For a man five feet nine inches tall Doctor Joe was still a commanding presence. It wasn’t that he dressed well. Oh, he bought suits from Roos Bros. and Hart, Shaffner & Marx, but the good doctor always managed to look a bit disheveled. It was like he had slept in his clothes, which was often the case during World War II. Neither did the many noon trips into his home garden before returning to the office help his wardrobe, especially his shoes. Finally, for many, many years Doctor Joe weighed somewhere north of 300 pounds.
Doctor Joe’s state of work attire could make us think his patient who owned a dry cleaning business hadn’t been sick for a while and hadn't done a barter transaction with the good doctor. Doctor Joe had one of his many barter agreements with the dry cleaner, but if the account was current, well, we didn’t use that service for a while. You see, while Doctor Joe was notably generous in many ways, he could be unreasonably frugal in other, small personal ways.
But Doctor Joe's commanding presence overrode all the wardrobe and physical issues because, one, he could move like a ballet dancer when necessary and two, the good doctor often roared like a lion, also when necessary.
Because of his great fondness for food, especially the rich pastas,desserts and pastries Doctor Joe’s patients placed before him when he made his house calls his weight as also a sensitive issue, which no one spoke about in his presence. He might have weighed even more but for the fact he expended tremendous energy when gardening, hunting, fishing or rock collecting.
Given his own large size, you can imagine how difficult it was for Doctor Joe to get patients to lose weight. I remember, one evening, when unannounced, Jeanne P. a long time patient (and good friend of the family) knocked loudly on our front door. When the door was opened, Jeanne angrily stomped into the front hallway and there confronted Doctor Joe, who had demanded she lose weight because of her uncontrolled high blood pressure. In an outraged shrill and tiny voice the 180 pound woman sounded off at Doctor Joe, “Me on a diet? What makes you think I need to lose weight? Ha, just look at you; you don’t need to lose weight, but I do? Ha again!!” Doctor Joe had more than his share of overweight patients. And during the period he practiced there was no Nutrisystem, Jenny Craig or WeightWatchers. In the 1950’s eat less; exercise more was about the only game in town.
Although, Doctor Joe could, and did, take many of his patients to task, he also demonstrated considerable concern over their well-being. That took time, but most of his patients would buckle down because they really wanted to please him and receive his praise when they met their goals. In today’s medical offices, the economics of medicine simply don’t allow doctors enough time during a consult to demonstrate their concern for the patient’s well-being.
Doctor Joe used various tactics to get the results he expected from his patients. He’d call family members in with the patient so he could explain what the medicine or home treatment was and what it would do. Then he asked the family member to keep a note pad showing when the patient received that treatment or medicine.
Older patients gave Doctor Joe the most difficulty. Often the older patient had lost loved ones or friends and was losing the will to live. When all else failed Doctor Joe just “chewed the patient out” for being selfish by depriving the spouse or friend or grandchildren of their presence. Since the transom over the door from the waiting room to the inner office was usually open, everyone could hear the doctor’s admonishments.
“Why do you want to go before your time when you have,” and then Doctor Joe would list things he knew the patient liked and could still do. “I can’t even think about not having another batch of your cannoli when I come to your house.” The Cannoli is a special Italian dessert that Doctor Joe especially liked.
Doctor Joe understood that his efforts would fail if he could not instill a will to live in his older patients. Without a will to live the human body’s marvelous ability to heal itself is greatly impaired. Men were harder to bring around, but knowing a man’s friends, hobbies, family and interests allowed Doctor Joe to succeed where today’s doctors could not. By the time he left the office that male patient was usually thinking about something he really wanted to do and certainly knew Doctor Joe cared deeply. And, that is what I mean when I say Doctor Joe could imbue patients with a will to live.
Today, should a person require care after hours they can access an urgent care facility or the emergency room at a hospital. How much do you think those urgent care physicians know about the patient? Nada, nothing, zip. That wasn’t the case in Doctor Joe’s time. There were plenty of interruptions to Doctor Joe’s personal time. Patients could look up his residence number; he listed it in the phone book so patients could call for help 24/7. Many of those calls were true emergencies and the phone call would end abruptly with, “Get ‘em to the hospital; I’ll meet you there.”
For all his knowledge of medicine, Doctor Joe was his own worst patient. For example, I was always struck by the fact that Doctor Joe prescribed the latest in powders and pills when treating his patient’s cold or sore throat. But Doctor Joe’s own remedy was to boil water, drop a tablespoon of honey in the bottom of a glass and add the juice of one lemon. He’d stir the glass vigorously as he poured in the hot water. The magic of this concoction was adding a liberal jigger of his best bourbon. Well, if you look at a bottle of Nyquil pharmacies sell today you will see that doctor Joe’s own remedy wasn’t much different.
In treating his patients Doctor Joe avoided over-medicating. Most tests involved careful scrutiny of the patient rather than sending a blood and urine samples to a lab. That wasn't an option until after the Second World War. And, more sophisticated special tests like EKG and pictures of the heart beating had yet to be invented. Doctors listened to the heart with a stethoscope, looked down the mouth with a tongue depressor and into ears with an otoscope (instrument with a light to help doctors see down the ear canal).
Where applicable Doctor Joe always considered the body’s own mechanisms to fight disease. He believed the body's natural mechanisms might need help but not so modern medicine overrode the body and possibly caused greater, more serious complications. An exception? Diabetes where the body stopped manufacturing insulin. With Doctor Joe there was always time to increase dosages or add, even change, medication.
When Doctor Joe performed surgery it was only because less invasive procedures were not effective. The concept of laparoscopic surgery did not exist, even in the early 1970s. And, post-surgery infections were more common than today and always weighed heavily on Doctor Joe.
When knee surgeries were just beginning to be performed. I was a candidate. A pioneering doctor associated with UC San Francisco School of Medicine, proposed surgery on my left knee. Doctor Joe convinced me to explore the positives and negatives. Yes, the knee might be made somewhat better. But, the knee would be laid wide open with infection a possibility; there would be considerable pain throughout the recovery period and there was an equal chance that the knee would remain stiff and inflexible with no improvement at all.
In my own managed care career going back to 1976, I found that by providing plan members with a second consult using peer specialists I had contracted for my provider network was very effective. With my system I avoided approving or denying surgery requests. Instead, when reasons provided by the doctor were vague and unclear I selected one of my PPO network provider and gave the provider selected instructions to, (a) affirm the diagnosis, (b) discuss all details associated with the proposed surgery, (c) outline any alternate procedures that were equally viable and (d) discuss probable outcomes, including return to work date or normal activities. When plan members were given the positives, risks, plus any viable alternatives to the proposed surgery, they virtually all took the least invasive approach without my involvement.
One thing Doctor Joe got to treat a lot during summer vacation was poison oak. That included his kids. We could always sympathize with anyone allergic to that horrible bush. When out hunting, even when there were no leaves on the poison oak vines, we were infected. A horrible price was paid if we had to urinate outdoors before the rash appeared. One time Brother Joe was bed-ridden, body swollen from poison oak blisters that covered him head to toe. Cutter Labs had an antidote, but only for warding off future episodes and you had to wait until the present outbreak was gone. Then, starting with one drop, we took the distilled oil from the poison oak bush with a small amount of water. When we got to 10 drops, we started to decrease one drop each day. After 20 days we could roll in a poison oak thicket.
Some topical relief came from Calamine Lotion. When I had an outbreak I would have loved to bathe in the stuff. Once, I decided to clear out thickets of brush in a flat area overlooking Russian River. I didn’t realize poison oak could grow like a vine and was wallowing in the stuff and pulling down thick vines that had no tell-tale leaves. After healing from that experience, I took a second Cutter cure, and still later a third.
Between Doctor Joe and his in-laws a quiet, on-going tug-of-war took place over the merits of Western Medicine and holistic remedies still used by many Italian families. (I mean, what could it hurt, right?) I was a sick kid with asthma, colds, flu, etc., so I got more than my share of both. On the Western medicine side the one thing that alleviated asthma was a shot of Adrenalin. Unless asthma caused you to struggle to breathe in a lung-full of air, you can’t appreciate how I, who hated needles, would beg for the shot of Adrenalin. But, there was and is a limit to how much Adrenalin one can take daily.
A back-up to Adrenalin was an over-the-counter remedy. But, I was too young to remember the name. The two best known of these powders was Elliott's Asthma Powder and Potter's Asthma Remedy. They came in a metal can the same size as for mustard powder. My parents put this green powder in a dish and then lit it with a match. The stuff didn’t flame up; it just hissed and sparked while making a lot of thick, acrid smoke. They covered my crib with blankets to keep the smoke in and kept after me to breathe the smoke in. I don’t know if the powder had any medicinal effect or whether my abject fear of being closed in darkness beneath the blanket got my own Adrenalin surging and hence relieved the asthma attack. Today’s medications for asthma and bronchitis are many and far more effective. Fortunately for me, after age 14, I out-grew my asthma attacks. Gee, that's about the time my father stopped smoking!