Who Was Doctor Joe?

It’s truly remarkable how patients tolerated Doctor Joe’s quirks and idiosyncrasies.  He could get away with being gruff and irascible because above all else he was a very, very good doctor.   He stood about five-foot nine inches tall.  He was a physically active man who liked to hunt and fish and who had a passion for gardening.  But, he also loved to eat and for a good many years weighed 300 pounds or more.  In his prime he had dark, somewhat curly hair that he combed straight back.  As he grew older, his nose, which he’d broken as a youth, grew more bulbous and beneath it he maintained a trimmed, but bushy moustache.  Still, as a young man, he was passably good-looking and carried his girth well.

I certainly hope so, because the family always maintained, that except for the weight and not having ever broken my nose, I looked just like Doctor Joe.  As his eldest son, I knew Doctor Joe “up close and personal,” as they say.   He was the one who nicknamed me “The Owl.”  True, I wore glasses, but he gave me that name because he often spotted me closely observing what was being said and what went on around me.  My brother, Joe, got the nickname “The Prince,” because given the many chores Doctor Joe assigned him, he was forced to conclude that brother Joe really didn’t like to get his hands dirty.

We wore many nicknames, but my family conferred one upon my birth, and another on my brother Joe upon his birth.   I was born in San Francisco on Easter Sunday.  Brother Joe came into the world the following year…..also on Easter Sunday!   Fate and the family decreed that I and brother Joe would forever be called “Bunny” and “Chick.”  We fought like brothers will do, but we were close.  Until we went to school we never thought twice about what people called us.

However, once in school my brother and I would tolerate our nicknames only when it came from within the immediate family.  We sent more than a few schoolmates home with bloody noses, for teasing us about our terribly cute nicknames.  I can still hear the derisive, singsong voice of the imprudent ringleader and the snickers of those around him.  Well, any fight that ensued typically produced blood, (generally not mine).  After a schoolyard fight a trip to the principal’s office was always required.  After telling our side of the story to the principal, we would have to wait for one parent or the other to pick us up.

God forbid if that parent should be our mother!  Early on my brother Joe and I had developed reputations for mischief as far as our parents were concerned, so we knew in advance that in our mother’s mind no reason for fighting carried enough weight to spare our backsides if she walked to school to take us home.  Knowing she was coming caused us to sometimes to successfully hedge the consequences by strategically placing a 10¢ comic book or two inside our pants.

Actually, we had greater fear of Doctor Joe’s bark than our mother’s swats.  But, in truth, his mind-set on fighting was much more tolerant of our school fights when we felt the need to defend ourselves.  In most other matters our mother was the more lenient.   Doctor Joe gave consideration to the issue that led to the fight.  We also got points if we weren’t the aggressor and if we had tried other ways to resolve the dispute without fighting.   “If attacked defend yourself, your family, including the family name, and your heritage,” he admonished us from time to time.   Heritage, in Doctor Joe’s mind, was at stake when someone called you “Wop,” “Dago” or “Guinea.”

The one instance I remember where Doctor Joe came to pick us up, he seemed more annoyed about the interruption to his office routine than our fighting.  He gave us a stern lecture with a lot of “bark” because we hadn’t tried other measures before fighting, but because we had defended ourselves and each other, the “bite” was only a couple of half-strength swats on the behind to make sure the lecture reached our brains (his comment).

When I was four Doctor Joe bought a couple of lots in the sand dunes south of Lakeside Village in San Francisco.  There, he had a custom two-story home built and there he would live out his life.  The new house would be the home where each of the “Raffetto Brothers” lived until going away to college.  The new house also had plenty of nooks and crannies where our father, a true “pack rat” could store his collectables (which my mother called trash.

It drove our mother nuts, but Doctor Joe wasn’t raised in a city, like we all were.  Born January 8, 1900, doctor Joe was raised on a ranch outside the town of Murphy’s, located in Calaveras County in the gold country of California’s Sierra Nevada foothills.  On the ranch nothing much was thrown away because money was scarce and going in to town took time.   Not, that our San Francisco home wasn’t presentable, but in those areas visitors didn’t see, Doctor Joe’s “collections” multiplied year by year.

Well, the more stuff you collect the more difficult it is to move, for after all, how will you ever find your stuff after it’s been moved.  At least that’s the way Doctor Joe felt.  When he couldn’t find something, us kids were often blamed for taking what he was looking for and not putting it back.  Not that we weren’t sometimes guilty, but more often Doctor Joe had used it himself and forgotten about it.  Anyway, around our house stuff was “big stuff” and it’s little wonder that when George Carlin came up with his routine on the subject, my mother would laugh until tears ran down her face.

When we moved into the new house, there were less than a half-dozen homes built along Stonecrest Drive.  So, our neighbors quickly came to know the noisy, mischievous “Raffetto Boys.”  Unfortunately, more than 60 years later, not a single neighbor remains alive to confirm the antics found in these chapters, so you simply have to take my word on the matter …or ask my brothers.

Seven years after my birth, brother Allen came into this world and quickly made his contribution to the noise level, not to mention the devilment we could foist on our neighborhood.   This juvenile mischief-making was long behind Joe, Allen and me when brother Bill was born.  I, who was then seventeen and a senior in high school, can still see the surprised looks on the faces of the staff in the Principal’s Office of our high school.  When asked what caused my mother to be hospitalized, we shocked the staff by announcing our brother Bill’s safe arrival into the world.   My mother was then only 35 years old — Doctor Joe, a very proud 52.

So, we got quick approval to leave the grounds of Lowell High School and walk a few blocks for our daily visits to nearby St. Mary’s Hospital where Mom convalesced (can you believe –two weeks?).  In 1952 they didn’t send new mothers home the day after giving birth like they do now.   In that era birth almost never involved a Cesarean surgical procedure as it does in one out of three births today.  It wasn’t that women were built differently than they are today, it’s simply that the practice of medicine was much different in those times.

Brother Bill was a very smart little tyke, so when he heard family members and patients call our father, “Doc” and “Doctor Joe” that’s what he called him.  We thought it was pretty funny and Doctor Joe took it in good stride, so pretty soon, except for Mom (who, unless angry, just called him Joe), we all picked up the habit.  For me as I write this, it’s easier to share with you stories about “Doctor Joe” than to remind myself that the central character was also my father.

All the while Doctor Joe’s family was growing in number he practiced medicine from a modest office on Santa Rosa Avenue and Mission Street in San Francisco’s Excelsior District.  He had no debt, not a single dollar, unlike young doctors today.  He opened his office right after graduating from U.C. San Francisco Medical School, and 45 years later, upon his death, we closed it down.   He never moved his office and never redecorated it –definitely not the custom for doctors today.   Medical office or home, Doctor Joe was a pack-rat whose “stuff” filled every nook and cranny in his office and any place visitors didn’t see in our home.

Let me interrupt my stories to say that for over 25 years now, my professional career included the development of health plans, including their distribution, sale and administration.  Paralleling my health insurance career, I waded into the managed health care field before it became a dirty word.  I assembled a network of doctors, hospitals, pharmacies, dentists, optometrists and assorted ancillary services.  Dr. Paul Ellwood, Jr., the fellow that is credited for coining the name Health Maintenance Organization or HMO, called my kind of health network a Preferred Provider Organization or PPO some 5 years after I formed what I had been calling my “provider networks.”

That’s why I say I’ve been able to observe and track US Health Care Delivery as it has evolved for well over half a century, including the time I was growing up in Doctor Joe’s house.  So, as I did when writing  of my brother Bill’s birth, I’ll offer more comparisons on what healthcare and medicine was like then and now.

To begin with for most of the years Doctor Joe was in practice the pace was slower.  Medicine was a profession then, not the business it’s become (a conclusion Doctor Joe’s foresaw when Medicare came on the scene).  Further, we tend to forget that the knowledge, resources and treatments were far less sophisticated than they are today.

Most doctors in the first half of the twentieth century operated as solo practitioners.  A minority had a partner or two, which made covering for one another a lot easier.  And, doctors didn’t move their offices as often as they do now, once they established their practices.  For one thing, doctors relied a lot more on the word of mouth of their established patients to build their patient base.  They had no choice because the code of ethics at that time prohibited virtually all advertisement.  So, when a doctor combined his practice with another doctor and moved his office you could be almost certain retirement was approaching for the doctor making the move.

People say doctors spent more time with their patients than they do now, often inferring the extra time made the quality of medical care received better than it is today.   That is not a valid conclusion, though patients did feel more valued and respected.

Given that patients often gained the will and motivation to stem deterioration of the aging process, I think more emphasis was placed on boosting their will to live to restore their good health.  “If you don’t want to live, you won’t!” my father used to say.  So, the added personal time spent with patients was and still remains highly beneficial.  However, even though doctors spend less time with their individual patients today than in Doctor Joe’s time, the outcomes (results) are better.  First the body of knowledge taught in medical school is so much larger.  Further, the tools doctors have at their disposal to diagnose and deliver effective care are far superior today.

Back when Doctor Joe practiced there was little in sophisticated diagnostic equipment available.  Doctors were forced to spend more time in observation and deductive questioning of the patient than is necessary today.   That is why Doctor Joe, like many doctors in that era, accepted many invitations to socialize with patients.  Networking socially built doctors’ patient bases.  Further, Doctor Joe thoroughly enjoyed all the good food, conversation and attention he got at such gatherings.  But, professionally, he also used these events to observe his patients, noting their good health and vigor and storing that data in his mind for future reference.

If asked Doctor Joe would say there were observable differences in behavior, pallor and movement when a person he observed was coming down with something.  Those powers of observation and excellent recall often enabled Doctor Joe to nip a potential medical problem in the bud.   In my role as “The Owl,” I often saw Doctor Joe unobtrusively assessing the health of his patients at these events.

He would first study a person he suspected of having a medical problem from afar.  He’d next asked some questions of that person’s family and friends.  Then he’d engage the person in direct questions about their health and how they felt.  On the other hand, people attending these events often came to Doctor Joe to get free medical advice.  Either way he provided an early diagnosis of an existing problem or sometimes the probability that a health problem would occur.    On the latter, when you tell someone you have never seen before to take care because they themselves or a family member will take ill in a day or two –and then it happened, well, you can bet that family became believers.  Word of this ability led Doctor Joe’s practice to grow quickly.

I think my brother Joe inherited some of that magic.  He just has an awareness of people along with an ability to read their body language and their responses about issues, family and interests.  He can file it away for years, with full and instant recall.  I think it’s why his banking associates, in awe over his marketing abilities, often called him “Magico Joe.”  I, on the other hand, can’t even remember a person’s name 30 seconds after being introduced.

I once experienced Doctor Joe’s superb diagnostic skill when our daughter, Mary, was quite small.   Mary was exuberantly engaged in noisy play, running and laughing with her friends for most of the day.   Then Doctor Joe told my wife to keep a close eye on Mary over the next few days because she was coming down with something.  We didn’t believe him.  To our eyes there were no signs to support Doctor Joe’s warning at all and Mary sleepily told us she felt fine as we tucked her into bed upon reaching home.  The following morning was a different story.

Long before he predicted my daughter’s illness, Doctor Joe’s diagnostic skills had reached the point where other doctors would ask asked him to provide a “second opinion” to assist the diagnosis and treatment of a particular patient.  Time and again his skillful questioning and careful observation allowed him to come up with the right diagnosis and with that set an appropriate course of treatment for the patient.  Most doctors today no longer possess these skills.  During the hurricane disaster in New Orleans the power went out inside hospitals and doctors were forced to use visual diagnostic skills whereas with full electrical power they would have ordinarily used mechanical testing equipment that is widely available now.

Although his parents spoke English poorly, Doctor Joe didn’t have a trace of an Italian accent.  Therefore, it was a surprise to hear him speak Zenazie, an Italian dialect then spoken in certain areas of the Province of Genoa.  That was the area where Doctor Joe’s parents had lived before emigrating from Italy to the United States.  The Zenazie dialect was the only language spoken at his parent’s ranch just outside Murphy’s, California.  But, off the ranch Doctor Joe only spoke English.

Doctor Joe’s father, Louis, wasn’t always a rancher.  In Italy my Grandpa Louie had studied to be a mining engineer and during the time he lived in the gold country of Calaveras County he’d held several jobs as a mining engineer.  To pursue a college education I’m certain Doctor Joe expressed a desire to follow his father’s footsteps and also become a mining engineer.  The University of California at Berkeley was a natural choice for him as it was close to home.

Before they formed the Department of Engineering in 1942, UC Berkeley had three engineering colleges –Mining, Mechanical and Civil Engineering.   UC Berkeley was also inexpensive and it had a solid reputation.  So, off went the future Doctor Joe to become the first and only member of his immediate family to become a college graduate.

I don’t doubt my father had an abiding interest in mining and geology, his personal library contained many books on the subject.  But, it is apparent his interests broadened during those undergraduate years at Berkeley.  But, Doctor Joe did not graduate with a mining major; instead, he graduated in 1926 with a Bachelor of Arts degree.

After he graduated, because of his academic record at Berkeley, Doctor Joe was able to use his BA degree to teach school in San Andreas, California.  Teaching let him put aside the money he needed to enter medical school.   He wasn’t the most patient man, or even the best communicator, so I suspect teaching must have been a struggle for him and his students.

It surprised many people that Doctor Joe became a respected physician and surgeon.  They thought that his stubby fingers would prevent his ever becoming a surgeon.  Further, growing up on a ranch in the foothills of the Sierras, led them to assume he wouldn’t be able to handle the academic rigors associated with the study of medicine.  They were wrong.  He slung hash in a sorority house to make ends meet while he got through his undergraduate studies.

On May 13, 1931 when he graduated as a physician and surgeon there weren’t many doctors who, like Doctor Joe, “did it all.”  Today, medicine is highly specialized.  You might find a doctor who handles office consults, home visits, surgery and obstetrics in a rural area, but not in any major city.  Although Doctor Joe never liked the feel of blood on his surgical gloves, nevertheless, he performed numerous surgeries and delivered more than 5,000 babies.  As his skills became recognized the doctors he worked with voted him Chief of Staff at St. Luke’s hospital in San Francisco where I was born.

By the time he graduated from medical school and opened his office, Doctor Joe’s knowledge of Italian had become rusty.  Nevertheless, he often had no choice but to speak in Italian because many of his patients were first generation Italian-Americans with severe limits to their comprehension and use of English.   I didn’t understand Italian; it deliberately wasn’t spoken in our home, although my mother spoke fluent Italian.

Italian was the only language spoken when Mom and her family lived in Vermont.  When she first attended school in San Diego, she spoke virtually no English and was taunted unmercifully by the other school kids, something she promised herself would not be repeated with her children.   So, if we kids heard Italian spoken in the house, the reason was usually that the grown-ups didn’t want us to overhear something.

The outside world saw only the professional side of Doctor Joe, but family and cronies also saw his personal side.   He always relished the respect that came with being a medical doctor and was sensitive to conduct that could diminish respect for him or the medical profession.  But, Doctor Joe had a way of putting himself in situations that made him a much-beloved, unique character even when his behavior and actions sometimes left him looking not at all the dignified professional -the image he wanted everyone to hold of him.  Although it often was very hard to keep a straight face when these situations occurred, no one laughed at Doctor Joe –not in his presence anyway.

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