Volume 56, Number 3 - Summer 2010

 

By Steve Osborn

A: I was born at the Port Hueneme Naval Base in Ventura County, in 1954.

A: My father came to California from the Philippines in the 1920s. He worked as a farmer for 15-20 years, and then he was drafted into the Army during World War II. He spent almost eight years in the military, but then he got tuberculosis and was released. He kept on going to the Sepulveda VA Hospital, which was affiliated with UCLA. They had a huge TB sanitarium there for World War II vets, and he spent a lot of time in there when I was a child. Children of disabled vets have access to all military bases, so that’s where we were all born.

A: Yeah, he still farmed with my uncles. I grew up in Pismo Beach around farms. We grew strawberries and some other vegetables, sometimes cauliflower, romaine. My cousins still operate it.

A: Absolutely. I tell this story over and over to my medical students, because I always ask them why they became doctors. This was definitely a life-changing event. 

My father had impacted gallstones, and he was septic, and he was dying. He was so sick that they couldn’t open him surgically. He would be too unstable and probably die on the table. He got the last rites, and they transferred him over by ambulance to the Sepulveda VA Hospital, basically to see what they could do surgically, last-ditch effort, because no one wanted to touch him where I was growing up. Everybody thought he was going to die. All my aunts were gathering around me saying, okay, you’re going to be the man of the house.

A: Eight years old. So then we were waiting for surgery, and they didn’t want to do surgery, and then one surgeon from UCLA said, “Well, this hasn’t been tried too much before, but we can get a scope and try to grab some stones into the bile duct and free it up.” An endoscopic procedure, basically. So the attending staff went over from UCLA to Sepulveda and tried to fish out some stones, and they were successful. 

I wasn’t aware of all this, so I thought my father was going to die, because everybody told me he was going to die. For a little boy eight years old to be told that, you just show up, and you’re extremely stressed, you’re extremely frightened. Then this doctor walks down the hall, pretty much coming to tell us, I thought, that my father was dead. And he passes my aunts, because the aunts wave him on to me, saying tell him, he’s the man of the house now. And he comes over, and he grabs me by the arm, and he smiles. Extremely confident. I still can picture, not his exact face, just that he was confident. And he said, “You’re dad’s going to be okay. We tried something, and we were able to take the stones out. I think he’s going to be well.” Then he just turned around and walked away. 

I said to myself as an eight-year old, “Whatever it takes, I’m going to be one of those guys, somehow.” I had motivation. I didn’t want to be a farmer, because I was picking beans when I was six, and I knew it was really hard. So I just said to myself, if I had to choose anything, I would try to be just like that guy: save lives and have extreme confidence, and just change people’s lives. And as he walked away, I just kept on staring at him, and it really had an effect. And I tell you, that’s all I’ve ever wanted to do since then.

A: I was on the tae kwon do team at UC Berkeley way back in 1976, and I am a certified instructor. I used to run the UCSF tae kwon do school, which a lot of nurses and medical students attended. 

Tae kwon do is a balance: it’s body, it’s mind and it’s spirit. All my sons earned their black belts and started their training to this art when they were four years old. I think it enables them to have a discipline to help them in some of the difficult parts in life, and it also gives them balance. I started them all on the philosophy of martial arts early on, though I am sure they won’t point to just that directly as giving them discipline, compared to it being a family tradition.

A: I think Rotary International explains it all, because that’s part of their name, and their motto is “service above self.” I think that all physicians, or everybody, no matter who you are, should understand that altruism truly enriches one’s life. It’s abstract, but it is something that motivates a tremendous amount of people. It motivates me because it enriches every aspect of my life. 

Physicians have partial altruism to begin with, because there are so many things they do for their patients, not just to be reimbursed for it. I told you about the balance aspect, mind-body-spirit. Altruism definitely comes under spirit, in that it enriches your life. You can do everything you want on the physical side and on the intellectual side, but in order to have balance you need altruism.

A: Marin County definitely has uninsured patients. Maybe not as much as other places, but we have our share of uninsured, so that’s a big issue. The Marin Community Clinics are being significantly funded by Sutter and Marin Community Foundation grants, which is great. I think that’s moving in a correct direction. 

For years, there has only been Sutter here in terms of the non-Kaiser hospitals, so there was not a lot of competition. Now there will be increased competition no matter how you cut it. I believe that Marin General will survive after Sutter stops managing it. It’s a very viable hospital, so there will be increased competition. Hopefully some of the prices of radiologic screening will come down, for example. I think that’s good. 

Another part that’s moving along is disaster planning. I am a Captain (Naval rank) in the US Public Health Service Reserves, and I was deployed to Katrina in September 2005 and helped with the reconstitution of the hospitals after the hurricane. I have been a reservist for 27 years now. What I want to do as president of the Marin Medical Society is to develop and stabilize physician disaster planning and participation. We will be offering several courses for the national incident command system (NIMS), in conjunction with FEMA, that will be used for disaster planning. We already have 30 volunteers on the physician side, and maybe 40 by the end of the month. We know there could be a huge disaster with another 7.2 to 8.0 quake here in the Bay Area. It won’t be as bad as in underdeveloped countries, but it can be quite serious, especially if we lose water supply from Hetch Hetchy. That could significantly affect hospitals’ ability to deliver care. 

We have the technology right now to be prepared for worst-case scenarios. We were partially prepared with H1N1 as a potential pandemic. If a disaster comes along, I would like to be able to save as many lives as possible. That is a central theme of what I would like to accomplish in my presidency, is to help the medical society get disaster planning off the ground.

A: Always want to have more, but the main issue is training. As we learned at Katrina, you can’t just throw a million doctors in there without adequate training. 

A: Our first training session, which takes place on June 5, is a four-hour course. It’s actually two separate courses, at two hours apiece. The session gives a rudimentary understanding of how the command system is set up and how we participate with each other. 

Doctors need to participate on the highest possible level. They are making some of the biggest decisions, but they have to understand how the command system is set up. My goal is to make the doctors a separate organization within that command system so we can provide physician coverage in a unified way. Before it was just some doctors here, some doctors there, but it wasn’t really organized.

A: I volunteer for two Wednesday afternoons per month here at the community clinic. So yes, absolutely, we take uninsured patients. We also take Medicare and Medi-Cal patients. The difficulty is not in me seeing a patient. The difficulty is, as a specialist, to treat that patient with surgery, and especially at Novato, which is not a federal hospital for Medi-Cal. However, they have Operation Access, which enables us to see some of these patients. Health care reform will help primary care physicians, but I’m hoping it spills over, so that maybe we can have better access to care for surgeries for some of the Medi-Cal patients.

A: Marin County is very diverse in that respect. Novato Hospital has a separate culture than Marin General, even though they are both under Sutter right now, but soon Novato will have to compete with Marin General. That is a reality. 

Kaiser is a different system. You come in through the base level. You either buy that premium or you don’t. So now we will have three different systems in Marin. There are different cultures, and because of that you’re not going to have a lot of cross-collegiality there. I respect all my colleagues from both Kaiser and Marin General. We do work together, but we have a separate culture here at Novato. 

I think the medical society has an opportunity to understand these differences. We have a great board, and we have some challenges, but I think this is going to make us or break us, that we can step forward and pull all the physicians together. There definitely are three separate cultures here, and there is a natural competition among them.

A: I think it’s in transition. I think the society in the past did the best it could, but we have a huge opportunity right now. I’m optimistic about our board. I’m close with the people from Kaiser and Marin General who are on our board. I’ve worked with them for many years. We are all going through changes with health care right now. We have to be prepared for anything. 

Change is coming so fast right now, that doctors have to understand that CMA and the county medical societies—which are considered one and interactive with each other—are their best bet to represent them in this vastly changing landscape, whether it be here locally or health care in general. So that’s my mission, to educate all my colleagues that we need to have members, we need to be participants.

I believe that altruism is important. I think doctors need to push their envelope a little bit more, leave their comfort zone in terms of that altruism. They need to give themselves a little bit more with this disaster preparedness, give themselves more with participation at the medical society level, in their own hospitals. They are no longer islands. We are in danger of completely losing our profession if we do not band together. So many other professions, such as law, are much tighter with their umbrella organizations. 

Doctors need to give a little more of themselves to save our profession. I think it’s doable, but I’m going to ask for people to sign up more, to participate a little more. I would like to grow our board with strong leaders. 

A: I’ve been doing medical missions through LifePlant International to the Philippines for the last eight years. One of the Filipino nurses, Marlene, graduated at the top of her class, and we gave her a kidney transplant. I had a question for her, and the answer she gave me seemed really simple, but it still astounded me. It showed me that sometimes you can be working so hard that you do not appreciate little things, and sometimes you don’t appreciate peoples’ spirituality. 

Marlene knew she had kidney disease when she was 20. But yet, she studied very hard and was at the top of her class, and she became a very good cardiac nurse. And then she suddenly went into kidney failure and required dialysis, and she was going to die unless she received a kidney transplant. While she could not afford a transplant, fortunately she had a sister who could donate a kidney. So we (LifePlant International) gave Marlene a transplant.

As I was leaving the Philippines, I asked Marlene, I know you couldn’t afford a transplant. What motivated you to work hard in college, knowing that you would probably die of kidney failure? Why didn’t you just slack? Why are you so motivated, and what got you by?” And she responded, “I just pray.” And I said, “That’s not a 100 percent guarantee.” And she said, “Well, you’re here, aren’t you?” And I couldn’t respond to that rationale. 

Sometimes you just have to go with faith and you just have to be an optimist. When she said that, I realized, okay, maybe it’s pure optimism, maybe it is spiritual. Whatever it is, I think physicians should get a little piece of that faith once in a while and just say, we should always work as hard as we can and just be optimistic about things. Sometimes the universe gets you there, and you just have to have faith.

I think this is why medical missions and altruism enrich your life, because they give you faith when you’re faced with dire situations, and you think you’re just going to crash and burn. I have nothing to lose by working as hard as I can. I’m always going to fail if I just say okay, it’s going to crash and burn, I’ll just crash and burn with it without trying. Working hard worked for Marlene as well as for me in the past. It worked for me from the get-go, when I said, “What are the chances that I’m ever going to be a surgeon? I’m just the son of a poor Filipino farmer. What are the chances?” It’s always been my contention, go full blast, deal with the failure later … but with real hard work that seldom happens.

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Mr. Osborn is the editor of Marin Medicine.