Moonshine and Freezer-Burned Deer Meat

Introduction

So, I found myself as the young doctor in a small rural town in Georgia. The doctor I replaced in that town had been there 30 or 40 years. People revered him. He knew their families, delivered their babies, showed up when it mattered. I had a high standard to uphold. He had developed a plan to supplement his income. I later found out that part of his following came from patients who drove long distances because he would prescribe amphetamines for weight loss. That was something I wasn't willing to do.

So I did it the hard way. I went out of my way to meet people, introduce myself, show up at community events. I became the medical director for the local fire department and emergency services, with oversight of the EMTs and paramedics. I volunteered my time to teach Advanced Cardiac Life Support (ACLS) to anyone willing to attend the classes. My family practice filled up fast. I was busy.

What I didn't understand, in my naivety, was the culture around paying your doctor. In that community, your medical bill sat at the bottom of the priority list. I did receive barter payments. I never did well in the bartering relationship. Two that I recall accepting, because it was that or nothing: a gallon of moonshine I was afraid to sip, having heard stories about local batches distilled improperly and contaminated with toxins. And about 4 or 5 pounds of frozen deer meat wrapped in aluminum foil. When I opened it later, the steaks had freezer burn so bad they weren't fit to eat.

After about a year and a half, the math was clear. I was working 60 to 70 hours a week, barely earning enough to cover my bills, and I didn't have an extravagant lifestyle. I had a wife and two young children. The hospital's future was obvious to me too. Emergency room volume was insufficient. Inpatient stays and surgeries weren't enough to keep the place viable. In a conversation with the administrator, it became clear that the owners were close to shutting it down.

I applied to a larger hospital in a neighboring town, about 45 minutes away, and was accepted as a staff emergency physician. The pay was $35 an hour. In retrospect, that's almost laughable. I can barely find general labor for that rate now. At least I earned enough to not be going deeper into debt.

Twenty-Five Years on Back Roads

My commute was all back roads. One traffic light between my house and the hospital. I ended up making that drive for 25 years. The biggest danger was cruising along in the dark on a country road when a deer would jump in front of your vehicle. That will wake you up.

I studied emergency medicine extensively and achieved board certification in 4 or 5 years. Before long, I was the Director of the Emergency Department and the Director of County Fire and Emergency Services. I volunteered my time with those departments and stayed engaged. Even as director, one of my self-imposed rules was fairness. We all took our share of nights, weekends, and holidays. I've never had a "work happens Monday to Friday" mentality because of those years.

For about 2 years, a friend and I shared a schedule where we each worked 7 days on and 7 days off. The 7 days on were brutal. I'd usually finish the week with 2 or 3 night shifts, which meant the first day or two of my week off was spent recovering, trying to shift my body back to a normal sleep cycle. If I had known then what I know now about what that was doing to my health, I would have made different choices. We'll get into that principle in more detail later.

When AIDS Changed Everything

During those years, AIDS became the hottest topic in medicine. In emergency medicine, you have frequent exposure to blood. AIDS was so new that there were no treatments. The only advice was to avoid exposure.

That fear started something in me. I began studying the immune system and how to boost immunity. I had always had an interest in what I called at the time preventive medicine. My grandmother subscribed to a small Reader's Digest-type publication called Prevention. I remember as a teenager reading a column in that magazine every time I visited her house. The column was written by an early forerunner named Jonathan Wright. When I came to the conclusion that my best defense against what later became known as HIV infection was not just avoidance but a healthy immune system, my study became more intense.

Most of the medical meetings on those topics were held on the West Coast. I would travel there several times a year. I read, I studied, I attended meetings with many of the pioneers in the field. One of my favorite sources of information was Jeff Bland, a biochemist and one of the best-read scientists I had encountered. I remember visiting him once in his office in Gig Harbor, Washington, and being amazed at the stacks and piles of medical papers, along with subscriptions to 15 or 20 journals that he read voraciously. I had studied emergency medicine with that fervor and I admired him for that work ethic.

Jeff Bland later became the founding force behind the Institute of Functional Medicine. Those early meetings were attended by maybe 100 to 200 people. This year, the annual meeting will be held in San Diego, and there will be thousands in attendance.

That's how many of us found our way into this work. I didn't sit down one day and decide to pursue functional medicine. I was a young doctor in a small town that couldn't pay his bills, then an ER physician on dark back roads, then a frightened clinician trying to understand a disease nobody could treat. Somewhere along the way, the fear of AIDS turned into a real curiosity about immunity, and that curiosity turned into the work I've spent the rest of my career doing: understanding what causes disease in the first place, and what you can do to keep the body healthy before things go wrong.