Chapter 2: Bridgeville: The house, the practice: getting going.

 

 

Chapter 2.

 

              When my grandparents and I walked into the house, the phone was ringing.  It was someone wanting to know if I would be hiring a secretary.  There were several letters in the mail asking the same thing, and two women who stopped to welcome me and bring cake, who wanted to know too.  I never did advertise the position.  I interviewed 6 women, and I hired Pam, who would become one of my best friends.  She was the only one who didn’t already have a job.  She had been out of the work force raising children for 10 years.  She lived 9 doors down the street.  She had proven she could make me laugh and she said she could ask for money, the piece of private practice I didn’t think I’d be very good at. 

 

              The previous doctor had left the house and office furnished.  We came in through the back that first day.  There was a laundry room.  The kitchen had a long hutch and a breakfast nook with windows all around.  There was a dining room and a little sunroom off the dining room.  Later I found out that for some time in the past that had been the “white” waiting room, with black patients waiting in the office waiting room.  The house was straight through, living room, dining room and kitchen.  There was a large foyer, which was where I put the piano when my grandmother had it shipped down to me.  The stairs went up from the foyer.  There was a master bedroom, with its own bath and study.  Unfortunately the bath and study had been added over the porch, and even then the support pillars were starting to break through the wood of the porch.  There was a second bedroom across the hall, and two small bedrooms at the other end of the hall.

 

              The color scheme was a little overwhelming.  The living room and dining room had green woodwork, green walls (institution green), and green venetian blinds, with dark maroon drapes.  First thing I did was tear down those drapes.  I thought the waiting room in the office had black corduroy drapes, until I took them down and discovered they were dark green and just had hung there for a year and a half, maybe more.  I tried washing the drapes but they fell apart in the washer. 

 

              The office was connected to the house off the kitchen.  Oddly enough, the connecting room had a toilet in it.  When I started meeting the townspeople, the questions I was most frequently asked was “Are you going to put in a bathroom?”  It seems that toilet was just for the doctor.  Patients from whom he wanted a urine specimen were given a cup and sent across the street to the Shell station, where they were charged a dime to use the rest room.  And yes, I was putting in a bathroom.  Nanticoke hospital had already had a plan for the renovations when they interviewed me.  Problem is, the renovations were supposed to have started before I got there, and they weren’t started yet. 

 

              The original office was one half waiting room.  The other half was divided into 3 rooms: an exam room with an exam table, a workroom with a small sterilizer, lots of glass syringes and reusable needles, and a dispensary with large bottles of pills still on the shelves.  There were several bottles of 5000 sodium bicarbonate tablets – enough to neutralize the acid of the 1400 residents of Bridgeville and then some!  There was generic acetaminophen (Tylenol) in all sorts of forms: red sugar coated, and white and white with pink flecks and white with green flecks.  Patients told me that if they went to the doctor with a sprained ankle or a headache, he would give them an envelope with the white pills.  If you came back and said they didn’t work, he would move on to the pills with the green flecks or the pink flecks, all the same medication. 

 

              The plans called for dividing the middle room into a nurses station with a sink and cabinets and a bathroom in the back half with doors opening into the first room, which was now the business office, and the back room, which would be 1 of 2 exam rooms.  The other exam room would be next to it, taking the back part of the waiting room.   Later I would have a small consulting room added, taken out of the waiting room.  We worked by appointment, so I didn’t need such a large waiting room. 

 

              So finally the workmen got going.  Paul Lynch and his crew did a great job on the renovations.  Problem was, they were also doing a great job on the Episcopal church, which had had a fire and was being rebuilt, and the house of one of the wealthier farmers in the area.  After they’d been working at my house or the church for a few hours, the farmer’s wife would pull up in a pick-up and say, “Come on, guys, it’s my turn now”. 

 

              Working at my place was driving the men crazy.  I hadn’t heard of it before, but they had a superstition about needing to go through any door both ways, using the same doors in and out.  There was the front door to the office, the door to the business office, two doors at the back of the business office – one to the house and one to the back door to the yard, the door from the business office into the bathroom, the door from the bathroom into the exam room, and the one from the business office to the nurses station, the door from the nurses station to the waiting room and from the nurses station to the first exam room, and from the waiting room to the second exam room.   Oh, yes, there was a door from one exam room to the other too.  A total of 11 doors, and the workmen went crazy trying to keep track of which ones they had gone through. 

 

              I had to have major electrical work done.  The doctor there before me had been a bit of a do it yourselfer.  The entire office worked off of a series of extension cords that ran to an outlet in the house and were stapled to the baseboards in the office.  Now it needed to come up to code.

 

              All those supplies I ordered were delivered.  I opened the boxes in the living room.  Pam arrived for work that day for the first time.  I was sitting on the living room floor, surrounded by boxes and their contents.  She stood looking at all of this and said “Well, I recognize the bandaids.  Other than that I don’t know what any of this is for!” 

 

              I really needed to see patients.  I had no money coming in.  So I thought, if we started scheduling patients and I met them in the waiting room and walked them through the construction into the house, maybe the workmen would get the hint and get finished.  I saw my first private patient October 9, 1980.  She was a young woman with a urinary tract infection.  I walked her through the construction, Pam did the paperwork in the little sunroom off the dining room, I talked to her in the dining room and took her up to the bedroom to examine her and to the bathroom up there for a urine specimen.  Office visits were $12.00.  She wanted to write a check but I asked if she had one dollar she could give me, so I could save it as the first dollar earned in the practice.  It sat folded in my wallet until the wallet was stolen at the hospital about 8 years later. 

 

              The workman took the hint and finished one exam room, so I could work.  Took them a bit longer but the office did finally get finished.  I learned a valuable lesson: never tell a workman “There’s no rush”.  At least, not a workman in the country. 

 

              My first year in the country was a whole series of revelations.  To start with, I didn’t live in the country.   I thought of it as that, but I lived in a small town.  And I loved that small town.  I had thought much of my life that I wanted to live in the country.  I didn’t.  To start with, it’s dark in the country.  I grew up with street lights, and lights in the windows of houses.  The country doesn’t have that. 

 

              Lots of the country doesn’t smell good either.  There were chicken houses and pig farms, and it all depended on which way the wind blew.  However, when it came to smells, it was hard to beat the early years at my house.  My neighbor to the north out at the street was an insurance company that let my patients use some of their parking area.  The next building up was the town hall, which also let my patients use their parking.  However, in back of the town hall and adjacent to my back yard (I had almost an acre in the back) was the local sewage treatment plant.  Again, it depended on which way the wind blew.  Since I couldn’t predict that, I never knew if I would be able to sit outside or enjoy the back yard.  At the other end of town there were a cannery, several packing houses, and a freezing plant for Birds Eye.  One of the plants processed jalapeno peppers when they were in season.  They dumped their waste into the town’s sewage treatment plant.  During jalapeno season, the air not only smelled bad, it stung your nose.  Fortunately, the town renovated the sewage treatment plant 2 or 3 years later, and the smell was gone. 

 

              During medical school I had been a vegetarian and baked my own bread.  It helped me study.  Knead the bread, set it to rise, study for an hour, beat the crap out of the bread, set it to rise again, study for an hour, knead the bread vigorously again, study for another hour, then study for a fourth hour while it baked.  Good bread and lots of study.  I stopped doing it when I was a resident and just ate whatever whenever.  But here I was, my own house, my own kitchen.  The warmest place in the house was at the top of the cellar steps, so I set three loaves of bread on the top step to rise.  Then I got my first call to the hospital.  It was from the oral surgeon, asking me to do a surgical clearance.  Well, that shouldn’t take long.  But while I was at the hospital, people caught me for a few other things, like my first admission.  I was taking medical call and ICU call.  I got home 18 hours later, and the bread had risen down three steps.  Another lesson: never try to bake bread when you are on call. 

 

              The office phone was also the house phone.   This was in the days before cell phones.  I had a pager and after some time knew where all the payphones in the county were located.  But local people called to be friends too.   I got a strange call one night: a man who said that his wife was taking a bath and caught her toe in the bathtub faucet.  He said he tried rubbing it with motor oil but he couldn’t get it out.  He said he thought about rubbing it with Vaseline but he was just trying to get her toe out, not make love.   The call was just too bizarre.  He wanted me to house call.  I declined.  It turned out to be my neighbor from four doors down, who I had met just once, being egged on the local high school principal, who had had a bit too much to drink, I think. Lesson number 3: kept the old number for the office and got an unlisted house phone.  Sorry, guys.  

 

              I didn’t know how the practice would go.  I had 30 patients by the end of the first month.  I only took the draw from the hospital for 3 months and in another 5 months had all the loans paid back.  Office visits were $12.  As a woman, I resented women paying more for medical care because of getting pelvic exams and pap smears (young men having nothing comparable, of course), so I did those included in the $12 fee.  Back then the state lab would do process and read the pap smears for free.  My most expensive visit was $25 and for that I would do minor surgical procedures, ingrown toenails, sutures, etc.

 

              I saw patients in the office in the morning, went to the hospital and made rounds at lunch time and except for Wednesdays, came back to the office for more patients in the afternoon.  I never ran on time.  I spent as much time with each patient as that patient needed, so my days got later and later.  When I was trying to figure out how to run the practice and how much to charge, I spent part of a day in Dan Alvarez office, a family doc in Seaford.  He estimated that he spent 7 minutes with each patient.  His patients loved him, and never seemed to feel shortchanged.  It took me 7 minutes just to say hello!  But the practice was up and running, and, if not very lucrative, at least not running in the red.  And I loved it: the practice, the patients, the town, the hospital.