Dr. Gabriel Tenorio Velez will begin this day just as he did the day before — a routine that has remained unchanged for years and will, most likely, continue for many years to come. He is a young man with children that still require a father’s attention and guidance. His marriage is strong. His love for his wife is as fresh as when they were dating — and sometimes it must still feel like dating, because Dr. Tenorio, like most doctors, is essentially a weekend husband and father.
Dr. Tenorio is a graduate of the University of Cuenca School of Medicine; a seven-year program. He performed his three-year residency in Cuba, with an emphasis in geriatric medicine, and is now a well-established physician, and one of Cuenca’s most popular and respected doctors in the expat community. He is also a highly regarded faculty member of the University of Cuenca medical school.
The morning I caught up with him he was preparing to attend a medical conference in Chile and was a little concerned that it might rain while he was riding his motorcycle to the airport in Guayaquil.
I began our conversation by asking him to outline a typical workday. Here’s his schedule.
5 a,m., Breakfast, milk and toast
6 a.m., Hospital rounds seeing patients.
7 a.m. – 10 a.m., Instructor, third-year medical students, U. of Cuenca
10 a.m. – 1 p.m., See patients
1 p.m. – 2 p.m, Almuerzo with family
2 p.m. – 4 p.m., Instructor, fifth-year medical students. U. of Cuenca
4:30 pm – 9 p.m., Hospital rounds; see patients
9 p.m., House calls to patients
11 p.m, Home
Dr. Tenorio reserves his Saturdays for house calls, morning and afternoon rounds at the hospitals where he has privileges, catching up on paperwork, and studying. There is always study. Medicine is constantly evolving and the best doctors are always keen to keep abreast of the latest innovations, therapies, and techniques.
He rests on Sunday.
I have a brother who is a doctor, so I was in no way surprised by his daily workload, but I was most pleasantly surprised by who he chose to go into practice with when he returned to Cuenca to “set out his shingle.” He chose a highly regarded rheumatologist with long experience in elder care who he has known since childbirth. He chose his mother.
The challenges facing health care in Ecuador are formidable. The tentacles of poverty, indifference, and inconsistent funding grab deep into Ecuadorian society, often making first-rate health care problematic. Public agencies cannot always guarantee that a prescribed medication recommended by a physician is, or will be available at any given time — or even that it will be forthcoming.
Dr. Tenorio estimated that in the public health system, doctors are allowed a window of 12 to 15 minutes per patient visit, and a minimum of 40 patient appointments daily. His concern is that such compressed appointments, restrictions on available medication, out-dated medical equipment, and underfunded therapeutic routines, present opportunities for a misleading diagnosis, imperfect remedies, and an ever-escalating possibility of disastrous consequence.
Private health care has its own history of disruption and failure, he says. Too often, promises are rattled like loose change, a lot of noise and shifting in hidden pockets. Overdue obligations are stacked like cord wood; the threat of debts due going up in smoke is already an issue few can easily ignore.
Such is the plight of physicians today. They have been pushed into a wedge between the properties of business and the priorities of caring for those in need.
Most doctors do not endure the crushing demands of med school in the hope of becoming an accountant; it is others who need to be held accountable.
As I was packing up to leave Dr. Tenorio’s office he said he had a story I might enjoy.
Many years ago the local newspaper published a story and photo of a new doctor in town. He was an imposing figure, sitting ramrod straight astride the Triumph motorcycle he roared through town. A young girl was so smitten with the dashing man in the photo, she cut it out of the paper and tucked it carefully away in a favorite book.
The young girl grew up, and in time fell in love with a man many years her senior, young in exuberance, and fiercely in love with her. They married, had children and spent the rest of their days together.
The years passed; a vast wheel turning in the sky, turning and turning on the axis of the sun.
One afternoon, the wife, mother, and recent grandmother was going through artifacts of her childhood to pass on to her grandchild and chanced upon a book she loved reading as a child. As she flipped the pages, a long forgotten photo, now brown with age, fluttered into her lap. A photo cut from a newspaper. A picture of the man she always loved. The portrait of the man who made her swoon as a child became her loving husband, and the father of her children.
She rose from her dreams and reflection and hurried to the present, towards a melody she always loved.
The roar of his motorcycle driving closer.