The New Year has brought with it a major upheaval in health care on the Upper Cape. It has nothing to do with insurance rates or preexisting conditions, but it’s resulted in the loss of the quality of care hundreds of patients have received for decades. After 47 years in practice, Dr Arthur Crago has retired.
I met Art Crago when I was working in the ER at Falmouth Hospital. I was newly out of my training in Boston in internal medicine, and though I was cramming my head full of medical facts to pass my board exams, I had little experience with hands-on care. It was late on a Sunday night when an elderly man came to the ER with a diffuse rash. I had never seen anything like it. To make matters worse, the patient had a fever and a sky-high white blood cell count. My book learning told me he had acute leukemia and disseminated Shingles. My gut told me he was really sick and needed a real doctor. Luckily for me, and even luckier for the patient, Art Crago was on call.
In those days, the ER was staffed by one physician, who, like myself, had a medical license but could be in any specialty and in stage of training. These were the days before we had “hospitalists” so if a patient needed more care than we could provide, we had a list of community physicians who “backed up” the ER and came in when needed. It was daunting to call and wake up a doctor you didn’t know to ask for help in the middle of the night. Some were less pleasant than others, but you could bet no one was happy to get a call from the ER. I mustered my courage and called Dr. Crago.
“I’ll be right in,” he said, in a tone that was extraordinarily cheerful, a tone that in the years to follow I came to recognize as Art’s default response whenever I asked for his help.
Within minutes, he was at the patient’s bedside. He was dressed in khaki pants and a short-sleeved shirt open at the neck, with the requisite boat shoes I’d seen on most of Cape Cod’s physicians. He had a two-way radio only slightly smaller than a bread box strapped to his belt. Most doctors carried beepers in those days, but Art was slow to give up his trusted walkie-talkie, and had handcrafted a leather pouch that attached it to his belt. Right away, I knew how important it was for Dr. Crago to be available to his patients.
Art listened carefully to the patient’s history without interruption, and performed the most thorough physical exam I’d ever witnessed in an ER. I joined him as he looked over the x-rays and blood work.
“Did he tell you about his son?” he asked me. “He’s the Harbormaster in Oak Bluffs.”
“No,” I said. I hadn’t taken time to ask the patient about his kids. By now it was close to dawn, but Art was talking as if we were taking a coffee break in the middle of a quiet afternoon. After a discussion that ran from fly fishing to the latest article in the New England Journal, Art said he agreed with my diagnosis, and thanked me for my help. He reassured me that he expected the patient to do well and then went back to talk with his patient. By the time he’d finished dictating his workup, Art had just enough time to go home, have a quick breakfast, and come back to make rounds on his patients in the hospital.
A few years later, when I decided to open a practice of my own, I was welcomed to join Dr. Crago and his coverage group at Falmouth Hospital. For the next 22 years, Art taught me what it means to be a real doctor. Along the way, I learned that as impassioned as Art was about medicine, he was equally devoted to his family, to his friends, and to fishing. It was the balance of those passions that best served his patients and that kept him going.
The practice of medicine has changed monumentally since I studied for my board exams in 1979. Art adapted to those changes better than many of his younger colleagues. He faced the same challenges with reimbursement, electronic medical records and pharmacy constraints that we all did. While many of us jumped ship and left private practice, Art stayed the course. Despite the forces of change, Art managed to hold onto the essence of his care for almost half of a century.
He knew his patients and their parents before them. He knew their stories, and knew that there is only one way to treat a patient: with respect, kindness, and an open ear. And if in the midst of an exam you could get a couple of hints about where the stripers were running, well that was worth a lot more than a chicken.
PLEASE NOTE THE DETAILS OF THE MEDICAL HISTORY ARE A COMPOSITE TO PROTECT PATIENT PRIVACY.