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Cracking Spines

Prescription? Perspective.

by Max Ross   ::   posted on Sep. 22, 2008 - 5:48pm

After a long night in an Albuquerque emergency room where two young gang members died of stab wounds, Dr. David Sklar arrived at home to find his living room full of packed-up cardboard boxes. His wife was leaving him.

On the verge of burn-out and a personal crisis, Sklar returned to the place where he first decided to become a doctor: Mexico.

In his new memoir, La Clínica: A Doctor's Journey Across Borders - which will be released on October 15 by University of New Mexico Press (the first installment in the company's "Literature and Medicine" series) - Sklar recounts his days pulling teeth, tending to sick babies, and reassuring patients in broken Spanish in an understaffed, under-funded Mexican clinic in the foothills of the Sierra Madre.

The Rake caught up with Dr. Sklar and talked with him a bit about his memoir. He will speaking at the University of Minnesota this Thursday, September 25, at noon.


The Rake: As a twenty-one-year old, what made you want to volunteer in a foreign place, where there would be so many difficult linguistic and cultural barriers?

Dr. Sklar: I think at the time I went down altruistically. I wanted to be a doctor, but I didn't want to do it just to make money; I wanted to make a difference in the world. And, you know, it was during the 1960s, when we were all looking at the world and trying to figure out how to engage, and make positive change. And so I went down there thinking maybe there would be a model there. Because the people who had started the clinic were very altruistic, and looked at it as a way to build an almost utopian community. Everyone would cooperate together, and participate in community development, and ultimately improve the lives of everyone.

The Rake: You make it clear, though, that the clinic's leaders certainly weren't infallible, either.

Dr. Sklar: Everyone has failings. In a lot of cases, as we try to learn, we find leaders, and we find they have their own problems. But you still have to take the best of what they teach us.

The man who led the clinic was a visionary - a creative, charismatic person. And so he attracted a lot of volunteers. It turned out that he had some serious issues [ed - but you gotta buy the book to find out what those are], which came as a surprise to us. What did this mean? Did it throw the project in doubt? How do you deal with people who have serious problems, but also fantastic, visionary ideas? And that's what the story's about.

The Rake: In retrospect, do you think your experience was actually enhanced by the problems you encountered?

Dr. Sklar: I was given responsibilities that I never would have had in the United States. For example, after a really short time in Mexico, many the people who'd come to help had to return to the U.S. to raise more money. And they left me in charge of the clinic.

So I had to make some very tough decisions. How much would I do? What did I feel comfortable even trying to do? What if something happened that was way beyond my capability of handling? What if the patients were unwilling to go into the city and get care from more traditional sources?

A lot of patients used non-traditional sources for health care, for example they used herbal cures and things like that. And I had to decide if I would participate in that kind of approach. Or would I strictly limit myself to what I guess you could call scientific medical care. So that was an eye-opener.

The Rake: Did this approach clash at all with when you returned to the U.S.?

Dr. Sklar: When I came back to the United States for medical school, I was thrown into a purely Western approach, with basic sciences and clinical experience. But I already carried with me this other, more traditional experience. The two weren't always consistent; there were conflicts. And I had to figure out what to make of those conflicts.

I realized that some of my teachers were only seeing one part of the whole pie. For instance, they ignored the family and the community - a lot of them were focused solely on the medical condition, but they weren't integrating it into the actual life of the person.

The Rake: So aside from just a personal voyage, it's fair to say that your general ideas on medicine were informed by your time volunteering.

Dr. Sklar: Of course - you know, we're people, and we get an illness, and you can't necessarily just cure the illness without understanding the person. Different people have different approaches to illnesses. Some want to participate more in the thinking and understanding and the administering of care. And others sort of want the medical system to make all of those decisions.

But there's really a huge range, in terms of how people feel about these things. And so I think it's important, before you start getting involved in someone's treatment, to understand where one sits on that continuum.

The Rake: Was writing about your time in Sierra Madre at all a therapeutic exercise for you?

Dr. Sklar: The experience [of volunteering in Mexico] was something that changed my life in many ways. And I don't think I fully understood how it changed my life until I started writing about it. In that way, the writing was very valuable. And I was able to start seeing some connections between that experience, and my decisions about work, and family priorities - all of those kinds of things.

The Rake: And the memoir really arose from when you returned to Sierra Madre much later.

Dr. Sklar: I went back later on in my life, it was about ten years ago. I was facing a divorce, and mumbling about career choices, and I was trying to understand where some of my life directions and goals had come from, because I knew a lot of them had come from my experience volunteering. When I went back, I found that things had really changed from how they were originally. A lot of the hopes and dreams for the clinic had not come true. It was actually falling apart. And the village was having a lot of problems with violence and drugs.

I was trying to make some sense out of that, and maybe find some meaning in it. You know, what does this mean? How do you go forward when things don't turn out the way you thought they would? And so the book was a continuing exploration of trying to make some sense out of it. Not only to help me understand my own journey in medicine, but hopefully to help other people, particularly students coming along now. A lot of them are probably facing some of the same questions, and see a healthcare system that has a lot of problems in it, and many of them, I would think, want to make a difference in peoples' lives.

So the book is one way of trying to pose some of these important questions. And in some ways, I hope, a way to help people reflect on their life in medicine, and maybe question some of the things that they learn, and try to find new approaches. We're all going to make mistakes. And when that happens, how do you deal with it?

The clinic may have failed, but everyone who came experienced a change in their priorities that went beyond whether a building is still standing or not.


Again: Dr. Sklar will speaking at the University of Minnesota this Thursday, September 25, at noon.