Practice, Traverse City
I found a beautiful home on the peninsula of Grand Traverse Bay, the price was right, we bought it and we moved in. It was located on the western side of the peninsula overlooking Grand Traverse Bay. The house was a rambling ranch with a large country kitchen, four bedrooms and a finished recreation room below. For the first time, the girls had their own bedrooms. It was on a two acre plot that backed up into dedicated forest land where nothing else could be built. The peninsula rose in elevation on both sides of the Lake and in fact there was a small mountain between the East and West Shores.
The girls and I spent many a day wandering through the fields looking for Indian arrow heads and artifacts. In spring, after a rain, the entire community could be found in the woods gathering morel mushrooms. The girls went to Mission Bend School, located at the northern tip of the peninsula, actually at the 45th North Parallel, half way between the Equator and the North Pole. The girls loved living there, the snow and the lake were a world apart from where we lived in Detroit. Agnes, the girls and I were very comfortable for the first time in our marriage. It was the first house we had ever owned and we loved it.
The shores of Lake Michigan can hardly be called a beach, more like an enormous rock garden. The house was up on a slight hill and the view of Lake Michigan was spectacular. I was not very wise in the ways of the North but because we had three fireplaces I was determined to keep them crackling at all times. My friends told me that the best wood to burn in the fireplace were “slab off” slices. Logs were squared at sawmills and the four slices that were cut off are referred to as “slabs”. I called the local sawmill to place an order. I was told that they only delivered in 6 yard truckloads. I had no idea what a 6 yard truckload was but the price was right so I ordered it. I told them to deliver the wood in the driveway beside the garage. Several days later, Agnes called me in a mild state of hysteria. She said there was a mountain of cordwood that stretched from the garage down the driveway and almost in the street. I came home immediately and indeed it was more wood than you could burn in a lifetime. That weekend I went to the local school and hired as many children as possible to stack cordwood. I think I gave them all a dollar an hour or some such miniscule figure but 20 or more of them piled cordwood in stacks all around the back of the house.
There was a medical office building within walking distance of the hospital. I rented offices and started practice. Within six months, my income had multiplied exponentially. Traverse City was a beautiful place to live, the people were very social and affable, and I was sure that I had found Nirvana.
For me it was a no-brainer; I wanted the job and I wanted to run a medical department. The only thing I didn’t realize was that I didn’t have the skills to do the job the way it should be done. The skills I lacked were the olive oil skills; the ability to be smooth with referring men, the ability to compromise and to move things by evolution and not by revolution. In Traverse City, I was a racehorse hitched with plowshares and we pulled against each other at every step.
I had the entire Department of Medicine in my grasp but I was arrogant, uncompromising and would not suffer fools graciously. I knew how to take care of the sick people but I didn’t know how to take care of all of the general practitioners on the staff. It was interesting in that Bill Brott ,the one residency trained general surgeon did his training at the DOH several years before I got there and was an intimate confidant of Ralph Limburg. A cute story is that Bill fell in love with one of the lady interns and when they married, Ralph Limburg gave the bride away because neither one of them had any family in Detroit. I’m sure that one of the reasons I was so very quickly accepted as chairman of the medical department was because of the recommendation I got from Ralph Lindburg in Detroit. I went to work and hit the ground running; I had no problems with the medical cases and relished in being my own man for the first time in my career. Oh how I wish I had been a bit more mature when it came to managing people.
For example: I had the contract to read all the electrocardiograms in the hospital. I was the only one qualified by training to do so but I was told that there were two general practitioners who took turns reading the electrocardiograms before I got there and that they wanted to at least continue reading electrocardiograms on their own patients. My initial reaction was to say no but, on reflection, thought that one or two ECGs more or less would not make any difference. Wallace Willman, D. O. could have been a poster photo for what a country general practitioner looked like. He was tall and lean, had wavy well combed silvery hair, a patrician nose and deep blue gray eyes set beneath thick eyebrows. He had a long narrow face and thin pursed lips. He always wore a well tailored black suit, white shirt and cufflinks, with complementary tie. What I found most impressive about him was that he rarely spoke. He had a huge practice and a good reputation in the community. He spoke to his patients in a paternal manner but rarely said anything to them of medical import. He had been in the community for 15 years prior to my arrival and did all the internal medicine in the hospital.
I routinely read out and reviewed the ECG’s taken daily. One day Wally interpreted an ECG on one of his own patients; the ECG showed second-degree heart block and he signed it out as being normal. I went to the administration and requested that he be denied ECG interpretation privileges. Of course it didn’t sit well with Wally. Today I would’ve handled the situation much differently; I would sit down with him, pour olive oil on, go over the ECG and teach him the various nuances to help him avoid errors in the future. That’s the smooth way to do it, but I wasn’t smooth in those days.
Similar situations with other GPs on the staff surfaced daily and instead of mollifying the events, I took them to task. I was not accustomed to being around average everyday physicians. I was so used to the high quality medicine practiced during my residency that I overlooked the fact that most practitioners were just ordinary docs and not the brilliant medical mentors with whom I rubbed shoulders in Detroit.
It was a quiet Saturday afternoon and I was making my final rounds of the day. I got a call from the emergency room nurse asking me to examine a patient. It was a nine-year-old girl complaining of nausea and belly pain. The mother explained to me that the family doctor was Dr. B. W. Green and he was out of town for the day. I thought nothing of it and proceeded to examine the patient. She had generalized pain in her abdomen but there was nothing point tender. Her temperature was normal so I ordered a flat plate of the abdomen and a series of blood tests. The x-ray showed some nonspecific abdominal gas patterns and the blood test was completely within normal limits. I wrote a prescription, told the parent her child should be fine within 24 hours and sent them on their way.
The next day I was making my early Sunday rounds when I saw the mother in the hallway. “How is your little girl today I asked?” With a look of utter disgust she said, “She’s alive and doing well, no thanks to you.” She then told me that Dr. Greene came in later that evening, examined the child and proceeded to do an appendectomy, telling her that all would be well because the appendix was caught before it had a chance to rupture. I was completely flabbergasted. I had so much faith in my ability to palpate the abdomen that I was shaken to my foundation with what the mother told me. I put my tail between my legs and mumbled something like, “glad to hear that your daughter is doing well” and ran down to the pathology lab. I asked the pathologist about the appendix that was removed late last night. “Sure thing”, he replied, “I have it right here, would you like to see it, it’s a perfectly normal appendix.” “Are you sure it wasn’t inflamed and ready to rupture?” “Naaaa, is a normal appendix.”
I was flummoxed, flabbergasted and angry. I confronted B. W. Green and he said “junior, this isn’t Detroit; when they come in with nonspecific pain in the abdomen, take the appendix out. That’s the way we do it around here.” It was a hard lesson to learn and one I never forgot.
My problem was I saw no gray area. Green was a surgeon by acclamation, a situation not uncommon in those days. If you wanted to do surgical procedures, you would work with a surgeon somewhere for a time and then go it on your own if you could get hospital privileges. In many small communities in the USA the staff was all self trained. In my mind these two men were incompetent and should not have surgical or medical privileges in the hospital. There is always politics and hospital politics can be very strange, particularly if the doctors in question have large practices and are accustomed to doing what they want to do in the hospital. My dilemma was that I was hired to bring the Department of Medicine up to standard and I only knew one way to do it. I requested a meeting with the executive committee and asked that their hospital privileges be removed. For the next hour I heard a series of platitudes but the outcome was that my request was denied. I am now aware that hospitals all over the country face the same dilemmas on a monthly basis with the outcome being the same. The medical world has great difficulty in disciplining members of the staff when it comes to levels of practice. A physician can be suspended on the spot for not having his charts up-to-date but will be given a pass on dangerous medical performance.
There was plenty of work to go around but being disenfranchised from two of the largest suppliers of patients to the hospital put a kink in my armor. The staff broke up into two separate cliques, one with me and one opposing me. I decided not to let it bother me and just kept working as hard as I knew how.