Psychiatrist on the Road: Encounters in Healing and Healthcare

After 18 years as a senior clinical psychiatrist at a New England inner-city mental health clinic, Dr Lawrence Climo was understandably surprised and saddened when he was given 2 weeks’ notice that his services were no longer needed. Financial constraints meant the clinic was replacing him with a nurse. Although his wife told him it was an opportunity, he remembers thinking that health care reform made him feel that his professional skills were “almost irrelevant or at least unmarketable.”

Happily for himself and for readers of his book Psychiatrist on the Road, such fears were unfounded. Dr Climo began by doing what he often recommends to his patients-keeping a journal, and then he looked for a job. His main requirement was that the job be located far from New England. He wanted “distance and quiet as the shock of being let go and the idea of retirement sank in.” He applied for a position advertised in Gallup, NM, as a locum tenens; he would be a temporary and itinerant psychiatrist at the Gallup Indian Medical Center. To his surprise and delight, his journey rekindled the spark of his profession, reminding him again that “the psychiatrist, like his or her patients, is a student as well as teacher,” and that the “mystique of psychiatry is about healing.”

Divided into 5 parts, his book chronicles the day-to-day stories of people who do not have primary care physicians or private insurance and who often live on the margins of care and social services. Dr Climo shows himself to be a thoughtful listener, a psychiatrist who believes that healing encompasses so much more than a prescription pad. He learns the Navajo emergence story, for example, but does not understand it until months later, after living with his patients’ many uncertainties and his own. He realizes why “north is the direction of death” and yet when he and his wife are leaving this first assignment and driving north to the next one, “north is merely 1 of 4 sacred directions, not a location or a destination to fear. It is a familiar and natural setting on the compass of life and of our world. I had merely been looking at it the wrong way. Attitude.”

This new awareness stays with him as he ventures to other locum tenentes (a state hospital in New England, an inner-city outpatient clinic in the South, a VA hospital), and in each place he begins as an outsider, relishing the opportunities they afford for fresh perspectives and unorthodox questions. He leaves each place feeling connected to and involved in his profession and his patients. He employs an interesting method for his introductory session when appointment times are limited to 15 minutes: he asks the patient, “if someone were to write a book about your life living with your illness and all you’ve seen and lived through and suffered and survived, what might be a good title?” The answers to this question fill his book with rich and illuminating examples of people working their way through illness. Some achieve spectacular triumphs, others are not even able to return for another appointment.

Through all of it though, the author brings a careful eye for detail, an open heart and mind for nuance and hope, and a constant willingness to go where the story takes him. It is a rich ride indeed that the reader takes with this itinerant-and wise- physician.