Hanging out a Shingle

In 1973, I moved to Santa Fé to study acupuncture with Sensei Nakazono, the Japanese aikido master who had recently established his Third Civilization Institute for teaching and training students from the U. S. and abroad, and been named to preside over the newly-created New Mexico Board of Acupuncture after curing a number of state legislators of various ailments.

I never felt attuned to his religious observances, his authoritarian style, or his practice of seeing patients several times a week; but I deeply admired his skill in healing patients with chronic disease, and learned a lot from his teaching.

I also esteemed Oriental medicine for its philosophy of the living organism functioning as a unified energy system, such as our modern Western tradition cannot easily accommodate, with our Cartesian fracturing of experience into “body,” comprising organs, cells, and molecules on the one hand, and “mind,” consisting of thoughts, feelings, and perceptions on the other.

In traditional Japanese acupuncture, skilled practitioners learn to palpate subtle variations in the radial pulse, taken at different positions and depths on each wrist, to assess the total energy state of each individual, with each reading representing a specific point along the course of the “meridians” or longitudinal energy currents traversing the body surface that have been found to correspond to the various internal organs.

Thus, avoiding the Western mind-body problem entirely, the acupuncturist diagnoses and treats illness globally in each patient as an integrated energy system, and can relieve pain and suffering, cure illness, and promote and restore health on a deeper level and with subtler methods than Western medicine seems capable of or even much interested in.

As my introduction to energy medicine, the Sensei’s teachings not only opened up new perspectives in my thought and new directions in my practice, but have continued to stimulate my thinking about health and illness ever since. I will always be grateful to him and honor his memory for sharing his truths so generously with me.

Obtaining my New Mexico license, I opened an office, and engaged Laurie Holmes, R.N., a graduate of the University of New Mexico nursing program, to help with the home births, which she did for several years until leaving for New York to qualify as a Certified Nurse-Midwife; she remains a dear friend to this day.

Although beginning to use acupuncture with a few patients, I’d already decided against making it my principal form of treatment. As much as Japanese medicine attracted me as a philosophy, it felt too alien culturally for me to devote the rest of my career to trying to master the practice. But it provided the ideal preparation for my encountering homeopathy at precisely that juncture.

In medical school, the term “homeopathic dose” was used almost affectionately, to signify an amount of medicine too small to have any effect whatsoever; and most American physicians would probably still agree that homeopathy defies common sense, ordinary logic, and some basic laws of chemistry.

Nor could I make much sense of it from an old text I found in a used bookstore, beyond wondering if I might try Apis mellifica, the medicine made from honeybees, for a patient who was dangerously hypersensitive to bee stings. I called Allan Sutherland, M.D., an old-timer I’d heard of from back east, to ask him if he thought Apis would be an appropriate prescription for her; and he replied in his gruff Vermontese, “Well, sonny boy, I think ya’d better come to our summer school!”

Administered by the National Center for Homeopathy, and designed for doctors, nurses, and other licensed health-care professionals, the course was held at Millersville State College, Pennsylvania, deep in the heart of Amish Country. Almost all of the physicians on the faculty were elderly and retired, or nearly so, rather than still earning a living from practicing it, as if the generation of active, full-time practitioners who should have been our teachers had never materialized.

With only two weeks set aside for the course, no full-time universities, clinics, or teaching hospitals to its name, and very few retail pharmacies to send patients to, it was a stretch to imagine that American homeopathy could survive much longer.

Yet from the moment I began that course, I understood that it was exactly what I needed.

The introductory portion was taught by Harris Coulter, Ph.D., a scholar and historian of the method rather than a practitioner; and from him I was reassured to learn that homeopathy had originated in Germany almost two hundred years ago, and was still being practiced by licensed physicians all over the world, as well as boasting such luminaries as Goethe, Darwin, Mark Twain, Gandhi, and generations of the British Royal Family among its adherents.

He was also at pains to emphasize that homeopathic medicines were prepared and marketed under FDA supervision, and were deemed safe enough to be sold over-the-counter, as well as extremely affordable and effective for first-aid and domestic use.

But once again, just as with acupuncture, it attracted me first and foremost as a philosophy, before I’d taken any remedies myself or seen them work in a patient; it offered a coherent, systematic body of thought, with principled assumptions that rang true to my own intellectual development, and a careful methodology that followed logically from them.

Like Freudian psychoanalysis, it came into the world fully-formed from the brain of a single extraordinary man, Samuel Hahnemann, M.D. (1755-1843), based on the ancient Hippocratic notion that the manifestations of illness and disease are the attempt of the organism to heal itself, rather than something simply bad or abnormal to be arrested, corrected, or eliminated by any means necessary.

Homeopathic physicians are trained to assess the complete picture of each individual patient’s condition, including and especially those unique features not commonly found in others with the same diagnosis. Largely of natural origin, the medicines are chosen because, when given experimentally to healthy volunteers, their own total symptom-picture matches that of the patient as closely and thoroughly as possible.

Each patient is therefore given just one medicine at a time, to resonate with and thus enhance the healing process that is already underway, and in such minuscule quantity as will seldom have any substantial effect unless it is properly chosen, unless its symptomatology matches the illness so closely that the patient will be exquisitely sensitive to it, a crucial safety factor.

Another feature that attracted me was that the whole process, comprising the interview, the analysis, the choice of the remedy, and the reactions to it, is conducted in the ordinary language of patients’ lived experience, of how they feel and function according to their own individual standards, displaying the signs and symptoms that they themselves are uniquely familiar with, while the technical language of diseases and abnormalities, which physicians learn in order to classify them, and include what the senses can’t see, hear, or feel, plays in most instances a derivative or confirmatory role.

Far from repudiating orthodox medicine because of it, I chose homeopathy as a way for me to re-enter the medical profession more wholeheartedly, by minimizing the risks and satisfying the scruples, doubts, and hesitations that had kept my practice at a bare minimum for so long. Never imagining or touting it as a panacea for everything, or even necessarily the best treatment for everyone, I embraced it because it was the method of treatment best suited to my own particular evolution and temperament.

It’s also a difficult and exacting art, requiring a lifetime of study, and a skill born of practical experience, such that even veteran prescribers may need to try several medicines before there is any real benefit; and sometimes, in spite of everything, there is no benefit at all. As to whether it really works, I offer the whole of my career as evidence that it does, having used it more or less exclusively for the past forty-six years, with never a cause to regret it.

Once back in Santa Fé, my first patient was myself. As I drove north in my old ’48 Plymouth to meet a friend, an oncoming car pulled out into my lane and hit me head-on at 50 miles an hour, before I had the chance to be afraid; I remember thinking almost matter-of-factly, “this is curtains,” as I’m sure it would have been if I’d been driving the compact car I have now.

When I regained consciousness, bleeding from a head wound, my dog Carina was whimpering in the back seat, the massive front end of my car was bashed in, and the other driver was standing on the road in front of me, maybe fifty feet away, visibly drunk.

I opened the door in a fury, but a crushing pain in my chest brought me to my knees and made further action or even movement impossible. When the ambulance arrived and the EMT sat me upright in the passenger seat, I felt tolerably OK; but at the ER, he put me on a Gurney, flat on my back, with the slightest change of position sending stabs of pain through my body that sapped my strength, and nearly persuaded me to stay overnight, as the ER doc was urging me to do.

I finally managed to call Laurie and asked her to bring my kit of medicines, fetch Carina, and drive us home. When she arrived, I wet my finger, took 10 or 20 tiny granules of Arnica 200 on my tongue, and in a few seconds was able to lift my bloody shirt over my head and take it off by myself, an incredible feat under the circumstances, after which my broken ribs healed without further incident.

That first winter, I saw mainly the usual acute illnesses, colds, flus, Strep throats, bronchitis, and other incidental complaints of pregnant women and their families, who were still the backbone of my practice. Whenever anybody needed medicine, I would rummage around in my books until I found one that seemed suitable, and the patient and I were often pleasantly surprised at how quickly and effectively they worked to relieve pain and suffering, as well as imparting a feeling of strength and well-being that sometimes helped cut short the natural course of the recovery.

Soon I was trying them at births, too, with similar results: at times none, but often good, and sometimes verging on miraculous. One woman I’d just met had recently given birth to her first child in the hospital, and called to ask me to make a home visit for a breast infection with high fever and severe pain that had forced her to stop nursing.

Bryonia alba, the White Bryony, was the medicine that seemed to fit her best; so I put a dose of the 30th dilution on her tongue, plus several more in an envelope for her to continue taking as needed. As I rose to leave, she begged me to stay the night, having no faith in the medicines, which she’d never used before; and when I awoke and saw her the next morning, her pain and fever were completely gone, and she never needed a second dose.

Applying to St. Vincent’s Hospital for admitting privileges, I was readily accepted onto the Medical Staff; and a few of my GP colleagues were genuinely interested in my oddball practice, featuring home birth, which was dicey enough, and homeopathic medicine, which they knew nothing about and must have seemed like an exotic form of sorcery from long ago and far away.

The OB’s in town were unenthusiastic about home birth, to put it mildly, and instituted a new policy that required anyone performing hospital deliveries to have completed at least six months of formal residency training, to make sure that my home birth patients needing hospitalization during labor were handed over to the OB on call at the time, a ruling that caused much unpleasantness.

But their problem was more with home births than with me personally. Although the OR nurses often let me in on how much they enjoyed making fun of my unorthodox methods in the midst of their hysterectomies, I never felt the same level of personal animosity that had dogged me in Boulder. Whenever I needed to admit patients in labor, with a few notable exceptions, I was more than grateful for their help.

For my home/office, I bought an old adobe house on Canyon Road, and fitted out two front rooms facing the street as my reception and consulting rooms, with a tiny bathroom adjacent to the one, and a small examining room in back of the other. I saw patients by appointment, four days a week, and even hired a receptionist for the first time.

For pregnant women wanting a home birth, I reserved ample time for getting acquainted at that first office visit, with their husbands or partners whenever possible; but the final decision about whether or not to work with them was usually made at the home visit, which I tried to schedule as soon as possible after that.

I could count on one hand the number of times I said no, because something just “didn’t feel right.” I don’t remember specific instances, and my intuitive abilities are nothing special, but those hunches were generally accurate.

I remember how hesitant I felt when a young patient in obviously straitened circumstances came to the office without her husband, who was rarely home, dealing dope, as I later found out, and only peripherally involved in the pregnancy. But she was so excited about the pregnancy and being a mom that I agreed to a home visit.

When I opened the door to their apartment, I was already standing at the foot of their bed; their home amounted to the one medium-sized room in the rear of their landlord’s house, with nothing else except a tiny bathroom and kitchenette alcove.

But I was charmed by her cheerful temperament and positive disposition in the face of so many problems and concerns, and even more by the friendly, unhurried way she brewed tea, treated me to a piece of her delicious, homemade coffee cake, and sat down to chat, all of which reassured me that she was making the best of it, and convinced me that the pregnancy, the labor, and the birth were her department, that she was someone I could rely on. As indeed she proved to be.

In robust health throughout, she walked the mile or so to my office for all her prenatal appointments, and paid me in full each time. When she went into labor, her husband met me at the door and finally introduced himself. An equally young kid, he kept leaving to do a quick dope deal and then popping back in; but he was pleasant and well-meaning, not at all rude, nasty, or spaced-out, and mostly stayed out of the way, while the birth was as easy as it could be, even though it was her first pregnancy, and she couldn’t have been more than eighteen or nineteen at the time. I’ve forgotten her name, but not her achievement.

Just as in Colorado, an important part of the prenatal care was teaching prospective parents the basics of labor and postpartum care, in case I didn’t make it in time, as was happening more often with an office practice to maintain. One sprightly lady named Kathleen was early in her first pregnancy, and lived in a trailer about 15 miles out of town with her husband, Maurice, a tall, handsome, and courtly gentleman, who replied to my lecture on emergency childbirth with something like, “Doc, just so ya know, when her time comes, I’ll be in town at the bar getting drunk!”

When her time came, I wound up staying all night in the trailer for what is often misnamed “false labor,” since it regularly performs useful work, just not enough to finish the job. She delivered a week later, as easily as could be; and I made it in plenty of time, without needing any help from Maurice.

With their second child, he telephoned when Kathleen went into labor, waking me from a sound asleep; and I rolled over to catch a few more winks before finally rousing myself about an hour later. By the time I made it to the trailer, Kathleen was sitting up in bed, all smiles, with a baby on each arm.

“You’re a little late, Doc!” she greeted me, not in the least angry, and quite rightly joshing me all over again for having missed the fact that she was carrying twins, while Maurice, far from absenting himself, had stepped up to the plate and taken care of everything in fine style.

The joy radiating from their faces consoled me for both derelictions, since they’d been blessed beyond anything they expected for having seen, felt, and managed the whole experience all by themselves — the thrill, the joy, and the hard work of it — without the professional help they naturally assumed they needed.

But the additional task of managing an office practice also introduced a whole new level of complexity that I’d never experienced in Colorado, including more serious problems that I couldn’t handle by myself, just the sorts of things that make even board-certified OB’s shudder at the very thought of home births.

One example was the first visit of a heavy-set woman in her late thirties, unmarried and six months pregnant for the first time. She didn’t want a home birth, just some help with persistent bleeding of bright-red blood that was more than just spotting.

Suspecting placenta previa, a low-lying malposition of the afterbirth that can be life-threatening to the mother as well as the baby, I sent her to the hospital for an ultrasound, and gave her the homeopathic medicine we call Sabina, made from a tree of the juniper family.

The next day she called to report that it had indeed been a previa, and that she’d miscarried during the night with no complications whatsoever, with the heartfelt relief in her voice indicating some consolation for the loss of the baby she had undoubtedly worried about even before seeing me.

Another woman who lived about 20 miles out of town completed her first pregnancy with a normal labor, easy birth, and a healthy baby, but no sign of the placenta, or even the slightest urge to expel it. After more than an hour of waiting for it, I reluctantly decided to remove it manually, pressing down firmly on the top of her uterus with my left hand, while exerting slow and steady traction on the umbilical cord with my right, until it finally came out; but it was still attached to the uterus, which had been turned inside out in the process, and a lot of blood poured out along with it.

Although I’d never seen it before, it was clearly a complete inversion of the uterus, a very rare, life-threatening emergency that arises from an abnormally firm attachment of the placenta to the uterine wall, such that my pulling on the umbilical cord had undoubtedly precipitated the hemorrhage, and left the poor lady in profound shock with a dangerously low blood pressure.

As best I could, I peeled off the remaining placental fragments manually, piece by piece, and then tried to correct the inversion and reposition the uterus in the vagina; but, never having seen it done before, I had no idea of the proper technique, and after a few minutes the bleeding resumed as before.

Fortunately, the baby was fine; so I left her with the nurse who was helping me after Laurie left for New York; and I put the mom in my car, hooked her up to oxygen, and drove to St. Vincent’s as fast as I dared. By the time I got there, she was only half- conscious, with a blood pressure of 0/0.

I flagged down the first OB I could find, but he wrote it off as a typical postpartum bleed, and took his time with typing and cross-matching her blood for a transfusion, waving off my desperate pleas for more immediate and drastic action.

Dr. Jerry Rodriguez, our newest and youngest OB, fortunately happened by at that moment and immediately recognized it, having seen just one case in his residency. Putting on a rubber glove, he made a fist and thrust it up into her va-gina as far and as hard as he could; and she awoke and sat up within seconds, as if nothing had happened, with a blood pressure of 130/70, a sight I’ll never forget, and would not have thought possible.

It wasn’t the first time that a patient I wasn’t able to help was saved from misfortune by a practitioner of the system I’d spent so many years finding fault with, nor was it the last. But the memory of that lifesaving rescue always tempers my criticisms with gratitude and admiration for all that modern medicine has achieved.

I should have foreseen the epilogue, that the woman never paid me; but slowly and grudgingly I had to accept that taking a small bite out of my living came much closer to the truth of what had almost happened to her than trying to change her mind.

A small cottage in Nambé, an ancient pueblo village maybe 25 miles north of town, was the setting for a third case, that of a twenty-year-old woman, pregnant for the first time, who gave birth to a daughter after an hour’s worth of strenuous pushing.

Although well-formed and weighing over 8 pounds, the baby was covered with thick, green meconium, took one gasp, and then stopped breathing entirely, while brisk suctioning of the nose and mouth produced nothing but a lot more of the same stuff.

I tried to intubate her, but couldn’t visualize the trachea, while the girl just lay there, pale, limp, and motionless, with a heartbeat of barely 40 per minute, responding feebly to mouth-to-mouth resuscitation, but unable to breathe on her own whenever I tried to let up on it.

Although my books recommended other medicines, on an impulse I chose Arsenicum album, the white trioxide of arsenic, which seemed the perfect fit for someone on that narrow ledge between life and death, and put a powder of the 200th on her tongue.

She awoke with a jolt almost instantaneously, crying and flailing, her heart beating vigorously at 140 per minute, and her skin glowing pink with the flame of new life; the whole evolution took no more than a second or two. After a night in the hospital to be on the safe side, both mother and baby went home the next morning, with no manifest sign that anything untoward had happened. Experiences like these are inscribed for life in every practitioner’s mind.

Of course, this same happy outcome could also have happened spontaneously, even without the medicine, since the child was well-formed and appeared normal in every other respect; and, in any case, it was just one patient, a mere “anecdote,” with no statistical significance whatsoever.

But all of us who were present, Laurie and me, the baby’s mother and father, and I daresay the child herself, by now fully-grown and undoubtedly steeped in the legend of her birth, know as surely as we can know anything in this life that the sequence of the infinitesimal dose and her abrupt awakening was no mere coincidence.

Although caring for pregnant women and their families was still the core of my practice in those early days, it was by no means the whole of it. The role model I had somewhere in the back of my mind was the old country doctor portrayed in the classic Westerns of my youth, at once down-home and businesslike, available for whatever comes up, and wearing old suit vests and dress shirts with the sleeves rolled up, which became my working uniform of choice ever after, in lieu of the starched white coat and stethoscope around the neck that proclaim the physician of today.

Naturally, a fair number of my patients expressed skepticism about the homeopathic approach, and even mocking disbelief in one case that I still recall, a lady with a urinary tract infection who came to see me for no better reason than that her husband had mentioned my name as someone he’d played volleyball with.

Unaware that I was a homeopath, and expecting a prescription for a sulfa drug to relieve her constant and painful urging to urinate, she became impatient, hostile, and even contemptuous at the mere mention of a thorough interview.

It turned out that she’d been separated from her husband for two weeks, and her UTI followed soon after an attempted reconciliation had come to blows, interspersed with episodes of passionate lovemaking, after the last of which he blurted out that he’d recently been exposed to gonorrhea.

The whole picture pointed to our medicine Staphysagria, made from a species of Delphinium. Putting one powder of the 200th dilution on her tongue, I also gave her a vial of the 12th, to take as needed, up to 4 times a day; and, within 24 hours, her symptoms no longer bothered her, and completely subsided the day after, although I had quite a time tracking her down to wring that news out of her.

It would also be a mistake to ascribe these instances of successful treatment to any particular skill on my part, beyond the comparable results that any genuinely committed student can confidently expect and readily call to mind; and I could just as well have cited other cases, alas too numerous to keep track of, who devoutly believed in homeopathy and suffered from ailments by no means hopeless, but whom I was nevertheless unable to help.

Finally, although the method is about as safe as any form of medicine can possibly be if practiced conscientiously, I would be remiss not to mention the fact that on extremely rare occasions a seemingly well-indicated medicine might even cause harm. The only example that comes to mind was a young wildlife photographer who sought homeopathic treatment to avoid elective surgery for a rectal fissure, which his internist had discovered after a 4-month history of rectal pain and bleeding.

Otherwise healthy, he had suffered from severe migraines in the past, but none in recent years, as well as amœbic dysentery and recurrent prostatitis even further back. His only other current complaint was a long history of chronic conjunctivitis, with redness, soreness, and crusting, for which he’d been using mercuric oxide ointment 3 times a week for the past 5 years or so. His rectal pains were sharp and stinging, especially when sitting for long periods.

Based on that whole story, I gave him a single dose of Nitric. acid. 200; and 12 days later he reported that the pain and bleeding had disappeared almost completely within a few days of taking it, and that he felt revitalized and almost euphoric as well.

After another week, however, his rectal symptoms came back, and slowly regained their former intensity, which prompted me to give him a second dose; and on the very next day his long-standing conjunctivitis flared up with a good deal of soreness, as well as some brownish “floaters” in his left visual field, which then “browned out” almost completely within a few more days, leaving nothing in his field of vision but a cluster of fuzzy blotches when he closed his good eye.

I sent him to a local ophthalmologist, who diagnosed it as optic neuritis, typically a precursor of multiple sclerosis, and referred him to the University of New Mexico Medical Center in Albuquerque for a complete neurological workup.

Their Retinal Team confirmed the diagnosis, and documented a worrisome fuzziness of the vision in his right eye as well. At their follow-up visit a few weeks later, the right eye was back to normal, but the left was almost totally blind, except for a narrow, crescent-shaped arc of light around the upper edge of his visual field.

I present this case lest anyone assume, as so many people do, that homeopathic medicines are completely harmless, or in other words, ineffective. To be sure, such cases are vanishingly rare when compared to the ever-present risk from milligram doses of pharmaceutical drugs.

Nor would I discount the possibility that in this case the medicine may have activated a latent tendency that would have come to light eventually even without it, since my patient never developed active MS in the several more years that I remained in New Mexico, as he, his wife, his eye doctors, and I all feared he would.

This train of thought also led me to wonder if the medicine might have aroused his energy system to concentrate the disease and expend its full force and intensity in the eye, rather than his brain and spinal cord as a whole. Either way, I can’t imagine a clearer demonstration of the real power of homeopathic medicines than these vanishingly rare cases where they appear to activate, catalyze, or intensify a latent, destructive process of which both the patient and his physician were previously unaware.

But when all is said and done, including these far-flung attempts to exonerate myself, I must continue to live with the fact, as must the photographer himself, that he must certainly have regretted ever making my acquaintance.

In 1981, about a year before I left New Mexico, St. Vincent’s Hospital required all physicians on the Medical Staff to obtain malpractice insurance, ostensibly to protect their patients, but mainly to enforce a more uniform standard of professional practice, at a time when about 10% of us hadn’t wanted or felt the need of it.

Almost everybody went along, but three of us continued to hold out, namely, Matt Kelly, a popular GP whose largely indigent Hispanic and Native-American clientele loved him for his minimally-invasive style of practice; Florence Khedroo, a quirky orthopedist who did very little surgery; and myself.

We knew we’d lose, since the Hospital clearly had the legal authority to make rules for our conduct there; but we each had good reasons for refusing the insurance, as well as a sizable following in and around town who applauded us for it, more than enough for us to relish the opportunity for a public debate with the Administration over what the practice of medicine really was and should be about.

At an open hearing on the issue, a number of local celebrities spoke out on our behalf, including Peter van Dresser, the well-known author and environmentalist, and Maria Benitez, the acclaimed and stunningly beautiful Flamenco dancer and choreographer of Chippewa Indian descent.

I also wrote an Op-Ed for the local paper to the effect that malpractice insurance was indeed required for most contemporary physicians, because of the potent drugs and invasive diagnostic and surgical procedures that they preferred, which are inherently risky, even when used properly, and were precisely why the three of us had built our practices around using them as little as possible.

When the Hospital Administration rejected our petition, we hired Morty Simon, a prominent labor lawyer in town, to seek an injunction against them in court. Pursuing the issue legally wasn’t so important to me, since I felt we’d already made our point, and just about the only people I ever admitted to the hospital were women in labor, whose babies I wasn’t allowed to deliver there anyway. But I wanted to support my two colleagues, who admitted and treated patients there on a regular basis; so we stuck it out together, to the bitter end, which wasn’t long in coming.