Practice, Ormond Beach
We packed the car and decided to drive to Florida. My mother came to stay with the children and Agnes and I took off. We had never been to Florida and I thought a few weeks away from the turmoil would do us both a lot of good. We motored leisurely southward, arrived in Florida and spent the first day in St. Augustine and the second day at Marine Land.
The next morning, as we drove south on A1A, we arrived in the beautiful city of Ormond Beach. Across from the ocean, were a cluster of buildings with a sign proclaiming “Ormond Osteopathic Hospital.” I knew nothing of Florida Osteopathic hospitals but it was noon time and I suggested to Agnes that we stop in, introduce ourselves and maybe have lunch in the doctor’s dining room. I told the receptionist that I was a vacationing physician and would like to meet the medical director. He was a charming man and within moments invited us to have lunch. He wanted to know if I was a general practitioner and would I be interested in moving to Florida. When I told him I was a specialist in internal medicine and might consider practicing in Florida, his face lit up like a landing strip at JFK for an incoming flight. For the next week we were treated like royalty. The director had taken the time to look up my credentials and told me in no uncertain terms that they would give me the best contract I could find anywhere in Florida. There is another little rub to all of this; Ormond Osteopathic Hospital was beachside but across the intercoastal waterway, Daytona Beach General was another large Osteopathic hospital, and both hospitals were in constant competition with each other. When Daytona Beach General found out I was in the area they sent a team to promise me a better deal if I would consent to be on their staff exclusively. I met with the Boards of Directors for both hospitals and told them unequivocally that were I to come to the area I would have to service both hospitals. I told them that I was going to continue my road trip south, look at Miami and Tampa and then return to Pennsylvania. I had no idea what I was going to do but told them I would contact them within the next few weeks. Miami and Tampa looked good but nothing was as appealing as Ormond Beach. I knew that if I pressed, the boards of both hospitals would agree that I should be available to both institutions.
They did; Agnes and the girls and I moved to Ormond Beach.
Having been invited to practice in the state of Florida, I needed a medical license. I held licenses to practice medicine in the states of New York, Pennsylvania and Michigan but there was no reciprocity permitted in Florida. The only way to get a license was to sit and write the examination. I had no problem with that because back in the 60s I was honed to a point where I could slash through any examination on Materia Medica. The kicker in Florida was that the examination was given in two parts, one being Materia Medica and the other in basic science. It was a well-known fact that the questions on chemistry and physics were so hard that you couldn’t answer them correctly if you had the book in your lap. It was done purposely because the good old boys in Florida were very protective of their little domain and did not want a swarm of “damn Yankee specialists” descending upon them.
The exam was given twice a year in Jacksonville, Florida. I sent in my application fee and went down to Florida for the weekend. The two-part examination was Saturday for materia medica and Sunday for basic science. I breezed through the first portion and went down to the pool for a bit of relaxation. I had a comfortable dinner and retired early. Shortly after midnight the telephone rang and the following conversation took place:
Is this Dr. Del Marco?
Yes it is. (At this point I will use fictitious names to protect the innocent and possibly the guilty),
This is Lt. Holden of the Florida state police; I have someone here from the Florida State Board Licensing Commission who needs to speak with you. Please come to the lobby as soon as possible.
What’s this all about?
We will discuss it with you when we see you.
I was a bit concerned but there wasn’t much I could do about it so I quickly threw on some clothes and went down to lobby. Standing with the state trooper was a well-dressed man in slacks, sport coat and golfing shirt. He approached me held out his hand and said:
“I’m Dr. Livingstone, the chairman of the Florida Medical Licensing Board. I understand that you are an internist trained in Detroit and have been doing work with cardiac pacemakers. I need your professional help and must rely on your complete discretion in a very delicate matter.”
“I will be glad to help you in any way possible, tell me what this is all about.”
“I’ll tell you on the way.”
We left the lobby. got into the waiting police cruiser and headed down towards the beach. We stopped at one of those beautiful private villas along the beach, and while we were driving he told me that one of his colleagues on the board developed severe chest pain.
“Why not take him right to the hospital?”
“The situation is complicated and delicate; hospital is it out of the question at this point. I need someone to make a diagnosis and you’re the only one I can depend on.”
We went up to the bedroom. Lying there was a man in his 50s, ashen gray, shallow breathing and scared stiff. Standing off to the corner was a blonde about 5 foot 10, broad were a broad should be broad and had a pair of 40s strapped to her chest that were, well, outstanding. I quickly surmised that they were doing the horizontal mambo when the pain struck him. Dr. Livingstone was in the room next to him probably engaged in a similar exercise.
I took a cursory look at the patient, checked pulse, respiration and vital signs as best I could, spoke reassuringly to him, turned and ushered Dr. Livingstone out the door. I told him that it would be best if we got the bimbo out of here and that there was nothing I could do unless I had some diagnostic tools to work with.
“You tell me what you want and it will be here.”
“I want an ECG machine, medical bag, oxygen and a cart with appropriate cardiac drugs if I need them.”
I went back of the room and sat with the patient and told him to hang on and that all will be taken care of. Within 30 minutes the room was transformed into a cardiac unit complete with oxygen. The ECG showed some moderate ischemia but nothing serious. Pulse and blood pressure within normal limits. I told him that I would have to take some blood samples and we would have to wait for the results. By this time the pain had subsided and he was more frightened than anything else. I gave him some Demerol and he began to doze off and was sleeping peacefully.
By this time it was 4:30 in the morning and Dr. Livingstone was getting a little bit concerned. He absolutely did not want to have to transfer his colleague to a hospital and I admit that the situation was a bit delicate. I weighed things in the balance and concluded that we could probably take care of him where he was for the next 24 hours if nothing changed and if the blood studies came back within normal limits. It was a bit of a stretch but considering the situation I didn’t think another 12 or 24 hours or make a difference. I explained the situation to Dr. Livingstone and told him that we would know more as time goes by and if need be we would always able to transfer him quickly to the hospital.
I told him about another problem. By this time it was breaking dawn and I had to sit for an examination in basic science at nine o’clock that morning. Dr. Livingstone looked at me and said;
“You stay right where you are and don’t worry about the examination. Doctor, I am the chairman of the committee and let me assure you that, as of now, you have a license to practice medicine in the state of Florida.”
The License was in my mailbox by the time I returned home.
That’s the way it was. I stayed with them for the next two days and when I was sure the patient was stable enough to travel, sent them on their way. I have rarely told this story before but it’s true……believe it or not.
The next decade was peripatetic. I bounced from Florida to Texas, to Florida to Texas like a ping pong ball on a hard wood table. I was so sure that I had developed enough hospital type political and social skills that I could handle the chairmanship of the Department of Medicine in both institutions. I was dead wrong. You may tame a tiger, teach him to sit up and rollover but you can never change his stripes. I gave myself credit for being able to do something that my character, makeup and personality would not permit. The defect in me is that when it comes to clinical medicine, diagnosis or treatment, I see no gray; it’s either black or white.
[ I referred to a peripatetic decade. We ziged and zaged several times because I was casting about for the perfect practice in the perfect locale, never realizing that I had it. I just didn’t know how to handle it. I am including a section entitled “Tall Tales”; it should unravel much of the peripatetic nature of my evolution, (growing up, maturing, whatever), it took time to smooth out the rough edges.]
Practice in Ormond Beach was a paradise. The weather was perfect, the practice interesting and lucrative and we had a beautiful home a block from the beach. That there was no qualified internist in the Osteopathic community made for a patient load that at times was overwhelming. I had more to do than a 12 hour day could contain and many were the days that I worked around the clock. I would go to one hospital in the morning, the other in the afternoon and then go back in the evening to read the ECG’s for both.
Most of my work consisted of consultations and a peculiarity of practice in the community. The physician requesting the consult would write for “Consult and Co-manage.” What that was, in essence, is I would examine the patient, make a diagnosis and then the referring physician would disappear from the scene and I would manage the case. The referring Dr. would peek in once or twice a week, say Hi to the patient and feel justified in submitting a bill. At first this didn’t bother me but as time passed I began to resent it.
Ormond Hospital added a wing and built a 6 bed intensive care unit. I helped with the design and made sure that we had every piece of modern equipment that was available at the time. It was the best equipped ICU in the area and I was delighted with it. I was named director of the unit and it became my second home. It was Nirvana, a medical amphitheater congruent with my skills. I began training classes for the ICU nurses. I had lectures given to them by members of the various specialty departments; surgery, anesthesiology and radiology. I gave a weekly course in electrocardiography and soon had the ICU nurses tuned to a fine edge. We did a lot of good work in that unit, and, looking back, it was the happiest time of my practice career.
I was busy in the unit and getting busier in the office. I was doing all the endoscopy and cardiac pacemaker implantation and my office was overflowing with follow-up patients. I was visited by detail men from all the pacemaker companies but one was very accommodating. Albert Beutel was a bright eyed, bushy tailed, overly enthusiastic pacemaker salesman for Medtronic, Inc. In the early 70s the indications for a pacemaker were very specific and restricted to complete heart block or extreme bradycardia. As the only DO specialist in the area, I had patients referred to me from all over southeastern Florida; consequently I implanted a lot of pacemakers.
Cardiac pacing was in the embryonic stages of development and hardly a week went by without some new development. Albert was very diligent in keeping me up to date with everything that was happening in the Medtronic R & D department. As one of his best customers, he invited me for a weekend in Minneapolis to meet with the engineers and tour the plant. I met and shook hands with the president and founder, listened to what the research engineers had in mind for the future and in general had a wonderful weekend.
Albert was an interesting man, diligent and bright. He had some good ideas on how to improve pacemakers but because he was a salesman, very few of the elite engineers paid attention to him. He would sit with me in my office for hours talking about innovations that he thought were necessary.
The next chapter relates a 180° shift in my career.