For the brave only: A behind-the-scenes look at a doctor's office
'Out of Patients' is doctor-writer Sandra Cavallo Miller's latest
HARK!
I hear…a grumbling cynic…
That alone, of course, is nothing new to the world of fiction, which has shown us jerky journalists, crabby cops, misanthropic musicians, sneering sales staff and so on.
But how about a derisive, doubting doctor?
If you cherish a view of the medical profession as being a bunch of caring, save-the-world types led by dedicated, devoted doctors–avoid this book, at all costs!
If, on the other hand, you want to know what doctors really do–and what they really think of you: Welcome to Out of Patients (pun intended).
Almost a year ago, HARK Valley introduced you to (unless you already knew her) Sandra Cavallo Miller, a medical doctor who wrote a novel about mosquitoes. Click here for that story.
In her 2021 novel, Where No One Should Live, Miller told the story of Dr. Maya Summer, an Arizona Public Health worker who advocates for a motorcycle helmet law–which makes her an enemy of a biker gang–and studies mosquitoes, those little flying thugs and deadly disease carriers.
Her fourth novel was published Sept. 21, 2021, by the University of Nevada Press.
But wait–there’s more…
In less than a year, she has another book published: Out Of Patients. (Click for the link to the book.)
According to the author, “This one is completely different, told in first person about a middle-aged physician who’s disenchanted with her career. It actually fits in the medical humanities, with themes about physician depression, burnout, and suicidal thoughts … in a darkly funny way, of course.
“There also happens to be a sort of ‘talking’ dog.”
Well, all right!
The University of Nevada Press is once again publishing one of its favorite authors–who, clearly, has a lot going on in her new novel. As the publicity material describes:
Norah supervises two medical students, one shy and one arrogant, creating major friction at the clinic. Her life is further complicated by her elderly mother, a feisty 86-year-old in Sun City who once rejoiced at Woodstock and partied at Burning Man. Troubled by a shadow in their past, both women find themselves on a quest for worth in their changing worlds.
Kirkus Review called Miller’s latest, “An astutely sensitive depiction of life as a physician … a companionably agreeable novel laced with lightsome humor … readers will appreciate the genuinely sharp insights into the often burdensome world of private medical practice.”
Hmmm, do we really want to know how they make sausage at doctors’ offices?
Sandra Cavallo Miller
Miller reads from her new novel at two events:
6 p.m. Tuesday, Sept. 20, at Burton Barr Library;
6 p.m. Wednesday, Sept. 21 at Changing Hands on Camelback.
In her medical career, Miller was a teacher as much as a doctor; as an academic family physician in Phoenix, she helped launch hundreds of medical students and residents into their careers.
The novel’s beginning takes us directly behind the scenes of a busy doctor:
They say a career in medicine is among the most fulfilling pursuits a person can undertake. That as a physician you will enjoy a lifetime of rewards and respect, that the sacrifices are worth it. They’re wrong.
Take this past afternoon. Things weren’t going great, and I felt a headache coming on, that familiar nag. Getting enough sleep usually kept those headaches at bay, but sleep had become elusive.
Even though old Ana Merriweather’s appointment said she had a hip problem, within one minute of saying hello she wept softly and crushed my hand in a grip worthy of a stevedore. Some of these elderly ladies with tissue-paper skin and feathery white hair have the steely clamp of a welder’s vise when they get upset.
Her problem went deeper than her hip. She wore a shiny silver jogging outfit, displaying a designer logo that someone other than me would have recognized. Her skin bore a trace of citrus fragrance, just a hint, just right for the doctor’s office, and gray hair floated in a coif around her head. Her lips looked suspiciously free of wrinkles for eighty. That botoxed mouth barely moved when she spoke, as tears wet her cheeks.
Dr. Norah Waters, the fictional physician, worked at a downtown Phoenix clinic until it lost its funding; then, she moved to a private practice on the Phoenix/Scottsdale border.
What do doctors really think of patients?
Several excerpts show a jaded attitude that may shock some:
The affluent patients hardly listened to me, while the less fortunate ones barely got by and they didn’t listen, either…
Go ahead, people: get mad at me because you made poor choices and now it takes three drugs to control your blood pressure. Kill the messenger…
Long story short: don’t take antibiotics unless you really need them. And eat less meat, because we cram those poor animals full of chemicals. Remember that the next time you eat a hamburger and ingest a dose of tetracycline.
Enough soapbox. No one listens anyway…
Oh, and check out this savage depiction of all-too-many “weak docs”:
They ordered too many labs and X-rays, a shotgun approach. They used expensive brand-name drugs when a simple generic would do fine and referred almost everyone to specialists for the simplest problems. At least part of their current knowledge came from the lips of slick pharmaceutical reps who spouted blatant advertising veiled as research.
Dr. Waters, though she is not reserved with her savage commentary, is one of “the good docs”; no matter how overworked and emotionally exhausted, she strives to do the best, for her patients.
Even so, she can be0 tempted by the greed encouraged by the medical system:
I saw now that I was happier drawing a salary, focusing on my patients and not wasting energy by figuring out how to bill the maximum, not ordering a test because it brought in more money. I’m not wired that way; in my old clinic, we cut costs wherever we could and sometimes where we couldn’t. But now I could charge a fair amount for an office urinalysis or an EKG, whether the patient really required it or not, so you can see the temptation. No one needs that clouding their judgment, and I’d rather not have money in my head when making decisions.
Miller's new book is dedicated:
To all the determined and often weary practicing physicians who carry on and strive to get it right.
But then there’s this line, deep in the novel:
I worry most about doctors and students who can’t admit when they don’t know.
Well, one has to ask–how much overlap is there between Dr. Waters and her creator, Dr. Miller?
“Well. Most fiction is based on the author's reality at some level. It makes it more authentic. I was in private practice for 10 years in the 1980s, but changed to academic medicine because I like teaching and I very much dislike running a business,” Miller told HARK Valley.
“Fiction is generally an altered mix of personal experience, of stories one hears or observes, and a blend of real-life characters. The rest is made up, that creative fun that Einstein talked about. Unlike Norah, I never ‘always wanted to be a doctor’ and nearly went into paleontology.”
Oh, but there is one area where the fictional character and her author completely merge:
“The cynicism is all me. Cheerful people make me nervous.”
That last sentence sounds like a great title for the prolific (five novels in three years) Miller's next novel!
“I's already been written,” said Waters, “and it features Norah's mom (Vivian) every third chapter in her first-person voice.”
Sandra Cavallo Miller's books