You have to realize that health care as it is delivered in the US today is far more specialized than when Doctor Joe practiced medicine. Surgeons hadn’t learned how to do surgeries laparoscopically (tiny incisions) or heart bypass surgery or heart valve replacements. If they did my first cousin, Claire, might have lived a longer life. Physicians’ specialty disciplines increased explosively after WWII and that was still going on in 1967 when I started contracting providers for my type of provider network (now called a Preferred Provider Organization or PPO). Hospitals also became more specialized. Hospital rooms went from private and semi-private to ICU (Intensive Care Unit), CCU (Cardiac Care Unit), BU (Burn Unit), NICU (Neonatal ICU) and many, many more. Hospitals with an abundance of staff physicians and equipment to treat patients that were near death came to be known as Tertiary hospitals. As a gravely ill or injured patient recovered under Tertiary care something called managed health care caused the patient to be transferred to less costly facilities, like sub-acute care and skilled nursing facilities.
In the 1950’s and 60’s in-patient hospital care often meant the patient came under observation of the most senior skilled nurses. The wealth of testing and monitoring equipment didn’t exist as we know it now, so a nurse often had to use the power of observation, and passed those observations to the attending physician, who made the diagnosis. No member of the hospital staff –not doctors, not nurses and not administrators held any responsibility for holding down cost of care. Indeed, the opposite prevailed. As long as care for the patient could be justified, the patient remained in the hospital. Today a gravely injured person’s treatment begins in the emergency room (ER). And, yes, today we have physician specialists (ER doctors) that only work in hospital emergency rooms. In the ER of a Tertiary hospital ER physicians make the diagnosis and do everything possible to stabilize the patient. Once the patient is stabilized the ER physician determines if further in-patient treatment is needed and if so admits the patient to the appropriate bed type and hospital staff (including physician specialists) who carry out his orders and provide the ongoing care.
Some medical disciplines were slow to evolve, one being mental health care. People used to disavow having any mental health issues that needed attention. Then too, medical insurance plans put severe limits on providing mental health benefits, and though a number of federal and state laws have been passed most health plans still do not deliver coverage for mental health on a “same as any illness” basis to this day. Why? When I started my medical insurance career with Blue Cross I was told that mental health benefits were limited to small, fixed dollar amounts for every procedure because one could not predict how long treatment would be needed and therefore could not predict how much money to allocate for making mental health coverage the same as any other illness. And, despite the law, that problem exists to this day.
That same situation also applied to pregnancy, chiropractic, podiatry and more. Congress lit a fire under the nation’s health insurance plans by first passing legislation mandating child-birth be covered as any illness (1974). Prior to that, health coverage excluded all maternity benefits from their plans. Like dominoes, the other medical disciplines where benefits were severely limited were forced to change thanks to similar government pressure. But, the last laws directing all health plans cover in-patient and out-patient benefits be covered as any other illness, applied to mental health. Interpretation of what the term “covered as any illness” truly means remains open to interpretation, although when the Affordable Care Act (aka popularly as Obamacare) was passed, this provision was greatly expanded.
However, when Doctor Joe was in practice, he had to get fairly creative to help a patient with a mental health problem. And, one such incident involving our family stands out for me. It involved John, who wasn’t a patient, but was Doctor Joe’s only first cousin. John lived in Santa Rosa, CA and our family rarely interacted with John, a master carpenter and custom home builder, until he fell off a 15 foot high stack of lumber after it had been hard hit by a fork lift. They found John buried under a pile of lumber and quickly got him to a hospital. But, it took several months before all John’s casts were removed. When he was physically able to go back to work he started turning down all jobs that took him off the ground. You can’t build custom homes if you are afraid to get up on the roof, so John’s income plummeted.
I’ve mentioned before that our family had a cottage near Healdsburg. That cottage sat 75 feet above the Russian River. The property sloped ever more steeply as you went from the frontage road to the back of the cottage and on down to the river. Well, Doctor Joe wanted a garage built in front and to the right of the that cottage close to the road. His had bought a new Cadillac and wanted that beautiful car kept away from the hot summer sun and cold winter rains. So he asked John to build that garage. John politely turned him down. “I only want to build a two car garage, not a two-story garage,” said doctor Joe. John still refused, but Doctor Joe kept on persuading. “Look, you want to get your son Eddie into the construction business. Why not show him how to do the work you don’t want to do and let him climb onto the roof?” That argument appealed to John, so that summer John and his son Eddie became guests at our summer place. Brother Joe and I had our driver licenses and could pop into town for food or building supplies. And, we didn’t have to return to San Francisco with our father every Sunday night, because Doctor Joe had appointments to see patients Monday morning.
So, each Sunday night before he left for San Francisco, Doctor Joe left us with our work orders for the week. There was one on-going chore everyone was assigned: carrying large smooth river stones up the steep 75 foot climb. I used all the mounds of rock that everyone carried up to edge flower beds and most of the vegetable beds. I carefully picked each stone and then set them in concrete, using a mix made to Doctor Joe’s specifications. He always had us use a “one-two-three” formula for the mix. That meant one part Portland cement, two parts gravel (skip the gravel if mortaring stones next to one another) and three parts sand. That formula (with the gravel component) applied to the concrete walkway we built for getting down to the river. I know my stone work was good because I went back to that home in Healdsburg some 50 years later and all those stone borders were still standing in place.
Another assignment: Brother Joe and I were forever hauling 3/4 inch hose in a wheelbarrow so that all the vegetables, flowers and fruit trees got watered. (Drip systems so popular today didn’t exist back then.). And, sometimes one of us got a special job. Brother Allen was tasked with replacing an old wood-lined septic tank with one built using concrete. Allen had to dig down over six feet into the hard clay soil (and no jack-hammer). Oh yes, about that garage! Our standing instructions for helping John was to stand by and be ready to do anything John asked and to make those tasks a priority. I don’t think we did more than carry materials, clean up and poke wet concrete into every crevice of the forms in which the concrete hadn’t reached. This last was pretty boring, I remember.
We had several heat waves that summer and were always trying to get John to let us go down to the river early to cool off. John didn’t usually mind our banter, as it wasn’t that easy for him to connect conversationally with us “kids.” But, we hurt our chances of an early exit, by jabbering and laughing and carrying on with cousin Eddie, until his father would holler, “Basta!” (Enough) and wouldn’t allow us to cool off in the river early. Early to us kids was twelve noon to two in the afternoon. By three, the heat had already started dissipating
That summer Doctor Joe started closing his office Thursdays’ and taking Fridays off. He was a speed demon, but driving up the two-lane Highway 101, past San Rafael and Petaluma, he was forced to watch his speed or be pulled over in one of Novato’s notorious speed traps. He didn’t like driving through Santa Rosa either because you had to slowly drive around the Santa Rosa courthouse.
But, then in the early “fifties” the State funded expanding Highway 101 so it would be four lanes from San Francisco all the way to Cloverdale, a town north of Healdsburg. Before that expansion was completed the San Francisco/Healdsburg trip often took three hours. But, when Highway 101 became a four lane freeway, we could bypass the Novato speed-traps and the slow drive around Santa Rosa’s city hall. Doctor Joe could put “the petal to the metal” and reach Healdsburg in under two hours. This change in Doctor Joe’s business hours stemmed from his desire to check the progress on the garage and see how his Cousin John was doing on a ladder or on the roof. That done, he went about the gardening tasks he so relished. Seeing John clambering about putting up the roof trusses made Doctor Joe glad he had successfully talked his cousin into building the garage.
I remember one particular week when it was hotter than all blazes. Doctor Joe sweated profusely and holding a towel he keep his face as dry as possible. He determined that some nice ice-cold beer would help tolerate the heat better. But, there was no beer at all in the refrigerator. A bit before lunch Doctor Joe gave me an envelope with some money in it and asked that I drive into town to pick up some hardware for John and a case of the locally brewed Grace Bros. beer he liked. At age 17 I drove into town and walked up to Mr. Tonelli at his Healdsburg grocery store and handing him the envelope which contained a demand for a case of beer written (and signed) on doctor Joe’s prescription form. “You are too young for me to sell you a case of beer,” Tonelli said at first. But, then he opened the enveloped and started laughing. He said, “Well now I’ve seen everything!” He handed the envelop off to his assistant, who said, “They’re too young; what do you want me to do?” “Read what’s on the paper that’s wrapped around the money,” Tonelli said. “It’s a prescription for a case of Grace Bros. beer; go fill it,” he added. That assistant came out with the beer, but personally put it into the trunk of the car we were driving so no one got the idea Tonelli’s sold beer to minors.
Sad to say, when that garage was finished it wasn’t very long that Doctor Joe’s “pack-rat” ways filled so much space the Cadillac would no longer fit.