I am an old-school family physician who has spent the last thirty-eight years tending to the population of Hamilton County in the center of upstate New York’s Adirondack Park. Hamilton County features the lowest population density of any county in the eastern United States, at 2.6 people per square mile. The people are rugged, stoic, and self-reliant. For economic and geographic reasons, providing health care to them is an ongoing challenge.

Devoting my life’s work to practicing rural family medicine in the Adirondacks has been a very rewarding experience. It is true that choosing that path meant placing myself in the lower end of the earnings bracket for my specialty, which is itself one of the least profitable fields in medicine. But my rewards, while less tangible, cannot be bought with money. In the hamlets of North Creek and Indian Lake, I have been able to experience the traditional role of town doctor, where I know almost everyone and almost everyone knows me.

This is especially true when caring for the elderly and infirm who cannot or will not leave their homes. Although they are time-consuming, I dedicate one day every two weeks to doing home visits throughout my practice territory, often driving 100 to 150 miles to visit six to ten patients who are too elderly, frail, or ill to travel. I have discovered that this can be a very spiritual experience, especially when the person’s medical needs no longer include aggressive or hospital-based care. We can focus on maintaining the individual’s comfort, reliving old times, giving reassurance, preserving the patient’s dignity, and making sure all concerns are being addressed. I often feel more like a member of the clergy than the medical profession, and it makes me realize how much the two professions have in common.

I have witnessed the digitalization, hyper-specialization, over-regulation, and dehumanization of medical care.

Having been in practice for three decades, I have witnessed the digitalization, hyper-specialization, over-regulation, and dehumanization of medical care. I have seen fellow physicians retiring from the profession they once loved years earlier than they had planned after succumbing to compassion fatigue, the medical equivalent of battle fatigue known to veterans of armed conflict. It is a sad irony that while the miracles of medical research have enhanced the tools of my trade to an extent I would have thought impossible thirty years ago, the intrusion of the managed care and medical malpractice industries has created such a burden on physicians that, for many of us, the flame of passion for helping our fellow man that was ignited in our youth has burned down prematurely.

In my case, the 9,400-square-mile Adirondack Park has become hallowed ground. When I feel stressed, I climb a mountain or get in my carbon-fiber canoe, and head for one of the thousands of ponds, lakes, and streams in the Adirondacks to reconnect with nature. Personal crises seem much less important when I am standing on a mountain summit or floating across a tranquil pond, surrounded by wilderness in every direction. There I can fill my brain (and my camera) with images of the heavenly landscape. The view reminds me how insignificant we are in the grand scheme of things, and why my professional work is so satisfying.

Later in my career it dawned on me that my Adirondack patients were at least as picturesque as the landscape, and that our relationship allowed for very natural, close portraits. And if I could write something about the patients – about their health, our relationships, or their own life stories – the impact of the visual image would be compounded. I was driven by a sense that their lives, hidden away in the folds of the mountains, testified to a dignity and courage that ought to be known beyond their own circle. If they would be willing to share the story written in their faces, I wanted to put it within the pages of a book to live on after they were gone.

As I drive over the mountain lanes, sometimes the camera captures a scene that looks like a Monet painting. Other times it is a portrait of a patient that looks like it could have been from the previous century.

Frank Lillibridge was the last master of Maple Grove Farm in Thurman. He grew up in the days when muscles, not machines, performed labor, and men worked on communal projects like cutting hay. His journals vividly portray a life that echoes the farm and forest seasons. In the winter he wrote of hunting and trapping rabbit, raccoon, fox, and muskrat. Each spring, the family tapped four or five hundred sugar maples. Time hardly seemed to touch the farm, or Frank himself, for that matter. An only child, he never married, and stayed true to his land and farm after the deaths of his parents.

Age snuck up on him; he came into my care when he was hospitalized for hypothermia. One cold, rainy day, he went out to dump ashes from the wood stove and fell. He lay outside all night till his neighbor found him the next morning and called the ambulance. Beyond his immediate injuries, he was so stooped, arthritic, and unsteady that I was convinced he would never return to the farm. But when offered a bed in a nursing home, he said simply, “I’ll be all right at home, and that’s where I’m goin’.” His friends took him back to Thurman, where he not only lived for another three years, but regained enough strength to go back to “cuttin’ and splittin’ a little wood.”

“I figured someone else might want to make syrup from it someday, so I left it for them, whoever they might be.” 

The last time I visited him, he asked me if I’d noticed the big maple out in the yard. Of course I had; it was a giant from another era, towering over his house. “I took sap from that tree for over fifty years, and people ask me, ‘Why don’t you cut it down?’ Well, I stopped making syrup when Dad got to be ninety, and I had plenty of other trees for wood. I figured somebody else might want to make syrup from it someday, so I left it for them, whoever they might be.”