CHANGE OF PACE

A change of pace from the politics of election time and the upcoming marathon Council meeting next Monday seems to be in order.

One of the possible results of the Republican victory will be changes not abolishment in the ACA.  The delivery of health care today would have been incomprehensible when I first began caring for patients after WWII.

There was an intimate and personal relationship between doctor and patient; something with all the rules, regulations, and third party interference that is impossible today. Health care has become big business.

With that in mind I am reposting for the second time a blog that I first posted in October 22, 2008 and again in February 2013. It is an anecdotal view of the practice of medicine in the post war period.

A Doctor in the late 40s.

For most of 1946, I had no car; instead, I drove my mother’s pre-war Plymouth.

It was post war and no cars had been available to the public for several years. Production had not yet met demands. I had tried to buy one at the various dealerships but only the Ford dealer gave me any hope. I was too naive to understand that he wanted dollars under the table before he would deliver one at a premium. Fortunately, a Lion member owned the Studebaker dealership, and I bought one of the first postwar Studies, and many more after that from the same dealer.  Ray Torbush was a member of the Plainfield Lions Club and we had a close and personal relationship for years until he passed away.

The self-contained medical building or offices are a post war innovation. As was common in those days, the office occupied a portion of our house, on the corner of Fourth and Grant. It had been the site of my father’s practice since 1911.

A porch had been enclosed and became the waiting room. A new entrance had been built on 4th street. There was a small entryway between the waiting room and the consultation room, which you entered from the upper left. A door at the far end of this room led to a hall, which was closed off, from the living quarters by two doors. You turned left down the short hall and entered the examination room, which had formerly been a kitchen. An old outside pantry and rear entry had been converted into a rest room and storage space.

In my childhood there was in that hallway a large wall mounted wood telephone (with crank). It was accessible from the living quarters as well as the office. To call that phone you asked the operator to ring #22; it was the 22^nd telephone installed in Plainfield. When I retired the number had evolved into 756-0022. The area code was not needed.

Most of my practice consisted of blue-collar families. Many were of Italian, Polish, or Irish extraction; the major population in the West End.  In those days, my practice was not specialized and included pediatrics, obstetrics, minor surgery as well as medicine. I also administered obstetrical anesthesia ^^to supplement my income.

In the 40s and 50s, there were a large number of area residents who were commuting to New York from a station on Grant Avenue.

Many were patients and all too frequently, someone would ring the office bell before 7 o'clock in the morning. They wanted to see the doctor before catching their train. It did not matter whether I was asleep or not, they were awake.

Before the war, it was not customary for doctors to have female help, but I soon felt I should have a nurse. This was not only for my "protection" as well as the reassurance of the woman patient.

I hired a delightful young RN (Barbara Wilson) from the Hospital for $48.00** a week! I put her small desk and filing cabinet for the patient’s records in the entry hall by the door. She was the first of many of the most compassionate nurses that worked with me. Most stayed for many years and left only when they had children or their husbands were transferred out of the area. Most of my patients came to regard them as their friend and for years after the nurse left continued to ask about them.

By the 60s I needed two “girls” in my office which was now on Park Ave.; one a nurse/office manager, the other a receptionist/secretary. In 1970 Nan Christmas, the wife of the then director of the Second Street Youth Center took over that position. I never had a better person in the office; there was no letter that left the office that was not grammatically and word perfect even if she had to correct me.

One day a young girl and her mother came rushing into the office. The girl while using the slicing machine in the family deli had cut off the extreme tip of a finger. The mother stayed in the waiting room while I, assisted by the nurse, repaired the wound.

When I went to tell the mother that everything would be okay, I found her lying on the floor, out cold. She had fainted. She was a greater problem then her daughter.

I had treated one of my patients, a young black man, (Clem Curry) who had pneumonia with ambulatory antibiotics. After examining in the office, I had discharged him as cured.

There were no other patients in the waiting room when he left. I remained sitting at my desk with the door to the reception area ajar. The outside door opened and this young man reentered and, knowing that I could hear, said to my nurse.” I forgot to ask the doctor if I could play the clarinet now.” I called out “Clem, of course you can". "That's funny", he said, “I never could before".

I had fallen for an old saw and started laughing. Fifty years later, Clem and I still laughed at this joke.

Once I told the patient, who was not following my advice or taking his medication, that unless he did as I recommended he was wasting his money and my time. He never came back. I had lost a patient I could ill afford.

Twenty years later when he reappeared in my office with a serious illness. He told me that he had been afraid to come back since he was not complying with his treatment, and had seen other doctors. Because he felt that I was a superior physician, he had swallowed his pride and sought my help. He continued under my care for several more years ultimately passing away from intractable heart failure.

Among my patients was a family with two young boys. The older one had developed ileitis. I had referred the family to a GI specialist at Mt Sinai in NYC; however, his case had not only been missed diagnosed by them as ulcerative colitis but the treatment had resulted in a demanding invalid. The younger boy was uncontrollable, probably because his brother was receiving so much attention.

One day he along with his brother and his mother were in my consultation room, when I looked up and noticed that he had not only opened the door to the entry area, but had tied the window drapes' pull cords to the to the door knob. He was getting ready to slam the door closed when I stopped him. I do not think mother even scolded him.

One Italian family had several daughters. The eldest had severe mitral regurgitation a complication of rheumatic fever, which ultimately proved fatal. One of the other daughters was very obnoxious and nosey. Her younger but naive sister was able to conceal her several months’ pregnancy when married. Helen and I were invited to the family catered wedding.

A little over five months after the wedding towards the end of her 7th month, she phoned me hysterically complaining of severe pains in her stomach. Suspecting what was the problem; I immediately made a house call and had her transported to the hospital in active labor. I was her obstetrician, almost all physicians, even those who professed themselves to be surgeons, in the 50s delivered babies.

The baby boy weighed about 3 pounds and ultimately suffered from a hearing loss. Her older sister questioned me whether I thought that the baby had come too soon after marriage, i.e.: questioning if her sister had been pregnant before the wedding. I pointed out that the baby’s size showed he was premature which satisfied her curiosity.

That delightful young lady and her husband now live in Florida. She has many grandchildren and frequently e-mails me. She has never forgotten my birthday.
 

There was an Irish foundry worker who lived on West 4th Street near Monroe Ave and was employed at Hoe’s. He developed severe urinary retention at work as the result of an enlarged prostate. Although in severe pain he walked about six miles from Middlesex to my office. I had the Muhlenberg ambulance  (in the 50s the Hospital still provided ambulance services) transport him to the hospital for the Urologist to treat. In those days that particular surgery was not only crude and brutal, but, there was a prolonged painful period of recovery most often complicated by urinary tract infection.

The distended obstruct red bladder was empty by forcefully inserting a trocar through the abdominal wall into the bladder. A tube was then passed through the trocar which then was removed. The drainage catheter was left in place until the prostate could be removed suprapubicly by manual dissection from the bladder wall. Now all this can be done painlessly without a scar through the urethra.

** Hey, an office call cost $4.00 and a house call $5.00.

^^ The fee for a delivery anesthesia was $5.00 in the 40s and had risen to $15.00 by the 60s.

Apology, this was supposed to have been posted by 7am, however I goofed. 

THE NEW WASHINGTON

The dramatic change in the national government as a result of this election seems to have been of greater magnitude than any previous ones.

The fact that the President is faced with a Congress that is controlled by the other party is not a too unusual occurrence after the midterm election. Some Presidents including Truman, Eisenhower and Clinton managed very well under those circumstances. What is to be seen is how Obama will react.

Unfortunately, Wednesday’s press conferences did not bode well since there appears to be some issues that either side does not seem willing to modify its position.

The Republicans will try to change the ACA but I do not believe that a veto of any major change will be overridden. I think that despite all their bluster that the changes will be of a tweaking nature most likely maintaining availability but cutting down on the mandatory elements. 

Unfortunately the oversight regulations that make the practice of medicine will not be changed.

The next few weeks should be of interest to see what the lame duck congress will do with financial bills that must be enacted.

One thing is certain, the new Congress will not be a gridlocked do nothing one similar to the present one. There may be many bills passed, and many may be vetoed but this Congress with 2016 upcoming will not sit on its butt.

ELECTON THOUGHTS

And then there is New Jersey.

I have not yet read or listen to the pundits take on the election results. 

However, it is obvious that Democracy works in most of this nation.

In Seven Blue states the Republican Party won Senate seats that had belonged to Democrats and in two states, Alaska where the final vote tally was not in and Louisiana where there will b e a runoff election, the Republican was leading.

A 9 seat change is a catastrophe. That means that in at least those states the electorate voted their opinion not the party ticket.

New Jersey is a horse of another color. A heavily industrialized urban state its party affiliations tend to be Democratic. Thus in National elections the chances of a Republican Senate candidate winning is slight. 

For a Republican to become Governor an incumbent Democrat has to be the world’s greatest “FU”. Consider who preceded Christie.

There can be little change in the Assembly  and the State Senate since the districts have been so gerrymandered over the past two decades that 90+% of the seats are “safe”. This applies also to the Congressional districts.

Almost all the NJ Counties have strong entrenched party leadership, Republican or Democrat depending on it being urbanized or suburban/rural. Union is no exception. Consider the Republican Party had only one Candidate running for the 3 Freeholder seats!

That brings me to our city elections. The results were of no surprise. I had expressed my opinions as was my right. I had hope that the large nonaffiliated electorate would finally overcome its antipathy and come out and vote. Obviously that was not to be.

The turnout was poor however in the 2^nd and 3^rd wards representing  about 30% of registered voters. There was in both wards an increase in protest votes for the Republican line holder over the number of registered Republicans in those wards.

However I had been hoping for a better turn out. It had been apparent that the Green strategy was to run a low key campaign in those wards in order not to increase interest.

Perhaps it was the realization that there could be no change in the overall makeup of the city government. We are an impatient society that does not understand that real change comes in small steps.

It is hard to explain the repudiation of the local party leadership in the BOE elections where the Campbell ticket once again prevailed by a small majority. The results here may have been due to the quality of the candidates that caused sufficient numbers to abandon the party line.  

Perhaps you can supply me with an explanation.

More tomorrow.