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S U N D AY, M A OR NC TH 0 30 , ,2 2 00 11 33

A Day in the Life OF A


COUNT∏Y DOCTO∏ Inside the joys and challenges of a modern-day Marcus Welby, M.D.

As one As one ne of of th tthe he few few do fe ddoctors oct c or ors ffo for or miles mi m illees ar aaround, roouund und nd, Howard H Ho owa wardd M McMahan cMaahhaann cM is is always alway lwaayys on lw on ccall aalllll

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T ’S

Madeleine Stowe Mad

Q: Madeleine Stowe plays the villainous pl Victoria Grayson so Vi well on Revenge. w What’s she like in W real life? —Nancy A., Lodi, N.J.

A: “People are A so scared when they sc meet me, but I’m really cheerful!” says Stowe, cheer 54. “My “M ethics are very different differen from Victoria’s.” And unlike her character un on the ABC drama, the actress is lucky in love. She and her husband, actor Brian Benben, have been together over 30 years and have a daughter, 16. “We’ve had challenges,” she says, “but we’ve been blessed.”

Larry Hagman

Q: How will Dallas deal with Larry Hagman’s death this season? —Dennis Koches, Richfield, Minn.

A: Five episodes of season two of the TNT reboot were filmed before Hagman died on Nov. 23 at age 81. Executive producer Cynthia Cidre says his iconic character, J. R. Ewing, doesn’t pass away until episode seven (March 4), and a funeral for the scheming oil tycoon




Braeden and Scott on the set of The Young and the Restless in 1984

Q: Who has been married the most times on The Young and the Restless?

The actor, 62, stars in the History channel drama series Vikings (premieres March 3, 10 p.m. ET).

—Sherry L., Whitehall, Pa.

Did you know much about Viking history before taking this role? I’m from Dublin, and I grew up with a knowledge of their contribution to Irish culture. They are stereotyped as invaders and pillagers, but they were much more sophisticated and complex. How did you get into character? I grew my hair very long and the costumes were pretty spectacular, so it was hard not to feel like a 10th-century Viking warlord! You live in New York City now. Do you go back to Ireland much? It’s my roots, so I come back at least two or three times a year. It’s tremendously important to me.

will air March 11. “I can reveal that J. R. does not die of natural causes, and the mystery of what happened to him will be solved by the end of the season,” Cidre says. “I hope it will do both Mr. Ewing and Mr. Hagman justice.”

A: With 14 “I dos” under his belt, Genoa City’s resident Casanova, Victor Newman (played Submit your by Eric Braeden), questions to personality takes the prize. And Victor’s about to tie the knot once more—with on-again, off-again love Nikki—on March 18. “I would love for them to be Before becoming an actor, you studied together forever, but things archaeology. Did you make any discovcan’t go right for very long eries? I actually worked on the excavaor the fans get bored!” tion of Viking ruins in Ireland and was says Melody Thomas lucky to find a perfectly preserved child’s Scott, 56, who plays Nikki. leather shoe with ornamental stitching. I The CBS soap celebrates don’t think there’s anything more exciting its 40th anniversary this than knowing the last time a human had month. Get an exclusive seen that shoe was over 1,000 years ago. first look at the new cast photo featuring 41 actors at

Q: How many female drivers race in the various NASCAR series? —Donna Pikey, Las Vegas < Danica Patrick

A: Eight women competed in the 2012 season, and NASCAR has four female drivers slated to race in 2013, with a few others possibly joining during the year. “We’re seeing more and more women in racing, either as drivers or mechanics, and that number will only go up,” says NASCAR Sprint Cup Series competitor Danica Patrick, 30. “But I’ve always wanted to be the best driver, not the best female driver.”



Enter for a chance to win the Smash soundtrack, Bombshell, signed by Katharine McPhee at /




2 • MARCH 3, 2013

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THE SECRETARY Drawing on four years of travel alongside Hillary Clinton, BBC correspondent Kim Ghattas crafts a candid portrait of one of the world’s most controversial and powerful women.

EIGHTY DAYS The true story of Nellie Bly and Elizabeth Bisland, two journalists racing to see who could circle the globe first—and faster than any man before them—is as riveting now as it was when it captivated the nation in 1889.


EGGSTRA CREDIT EG Yo can’t beat You ou our recipepa packed iPad iss issue. Download it at dashrecipes .co .com/eggs. It’s free!


The fairy-tale film is alive and well, judging from the highly entertaining 3-D adventure director Bryan Singer has created from the story of Jack and the Beanstalk. Our hero (Nicholas Hoult, above) sets out to rescue a princess (Eleanor Tomlinson) from the giants who dwell sky-high; fine actors like Ewan McGregor, Stanley Tucci, and Ian McShane round out the cast. Fee, fi, fo—fun! (PG-13)

HUNGER IN AMERICA A Place at the Table looks at the 50 million Americans (like single mom Barbie and her kids, left) who struggle to have a nutritious meal every day. Poverty, politics, obesity rates— they’re all tied in to the crisis, as this eye-opening documentary illustrates. (In theaters and on demand)



If you’re daydreaming about spring break, check out—a vacationplanning website that bases its recommendations on your children’s ages. Punch h in a destination and you’ll get a list of hotelss and activities tailored to your brood, along with reviews from families just like yours.

Retailers are cutting prices on Japanese brands (from TVs to PCs) to make room for new models coming out in April, says timing expert Mark Di Vincenzo, author of Buy Shoes on Wednesday and Tweet at 4:00. For more tips, go to Parade .com/now.


A GRIPPING NEW TV SERIES Radha Mitchell (right) stars as a woman whose life is shattered when her husband crosses a crime syndicate and she becomes a Red Widow with a debt to repay. (ABC, March 3)

4 • MARCH 3, 2013

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Happy & Healthy

Kennections By Ken Jennings HOW TO PLAY

All five correct answers have something in common. Can you figure out what it is?

1. Underwood, Olivetti, and Smith Corona were originally manufacturers of what bygone devices?

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2. Danish-born comedian Victor Borge performed his most famous routines sitting behind what?



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✎ 4. A cryptanalyst’s job is to try to break what?

✎ 5. What honor society became the first Greek-letter college fraternity in the U.S. when it was founded at William and Mary in 1776?


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OCILLA, GA. POP. 3,414

THE COUNTRY DOCTOR IS IN A day in the life of a vanishing breed— the small-town American physician



Imagine this: You are a young doctor who has recently graduated from medical school. An excellent student, you could choose to practice almost anywhere—including Atlanta, where your advising professor has connections. Instead, you set up shop in a small southern town, much like the one you grew up in. It’s the kind of place where the neighbors all know each other, where families have lived for generations and still attend the same church. It’s also a place where a young doctor is unlikely to get rich. In this town of Ocilla, Ga., there are a host of health challenges: obesity, drug abuse, depression— the usual troubles that doctors have to manage, except you’re doing it without the benefit of specialists to advise you. As one of the only doctors for miles around, you are on call every night and

need a range of skills that no city doctor would dream of having: Your patients depend on you for everything from putting a cast on a broken bone to performing surgery. Still, you like the idea of knowing your patients, knowing their families. But two decades pass, and the job has gotten harder. The per capita income around here is roughly $15,300, and unemployment is over 12 percent. Insurance companies have been chipping away at your earnings, and a growing number of your patients are now battling chronic diseases like diabetes and emphysema. Things would be easier if you closed your practice and took a position with the regional medical center 30 miles away. At times, you’ve been tempted. But then, what would your patients do?

6 • MARCH 3, 2013

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A BIG IMPACT IN A SMALL TOWN Clockwise from left: 79-year-old Wydene Tomberlin gets a hug after presenting McMahan with an apple; joking around with patient Veronica Watts in the examination room; McMahan spends a few extra minutes chatting with Shedrick Gaskins during a checkup; the old-fashioned leather doctor’s bag that McMahan has carried since starting medical school in 1976.


hese questions are ones that Howard McMahan, M.D., has lately begun to contemplate. Now 58, McMahan has spent more than 20 years caring for the residents of Ocilla, a rural town (pop. 3,414) three hours south of Atlanta. Tall and spry, with short

gray hair, he looks the way you’d imagine a country doctor might. His manner is courtly; he says “yes, ma’am” and “no, sir” and favors bow ties and shirts that have been neatly pressed. As a doctor who knows all his patients by name—and often their parents and grandparents as well—

McMahan occupies an increasingly rarefied niche. Over the past 15 years, the number of new general practitioners (physicians trained to handle a wide range of ailments) has been significantly declining, as med students drift away from the field in favor of more lucrative and less demanding specialties. By 2020, the Association of American Medical Colleges projects, the U.S. will be short 45,000 primary care doctors. The scarcity is felt keenest in rural areas, home to nearly 20 percent of the nation’s population but just 9 percent of its M.D.’s. On the Monday I arrive, McMahan has been in the office since 8 a.m., seeing patients and reviewing some of the 23 lab and X-ray reports that have arrived over the weekend. His office, a low-slung brick building located

across the street from a pecan orchard, is filled with framed photos of Ocilla’s championship baseball and wrestling teams. Farming is Ocilla’s main industry, and patients often show their gratitude in countr y ways. McMahan once arrived at the office to find a load of homegrown watermelons left as a thank-you. It wasn’t the first time. “Homemade fudge, peanut brittle, pecan brittle, jellies and jams,” he recalled, moving briskly between exam rooms. “It’s a regular occurrence.” McMahan’s 10 a.m. appointment is with 79-year-old Wydene Tomberlin, who has come bearing an apple as a gift. McMahan takes it cheerfully, adding, “You can tell I’ve had an influence! She used to bring me chocolate.” Tomberlin’s ankle had recently

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been treated for a staph infection, and in the office she admits that the leg is still giving her pain. “It’s okay today, but on Thursday and Friday I could hardly walk on it,” she says. McMahan kneels to press gently on her ankle. “You soak it or put a poultice on it?” he asks. “You take any pills?” Tomberlin says no. “Miss Wydene used to take a lot of pain medication,” he explains. “We’ve worked hard to get her off that.” Though the ankle is no longer tender, McMahan orders a blood test to confirm that the infection hasn’t returned. Then, to my surprise, he lingers, asking about Tomberlin’s family— he also treats her brother Wycliff and his wife, Ann. Eventually, McMahan escorts Tomberlin out. “That’s one of the advantages of practicing in a small town,” he remarks. “You don’t just see your patients. You see their family, you see their friends. It can help.”

CARING FOR ALL STAGES OF LIFE McMahan spends one morning each week at

the local nursing homes. Here, he checks in on patient Madelyn Posey.

While such patience can be rewarding, it comes at a cost. Tomberlin’s visit, originally scheduled for 15 minutes, has taken almost 45. Which means that McMahan is already running late. It’s a common problem. “Patients get frustrated all the time because they have to wait,” admits Kay Vickers, a nurse who has worked with McMahan for 18 years. She



“It’s hard for patients to find a primary care doctor right now,” says Jeffrey Cain, M.D., president of the American Academy of Family Physicians (AAFP). “In 10 years, it will be impossible.” Experts predict that the U.S. will be short 45,000 primary care physicians by the year 2020—throwing an already overstretched medical system into crisis. (Currently, the average U.S. physician is responsible for 2,300 patients—more than twice the recommended number.) “We’re standing on the edge of a primary care cliff,” says Cain. Why?

shrugs. “But it’s a trade-off. When you get in the room with him, he does the same thing for you.” When I later mention Vickers’s observation to McMahan, he looks sheepish. “The majority of the time, I deliver more care than I bill for,” he acknowledges, adding that he often ends up staying in the office until 8 or 9 at night. McMahan concedes that he could probably get through

• THE POPULATION IS EXPANDING. Various experts predict that the number of Americans will grow 15 percent by 2025. And the Affordable Care Act may pour 32 million more people into the health care system. • MANY GPs ARE NEARING RETIREMENT. One in three physicians will hang up their stethoscopes in the next 10 to 15 years. Meanwhile, the number of Medicare patients is rapidly rising as the baby boom generation ages. • AND THERE AREN’T ENOUGH NEW DOCS TO TAKE THEIR PLACE. Family medicine, which often pays a third of what specialties like radiology and orthopedics do, is “not as appealing to medical students,” says Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges. Only 8 percent of med school graduates go on to practice

the workday faster if he were willing to stick to the schedule. But in practice he can’t bring himself to. “There’s too much complicated information,” he says. “I want to make sure people understand.” McMahan is starting to streamline his practice by offering patients the option of a “virtual visit”: getting their lab results online, for instance, and then discussing them over the phone or even face-to-face via computer video chat. He points out that such a system would spare patients having to take time off from work—but acknowledges that the option hasn’t caught on yet. “Most folks still prefer the hands-on personal touch,” he says.


n a typical day, McMahan sees about 25 patients, and for the next nine hours, I watch him hop from room to room, working through the day’s appointments. The problems range widely:

primary care; the AAFP says that number should be more like 50 percent. So what’s the solution? Medical schools have pledged to up their enrollments by 30 percent, a goal that Mitchell says the colleges are on target to meet in the next few years. Plus, many med schools are offering debt repayment to graduates who select careers in family medicine. Meanwhile, experts like Cain and Mitchell are calling for more physicians to turn their practices into “patient-centered medical homes,” where nurse practitioners and physician assistants handle much of the basic patient care, with doctors stepping in when necessary. Still, Cain says these are just stopgap measures for the looming shortage. “We’ve been making tiny steps toward something that needs big strides,” he says. —Vi-An Nguyen

8 • MARCH 3, 2013

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One man complains of “a deep bone ache” in his legs; another patient is recovering from pneumonia and needs a chest X-ray. One mother is now struggling with postpartum depression but doesn’t want to take the antidepressant McMahan prescribed because she fears it will make her gain a lot of weight. McMahan assures her that’s unlikely. He will also refer patients to a psychiatrist when necessary, though the nearest one is an hour away. “Mental health resources in Georgia are very limited,” he sighs. I notice that with each patient, McMahan listens intently and looks them in the eye when he talks. He acknowledges later that the eye contact is deliberate. “That’s the No. 1 complaint I hear about other doctors,” he says. “Patients say, ‘He never looks at me! He’s always on the computer.’ So I always look up. I put my hand on their shoulder.” He shrugs. “Sometimes compassion is even more important than a prescription.” Such personal attentiveness does take effort, McMahan admits—especially given that computerized medical records have become ever more complicated, with dozens of menus that a physician must click through during each visit. But he’s sympathetic to patients who feel as if they’re being ignored. When McMahan’s then 24-year-old son was diagnosed with a rare cancer in 2008, the famil y sought treatment at Memorial SloanKettering in New York, and the process deepened his perspective. “When you carry some of the battle scars that your

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patients carry, you meet them at their level,â&#x20AC;? he says. What does it take to Besides running be a country doctor today? To see more his private practice, photos of McMahan the doctor spends one in practice, go to morning each week /countrydoctor making the rounds at the local nursing homes, checking medications and visiting with patients he knows. He also treats patients at the local detention center, a mixed-use facility in

Ocilla that houses immigrations and customs detainees, along with federal inmates. The detention center work â&#x20AC;&#x153;is necessary,â&#x20AC;? McMahan saysâ&#x20AC;&#x201D; both for the health of the patients inside and because itâ&#x20AC;&#x2122;s comparatively lucrative. That extra income is what allows McMahan to keep his practice rates more affordable. â&#x20AC;&#x153;I pride myself on providing value to my patients,â&#x20AC;? McMahan tells me later. â&#x20AC;&#x153;Because my patients arenâ&#x20AC;&#x2122;t wealthy, I tend to prescribe a lot of generics, and I also use a lot of older medications that are proven, that have stood the test of time.â&#x20AC;?

Legal Notice

If You Currently or Previously Owned, Purchased, or Leased Certain Toyota, Lexus, or Scion Vehicles, You Could Get BeneďŹ ts from a Class Action Settlement. There is a proposed settlement in a class action lawsuit against Toyota Motor Corp. and Toyota Motor Sales, U.S.A., Inc. (â&#x20AC;&#x153;Toyotaâ&#x20AC;?) concerning certain vehicles with electronic throttle control systems (â&#x20AC;&#x153;ETCSâ&#x20AC;?). Those included in the settlement have legal rights and options and deadlines by which they must exercise them. What is the lawsuit about? The lawsuit alleges that certain Toyota, Lexus, and Scion vehicles equipped with ETCS are defective and can experience unintended acceleration. Toyota denies that it has violated any law, denies that it engaged in any and all wrongdoing, and denies that its ETCS is defective. The Court did not decide which side was right. Instead, the parties decided to settle. Am I Included in the proposed settlement? Subject to certain limited exclusions, you are included if as of December 28, 2012, s9OUOWNOROWNED PURCHASED ANDORLEASED A â&#x20AC;&#x153;Subject Vehicleâ&#x20AC;? that was s$ISTRIBUTEDFORSALEORLEASEINANYOFTHElFTY3TATES  THE$ISTRICTOF#OLUMBIA 0UERTO2ICOANDALLOTHER 5NITED3TATESTERRITORIESANDORPOSSESSIONSOR s7EREACOMPANYTHATINSURED3UBJECT6EHICLESFOR residual value.

a brake override system on certain Subject Vehicles; (c) a customer support program to correct any defect in materials or workmanship of certain vehicle parts for other eligible class members; and (d) at least $30 million toward automobile safety research and EDUCATION3OMEOFTHESEBENElTSREQUIREACTIONBY class members by or before certain deadlines. 0AYMENTS WILL VARY DEPENDING UPON SEVERAL FACTORS such as the number of claims submitted, the amounts claimed, and other adjustments and deductions. What are my options? If you do nothing, you will remain in the class and will not be able to sue Toyota about the issues in the LAWSUIT BUTYOUMAYNOTRECEIVECERTAINCASHBENElTS for which you may be eligible. 9OU CAN EXCLUDE YOURSELF by May 13, 2013, if you donâ&#x20AC;&#x2122;t want to be part of the settlement.9OUWONTGET ANYSETTLEMENTBENElTS BUTYOUKEEPTHERIGHTTOSUE Toyota about the issues in the lawsuit. 9OU CAN SUBMIT A CLAIM FORM by July 29, 2013, if YOUDONTEXCLUDEYOURSELF FORANYCASHBENElTSFOR which you are eligible and which require a claim form.

9OUCANOBJECTTOALLORPARTOFTHESETTLEMENT by May 13, 2013, if you donâ&#x20AC;&#x2122;t exclude yourself. 4HE3UBJECT6EHICLESAREIDENTIlEDATTHESETTLEMENT website and in the full settlement notice available The full settlement notice describes how to exclude on the website or through the toll-free number yourself, submit a claim form and/or object. BELOW  4HE CLASS INCLUDES PERSONS  ENTITIES ANDOR The Court will hold a fairness hearing on June organizations. 14, 2013 at 9:00 a.m. to (a) consider whether the This settlement does not involve claims of personal proposed settlement is fair, reasonable, and adequate injury or property damage. and (b) decide the plaintiffsâ&#x20AC;&#x2122; lawyersâ&#x20AC;&#x2122; request for fees up to $200 million and expenses up to $27 million What does the settlement provide? AND OTHER AWARDS FOR .AMED 0LAINTIFFS AND #LASS The proposed settlement provides for: (a) cash 2EPRESENTATIVES9OUMAYAPPEARATTHEHEARING BUT payments from two funds totaling $500 million for you are not required to and you may hire an attorney certain eligible class members; (b) free installation of to appear for you, at your own expense.

For more information or a claim form: 1-877-283-0507

With elderly patients especially, McMahan likes to check for new prescriptions, some of which may have been suggested by outside specialists or hospital internists. He does so to guard against potentially risky interactions, but also to reduce redundancy, so patients are taking only the pills they need. â&#x20AC;&#x153;Everybody wants to prescribe,â&#x20AC;? he says. â&#x20AC;&#x153;What they donâ&#x20AC;&#x2122;t do is unprescribe. They forget that even an eye drop costs money or can cause a drug interaction.â&#x20AC;?


he question of how to balance care and cost is one that has occupied McMahan since he was in medical school. As a resident, he recalls, he subsisted on tomato soup and hot tea and slept in a house that had been foreclosed on by the Federal Housing Administration. As a student, McMahan was obsessive about preparation. â&#x20AC;&#x153;I would hole up for three days at a time, studying,â&#x20AC;? he remembers. â&#x20AC;&#x153;In college, I never took an exam where I didnâ&#x20AC;&#x2122;t know every potential question and the answer to every potential question,â&#x20AC;? he says. â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;ve been that way since second grade.â&#x20AC;? McMahanâ&#x20AC;&#x2122;s father was a sergeant major in the army, and his postings took the family all over: to New Jersey, Arizona, Germany, France, and Taiwan. As a boy, McMahan recalls, he was â&#x20AC;&#x153;skinny and pale-faced,â&#x20AC;? adding: â&#x20AC;&#x153;I was always the new kid, the outcast kid.â&#x20AC;? After graduating, McMahan and a fellow doctor set up an ofďŹ ce in Washington, Ga., but business was slow; the first year, McMahan earned just $12,000. He and his wife had three children by that point, and they lived frugally. â&#x20AC;&#x153;That whole year, we didnâ&#x20AC;&#x2122;t buy anything except food to eat,â&#x20AC;? he recalls. A few years later, McMahan learned that the hospital closest to Ocilla was closing because it had no physician, and the town was in dire need of a medical practitioner. The family moved there a few months later. Starting out, McMahan provided mostly acute care, what he describes as â&#x20AC;&#x153;lumps, bumps, rashes, colds, sore throats.â&#x20AC;? These days, though, heâ&#x20AC;&#x2122;s more likely to see patients with multiple chronic diseases: diabetes, high blood pressure, heart disease. Most are overweight, and many smoke. (In Ocilla, smoking is still permitted on the grounds of the local hospitalâ&#x20AC;&#x201D;a policy McMahan

10 â&#x20AC;˘ MARCH 3, 2013

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FEELING STUCK? Like no one listens? Feeling like you have more talent than people recognize? Don’t Just Get Heard —

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has been trying to change.) As the doctor to a high-risk population, McMahan spends much of his time trying to convince his patients to eat better and to exercise: unpopular prescriptions in the rural South. “It’s like the Pogo cartoon,” he says ruefully. “ ‘We have met the enemy, and the enemy is us.’ ”

now. Is health care a privilege or a right, and who pays for it? And how much do you get when there’s a limited resource?” One of the last patients of the day, Linda, a blond woman with diabetes and severe heart disease, is a case in point. Despite having had openheart surgery, she rarely checks her

finally. “That’s my anxiety. If you aren’t measuring it, I don’t know what to do to help you.” He advises her to walk down the road each day as far as she’s able, and also to eat more vegetables. Before she leaves, he gives her a recipe for grilled okra with garlic and olive oil. Afterward, he tells me, “Linda’s a hard sell.” He shakes his head. “I feel like a failure. You saw. I almost begged her: ‘What can we do together to change your behavior?’ ”

B A PERSONAL TOUCH “Sometimes compassion is even more important than a prescription,” says McMahan, who always takes extra time with his patients.

Talking with a 38-year-old minister who has type 2 diabetes (and five children), McMahan is encouraging but stern. “You’re still in the stage where you can turn this thing around,” he counsels. Then he turns up the heat. “You might want to consider: If something were to happen to you, who will take care of those kids?” The minister looks chastened. He tells McMahan that his aunt, who died recently, lost both her legs to diabetes. He pauses. “I keep thinking it’s far off.” As a doctor, McMahan says, he can sometimes feel powerless in the face of people’s habits. “We’re a bunch of hardheaded southerners,” McMahan acknowledges. “But we’re talking about societal issues

blood sugar and sometimes skips her medication. When she tells McMahan that she feels fine, he squints at her. “How many pillows are you sleeping on?” he asks. “One!” she answers quickly. “I know what that question means!” (Sleeping on more than one pillow can be a sign of labored breathing and sleep apnea.) When McMahan asks about her blood sugar, she grows even more stubborn. “I don’t take it very often,” she says frankly. “Is it because you don’t want to get the bad news?” he asks. She shakes her head. “I just don’t want to.” McMahan sits silently for a moment. “To keep the coronary disease from progressing, we’ve got to control your blood sugar,” he says

y the time the final patient leaves, at 7 p.m., McMahan looks worn out. Retreating to his office, he lowers himself into an old red leather chair and stretches his legs in front of him wearily. “It’s all the kneeling,” he says, rubbing his eyes. “As I get older, it becomes a challenge.” Before heading home, McMahan stays to read over the notes for each patient he saw. “It’s easy to miss a detail when you’re busy,” he explains, peering at the computer screen through bifocals. “I try to go over each chart while it’s still fresh in my mind.” Because one patient had fretted over the cost of her medications, McMahan now goes back and tries to streamline them, swapping out two brand-name pills and replacing them with generics. “Being a smalltown doctor, you know who’s going to have to decide whether to pay for groceries or medication,” he says. In the late 1960s, McMahan notes, there were fewer than 50 medicines a doctor might commonly use or prescribe. Today there are thousands, many of them almost identical, but with subtle formulation changes that can alter their efficacy or side effects. For older patients, the problem is exac-

erbated by the fact that hospitals have a 30-day window to update a patient’s medical record (though the health care act will change that). “When you’re the patient’s physician, you can’t wait 30 days to find out what was done to them at the hospital,” he says, then sighs. “But the motivation for the hospital to move more quickly is low. Once the patient leaves, it’s not their problem anymore.” At times, McMahan admits, his decision to become a small-town family physician can feel perverse. With no urgent care in the area, McMahan is always on call; he last took a vacation seven years ago. “I remember running into one of my former med school professors, and he asked me, ‘Why are you not a surgeon?’” he laughs. “It’s tough. For the first five or six years, I kept thinking that maybe I should go back and train to do otolaryngology or some other specialty.” Since starting out, he adds, cutbacks by insurance companies have eaten away at the modest profit margin he once relied on. “For many family doctors, it’s nearly impossible to make a living now,” he says. “You have to make enough to pay the light bill, and to pay your employees— while still trying to be compassionate and not overcharge patients. That’s why so many physicians these days are selling their practices.” For a moment, McMahan seems glum, but then he shrugs the mood off. “The truth is, this is what I want to do,” he says, as we walk out into the warm night air. “I like being a family doctor. I believe all Americans deserve a physician that they can rely on. That’s one thing I’d like to publicize: You can get good care in a small town. And I’m doing what I can to keep it that way.”

12 • MARCH 3, 2013

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Ask Marilyn By Marilyn vos Savant


What percentage of appealed court decisions are overturned? —Kara B.,

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According to the latest figures from the Bureau of Justice Statistics, about 15 percent of civil trial decisions were appealed, about half by plaintiffs and half by defendants. Of these, about 43 percent were dismissed or withdrawn, often due to the parties’ settling. In the remaining 57 percent, about a third were modified or reversed, either by an intermediate court or a court of last resort. Interestingly, verdicts favoring the plaintiffs were modified or reversed twice as often as those for the defendants. So roughly one in five appealed decisions are invalidated, but most of those cases are sent back for a new trial. ®


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By Ann Hood

very Friday night, they gathered at one of their houses in a cloud of cigarette smoke and Aqua Net. They came in twos or threes, dressed in velour sweat suits, skirts with matching sweaters, elasticwaist jeans, and shirts that said BEST MOM or DECK THE HALLS. In their hands: coffee cans filled with pennies that clanked as they walked. Some wore wigs, big bubbles of fake hair. Or wiglets or falls, bobby-pinned in place like the mantillas they wore to church on Sunday. There were 12 in all. The Dirty Dozen, they called themselves. But more often, they were just The Girls. Most had grown up together in Natick, R.I., a small village in a small state. Their houses all sat within a mile of each other. Yet they arrived in station wagons, the ones they drove to and from school, the beach, and the park, overloaded with kids. Their husbands were foremen in factories. Others worked on the army base or ran the produce department or the deli counter at the local store. One of The Girls—no one could remember how she came to join them—was married to a doctor. She wore a blond fall, cat-eye glasses, drank Chablis. She didn’t fit in, really. The Girls married young and stayed married. This one had an affair and left town. Then they were 11 around the kitchen tables covered with plastic cloths. My mother was part of this group. For as long as I

The Girls

Loyal, loud, tough-talking—these were friends impossible to replace

can remember, Friday nights were sacred, hers. The hurried dinner—maybe tuna casserole, eggs in purgatory, fish and chips from the takeout place. Then her disappearance to get ready. She left my father in charge for the evening, which meant popcorn and Dr Pepper and staying up late. But never late enough for me to hear her come home. Best was when it was my mother’s turn to host. She began cooking on Wednesday. Marinating. Peeling. Simmering. Friday we were banished to the TV room so she could set up metal trays with small bowls of chips and dip, platters of cold cuts or fried chicken or meat loaf. Always a salad. Always cake or pie.

WHEN IT WAS MY MOTHER’S NIGHT TO HOST, IT WAS IMPOSSIBLE TO SLEEP. On my mother’s nights, it was impossible to fall asleep. The excitement of The Girls, so many of them! All squeezed around our small table, laughing and smoking and playing poker. I would creep down the stairs and sit on the harvest gold carpet, listening. They shared worries: about husbands and children and money, always money because there was never enough. They told each other “I hate you” and “I love you” with

equal passion and frequency. They were not like mothers on television. No, they were rough around the edges, high school dropouts, secretaries, and assembly-line workers. They spoke with a hard accent that dropped r’s and added s’s. Kmahts, they said, instead of Kmart. “Your deals” instead of “your deal.” Years of Friday nights passed. Three of The Girls moved away. Then cancer struck. Colon. Lung, twice. The Girls dwindled from 11 to eight to five. Alzheimer’s dropped them to four. They broke hips and had cataract surgeries, knee replacements, and lumpectomies. Still, they met every Friday night. After their families were grown, they took trips. To Atlantic City. To Foxwoods casino in Connecticut. Overnights and weekends and afternoons. They met for coffee and counted their pennies and planned more trips to more casinos. Then one day, one of them was driving home from my mother’s when she was hit broadside by a teenager in his brand-new car. She died instantly. That Friday was the first Friday that The Girls didn’t play. The next week, another one was diagnosed with stage 4 cancer; she lived only four months. Unsure how to help my mother heal, I signed us up for bridge classes with my



14 • MARCH 3, 2013

© PARADE Publications 2013. All rights reserved.

19-year-old son. I imagined finding a fourth player, setting a new routine. I imagined I could convince her that things weren’t as bad as they seemed, even though I knew they were. The day before the last class, the teacher announced that we were all bridge players now. “You can go home and teach your friends,” he said triumphantly. “My friends are all dead,” my mother said softly. I glanced over at her. She had turned her head so that no one could see her crying. How foolish I was to think that a new foursome, could replace The Girls. I realized in that moment that there are some things for which there are no substitutes. There are some things that we must mourn and cherish and say goodbye to. Every so often now, on a Friday night, I drive to my mother’s. I bring her treats that make her smile: a bouquet of zinnias, an apple pie warm from the oven, a bunch of flat-leaf parsley. I drink coffee with her and talk about things that don’t matter. She’ll look around the empty table and say, in a voice filled with wonder, “Just yesterday, we were all here playing cards.” I take her hand, bent with arthritis, rough from hard work, and I hold on tight. Or as tight as I can before I let go. Ann Hood’s new novel, The Obituary Writer (W. W. Norton & Company), will be published this week.

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19-year-old son. I imagined finding a fourth player, setting a new routine. I imagined I could convince her that things weren’t as bad as they seemed, even though I knew they were. The day before the last class, the teacher announced that we were all bridge players now. “You can go home and teach your friends,” he said triumphantly. “My friends are all dead,” my mother said softly. I glanced over at her. She had turned her head so that no one could see her crying. How foolish I was to think that a new foursome, could replace The Girls. I realized in that moment that there are some things for which there are no substitutes. There are some things that we must mourn and cherish and say goodbye to. Every so often now, on a Friday night, I drive to my mother’s. I bring her treats that make her smile: a bouquet of zinnias, an apple pie warm from the oven, a bunch of flat-leaf parsley. I drink coffee with her and talk about things that don’t matter. She’ll look around the empty table and say, in a voice filled with wonder, “Just yesterday, we were all here playing cards.” I take her hand, bent with arthritis, rough from hard work, and I hold on tight. Or as tight as I can before I let go. Ann Hood’s new novel, The Obituary Writer (W. W. Norton & Company), will be published this week.

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A Day in the Life of a Country Doctor