Mark Lichtenstein: A Remembrance

by Brendan N. Buckley, M.D.

GREENSBORO – One evening, early in the year 1980, a phone conversation between Washington D.C. and Greensboro, Vermont concluded with words to this effect:

“Well, OK, if that all sounds good to you, then I guess you’re welcome to come here. Let me know when you’ll be arriving. I’ll find a place for you to stay.”

Over the preceding half hour Mark Lichtenstein had done his level best to talk me, a second year medical student, out of choosing Greensboro as the place to experience a summer of rural primary care medicine. And, when it came to making a point, Mark’s level best argument usually trumped most peoples’ debate skills, and their resolve to continue debating.

But, I was determined — hidden behind the guise of an eager medical student, was a more eager soccer player, looking for an excuse to return to Vermont to re-join his summer soccer teammates in the Burlington area. Mark never stood a chance of successfully turning me away.

I arrived on an early summer Saturday evening, rendezvousing with Mark in the Mackins’ kitchen, a minute’s walk from the Greensboro Health Center (now library). Before my car engine had cooled I found myself accompanying Mark to the health center where he skillfully removed a piece of metal from a man’s eye – easy peasy, just so. Welcome to rural health care – Saturday evening urgent care visits and all.

Over the course of that summer, I was at Mark’s side most days, and at his and Cindy’s dinner table more often than not. For a medical student accustomed to tuna casseroles, spaghetti, and

tacos, the food was eye-opening and mouth-watering as Cindy joyfully introduced me to a world of cuisines.

By day, I dutifully shadowed Mark. Our conversation paralleled primary care medicine – always something different, no two days, no two patient visits ever the same. But beyond the specifics of medicine — hypertension, diabetes, foreign bodies in eyes, broken ribs, depression — we spoke of the wonder and the challenge of delivering care in this beautiful place.

Mark saw the big picture — the need for structure and foundation for the care he was providing. He saw the obstacles confronting access to care — cost, transportation, distrust, lack of understanding.

As I arrived, he had only practiced for a year, working within a health care structure that had been in place about five years, and that had been characterized by a revolving-door cast of physicians. Mark had already committed himself to staying for the long term. As part of that commitment, he embraced the idea of community health by reviewing and reforming existing practice habits, and introducing new ones: Child Protection Team, Well Child visits, incorporating alliances with mental health workers, setting standards for our on-site lab and pharmacy — no task too unimportant for him to address.

Through the summer, over hours of conversation, as we drove to and from Copley, as we lunched on the grassy bank in front of the Greensboro Health Center, as we sipped beer and inhaled the aromas of Cindy’s cooking, in between patients, in between innings as we played for the Greensboro Lakers softball team, a deep friendship blossomed. By summer’s end we were already scheming how I might one day return to practice at his side.

And, lo and behold, thanks to a big push from Mark, and David Reynolds at Northern Counties Health Care, the National Health Service sanctioned my fulfilling my medical school scholarship obligation here, and I joined the health center staff in 1985. I arrived expertly trained to treat patients in their hours of dire circumstance — pneumonia, heart attack, kidney failure, stroke, acute abdominal pain — I was just who they needed. In short, I was very good at hospital-based care, and far less experienced at office medicine.

Mark never lost faith in me — he answered all my questions, endured my many interruptions of his workflow, stayed later into the evening than he wished to review our day. His patience knew no limit; his enthusiasm for our partnership never wavered. He was the most understanding partner one might have wished for. As I began my career, he explained the vacation policy and then admonished me that he would not stand for me NOT taking every available day off that I was allowed. He was my partner, my mentor, my protector.

In the beginning, it was difficult for me to match his grace — when he took time off, I felt a bit at sea without him to turn to, so reassuring was his presence. As I grew into my role, as my confidence and self-assurance increased, I began to envision a life here and to imagine a future for our partnership and our health center. My interest caught Mark off guard. Not that he had not anticipated our working side by side for years to come, but, several years into his own career here, he had become accustomed to making all the decisions, to being the one voice that mattered; now I wanted to have a say too.

It should come as no surprise that, when I challenged Mark to share in the leadership of our health center, he understood my position and welcomed my input. In fact, over time we tried to foster a work environment in which all felt empowered to speak up with suggestions and concerns. I know that such a change was not always easy for Mark; it was within his nature and his intellect to quickly grasp issues and arrive at solutions; I am sure he respectfully bit his tongue at many a staff meeting while the rest of us wrestled with a question of policy or protocol.

To work beside Mark, to see him with patients, was an opportunity to learn about trust and caring. It was impossible to miss. He was an empathic man with a gift for understanding. A mutual devotion grew between him and his patients. Once he retired, at the end of 2014, a typical day for me at the health center would include at least one of Mark’s former patients asking after him, singing his praises, mourning his departure.

It was difficult to lose Mark as a colleague in 2014. For many of us who had worked with him for so long, he WAS the health center. We cried then and we cry again now — a devoted physician, a beautiful man, a dear friend, is gone.

A decade ago, a handsome building appeared along the Lamoille River, at the base of Slapp Hill — a new health center. It had long been our dream to move from the old Hardwick Hospital building on High Street into a modern facility, one designed to best serve our community.

Already, that new building has undergone interior reshaping and renovation to accommodate an ever-growing staff. Where forty years ago there were four providers, now there are nine. The staff includes a community coordinator, a mental health counselor, and a nurse dedicated to help those in recovery from addiction. There are plans for a teaching kitchen. The employee and patient parking areas overflow.

Without Mark’s commitment to our community, and his vision for our greater welfare, I doubt such a health center would have come our way. His passion inspired a new generation of health care workers to join him. In following his lead, we helped build a health center in which we take great pride. May it stand as a legacy to Mark.