Wisdom and humor from a Vt. doctor

For the Valley News
Published: 11/19/2020 8:45:13 AM

Many of us who decided to become doctors back in the 1960s and 1970s were inspired by the earliest wave of black-and-white television shows that depicted the valiant life-saving work of physician-heroes such as Dr. Kildare, Ben Casey and Dr. Konrad Styner played by Richard Boone on Medic.

The most influential role model, in all likelihood, was the gentle, wise, caring and avuncular Marcus Welby played by Robert Young. Well before the intrigue, politics and romantic trysts of M.A.S.H., ER and Chicago Med, Welby epitomized the physician who cared about his patients and was dedicated to their well-being.

Fast forward 50 years and many of us bright-eyed optimists from that era are now retired, having long ago abandoned the Welby model to spend our professional lives as academic physicians, research scientists or hospital administrators.

Not Beach Conger! As he closes in on his 80th birthday, Conger remains fully engaged in taking care of patients as a modern-day Welby. With a platinum resume of Amherst College, Harvard Medical School, residencies in Boston and San Francisco, and a fellowship at the Centers for Disease Control (in the days when it was an independent leader in science), Conger chose to practice medicine in a small Vermont town – Windsor to be specific.

Forty years of a general office-based internal medicine practice provided him with enough experiences, anecdotes and stories to fill several volumes, and he has done so. Bag Balm and Duct Tape (1988) and It’s Not my Fault (1995) are both subtitled “Tales of a Vermont Doctor” and are full of the humor and wisdom that Conger accrued through his practice. Written with an easy style and finely tuned sense of timing, these are delightful books to curl up with on a winter night by the woodstove.

Now, 25 years later, Conger has taken up the pen again, and written We Have Met the Enemy and He Is Us: The Opiate Education of a Vermont Doctor (Onion River Press, 2020). His objective was not primarily to add to his list of entertaining tales, though there are many scattered through these pages. Rather, as he writes in both the introduction and the final chapter, his goal in writing the book was “to do the right thing.”

The “right thing” for Conger has several elements. First, and most important, is providing personal, individualized care to each of his patients. That should not be difficult, but in today’s world of health insurance forms, high technology interventions for diagnosis and treatment, a pharmaceutical armamentarium that can easily overwhelm both doctor and patient, and a relentless emphasis on productivity, it’s almost impossible to be Marcus Welby. Nonetheless, in story after story, Conger demonstrates that the traditional skills of the physician; careful listening, understanding the patient’s life situation and tailoring treatment to that situation remain at the heart of his care. His stories are entertaining and enlightening about patients such as Billy O’Connor, easily dismissed as an alcoholic but a man with a history of having been a star high school pitcher; William Fusswood, a laconic curmudgeon whose one-word answers to Conger became hour-long visits with a medical student clerk; and perhaps the most colorful character of all, Vida Edwards, born in 1927 and content to continue the therapeutic nihilism of Conger’s predecessor despite a blood pressure that threatened to break world records.

Another element of “doing the right thing” for Conger was teaching primary care to Dartmouth medical students. He describes a special young woman named Davida, whom Conger had known since she was an infant, and who appears in his office one day for her primary care clerkship. When Conger was not-so-gently edged out of Dartmouth Medical School’s primary care teaching program because he failed to follow rigid guidelines, he continued his preceptorship of the young Davida who blooms into an outstanding doctor under his guidance.

Caring for patients for 40-plus years and being a role model for decades of medical students might have been enough of ‘the right thing’ for most people, but not for Conger. When he began to notice that he was having less fun in the increasingly digital and business-dominated world of today’s medical practice, he turned his desire to “do the right thing” to the opiate epidemic, which was taking a terrible toll in Vermont.

While many doctors were apt to affix blame to those addicted to these substances, Conger learned to see them as individuals with a chronic illness no different than diabetes. He also thought deeply about the origins of the addiction crisis and the role that the medical profession had played in its origin. He identifies the “enemy” of the title as physicians who over the last 20 years increasingly prescribed narcotic medications for pain relief, often for minor problems and often in amounts that far exceeded the need. Pharmaceutical companies were more than happy to collaborate, turning out medications like Oxycontin and Percocet that were marketed as non-habit forming, a lie that ranks with the tobacco companies’ cover-up of the link to cancer and the fossil fuel industry’s denial of global warming.

Conger does a fine job of explaining how the widespread availability of opiate drugs led to the epidemic of addiction and how that in turn, led to a backlash where physicians’ adopted the attitude of “suffering is better than addicting,” leaving thousands of individuals with no legal method to deal with their physiological dependence. Learning the details of the day-to-day trials and tribulations of those with chronic addiction was not an easy process. Conger’s teacher in this effort was another memorable character, Brittany, a woman in her 30s with cystic fibrosis who was addicted to opiates. Through her, Conger became acquainted with the nearly impossible lives of those dependent on drugs. He patiently cared for her until she died, a moment in the book that will evoke tears in even the sternest readers.

Conger took his experience with Brittany and applied it to his current practice at a community health center in Burlington. Having founded the first community health center in San Francisco more than 50 years ago, he has come full circle and continues to do the right thing.

There is a long history of physicians who were also accomplished writers. Some, like Kafka, Chekhov, Maugham, Percy and Williams, devoted themselves primarily to writing novels, short stories, or poetry. Others wrote essays about their experiences as physicians, including Lewis Thomas, Oliver Sacks and Atul Gawande. Conger can proudly take his place among the latter, having provided us with a book brimming with humanity and the impact one person can have on the world.

(Michael F. Epstein is a retired physician who reads and writes in Brownsville, Vt., and Cambridge, Mass. His website, EpsteinReads.com, provides more than 1000 book reviews to help answer the question: What should I read next?)

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