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The Last Gandy Dancer

After I retired, my wife and I moved, giving me a reason to go through my old files. I found the notes from this story scribbled on some scrap paper that used to be everywhere in our offices. “Keep good notes,” someone once advised me. These are good notes and a good story.

Thirty-five years ago I was on the faculty at the University of North Carolina in Chapel Hill and spent a lot of time traveling around the state. Mostly, I drove alone—a pleasure I felt I deserved after a busy week filled with people. Frequently I’d take three hours for a two-hour drive, stopping in little towns and maybe trying the local barbecue. I was a Great Plains Midwesterner, familiar with distant horizons and big skies, and didn’t know much about the South, either the people or the terrain. Driving around helped.

Once a month, I went to a student-volunteer clinic in rural Eastern Carolina, a few hours from where I lived.

On a summer Saturday, a patient there, a tall older Black man wearing a white cowboy hat, had been seen. His chest film showed a large, worrisome mass. Arrangements had been made to admit him to a teaching hospital near Chapel Hill. Since he had no transportation, the staff asked if I would take him back with me. As we headed out, he began to talk.

He was born in Florida in 1923 and remembered that his father had one of the first Model Ts in the state. His father had to wind it up to start it, and his father kept driving it into ditches and finally gave it away. He and his father and brothers hitchhiked and rode the rails to South Central Florida to work in the turpentine camps. They lugged buckets from the trees to the copper stills. At the end of the day, the creosote from the distillation process peeled off his face “like an onion.” He and his brothers also planted crops for 15 cents a day each. They earned enough to buy beans, cornmeal, bacon fat and chicken on Sunday–he laughed as he said that he and his brothers thought that a chicken had only a neck and two feet.

After a few years, he got tired of the turpentine and walked away down the rails looking for work. He got jobs that took him to West Texas, Missouri and Kansas, living in shacks and boxcars. In 1938 he went back to Florida. He got a job with the railroad and by 1947 was promoted to gandy dancer.

My own grandfather was a railroad engineer in the 1920s, and he knew gandy dancers. They were crews of men, four to a team, two teams to a rail, whose job was to lay and maintain track. Each man used a five-foot iron bar (a “gandy”) to lift and move rails back into alignment after the wear and tear of heavy train wheels.

He was the man who sang the call and response that created the rhythm for his two teams. The chants were often bawdy and short, to help the crew synchronize lifting and moving a rail onto the ties together. He sang one as we drove: “Train don’t go to Jacksonville, the train won’t go, but a woman will…” Click, click, click, lift. Click, click, click, lift.

He worked on the Florida Seaboard Railway, and on a good day they could lay three miles of rail. Gandy dancers laid tens of thousands of miles of track in the largest network of railroads in the world. They were also instrumental in creating a branch of American music that was talked/sung to a regular beat. They mostly came from immigrant groups—Chinese in the West, southern Europeans in the Northeast. Crews in the South were African-Americans. Gandy dancers disappeared in the early 1950s, replaced by machines.

After losing his job in 1953 he met a woman from South Florida, and they moved to Orlando, where he was a roofer by day and scrubbed stoves and floors at a Morrison’s cafeteria at night. He got three hours of sleep, but managed to buy a car and a refrigerator and wanted to buy a home. Suddenly his wife said she wanted to move to Georgia and took everything and drove away. He never saw her again.

He worked for a few months, but got downhearted, moved to South Florida and worked on a shrimp boat for a few years. He ended up as a migrant worker near the Everglades, where Big Ag treated him like a slave and charged him double for everything. Eventually he ran away and came to North Carolina, where he now lived with an older lady who fed him. His money was running out; his cataracts were bad, so he could barely see.

We rolled in my VW van down the two-lane highway, him telling me his story and occasionally singing and laughing at the things he remembered. We finally pulled up to the University Hospital admissions entrance. He put on his cowboy hat, thanked me and walked inside.

A couple of days later, I went to the hospital to see how he was doing. I looked at his admission note, which read, in part: “A 64yo black male with a pulmonary nodule, admitted to rule out ca. Social history: migrant worker originally from Florida. Family history non-contributory.”

It didn’t surprise me, but I wanted to find the admitting team and let them know that their note wasn’t even close. This man had lived a remarkable life, full of pain and resilience and abandonment and redemption. This man had lived in the terrible, remote area of South Florida migrant workers that Zora Neale Hurston wrote about in Their Eyes Were Watching God. This man was one of the last gandy dancers. Did they even try to find out?

Of course I knew the answer. If I had been his hospital attending, I’m not sure whether I would have sat and listened to the story either–or if he would have told me. We would have had the workup to do—get bloodwork, CT scan, pulmonary consult and a treatment plan. Only touch on the history relevant to the problem. He wanted to leave. They wanted him to leave as well.

In my practice, I heard about lives that could have been the stuff of novels, but instead became stories I told to my colleagues and family. I took care of a 100-year-old man who had been a cabin boy on a whaling ship in the Pacific. I took care of the greatest blues pianist, ever. I took care of a Nobel Prize-winning writer; I took care of someone who fought in the Spanish Civil War as a member of the Abraham Lincoln Brigade. I took care of people who let me enter into their vulnerable, dramatic, exciting, mundane lives and trusted that I would use what they told me to help them. It is the gift of medicine–the stories and the trust that comes with them.

So what keeps doctors from finding out who patients are; from “gaining entrance to the secret gardens of the self,” as William Carlos Williams wrote?

People quickly mention time, but that is not the reason. It is something else. We may be reluctant to go through the doors our patients open for us because we might find out something about ourselves in the process—come face to face with our own vulnerabilities, our inadequacies and our failures. Not going through those doors, though, robs us of the richness of our profession, reducing medicine to formulaic work without insight into others’ humanity or our own.

So it seems that the least we can do for our patients and ourselves is to listen. Perhaps it is also, in the end, the most we can do.

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John Frey is a family doctor and teacher, now retired, but not really. He is an emeritus professor in the department of family medicine and community health at the University of Wisconsin—Madison. “I have been writing essays and stories during most of my fifty years in medicine—for myself, for others—as a way of trying to understand my work and the extraordinary lives I have had the privilege of seeing.”

Comments

20 thoughts on “The Last Gandy Dancer”

  1. Thank you John. Sitting on the steps of that old building in Chapel Hill almost 40 years ago where you told me to avoid administrative leadership until I just couldn’t any more, I learned that stories are the key. I now believe more than ever that genuine curiosity is the most important strategy for maintaining physician empathy. Please keep writing, and I will too.

  2. Thank you, John. The stories we hear from our patients are so important in making medicine rich. They balance the parts that are mundane or hard. I am sure that listening is good for patients; I know it was always necessary for me.

  3. For fifteen years I have had the privilege of writing stories about patients at our local hospital. It is a program entitled “VITAL PATIENT STORIES” and is designed to enable the staff to get to know WHO the patient is. Most of my patients have been in Hospice care. To share their life stories, not a typical biographical sketch, has been the reward I have known beyond description.
    I enjoyed this essay more than I can say. If only doctors knew what treasures lie beneath the surface of the pain their eyes can only see.

  4. Thank you for sharing this story. As a physician you are allowed to ask your patient any question. You become privy to patient lives that no one or few may know. You learn that sometimes life is stranger and more interesting than fiction. I have always considered this one of the great privileges of practicing medicine.

  5. After almost 50 years in nursing and medicine, this story resonates. How do we teach the vital skill of really listening to who our patients are to our students and residents?

  6. This elegantly-told story is replete with all of the reasons why doctors need to be curious about the their patients. It should be required reading for medical students and residents, a reminder that patients are more than their disease or symptoms.

  7. Marc D. Wager, MD

    What a great read! I know it was a rhetorical question: “So what keeps doctors from finding out who patients are; from ‘gaining entrance to the secret gardens of the self,’ as William Carlos Williams wrote?” but let me propose an answer from my 30+ years in pediatric practice:
    -the focus of our patient visits has changed from listening to the patient to clicking boxes
    -the actual visit has become less important than the documentation of the visit
    -corporate medicine and insurance companies have taken over!

    1. I really wouldn’t blame insurance companies or “corporate medicine.”
      If you are in your own private practice and want to, you can spend more time with your patients, and see fewer patients.
      Of course that means you will earn less money.
      But since even general practitioners and pediatricians earn average incomes
      that put them in the top 2 % of all Americans, that might
      be doable.
      That said, I recognize that you may already be committed to huge mortgage payments on 1 or even 2
      very expensive homes. And/or you may be sending 3 children to pricey private schools.
      You and your wife may not want to send them to K-12 public schools. You may have other heavy financial
      obligations. Or, you may be working in a group private
      practice where your partners expect you to see a patient every 15 minutes in order to keep up the Group’s
      revenues to their expectations
      In any of the above apples to you, you may not have much choice. You have to keep on seeing as many patients as possible, hour after hour. I
      But if you are not trapped in a situation that leaves you with no choices, you might well want to spend more time with patients, hear their stories, and enjoy the emotional
      riches that this writer, and others in this string of comments describe.
      Alternatively, you might want to consider taking a job working for a group practice that, like some of the group practices In the West, encourages doctors to spend a great deal more time with their most complicated cases, while nurse practitioners see the vast majority of easy cases, referring them
      to you only if necessary. I have written about
      group practices like these on HealthBeatBlog.com.
      Of course in that case you would be paid on salary,
      earning less than you would in a very lucrative private
      practice– though still more than roughly 3-4 % of all American families.
      My point is simply that it is up to you, your spouse,
      and your partners– not the insurance companies or
      “corporate medicine.

      .

  8. So what keeps doctors from finding out who patients are; from “gaining entrance to the secret gardens of the self,” as William Carlos Williams wrote?…….

    Such a good question. What a wonderful story about this man. Growing up in a small town in the south our doctors knew our family history, the inside of our homes, our hopes and dreams, not gained in the office but by being part if our lives. There truly is no time left anymore in ten minute doctor visits or hospital evaluations.

  9. The essay jolted me out of the complacent, everyday type of story we meet. Very moving to read the essay of a medic who goes back to student days when patient History-taking was an important part of therapy and care … It’s a pity we so quickly forget the basics in our profession. May your work be greatly bessed

  10. I love this. I’m reminded of the man I met when I was a second-year resident and he was 106 years old. That was the night I heard the story of the 1906 San Francisco earthquake told by someone who was there.

    1. I was touched by this narrative essay. It speaks about our shared humanity and how this connection is important for our heart, mind and soul.

  11. David D, Esselstrom

    Thoughtful, well-written, and poignant. Touching the lives of others is the only way to get in touch with our own.

    Thanks for this.

  12. Thank you for this wonderful story about this remarkable man. The stories we are allowed to hear are what make practicing medicine a privilege.

  13. this is perfect and so true. It’s finding the stories like this that make family medicine magical. Thank you.

  14. Thank you for this beautifully written essay. It is obvious that in your career, you found meaning in the medical stories as well as the human stories of your patients. I hope you keep writing.

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