again. Yes, there are inconveniences, but the act of healing is no different today than for Hippocrates. People suffer. They need our counsel; they need our help.”


Several fishermen have floated past, and I sense the pull of the river. “Son, what say we try our luck some more?”


He rises quickly and says, “Thought you’d never ask. Trust me with the oars today?”


“Yes, sir! Keep us dry, greenhorn.”


The water in the lower river increases as tributaries converge under gravity’s pull. Standing in the bow with thighs pressed to brace, I unhook my caddis and with familiar cadence begin to separate fly from fisherman. Like his questions, his rowing is attentive. Over the next hour, I turn a few fish, enough for a feeling of success. Eventually, we see the sun arcing toward the ridgeline, and we know it’s the twilight of the float. I sense he wants to cast again.


“Let’s beach it up ahead. We can wade that stretch together.”


We both settle streamside atop a granite boulder. While surveying the water’s potential, I think to myself. I want my son to know that the ancient virtues are balustrades common to all people, all cultures, and all faiths. They are habits, a path to happiness. I want him to know that if healers exercise courage, wisdom, and benevolence, then our lives are the real trophy. And I want him to know that as for Shackleton, the sacrifices are few if the expedition completes you.


I fumble several attempts to unite fly and tippet. My waning vision is a reminder of mounting burdens, of family, friends, and patients lost. Breaking the silence, I say, “Improve the world, first in your own heart and head and hands. Then work outward from there. I think this is especially true for surgeons and fishermen.”


“Love yourself and then love others,” he concludes eagerly. Then after a pause, he pleads, “In the name of love and Aristotle, can we fish?”


“Yes, yes. Let’s fish.”


We stand side-by-side in the river. He covers the water effortlessly, casting with rhythm and efficiency that’s far more art than sport. With a few fish fooled, the light has faded to dusk. We store the rods and navigate the final stretch of the river in silence. At takeout, light is all but gone save the soft glow of flickering streetlights. With gear secure, I run a hand along the Integrity’s white ash gunnel and say, “This boat is perfectly crafted for its work, now you must decide if you will be for yours.”


“Indeed, I am,” he says without hesitation. “And I don’t fear sacrifice, particularly if it means no cranberry sauce.”     

The water erupted soon after his fly landed near the riffle’s foam line. “She’s got spirit,” my son roars, gathering extra line. “Watch and learn old man.”


The Roaring Fork is a freestone mountain river that rages in torrents in the early summer while washing over boulders and fallen trees. Our Western drift boat is made for this challenge. The flat-bottom gently arcs from bow to stern allowing it to walk on water providentially. We named her Integrity, a loose reference to Antarctic adventurer Sir Ernest Shackleton for his legendary character of endurance and sacrifice.


“She’s still running,” he says, his right arm reaching skyward and his left deftly working the reel. “Plenty feisty.”


I coax the Integrity through a narrow wash and into calmer water. Although the powerful fish has not yet breached, her shadow is arresting. The sunlight’s wavy mirage can trick an angler into seeing trophies that are not real, but the rod tip bows deeply again and there is hope. When trout break the surface, I feel a surge of energy, both physiologic and frenetic. It endures until the fish is safely in the net. Even when I am on the oars and the rod is not mine, there is a fear of loss, a feeling all too familiar to an aging physician, father, and fisherman.


The fish runs and rests then leaps in a nervy but exciting ballet. Eventually, she tires and is safely in, witnessed, and freed. A catch like this lives in perpetuity.    

BY FREDERICK UELAND, MD

“What a fish,” I say, peering into the quieting water. “Watching you just then, casting and landing that Brown… can I just say it was beautiful?”


“Thanks, Pops! Exhausting. What say we break for an early lunch?”


I guide the boat ashore. Ice-cold beers and fresh sandwiches from the cooler rekindle our spirit and fuel the conversation. It is there, in the shade of an Aspen stand on a river high in the Rockies, where philosophy seduces reality, and my thoughts are profound.


“I just read a book about Aristotle and happiness,” I say. “Twenty-three centuries ago he put pen to papyrus saying happiness is attained by developing one’s character and acquiring virtues.”


He sits in silence before saying, “Really, Dad? Are you going to turn philosopher on me today?” Then he adds, “I think I remember the classic virtues. Justice, prudence… temperance… and wait for it… courage!”


“That’s right,” I nod. “To Aristotle, happiness wasn’t wallowing in life’s torrid

FREDERICK UELAND, MD

Frederick R. Ueland, M.D. is a Professor and Director of Gynecologic Oncology at the University of Kentucky. His academic interests are in ovarian cancer diagnostics and treatment. He and his wife Michaela live in Lexington and have five grown children, chickens, horses, and honeybees. They travel regularly to the Colorado Mountains to enjoy family and the outdoors.