1

                            TIM HUGHES

                       Dr. Fitzhugh Mullan,
                            Interviewer


Mullan:   What is your date of birth?



Hughes:   July 14, 1950.



Mullan:   We're sitting on the deck of Dr. Hughes' home

overlooking Penobscot Bay, is that right?



Hughes:   Right.



Mullan:   And it's headed towards sundown on a beautiful July

evening, it being July llth, not quite his birthday but coming

hard on it, and with a smattering of boats and Isleboro Island in
the background, and a picnic table between us.     I'm glad to be

here, and I wonder, Tim, if you'd tell me a bit about where you
were born, where you grew up, and how you grew up.


Hughes:   I was born at McDonald's.     In Cleveland, the obstetric

hospital is called McDonald House, and when we were kids, we
always thought we were born at McDonald's.     So I was born at

McDonald House in Cleveland, Ohio and grew up in a well-to-do
family--my father was an executive, business executive--in the
country, but not in a community area, rather a farm house

surrounded by woods on three sides and suburban sprawl on one
                                                                     2

sides.    I went to a private school and had a fairly isolated

childhood, I guess I'd say.


Mullan:     Isolated in what sense?



Hughes:     That my friends were upper class, well-to-do people, and

I didn't have too much exposure to poverty or suffering or pain,
but I did take trips in high school, initially with my father and

then later on on my own, I guess mostly--only to Latin America, I
guess, come to think of it, but to places where I saw poverty and
saw a different way of living.

     Then I went to Dartmouth College and mostly had fun,

especially for the first two years.    I goofed around.   And then
halfway through, I decided I'd better do something with my life,
and at that point, in a naive fashion I decided I would either go
into writing or medicine.    I'd gotten a lot of awards for writing

at the time, but I thought that that wasn't a worthwhile venture,

a worthwhile way to spend one's life, and so I thought that the
best thing to do f o r one's life was save lives, and so I decided
to try to go on to medical school, and I succeeded, much to my
surprise.


Mullan:   Had you liked science?



Hughes:   No, I never liked science.   I still don't like science,

and I don't really fit into the medical mold, I don't think.
                                                                        3

Mullan:     How did you find taking science?



Hughes:     Oh, I did okay in it, but I wasn't interested in it so

much.      I majored in English literature.


Mullan:     So you applied to medical school?



Hughes:     So I applied to medical school, and I got into three or

four of them and decided to go to Case Western Reserve.



Mullan:     What years were these?



Hughes :     ' 6 8 to '72 I went to college, and '72 to '78 I went to

medical school.      I was in medical school six years, because I

took a couple years out.     After one year of medical school, I

decided I didn't know what the hell I was doing.       The dean then
was a well-known dean, well-known for his liberalness, and--


Mullan:     Fred Robbins?



Hughes:     No.   It was before Fred Robbins.   It was Dean Caughey.

I remember going to ask him if I could take a year off because I

felt lost, and he said, "Yes, but there's one rule.      The rule is
that you need to come back within three years, because we had one

person actually come back after thirty years, too long."      So I

thought that was a pretty reasonable request.
                                                                         4

        So I took a year off, and I worked on the border between
California and Mexico in a small United Farmworkers' clinic, with
Cesar Chavez, and there I met my future wife.        It was probably a
seminal year for me.       I worked in a rural area, and I learned

about the community of farm workers, and I learned about what
it's like to be in a family, a Latin American family.        And that

gave me direction in medical school, because the following year I

took another year off.      I went back for my second pre-clinical
year, and then following that, I took another year.        I looked at
primary health care projects in Central and South America for the

year.     So basically, my wife and I--then wife; we were married in
between--hitchhiked down from California through Mexico and Latin

America and we used the search for a primary health care project

as an excuse to get out into the country and see people.
        I decided, after doing that, that I didn't want to work in
another country, in another culture.      So   I went back to medical
school and finished off.



Mullan:    Decided you didn't want to work medically?



Hughes:    I didn't want to work long term in a developing country

that was non-English speaking, at least.



Mullan:    Why was that?



Hughes:    It became clear that the solution to health care

problems in developing countries has to come from within, within
                                                                        5

the country, and what people really need is teaching, and it has

to be teaching from within the culture.        So   a foreigner has
relatively little to contribute.
     So I left that right there, that whole idea of going off
and, I suppose, saving the natives, whatever, at that point and

went back to medical school, chose family medicine because of my
prior year off.



Mullan:    Because the farmworkers needed family docs or that

setting invited family medicine?



Hughes:    No, because of the community aspects of working in a

Latin culture.    The rewarding parts for me are the fact that

every person has a story and every person is connected to a whole

bunch of other people and they all interrelate.         That's what
interests me.
     So I went back, and I finished, and at that point I thought,
"Well, maybe I'll do family medicine in this country, but in a
HispanoAmerican culture."     So I went and did a residency in

Fresno, California, a family practice residency for three years.
Then I started getting back to this idea of going to another
country.

     So in the last year there I did a l o c u m t e n e n s in New

Zealand.   We had decided to go to New Zealand, try to live there

for a while.    I got a job and had spoken to all of the major

people in general practice in New Zealand, and everybody was in
favor of me coming except for the licensure board.         There's no
                                                                     6

reciprocity between the United States and New Zealand, and you

can't get a license to practice medicine in New Zealand if you're
an American graduate.    I had a job.     I just didn't have a
license, and I couldn't get it.    So   we came back here in '82.



Mullan:    You'd gone to New Zealand?



Hughes:    We'd gone two times to New Zealand.    We came back to

California with no job and nothing to do, and so my wife Cris and
I, bought a truck, and we drove across the country looking for a
place to settle, and we ended up almost settling in a place a
couple hundred miles further northeast of here, the most

northeasterly town in the United States, called Lubec, which is
extremely isolated.    The hospital is thirty miles away, so it
would be a long drive to do daily rounds.      We decided that was

too much, and we came back here.   We ended up here in '82.



Mullan:    How did you come to Belfast?



Hughes:    There was an ad for a local clinic in the nearby town of

Liberty.    It was the same ad that my partner David Loxterkamp
answered two years later.



Mullan:    But you didn't go to Liberty?



Hughes:    I went to Liberty initially but in negotiating the

contract with the then head of the hospital here, it didn't seem
                                                                         7

as though it would be safe for me to sign on the dotted line.
All I wanted to do was not lose money.        I said it would be okay
if I didn't make any money for the first few years, but I just
didn't want to lose my own money.       I wanted a guaranteed salary

of $7,000 a year.       I figured that's what I could do to break

even.


Mullan:     In terms of what you had to pay to set up?



Hughes: Rent and food, that sort of thing.



Mullan:    Malpractice?



Hughes:    No.     They were going to pay for setting me up, but I

just needed living expenses, which $7,000 in 1982, that's not
very much.       But they wouldn't do that.   So I decided to back out

and work in another community clinic near here and then just

settled in.
        I started working in Searsport, where we are now, with a

cardiologist who was here, and it was clearly a primary care
place to work.       People wanted a doctor to deliver their babies
and etc.     So the cardiologist left, and in the meantime David

Loxterkamp had come.       So that was two years later.



Mullan:    There were other family docs in town at the time?



Hughes:    There were two or three others.
                                                                      8

Mullan:    And they weren't interested in partnering?



Hughes:    The history of this town is that no one had been

together in practice except for David and myself.     There have

been a few associations but no real partnerships.


Mullan:    Do they cross-cover?



Hughes :   Yes, we cross-cover.



Mullan:    So this seems a long way from the border, a long way

from international health.    How does it square with the

directions you started in?



Hughes:    Well, it doesn't at all.   I mean, these are different

directions, and I've taken years off since then.     In '89, '90, I
took a year and worked with McGill University, setting up a

family medicine residency program for the country of Costa Rica.
So that was a continuation of this desire to do something in

another country, and it was good because it was teaching, which
is what my conclusion was ten years before, that that's what was
needed.    And it was good because it felt like I was setting up a
continuing program.    I wasn't just going down there and teaching
people how to deliver babies or whatever, and leaving.      We were

teaching teachers.    It was a process of figuring out what family

medicine means in another culture.    It's a very context-dependent

concept, generalism or family medicine.
                                                                             9

Mullan:     Did it take root?



Hughes:     Yes.   I haven't kept up in the last couple of years with

my friends there, but it was thriving years later.        When McGill

pulled out two or three years after I left, it was thriving.



Mullan:     Your work here has coincided with a significant growth

in the visibility and credibility of primary care, maybe less in

the eighties, but certainly in the nineties across the country.
There have been more students choosing primary care.        There have
been more family practice residencies set up, etc.       Have those
influences been felt by you in practice one way or another?             Is
the currency of primary care different in this community than it

was when you started?



Hughes:     I don't think so.   I don't know.    I don't think my

relationship or standing in the community has changed any.          I

guess that's sort of what you're asking.        It doesn't seem like it
to me.     I'm not a political person.   I don't hang around with
doctor issues much, and I don't think it has made any difference.
In my personal family life, I have felt the change.       My parents
are eighty-four and eighty-two, and my father was involved with
the Cleveland Clinic Foundation for many years, and so his care

has always been specialist-oriented. But the older he gets and

the more frustrated he gets with fifteen doctors for fifteen

different ailments, the more he appreciates my approach to health

care.     So that's kind of neat.
                                                                      10

Mullan:   That's not the system changing, but your dad changing?



Hughes:   Right.     But he is representative of his generation who

built the specialist care system.



Mullan:   The practice you built is unusual in this community in

that it's a partnership, and as I understand it, now with another
physician, a PA, and a number of ancillary people, it's a
sizeable operation.     How do you feel about that?   You're running
a small business.      Is it what you saw yourself doing?



Hughes:   No.   I mean, it just happened.   I really don't like the

business aspects of what I do.     I just kind of avoid it.   It
seems to run okay.     David's been more responsible than I have
been with the financial aspects of that.



Mullan:   Where do you foresee it going?



Hughes:   No idea.    I don't know why, but I would rather have been

an employee, just not have to deal with all that.


Mullan:   Do you see heading there?    That's one option.



Hughes:   I mean, I want to be connected to a community and now I

have a place where I belong, and we've built something that

exists, an entity that I am an employee of.     I'm an owner of it

too.   But I don't know.
                                                                         11

Mullan:     The theme of community has always been strong for you

from your first inklings that you wanted to go into medicine.
Tell me a bit about how that has been realized through your life

and practice here.



Hughes:     Well, this is a small town.      What more can I say?

Everybody here is connected to everybody else, and one of the
values of bringing up a daughter here is that everyone knows who
she is, and when she begins to experiment with who she is, that
will probably be cloying for her, but it'll also be reassuring

and provide a structure for her, that people will tell her who
she is.     I won't.    Other people will.    I think that those
connections in a small town are important.        People know me as a
doctor, and now they know me as sort of the town historian, and

they know me as the crazy guy that walks out to the monument on
the ice, and they know me because I row down to the harbor every

night.     So   there's all these different hats that I wear.


Mullan:    So the sense of community that you sought exists here?



Hughes:    Yes.    I don't know if I consciously went after that,

though.    It happened.     It's a nice place to be.   I didn't begin

life with this idea.       I was naive.   I thought the idea was to do
good.     "NOW, what's the best way to do good?" And things kind of

went from there.       I didn't have a grand plan for my life.
                                                                      12

Mullan:    But this theme of connectedness which many people, but

certainly many physicians, don't recognize or value is one that
certainly going back to the time with the farmworkers and the
first year of medical school has been in your mind, and you

certainly seem to have captured it here, which is not something

people always do, even when they have an idea.


Hughes:    I think I've always valued a different type of factual
knowledge or pursuit of knowledge or truth than is generally
accepted in medicine.    In medicine we search after the scientific
truth, the objective reproduction of tests, and this other way of
searching for truth, which is through the stories of people or
when things seem right, it's a little bit more intuitive and a
little bit more nebulous, but both ways of searching out truth
are based on belief.    So I think it's just as valid.   And that's
where I've come from, I think.     It's not that I reject scientific

truth, but it just seems like there's other valid avenues to find

out what's going on and to find truth.


Mullan:    Tell me more about that.



Hughes:    Well, I'll give you an example.   A medical example would

be a woman who I saw last week. Ten years ago I delivered her
baby and hadn't seen her in those ten years until I was in the
laboratory here in the hospital.      I was on the phone in the lab,
and I heard a "Code five, physical therapy.     Code five, physical

therapy.   Code five, physical therapy."     I don't know what code
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five is.     Nobody knew what code five was.   So I opened the door
to the lab, and twenty people were running down to the physical
therapy department.      I didn't know what Code 5 was, so I kept on
the phone.     Finally somebody opened the door and said, "Dr.
Hughes, you're needed down in physical therapy."

       I hung up the phone, and I ran down there, and there was a

woman who was shaking uncontrollably on the exercise machine.        It
was this woman, Brenda, who I'd delivered ten years before and

hadn't seen her since. We got her on a stretcher, and she was
shaking uncontrollably and we wheeled her--



Mullan:    Seizing?



Hughes:    Well, to all external appearances, she was seizing.      We

wheeled her past her mother in the hallway, who was an employee
in the hospital.      We'd just thrown a sheet over her, and she was

just making all kinds of racket, and we just wheeled her as fast

as we could down to the emergency room and got an IV going, gave
her some Valium and oxygen.     She had two or three more episodes,
and each one seemed a little bit more bizarre.     A couple of times
she was banging her head.     During one of them she was talking to
me, and she was talking with her lip pulled down on her face so
that it just seemed very strange.     Later she couldn't move her
leg.   She could walk to the bathroom, but she couldn't move her

leg on exam.

       So I looked at her chart, and she'd seen a couple other
doctors, and she'd had these spells.     Apparently she'd been
                                                                   14

seeing a neurologist in Augusta.   So I called this neurologist
up, a woman, and she said that she was fascinated by this
patient, she thought she had an extremely rare neurologic
condition, and she was scheduled to have muscle biopsies done the

next day, and she'd had MRIs and EEGs done, and everything was

normal, and yet she has these spells.
     There was another note about how she'd consulted another
neurologist in another town, and so I called that one up, and I
got the same story, only he said--"I doubt if it's a seizure."
But he'd referred her down to Portland, to another Neurologist

who'd done MRIs and EEGs and also had referred her to Hanover,

New Hampshire, a nearby Tertiary Care Center for further MRIs and
EEGs and exams under Amytol anesthesia.

     Anyway, several neurologists had seen this woman, who had
had all the same tests done, and it soon became clear to me that

this woman was not having seizures.   I don't know if I know what

she was having, but she was not having seizures, and also, she

was like this and she couldn't move her leg.   She could walk to
the bathroom, but she couldn't move her leg on exam.
     So what do I do with this person?    It was fascinating to me
to try to put together this person's story and trying to figure
out what was happening and then how to deal with it.    The

neurologist, the one in Augusta, was persistent in her belief

that this woman had a rare neurologic disease, and I was quite

sure, I still am quite sure, that she does not have a neurologic

disease but that she has a psychiatric disease.
                                                                          15

         I decided to confront the patient and began talking to her
in language that I expressed that I care for her and that I
believe that she cannot move her left leg, but I also believe

that this lack of being able to move her left leg is a message to

me, it's a communication to me that something is wrong in her

life.     The day I confronted her, her symptoms cleared,
momentarily, then they came back.          I don't know if that was cause
and effect or not.       I discharged her to go back to the
neurologist to finish the work-up, and then I told her, "I

believe that this work-up is going to be negative.          I believe you
do not have a neurologic problem, but I want you to finish with
the specialist, and then come back and see me, and I want to see
you.''    And she didn't show up.       So she may still be in the

clutches of the neurologist.

     But I think that she's a good example of the two approaches
to this woman, and neither of them have found an answer yet.         But

one approach is to do a lot of objective testing, which,is valid,

and the other approach is to look at this woman's life and l o o k
at her, her past, and l o o k at her context, and try to figure out
what the heck is happening with her.         They both might have truth
in them.     So   that's what I mean.    That's an illustration of
another way of looking at truth.



Mullan:     Are there particular belief systems--that's not quite

the right word--that inform or influence your practice and your

thinking, religion, philosophy, scientific perspectives?
                                                                      16

Hughes:     I don't know, other than what I just told you.



Mullan:     But there's not a particular camp or school of thought,

psychiatric, philosophical, religious that you draw, that you've

read or studied, that you would say informs your work?



Hughes:     Not that I know of.   I'm not a devotee of any school or

anything like that.



Mullan:     Is religion important in your life?



Hughes:    No.   I don't go to church. Actually, my wife does go to

church, and when she goes to church, I go out to my best friend's

house, who is a dairy farmer, and we milk cows together.       There's
nothing more religious to me than shoveling cow manure, standing
behind these beasts that give us pure milk, and shoveling their

shit.     It's humbling.

You have to actually stand in the gutter with boots on and shovel
the cow manure into a big wheelbarrow, and then you wheel it out
and you dump it in a big pit.


Mullan:    And that gives you meaning or gives you--



Hughes:    I don't know.   It's humbling.   Good question.   It's a

rejuvenating thing, a recharging that I can do that seems to have

a spiritual dimension to me.
                                                                  17

Mullan:   I know from what David told me that you have--1 believe

it's called a Thursday morning meeting, a staff meeting where
you, as a group, try to relate to one another.    Tell me about
that and where that came from and how it works.



Hughes:   David and I are really good friends, you know, in the

deep sense, I think, and we each grow from each other.    We've

done that ever since we've come together, and I'm not sure where

the genesis of that all came from.   It might have been David's
longing for more personal connection. And then Mary Beth came on
the scene, which is our psychological/social worker/counselor

person.
     Then also we came across an article written in the family

medicine literature by a group in southern New Hampshire who had
started a similar kind of a group in their hospital.    I went down
to visit that group and got permission to attend one of their
meetings, and it was good.   It was neat.   People just talked

about personal problems that they had had, personal, often
medical-related.   I think somebody was talking about a lawsuit
that they were going through at the time, during the session that
I was there.   People let down their guard and took off their
epaulets, everything that tells us that we're doctors, and we
need that.   We need to be human beings.



Mullan:   This is the way you run the group?   It's the entire

staff?
                                                                       18

Hughes:   No.    It's just us caregivers.   Actually it began with

David and myself.    For two or three years it was David and myself
and the counselor, Mary Beth.    Then we invited Scott, who was our

physician assistant for a number of years, and finally he came.
Now he comes regularly, and now that we have our third partner,
Lisa, she comes.    And we've invited other members of the medical

staff on the hospital.    None of them have come except for two new
people who are coming.    They used to come.   They come

sporadically.


Mullan:   Are you aware of Balint groups?



Hughes:   Yes.



Mullan:   He was an Englisll--well,he actually wasn't.      I think he

was Continental, I've forgotten, Austrian or something, but he

worked and practiced in England, and he used basically group
psychotherapy techniques with practicing physicians.       It was an
important element of the early Family Practice Movement, or
General Practice Movement, in the fifties in the U.K., and it had
elements in common, it seems to me, with what you're trying to
do, the philosophy being to make the practitioners more

functional if there was a good and shared understanding of

themselves and their issues.



Hughes:   Yes.   If I'm not mistaken, the Balint groups were

focused on patients, weren't they?    Patients were discussed?
                                                                     19

Mullan:    Yes, that's right.



Hughes:   And in our groups, the focus is on ourselves, caring for

ourselves.    I think in the Balint groups it's caring for yourself
in relation to your patient care, but in our meetings we're human
beings first.



Mullan:   And this has been useful, you feel, for the practice and

for your relations with each other and yourselves?


Hughes:    It was really useful for David and myself.   The smaller

the group, the more intimate it is and the more deep it is.     So

it was quite useful for him and me.   Now that's it's bigger, it's

a little less personal, but I think it's still an important
issue.    It's an important meeting that we give time, an hour each
week for ourselves.   It's a statement that's important to make.



Mullan:   How about issues of privacy, both in regard to that

group as well as the many issues you deal with your patients in
the small-town setting?   How difficult is it to maintain barriers
appropriately?


Hughes:   Privacy?



Mullan:   Well, you're clearly privy to fairly intimate details

about the lives of your patients, some of whom you also see when

you go to the grocery store or the gas station.   So are members
                                                                    20

of your staff privy to some of that same information within the

group, just within your own practice, if you're engaging very
forthrightly about things that are going on in your life.     There
would be, I presume, items factual and attitudinal that are

shared that are fairly personal.    Problems with keeping
perspective on that and being able to function while not

disclosing or having others disclose information?



Hughes:   Well, I haven't had that problem.    I've certainly shared

personal details and haven't felt that I'd been done wrong by
anyone or anything.   So   I guess I don't have any problems with
it.   It's a tremendous privilege to be a doctor in a small town.
I haven't had any problem that I can think of, with
confidentiality.



Mullan:   I can't remember if it was David, the discussion we were

having, or whether it was an earlier discussion, but someone
talked about living in the crystal glass in terms of being a doc
in a small town where people are constantly watching you,
observing you.   Your amount of privacy is pretty limited.   Is

that an issue?


Hughes:   Well I'm only a part-time doctor now, and so hopefully

I'm getting a little bit away from the label, which is nice.

It's nice to have more than one label in town because then people

get confused; they don't treat you as just a doctor.    I don't
feel that.   You can go downtown in your blue jeans, and they will
                                                                      21

treat you like everybody else.    There's a problem with being on
call and being vulnerable all the time.     That's the nature of the
game.     But I don't think we're treated like the generation before
us, in which the doctor was sort of revered and also separate

from his community, and suffered socially because of that.      Maybe

elevated but also alone.    I don't think we're that way.


Mullan:    The call schedule and the kind of steady pressure of

being a family physician, appreciating now that you're working
part-time, and we'll come back and talk about that, but for the

many years that you were working full-time, how enervating, how
problematic was that, and how did you deal with it?


Hughes:    I just bluffed it through.   I don't know.   It's fun to

really work hard too, you know.



Mullan:    It was not troubling for you?



Hughes:    It wasn't troubling for me to--1 mean, yeah, there's

times when you don't want to get up in the middle of the night
and this sort of thing.    I don't think I suffered.    There are a
lot worse fates people face.



Mullan:    Let's pick up on the English major side of you in terms

of your interest in writing and interest in things nonscientific,

which I gather stayed with you, and now you're spending more time
nurturing that side.    Tell me about how it developed.
                                                                        22



Hughes:    I think it developed from the privilege of being able to

sit in a room with a person and ask them anything that I wanted.
I'm granted that privilege by society, and it's quite an amazing
privilege.     I found myself always looking forward to the social
history part of the complete history and physical or whatever.          I

just couldn't wait to find out who this person was, where were
they born, and where did they go to school, and where do I place
them, and why are they the way they are, and why do they have

whatever complaint they have, and that sort of thing.      And so
that started me going on this idea of that people are just
walking stories.
     So   then I took some more time off, to David's grief, and I
worked in an institute called the Salt Institute, in Portland,
which is dedicated to preserving the culture of Maine.      Basically
it teaches you how to become an oral historian.    They have a

magazine that they put out.    So I did that for three months, and

then I came back here and, for no good reason, probably similar
to you, I just wanted to get people's stories down.      And   so for
three months--1 gave myself three months to try and figure out
whatever it was that I wanted to do.    I didn't know.    I just knew
that I wanted to do more than medicine.
     I picked twelve people out of the community, and I went to

them and I said, "Can I hear your story?" And all twelve of them

said "Sure."    So I sat down and I think I did about a one-hour

interview about three or four times with each one, transcribed it

all myself, and then distilled what I thought was that person out
                                                                           23

of all those however many pages it was, three hundred pages, of

oral testimony, and then I gave it back to them, and it was
really rewarding.     It was really neat to do that.        And that's how
I got into this whole thing.



Mullan:   When was this?



Hughes:   It was about '92,     something like that.     And then at the

same time, I had started talking to another friend of mine, Jay,
who was the editor of one newspaper in town and then was the
editor of the other newspaper in town, and he's a good writer,

was editor of the M a i n e T i m e s for a while.   He's a good writer.

I   started going there every--I think it was Wednesday nights,
exhausted from working in the office.         I was teaching in Augusta
on that day at Alex McPhedran's residency program.           Then I'd come
to Jay's house, and we'd just talk about journalism and

literature and how to get it down on paper.           I interviewed him,
he interviewed me, we just started this mentor/mentee
relationship.



Mullan:   I'm going to turn the tape over.



[Begin Tape 1, Side 21



Mullan:   This is Dr. Hughes, side two of the first tape.
                                                                    24

Hughes:   Anyway,    Jay and I were getting together on a weekly

basis, and he was teaching me the craft of journalism, of setting
things down, observing and looking at things and then writing
about it, but we needed something to do.     And then into our life

walked this filmmaker, Fred Wiseman, and he wanted to do a film

about Belfast, and we got involved with thinking about that.
Then Fred left and went to France and did a film on the Comedie
Frannaise for a year, and at that point, we said, "What are we

going to do with this?"     So we decided we would try to write a
different kind of a history of a town, of our community, see if
we could do something creative with it.
     So that's what we're in the process of doing now.    We've got
a major grant from the Maine Humanities Council, and the hope is

to write a type of history that is constructed from the community

itself rather than from someone coming in and looking at it and
saying, "This is what happened, and then this happened, and then
that happened.''    We're trying to involve everybody so that
everybody owns it, and then come up with a story that is a
consensus but still a compelling story of our town.



Mullan:   How far along are you?



Hughes:   Our goal is to have it written and published by June of

'98, and we just started seven months ago.    So we're not very far

along.



Mullan:   And you're working about half time on it?
                                                                    25




Hughes:    Yeah, well, probably more than that.   I don't know,

probably half time.     Two days working as a doctor is sort of like

three or four days, and then the rest of the time is left f o r the

history project and my family.



Mullan:    And you plan to stay on that schedule until you get it

done?



Hughes:    Yeah.



Mullan:   And do you enjoy the back and forth between research and

medicine?


Hughes:   Well, medicine is a real grounding for me.    It keeps me

connected to people.    You sit in a room and you have to do

something. You have a job, and you have to fix stuff one way o r

another, and that's your responsibility. And so it just connects
me with the community.    It gives me a label, as we talked about
too.    So I wouldn't want to lose that.   I like doing both things.


Mullan:   Are you able to afford it with the help o f the grant?

Is it coming out of your own hide?



Hughes:   Not really.   Right now I'm just living off of the

medicine part of my salary, and I should be getting money through

the grant.   A lot of what we're doing is we're selling books
                                                                       26

ahead of time, too.      We've sold about 130 books now at $75
apiece, so that's partly how we're financing what we're doing.
But I just don't feel comfortable using that money to pay myself
until we've got a product.



Mullan:   You're selling book futures?



Hughes:   Yeah, right.    Well, it's another way to involve the

community, basically.


Mullan:   Great.   For yourself, what do you see in the future?

How would you like to play this story on out?



Hughes:   I don't know.    I really don't.   It's fun to write.     It's

fun to see people, and it's fun to be here.



Mullan:   Do you see staying here?



Hughes:   I see staying here until Rosie's grown up, until my

daughter's grown up.     And I like to travel, so we'll see.      I can
stay here.


Mullan:   Tell me about the family side.     I think you mentioned

you met your wife when you were working with farmworkers.        She

was doing likewise?



Hughes:   She was an outreach worker for the farmworkers.
                                                                     27

Mullan:   She was on a volunteer leave from--



Hughes:   She was a college graduate.    When I went back to medical

school, she went back to get her teaching credential and became

an elementary schoolteacher and did that for a number of years,
and now is kind of in between and looking to see what to do next.



Mullan:   She taught here in Belfast?



Hughes:   She taught pre-school here in Belfast.    She taught

second, third, and fourth grade in California when I was doing my

residency.



Mullan:   And has medicine been good for family life or hard on

family life?



Hughes:   It probably hasn't been good except for that it brings

in steady income.   So   it is good from that point of view.
Certainly it's very time-consuming.     And working part-time has
helped that out immensely.     I think if you work two days a week
as a doctor, you're really working about a forty-hour week.


Mullan:   And the rowing you've mentioned a couple of times.     Tell

me about what that is.
                                                                     28

Hughes:   Oh, it's just a way to get exercise and to get out.

I'll show you my boat shed, if you want, after.     I have a bunch
of boats in there.


Mullan:   What sort of boats?   Is it what you row down the--



Hughes:   Yeah.   I have a racing shell and another rowing shell

that's f o r when it's rough out there, and two o r three kayaks.


Mullan:   So it's a regular routine?



Hughes:   I don't do it every night.   I do it when I can and when

the tide is right and when the weather is right.    The routine

part is that my dog and I go down along the beach together.     So

it is a routine, I guess, but it's not at a certain time every
day, so many times a week, or anything like that.



Mullan:   To go back to the big picture, as you've practiced
medicine, family medicine, and observed from this vantage point
the ebbing and flowing of the policies and issues related to
medical practice, do you have any thoughts about where it's all
headed, where family medicine is going? Any predictive value

that you'd care to share?



Hughes:   Well, I can tell you what my hopes are.   I think family
medicine has a lot to offer the world, the culture of medicine

today, because it's based on healing illness instead of curing
                                                                     29

disease.     I think that's really important in our alienated

society today.     We don't pay attention to people enough in our
medical system.     I see that with my parents.


Mullan:    In terms of how they're treated?



Hughes:    Yeah.   People just want to be cared for.   That's what

they want.    They want to be cared for.   And when I think about
what I'm doing with medicine and this writing, this oral history
,   people want to be heard.   That's what they want, and they want

to be cared for, and they want to be listened to.      That's almost
more important than living for people.     I started my life out
with this idea that I would save lives and that was the most
important thing you could do, but I think I'm changing my mind

about that.    The most important thing you can do is make people
feel like they have a worthwhile and meaningful life.     That's
more important.



Mullan:    Than saving or prolonging it?



Hughes:    Yeah.   And that's what family medicine is all about, I

think, is that it begins to shift health care from a curing focus
to a meaning focus.    What's most important for this person?
Hospice is a good example.     What's most important for a dying
patient?   It's not to keep them alive, right?    We all know that
now, but fifteen years ago we didn't know it.     The thrust of
family medicine, the importance of family medicine in the culture
                                                                     30

of medicine, the world of doctors and all this sort of stuff, is
that.     We pushed the focus o f f to that side.


Mullan:     As sort of a summary, are there things in terms of your

practice and experience that we haven't explored?     Obviously

there are many things we haven't explored, but are there themes
that you'd like to add or you'd like to talk about that we

haven't touched on?



Hughes:     I don't know.



Mullan:     I always ask at the end, just to give you the

opportunity, if I've missed something that somebody's been

itching to talk about.



Hughes:     No.



Mullan:     I think the thing that's been most thought-provoking to

me about our interview is the similarity of our entry into
medicine.     I was, in fact, a history major, but I was much more
entertained by English and history, arts, than I was by the
sciences.     I was competent in the sciences and did well enough to
do pre-med, but I'm frequently surprised that as I follow the

trail of generalism, I find over and over again people who

whatever their path into generalism, whatever practice they have,

came from a similar kind of approach to the latter part of their

youth.    As they matured, their interests were in English or in
                                                                    31

writing or history, and yet they had an itch to do something
practical, which medicine was.    As they got into medicine, they
mastered the science well enough to become physicians, and yet

they gravitate back to a kind of practice which accommodates a
broader world view that is not defined simply by a scientific

formulation or quantitative formulation, but has qualitative and
intuitive aspects to it that aren't easily captured in the
scientific paradigms that we all learn.

        Just today, Alex McPhedran, a neurologist, the story on Alex

McPhedran was he was a neurologist turned family practitioner.
Well, he was a history major turned neurologist turned family
practitioner.    The common theme was history and the family
practice with a siding into neurology, is the way I would
summarize his history.    So I find this theme endlessly

fascinating, partly because it's replaying my own tape, which is

always nice to hear, because as I went through that, I felt like
a misfit.    I had a lot of friends who were history majors and
were going right to law school or economics graduate work or
history graduate work, and I had a lot of friends w h o were pre-

meds who were majoring in biochem, or chem and biology, who,
parenthetically, found the first couple of years of medical
school a piece of cake, as I struggled through the first couple
of years of medical school, less well prepared and less inclined

to the disciplines that became anatomy and physiology and

biochemistry that we had to labor through.    So it's always

refreshing to find every time I can replay that with someone

else.
                                                                     32

     Inexorably--and you wouldn't have defined it then, but it

has for so many led back to a kind of practice that is generalist
in nature, whether it's family practice or internal medicine or
pediatrics.   It does lead in that direction.



Hughes:   But it need not.   Neurology is another good example.

Alex approaches a neurological problem from that point of view,
from a historical perspective.



Mullan:   I don't mean to be simplistic about it.    Certainly you

can have oncologists or surgeons whose--



Hughes:   Whose approach is generalist.



Mullan:   Who have a world view, who would be comfortable with and

would be compatible a generalist point of view.     But I do think
there's a difference. And Alex said it himself, said, "The

reason that neurology appealed to me at the time it did is
because there was a set of skills which largely, at that point in
time, the fifties, were, in terms of your skill in physical
diagnosis and cognitive exercises connecting the physical
symptoms and signs with a mastery of literature of neurological
disease, but it had a definitiveness that was appealing.     You

could explain this reflex in terms of an understanding of the

cracks in the spinal column, for instance."     And that I would

consider a non-generalist instinct, I mean that desire.
                                                                    33

Hughes:   Yes.



Mullan:   Not that Lie generalist doesn't ses k definition, but to

be a good generalist, you've got to be comfortable with a great
deal of lack of certainty, a great deal of ambiguity, which is

often the way human disease--the human condition--presents
itself.   It doesn't present itself in DRGs that are neatly
labeled and parked often, and at least the generalists are seeing

very often, like your lady with her pseudo-seizure.     There's a
hell of a lot of ambiguity in that that you were prepared to

embrace if she'd come back to you, if she's smart enough to come
back to you.



Hughes:   We'll see.



Mullan:   Well, it's been good, and when you get the transcript

back, if there are things you want to add, please do.



Hughes:   Okay.



Mullan:   Thanks f o r sharing this.



[End of interview]