48 Dartmouth Medicine Spring 2005

Radebaugh made many a house call during his career.

ate for some income. It was potato-picking seasonin Aroostook County, l00 miles to the north, so Irented a small room there and picked potatoes forfour days. Finally a phone call to Dotty revealedthat someone had made an appointment. I returnedhome eagerly and stepped into the waiting room togreet my first patient—only to find that our newpuppy had left a calling card in the middle of thewaiting room. Embarrassed, I cleaned the rug be-fore inviting the mother and child in for an inter-view and examination.

ther patients followed, though slowly atfirst. Soon, however, the visiting nursesalerted me to a number of families living in

poverty whose children needed care. I would oftentell such parents, when I needed to follow up on achild with an ear infection, for example, that Iwould be making house calls in their neighborhood.“Why don’t I stop at your home to check that earwithout any extra cost to you,” I’d say to them.They were always grateful.

One of my early house calls was to a familywhose address appeared to be in the middle of afield. Puzzled, I asked for help from a neighbor atone end of the field. “Yes,” was the response, “thereis a family living in the field—in that little hill is a

Dartmouth Medicine 49Spring 2005

A retired member

of the Dartmouth

faculty reflects on

his varied career—

and makes the case

for the powerful

healing effects of

the house call.

learned the value of making house calls early inmy career and even in retirement continued tomake home visits as a volunteer caregiver. The

hustle and bustle of the usual medical practice al-lows the doctor to acquire only a superficial knowl-edge of the patient as a person. Sometimes the in-dividual behind the clinical history—not to men-tion the patient’s family and living situation—iscentral to the success of treatment. In addition, Ihave learned much from my patients, especiallywhen I get a chance to see them in less structuredsettings. They have taught me the importance oftaking time to listen, of digging for real answers, ofregarding everyone with respect.

My interest in medicine arose during highschool when I found part-time work as a hospital or-derly. After service in the infantry during WorldWar II, I entered Bates College on the GI Billand—thanks to summer studies at Bowdoin and theUniversity of New Hampshire—graduated in two

John Radebaugh, a retired pediatrician and family physician, is aclinical associate professor emeritus at Dartmouth Medical School.He also did a rotating internship at Mary Hitchcock MemorialHospital. All the photos in the article are courtesy of the author.

By John F. Radebaugh, M.D.

few resources. I also appreciated the dignity withwhich Dr. Blodgett approached patients, as well astheir confidence in his caring manner.

By the time I finished my training I was married,and my wife, Dotty, and I had three small chil-dren—so I needed to open a practice quickly. Wesettled on Bangor, Maine, and bought a smallhouse; as was the fashion then, I planned to open ahome office. I even created a clinical laboratory ina former pantry next to the examining room. I wasable to perform blood counts and throat cultures,which I incubated in a cardboard box heated witha 15-watt light bulb (I tested different-sized bulbsand determined that 15 watts was perfect to main-tain a 98.6-degree temperature). I hung my shinglein August of 1955 and awaited patients. My firstvisitor was a woman who brought her ailing dog.This was not an auspicious start!

After a week of no (human) patients, no in-come, and mounting bills, we were getting desper-

and a half years. Then it was on to Harvard Med-ical School, a rotating internship at Mary Hitch-cock Memorial Hospital, and a pediatrics residen-cy at Massachusetts General Hospital.

There, I came under the influence of Dr. Fred-eric Blodgett, who made regular house calls in thewest end of Boston, an area filled with tenementhousing. He knew the neighborhood well. As hewalked the streets, former patients would call downfrom their apartments, “Hello, Dr. Blodgett,” andhe’d call back to them by name. I clearly rememberone of the first times I accompanied him, to see asick child in a fourth-floor flat. The building was inpoor condition outside, but inside the apartmentwas immaculate. As he listened to the mother de-scribe the illness and then examined the child, heplaced them both at ease by explaining exactlywhat he was doing. He obtained a throat culturefrom the patient, who had tonsillitis, and left somemedicine, assuring the mother that he would returnin two days to check on her child’s progress. I im-mediately realized the importance of such visits, es-pecially for families without transportation or with

House Calls with John

I

O

50 Dartmouth Medicine

morning after a child with a high fever was seen in the office; theywere asked to call by 7:00 a.m. and cancel the visit if the child was pro-gressing well. Often we made eight to ten house calls a morning, inaddition to our hospital visits.

Occasionally house calls could be life-saving. One morning, mylist included a child with croup. Upon arrival at the home, I realizedthat the child was in extreme distress—struggling to breathe and inmuch more difficulty than the usual child with croup. I suspectedepiglottitis, an infection of the small flap of tissue that separates theesophagus from the trachea, or windpipe. A swollen epiglottis cancompletely block the airway. There was no time to wait for an ambu-lance, so I phoned the emergency room, bundled the mother and childinto my car, and drove—horn blaring all the way—to the UniversityHospital. An ear, nose, and throat specialist and an anesthesiologistmet us at the door and took the child right up to the operating room.The anesthesiologist inserted an endotracheal tube to provide a tem-porary airway, and the child immediately went into a deep sleep, re-lieved of his tortured efforts at breathing. The ENT doctor performeda tracheotomy, cutting a small opening in the child’s neck, which al-lowed the insertion of a special airway tube. The tube was removed infour days, after the swelling of the epiglottis had subsided.

n the early 1960s, I started volunteering on evenings and week-ends at an inner-city clinic run by a faculty member at the Uni-versity of Rochester Medical School. It served impoverished,

mostly minority families that had little access to the kind of care I wasable to provide the families that were patients of my daytime practice.So I was receptive to making another change when, in 1964, I re-ceived an offer to join the Rochester faculty. I announced my decisionto my colleagues with regret, for they had taught me many of the fin-er points of pediatrics.

As a junior faculty member, I was fully involved with hospital re-sponsibilities but soon had my eyes opened to a totally neglected pop-ulation. Unbeknownst to me, Rochester was surrounded by many mi-grant farmworker camps. Naomi Chamberlain, a perceptive African-American member of the medical school’s faculty, introduced a few ofus to conditions in the camps. At one, I saw workers housed in a chick-

potato house with a little door at the end.” The structure was partlybelow ground and had no windows. Needless to say, I did not chargefor the house call and levied very modest fees for future office visits.

But the patients were not the only ones having financial difficul-ties. I did not send any bills for the first six months, in the belief thatthe schedule of charges posted in the office would be adequate notice.This did not prove profitable. When I began to send bills, our finan-cial status improved, though not appreciably. At the end of my firstyear of practice, my annual income was minus $50.

ut things improved. I got to know the three other pediatriciansin Bangor; we asked each other for advice and shared nightand weekend call. Soon I was quite busy and began seeing pa-

tients with more complicated problems that taxed my abilities. WhileI was covering for one of the other pediatricians, I made a house callon a child with a draining ear. He was already on an antibiotic andexhibited a fever and a stiff neck. Suspecting meningitis, I immediatelyadmitted him to the hospital. A spinal tap, however, showed no or-ganisms in the spinal fluid or the ear drainage. I had to guess, lackingany information to the contrary, that he was suffering from the mostcommon cause of meningitis in his age group and treat him with theappropriate antibiotics. Cultures the next morning still showed no or-ganisms, but because the child was worse I arranged to have him flownto Boston. Two days later, he died of tuberculous meningitis, whichcan only be diagnosed with special bacterial stains for tuberculosis. Itwas not a possibility I had even suspected.

This experience was devastating to me. Realizing that I neededmore training in tuberculosis, I left my practice for two weeks to workwith the country’s foremost expert in childhood tuberculosis, Dr. EdithLincoln at Bellevue Hospital in New York City. I returned a bettertrained pediatrician and later encountered a number of young patientswith tuberculosis.

I continued to make many house calls, including at night. Thesewere very tiring, but I never refused such calls. Sometimes, however,after answering the phone, I’d fall right back asleep—only to be awak-ened again by a second call a little later when I didn’t show up. Andoccasionally in the middle of the next day, while I was taking a his-tory in the office, a surprised parent would say, “Why, Doctor, I believeyou’ve fallen asleep.”

I also began to carry a harmonica wherever I made house calls,finding that a few tunes were an ideal way to distract a frightenedchild. And I always remembered birthdays, whether in the office oron home visits, playing “Happy Birthday” for the unsuspecting child.

I had been in Maine for three years when I started receiving queriesfrom practices elsewhere. I determined that one of my mentors at MassGeneral had been passing my name along. At first I turned down theseapproaches. I didn’t want to abandon the families in Bangor that hadcome to depend on me. But one call from a three-physician privatepractice in Rochester, N.Y., was appealing. Not only would I have aclinical appointment at the University of Rochester Medical School,enhancing my opportunities for continuing medical education, but Iwould have associates to share call with and could give up responsi-bility for managing an office.

So in 1958, Dotty and I moved the family to Rochester. One rea-son I even considered the move was the practice’s emphasis on mak-ing house calls. Parents were told they could expect a house call the

Spring 2005

Radebaugh was director of the University of Rochester’s Migrant HealthProgram in the late 1960s. Above is a 1968 photo of the program’s clinic.

B

I

en coop with whitewashed walls covered withchicken excreta. In addition to primitive livingconditions, contaminated water supplies, and in-adequate toilet facilities, they had no medical careat all. I was shocked that such conditions existed inthe Rochester environs.

In 1965, under Naomi Chamberlain’s leader-ship, we began to hold a weekly evening clinic atone of the farms. Soon, we had enough volun-teers—nurses, medical students, and several otherfaculty members—that we could open the clinictwice a week and also make some house calls.

One evening, I received a call that a woman inone of the camps was in labor. Another physician,two nursing students, and I soon arrived at herhome. She looked pregnant, complained of crampypain, and seemed to be in active labor. Since theUniversity Hospital was 25 miles away, we didn’ttake the time to examine her but just bundled herinto my car and drove hurriedly to the emergencyroom. While I was assisting her into a wheelchair,her membranes ruptured and I was completelysoaked. We left her in the hands of the obstetricpersonnel and headed home.

The next morning I called to check on herprogress. “Oh, she isn’t here,” I was told. “She wasdischarged last night.”

“How could you do that?” I asked.“She wasn’t in labor. She just had a full bladder

and pseudocyesis.”Never having heard of this diagnosis—but not

wanting to appear ignorant—I hung up the phoneand pulled out my medical dictionary. I learned thatpseudocyesis is a “false pregnancy.” It usually occursin women under emotional stress or with a verystrong desire to become pregnant and can mimicthe symptoms of pregnancy over many months.

What I had supposed to be ruptured membraneswas instead an accidental emptying of an overfullbladder—it having been an evening too cold forour patient to comfortably use the outhouse at thecamp. For about a week, the other doctor and I werethe laughingstock of the hospital.

Another visit proved more productive. I exam-ined a man who had broken his arm two weeks be-fore but had received no treatment. Lacking trans-portation, the workers were at the mercy of thegrowers. I was able to arrange for his admission tothe University Hospital.

oon I was named director of the university’sMigrant Health Program. I grew more andmore incensed at the conditions in the camps

and the exploitation of the workers. On one housecall, a farmworker showed me the 10-cent check hehad received for two weeks of work; the crew boss-es would peddle liquor to the workers at inflatedprices and deduct fines for minor infractions.

In 1968, I testified before a committee of theU.S. Senate and led Senators Robert Kennedy andJacob Javits on an inspection tour of the camps. Lo-cal growers were, not surprisingly, unhappy withthis activism. But so, too, were doctors in privatepractice in the Rochester area. They complainedthat the Migrant Health Program was “socializedmedicine.” The dean and my department chairasked me to meet with these critics but ultimatelystood behind the outreach effort.

I was impelled to look beyond injustices in theRochester area by the 1969 Biafran refugee crisis.The Biafrans of eastern Nigeria had suffered the

Dartmouth Medicine 51Spring 2005

I soon had my eyes opened to a totally neglected population.Unbeknownst to me, Rochester was surrounded by manymigrant farmworker camps. At one, I saw workers housed ina chicken coop with its walls covered with chicken excreta.

Radebaugh spent seven weeks as a volunteer in aBiafran refugee camp in 1969. At left is a Biafrannurse with a young charge. Above is a pair of siblings,probably orphaned, whom he saw constantly together.

S

52 Dartmouth Medicine

that ordinary water is much healthier and not nearly as expensive.Such teaching was an important element of house calls.

Our house calls also made us aware of environmental problems.Frequently I saw patients who had developed sudden asthmatic at-tacks when planes spraying pesticides flew too close to their homes.

In addition, I became aware of the efforts of César Chavez and theUnited Farm Workers union to improve the lives of migrant workers.We’d been in the Imperial Valley for three years when César sent a re-cruiter to our home in Brawley. He invited me to help establish aunion-funded clinic near Fresno, in the San Joaquin Valley. I admiredCésar’s non-violent approach and decided that working with himwould be a privilege.

While the search for a clinic site was in progress, the Fresno Bee re-ported that “the first case of polio in a decade took the life of an Ave-nal farmworker.” César’s office called and asked us to investigate thedeath, suspecting it might have another cause—possibly even pesti-cide exposure. A colleague and I drove to Hanford, about 40 mileswest, and met with the doctor who had made the diagnosis. He was aretired pathologist who maintained a microscope in his office. Heshowed us his slides, which demonstrated marked nerve-cell damagein the pons, deep within the brain. He commented, “I have neverseen such a rapid onset in a previously healthy man or such markednerve-cell destruction with polio, but I am open to suggestions.”

We told him that we intended to visit the home of the man whohad died, a plan that he encouraged.

he deceased, according to fellow workers, had been plantingmelon seeds treated with Thiodan fungicide and Dieldrin in-secticide. The men handled these seeds with bare hands, and

the “polio” patient had padded his metal tractor seat with the emptyburlap bags the seeds had been stored in. We visited his home and tooksamples of rice, tortillas, beans, cooking oil, and pastries in case theywere needed for analysis. En route home, we stopped to talk againwith the doctor, who had prepared more slides for analysis and waswilling to assist us in any way possible. I asked him to forward a fewslides to a pathologist at UCLA Medical Center—someone I hadknown in Rochester. “He is especially interested in neurologic prob-

largest genocide since the Nazi Holocaust. I volunteered my servicesas a pediatrician in the Biafran refugee camps, hoping I could help savethe lives of a few of these victims of a tragic civil war. I was granted aleave of absence from my faculty position and traveled to Africa un-der the auspices of Operation Medicorps.

The conditions in the camps were haunting. The children all hadthe potbellies, skeletal arms and legs, skin sores, and swollen feet char-acteristic of kwashiorkor, or protein deficiency disease. Malnutritioncomplicates infectious diseases, and many children also suffered fromtuberculosis or intestinal parasites. Some had enlarged livers due tomalaria; others had congestive heart failure, also from inadequate di-etary protein; and most had scabies, a skin parasite that caused themto scratch incessantly. Sanitation was a major problem due to rampantdiarrhea. Flies were so prevalent that the children could not keepthem off their food and had a hard time sleeping.

Yet the children also had a strong will to survive. With proper foodand good care, their health slowly improved. They began to respondto adults by hugging our legs or crawling onto our laps. Once, when Isat to watch a movie with the children, I found myself cradling half adozen in my arms and several others on my lap, with a few more drapedover my legs. Clearly, caring was as important as medicine. As I sawolder children carrying younger ones to the dining hall, or feedingthem in their rooms, I felt a strong sense of community and purpose.

hen I returned after seven weeks to my safe and loving home,I couldn’t forget the Biafran children—and the uncertain-ties and losses they would return to. In that frame of mind,

I received a telegram a few months later. It read: “it’s official. we arefunded for july first. a day to celebrate. we are all waiting foryou. viva la causa. la clinica gilbert lopez.”

I had been offering advice from afar to a group that was trying toorganize a farmworker clinic in Brawley, Calif. They had receivedfunding for the venture and wanted me to join them. I decided thatfull-time service to a migrant population was where my heart lay. Itwould be a big change from my part-time academic practice, part-time migrant activism. And it would be an even bigger change for thewhole family, from the cool Rochester climate to the dry heat of theImperial Valley and from Rochester’s mixed culture to a predomi-nantly Mexican-American, Spanish-speaking environment.

After a one-month immersion course in Spanish, we moved toBrawley in the summer of 1970. The Clinica de Salubridad deCampesinos approached many of my ideals of community-based med-icine. Its board, consisting mostly of farmworkers, quickly won theloyalty of patients and staff alike. House calls were not the habit ofmost local physicians but soon were very popular with our patients.Many of the calls, usually made in the evenings, were for upper respi-ratory infections, skin infections, vomiting and diarrhea, ear infec-tions, or high fevers of unknown origin.

During one house call, I dropped my stethoscope next to the sickchild’s bed. As I stooped to pick it up, I glanced at the bedsprings andwas surprised to see a dozen black widow spiders and their nests. I sug-gested that when the child was ambulatory, the parents should sweepout the spiders.

On another house call, I noticed a large bottle of Pepsi-Cola in therefrigerator. It was a favorite beverage for many families in that hot cli-mate. I explained that soft drinks are not a wise way to satisfy thirst,

Spring 2005

Radebaugh testified in 1973 against the use of the short hoe onCalifornia farms. Above, he demonstrates its use in his own garden.

W

T

lems,” I explained. The doctor said he’d be happyto send along the requested specimens.

Later, I studied the pathology of Thiodan andDieldrin, both of which can be readily absorbedthrough the skin. I learned that the brain findingswere more consistent with a toxin exposure thanwith an infectious disease such as polio. Ultimate-ly, a definitive diagnosis from the Los Angelespathologist corroborated that suspicion.

In May 1973, I testified before the CaliforniaWorkmen’s Compensation Board regarding the useof the short hoe—known as “El Diablo” by theworkers. Less than 17 inches long, it required farm-workers to stoop all day as they were thinning orweeding lettuce. Crew bosses could easily spotworkers who stood to ease the strain on their backs.Those who stood too many times were dismissedfrom their jobs.

Growers insisted that the short hoe was the onlyway to properly care for lettuce. Those of us whotestified on behalf of the workers showed x-ray dataand described workers incapacitated by permanentchanges in their vertebrae after only a few years ofthe constant bending. But the workers themselveswere the best testimony. One older worker demon-strated the position required to use the short hoecompared to a long-handled hoe. He also demon-strated the post-work position of the back at theend of a long day in the fields. Shortly after thehearings, California prohibited the use of the shorthoe, a wonderful victory for the workers.

Yet despite my pride at being part of such efforts,by the end of 1975 I had reached a burn-out state.The fatigue was physical, psychological, and eco-nomic (since I was essentially a volunteer for theunion; Dotty and I got an allowance for an apart-ment, gas for business use of our car, and $25 a

week). Although I admired César Chavez, it wastime to move on. Over the next seven years, Iworked at a clinic serving farmworkers in Wood-burn, Ore. (which closed due to loss of its funding);at a network of three neighborhood health centersin Pueblo, Colo. (where administrative problemsdrove many staff—including me—to leave); at aclinic in Greeley, Colo. (where administration wasagain a problem); and at an urban communityhealth center in San Jose, Calif. (from which boththe medical director and I were fired when a new di-rector decided to start with a clean slate). Suchwere the vicissitudes of working in this underfund-ed arena. But by this time, I had added board certi-fication in family medicine to my credentials in pe-diatrics, opening up additional opportunities.

n 1982, I was offered an associate clinical pro-fessorship in Stanford Medical School’s De-partment of Community and Family Medicine.

I would teach part time in the family practice resi-dency at San Jose Hospital and oversee the pre-ceptor program for first-year medical students. Thestudents were pleased to have an opportunity towork with live patients and soaked up informationlike sponges. Among many other lessons—such asthe importance of caring, of learning to listen topatients, and of not being hasty with advice—Itried to teach them (including by example) the val-ue of home visits.

Occasionally, a house call would uncover a prob-lem that could only be solved outside the parame-ters of medicine. The visiting nurses once asked meto see a family that lived in a rural area south of

Dartmouth Medicine 53Spring 2005

Our house calls made us aware of environmental problems.Frequently I saw patients who had developed suddenasthmatic attacks when planes spraying pesticides flew tooclose to their homes. One patient died of toxin exposure.

During the early 1970s, Radebaugh worked at theClinica de Salubridad in Brawley, Calif., then at a clinicrun by César Chavez’s farmworker union. At left isChavez, above is Radebaugh at the Brawley clinic.

I

54 Dartmouth Medicine

tients in San Jose, but I was eager about the chance to promote teach-ing and service opportunities at Dartmouth.

It was a chilly 10-degree day in January 1986 when we moved toHanover. My colleagues in the clinic included a seasoned family physi-cian, a family physician who had a half-time research project, and aformer dean of the Medical School who was an internist.

One of my first students was an African-American woman fromNew York City who was in cultural shock from the transition to themostly white community of Hanover. She seemed uncertain of her-self in the clinic, and I tried to take extra teaching time with her. Sheaccompanied me on some house calls, one of which was to the homeof a former nurse who had rheumatoid arthritis and was houseboundin a second-floor apartment. The patient liked my student so muchthat she wanted her to accompany me on future house calls, which,of course, was easily arranged. Over several months, the student de-veloped a close relationship with the patient, which proved beneficialto both of them.

In addition to seeing patients in the clinic (and making housecalls), I maintained contact with the preceptors who opened theirpractices to first-and second-year students. The students’ time in theirpreceptors’ offices helped them to correlate classroom teaching withreal, live patients.

n January 1989, I was asked to take over the practice of one of ourpreceptors whose National Health Service funding had been re-voked. That left the Mt. Moosilauke Clinic in Warren, N.H.,

without a physician. Because of the poverty of many of the patients,the program was unable to hire another physician and approachedDartmouth Medical School for help. I stepped in to serve this ruralpopulation. I often had medical students with me as I saw patients inthe clinic and in their homes. In many ways, my years there wereamong the most satisfying of my career.

It was while I was at Mt. Moosilauke that I proposed a studentelective focused on home visits. It was clear to me that studentslearned much by venturing onto patients’ turf. Other family mem-bers, pets, the state of repair of the home—all of these elements placed

San Jose. In a small house, surrounded by high raspberry bushes, I meta middle-aged woman who had just received a notice saying that herwelfare benefits were being canceled and that she had to find full-timework immediately. She was distraught, for she was the only support forthree retarded children, all in their twenties, who were ambulatory butcould not support or care for themselves. They would have to bemoved into an institution! She said she’d take her life before she wouldallow that to happen.

I said I would try to persuade the welfare department not to dropher from its rolls. Hoping this was not an idle promise, I met with thevisiting nurses to plan our action. We calculated that putting three re-tarded children in an institution would cost the county far more thanthe present welfare benefits, which allowed the mother to care for herchildren. After a few more house calls, we got a date for a court ap-pearance. The mother, her three children, a visiting nurse, a socialworker, several welfare department representatives, and I were presentfor the hearing. Our arguments persuaded the judge to order contin-uation of support for the mother. I was pleased with the outcome ofthis unusual situation. To my mind, it is important not to overlook so-cial problems that can often complicate medical care.

new challenge soon arose for our family practice clinic. It be-came a refuge for AIDS patients from San Francisco who feltunwelcome elsewhere. Word spread that ours was a caring pro-

gram. I recall one such patient, a Mexican-American, who was re-ferred to me by the visiting nurses. Though he was in the final stagesof his illness, he wanted to continue home care. He was in no pain butwas emaciated and depressed.

On my second visit, he voiced a desire to visit his brother inHawaii; would we allow him to do so? I discussed the idea with his fam-ily and the home-care nurse, and we agreed that he should go. Hemade the trip and returned two weeks later, obviously much happierafter a very satisfying visit with his brother.

Soon he was on a hospice regimen, and within two weeks of his re-turn he was in a terminal state—semicomatose and unable to eat. I wascalled to his bedside late one night, found him close to death, andstayed there for the next few hours. When he died, the family calledthe undertaker, who upon arrival realized this was an AIDS patientand refused to accept the body. “If you refuse, your name will be pub-licized all over the San Jose papers,” I threatened. “There are no risksto you as long as you wear gloves and are careful with needles.” It didnot take long for the undertaker to decide to cooperate. I visited thefamily twice in the succeeding weeks to support their grieving.

Meanwhile, Stanford had decided that the Division of Communi-ty and Family Medicine would be placed under the Department ofMedicine. I was concerned because the Department of Medicine val-ued research publications more than the service and educational aimsthat were a priority for me; I had published only five papers during myentire career.

While exploring other opportunities in medical journals, I saw anad for a family physician at Dartmouth Medical School. My careerhad started in New England, and both Dotty and I had family backEast. More important, I liked the sound of the program. I applied andwas invited to come for a visit. We were well received by the faculty,which ran a primary-care clinic and a preceptor program for medicalstudents. Once again, I did not relish the thought of leaving my pa-

Spring 2005

Radebaugh spent the last few years of his career on the Dartmouthfaculty. Above, he plays his ever-present harmonica to woo a wee patient.

A

continued on page 62

I

continued from page 54an important framework around the center ofattention, the patient. In addition, eliminat-ing the artificial barriers of the white coatand the office or clinic or hospital—whichcan be threatening to patients—strength-ened the true teaching, much of whichcomes from patients.

was thus delighted when one of our stu-dents, Patricia Ruze (now Chapman), a1990 Dartmouth Medical School gradu-

ate, wrote the dean about her experiencemaking house calls. Here is her letter, slight-ly condensed:

“Dear Dean McCollum: I am writing toshare my enthusiasm for a one-day elective Irecently attended. The informal elective isthe work of Dr. John Radebaugh, whom youknow as a faculty member in the Departmentof Community and Family Medicine. Forsome time now, Dr. Radebaugh has been ex-ploring the idea of a single-day elective formedical students, which might be called‘Plain Doctoring’ or ‘House Calls with John.’The elective consists of a full day of visitingfour or more families, several visits withhealth-care professionals in the community,and several readings in epidemiology andfamily medicine.

“Our day began in Bowler Auditorium forPediatric Grand Rounds. Radiology was ournext stop. The two of us reviewed films withthe radiology staff for patients we would seelater that day.

“We then proceeded to the depths of theHospital to the autopsy suite, where a pathol-ogy resident presented his gross specimensand his findings for a recently deceased pa-tient. Not unexpectedly, the partially fixedbrain tissue revealed a peach-sized necroticmass characteristic of glioblastoma multi-forme. We were later to visit this patient’sfamily in their home in Warren, N.H.

“Dr. Radebaugh and I, with a long list ofpatients’ names and addresses, packed our-selves into his car. Our first stop was NewEngland Industries in Lebanon, N.H., whichproduces machine parts. Dr. Radebaugh hadmet previously with the owner of the com-pany, who this day welcomed us and pre-sented us with ear plugs and safety glasses.We had come to see Mr. R.M., a patient ofDr. Radebaugh’s who has persistent problems

62 Dartmouth Medicine Spring 2005

WillowBrook Prosthetics & Orthotics

Robert Diebold, C.O., Orthotist • David Loney, C.P., Prosthetist

190 Hanover Street • Lebanon, NH • 603/448-0070

Great Place... Great Memories

dartmouthcoop.com DartmouthImages.com

Or visit the in Hanover

House Calls with John

I

Dartmouth Medicine 63Spring 2005

“From there, we headed towards Warren,N.H., stopping to meet a nurse who directsthe Visiting Nurse Association in Canaan. Ihad a chance to hear her opinions aboutcommunity health care in the Upper Valleyand to share my own views. Dr. Radebaughcaught up on the news about patients he wasfollowing.

“We visited, counseled, and examinedseven more patients during the remainder ofthe afternoon, including an elegant womanpainter in her scrupulously cared-for colonialand an overweight hypertensive who lives ina cat-infested trailer. One highlight of the af-ternoon was meeting and examining a de-lightful middle-aged woman with transposi-tion of the great vessels.

“I could go on with tales of these individ-uals, their medical histories, their homes, andtheir jokes, but the day was long and I real-ize that your time for reading student lettersis short. I write only to share my memoriesand to offer a vote of support for this oppor-tunity. I feel grateful to have attended a med-ical school that encourages a broad perspec-tive in medicine and supports enthusiasticfaculty such as Dr. John Radebaugh.”

I have to say that I regard that letter as acapstone of my career.

After my retirement in July 1991, I con-tinued to serve as a volunteer physician withthe Good Neighbor Health Clinic in WhiteRiver Junction, Vt., which provides free careto un- and underinsured individuals in theregion. I also served occasionally as a substi-tute physician for small practices. In thoseroles, I continued to make house calls.

nce I was covering for another doctorand was asked to visit a woman in herseventies who was originally from

Finland. When I arrived at her home, she an-swered the door with surprise and suspicion.“I don’t know you and will not allow you toexamine me,” she said firmly.

“I’m not replacing your doctor, only try-ing to help him,” I replied.

Just as she was about to close the door inmy face, I reached into my bag, pulled outmy still-ever-present harmonica, and startedplaying Finlandia, the Finnish national an-them. There were tears in her eyes as sheopened the door to welcome me in.

It was a most cordial visit, and it con-cluded with a request: “Please play Finlandiaagain the next time you come.” I did.

with nasal polyps. Weaving through themaze of giant metal monsters, noisily pound-ing frail strips of steel into a precise geome-try, we found R.M. rolling a drum of indus-trial chemicals into the plant’s back door.

“R.M. told me that his nasal polyps hadbeen treated surgically several times but con-tinued to reappear and caused him difficultybreathing. The etiology of the recurrentpolyps was unclear. R.M. felt that the chem-icals he was working with at the plant con-tributed to the development of the polyps.

“He gave us a tour of the plant. We ex-amined the labeling on many of the drums ofchemicals that he was frequently exposed to.R.M. asked me to climb the stairs leading tothe operator’s station of a machine thatchemically and mechanically washed someof the metals used in production. He turnedon the machine so that I could experiencethe sharp odor and harsh racket of his dailyworking conditions. This was a new experi-ence for this medical student from suburbanConcord, Mass.

“We proceeded on to the home of Mr. andMrs. D.C., a middle-aged, middle-class cou-ple. They were expecting us, and we sat andchatted about his recent hospitalization forCOPD [chronic obstructive pulmonary dis-ease]. I examined his lungs and heart, and wegave him a report on the chest films we hadreviewed earlier in the day in radiology.

“Our next stop was Mr. T.S., a frail butgood-humored 92-year-old New Hampshirefarmer whose wife died 10 years ago, leavinghim to live alone with his horse team, ad-vanced bilateral cataracts, osteomyelitis, andsevere hearing loss. As we approached histiny, run-down wooden shack nestled in theweeds just off a dirt road, I asked myself howit could be that I have had a full four years ofmedical school here at Dartmouth, yet havebeen so successfully sheltered from NewHampshire’s poverty.

“My country doctor and I lunched for 50¢at the Lebanon, N.H., Senior Citizens’Center. There, I met many septa-, octa-, andperhaps even nonagenarians—most of whomknew Dr. Radebaugh well and had manysores, aches, or pains to report, along withjokes and bits of gossip. It was valuable forme to get a sense of the services that areavailable in the community. I met a socialworker and a community health worker andnow feel I have a better sense of what can beavailable for the elderly in the Lebanon area.

UNIVERSITY PRESS OF NEW ENGLAND

The Science We Have Loved and Taught

Dartmouth Medical School’sFirst Two Centuries

By Constance E. Putnam

“A splendid study rich in detail.”— John Harley Warner, Ph.D.,

Chair, History of Medicine, Yale

“Well written, imaginativelyresearched and organized.”

— Gert H. Brieger, M.D., Ph.D.,Professor, Johns Hopkins

Hardcover6" by 9"384 pages24 illustrations$35.00 (U.S.)Postage $5.00

Contact:800.421.1561www.upne.com

Phoenix Book Group

Explore chronic illness—the despair and indignity,

the self-discovery and humor—through the lens of literature.Books discussed will include:

Still Me by Christopher ReeveThe Radiant by Cynthia Huntington

Waist High in the World by Nancy Mairs

2nd Wednesday of every month 6 p.m., Dartmouth Bookstore, Hanover

“You think that your pain and yourheartbreak are unprecedented inthe history of the world, but then

you read.” —James Baldwin

For more information:DaveSalvatore@Adelphia.net

or 603-927-4845

Sponsored by DHMC’s Continuing HealthEducation Center & Multiple Sclerosis Center

O