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My First Practice Experience

by Robert Bunata, MD

This article was originally published in the September/October 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

The first time I saw and treated patients in a private practice setting, other than moonlighting in an ER or at the Cook County jail, was in 1968 when my dad, a general practitioner, had a heart attack as he entered Oak Park Hospital to make rounds on a freezing January day.  He checked himself into the ER, ordered an EKG, and later called me from the ICU to ask if I could cover his office appointments once or twice a week.  My mother, who knew all of his patients, called and rescheduled appointments for the evenings when I was free from my third-year orthopedic resident responsibilities.  

I dressed in a suit and tie, removed the blood stains from my shoes, and carefully combed my hair. Not the usual resident attire; I had to look dignified to fulfill this responsibility.  The first night, elderly Mrs. Novak came for her office visit with a simple request for cough syrup, adding a weak, pitiful “cough, cough.”  I wrote a script which she promptly handed back, “No, no. that’s not the right one,” she admonished. “The one with the silver label, the one your dad gives me. I think the name is, oh, I don’t remember. I wrote it down so there’d be no mistake.”  Knowing exactly what she was seeking, she handed me the note.  I looked up the medicine’s name in the PDR (an old-fashioned, remarkably thick and heavy red book with Bible thin pages listing every known medicine in three separate indexes in a way only Sherlock or an egghead could understand).  Carefully perusing the ingredients, I saw: 15% alcohol.  Over the next few weeks, I got several more requests for medicinal nightcaps.       

The second evening a patient reported, “I’ve got my usual sinus infection again, and I need the treatment your dad does. It’s the only thing that works.”  I nodded knowingly and said, “Just a minute while I get some extra supplies.”  My dad shared this office, a converted residential apartment, with a friend who was a dentist.  My dad’s part was the dining room and kitchen, while Ed drilled teeth in the bedroom and made crowns in a closet. They were like two peas in a pod.  I stepped into Ed’s closet and, despite my dad still being in the ICU and after much hesitation, called the Oak Park Hospital where a dedicated nun answered, “Okay, I can let you talk to him this time, but we can’t make a habit of it.” Hah, little did she know.      

I got carefully worded instructions as to what “the treatment” was. After wrapping a generous wad of cotton on an applicator, I soaked it in epinephrine and then in cocaine (standard office formulary at that time).  Next was the hard part, a part my dad had extensively practiced but I had never conceived of doing.  I put on the doctor’s head mirror, the kind you used to see doctors wear in cigarette commercials, and sat facing the patient, who was in a chair in front of a bare lightbulb.  I tried to look professional and adept at peeking through the hole in the center of the mirror while focusing on the patient’s nose, but I blinded him with the concentrated glare.  Since my retina-burned patient squeezed his eyes shut and couldn’t see my incompetence, I felt comfortable peeking around the mirror’s edge.  I jammed and twirled the cotton swab quickly into one nostril, then the other, pausing to wipe away the tears, his and mine.  Seeing no blood, I surmised I hadn’t done much damage.  After a burst of sneezing and snorting, the patient said, “Thanks, doc, that’s a whole lot better already,” as he blew more stuff out than I cared to look at.  

My dad’s carefully worded instructions included, “I usually charge ten dollars, but his wife recently fractured her ankle, and they have more medical bills than they can afford. So charge him three dollars total.” The instructions didn’t end there. “I know what you’re thinking so listen, I decided long ago that for my peace of mind I would maintain my independence.  I choose to run my business as I see fit, believing that if I take care of my patients, they will take care of me. They’re our neighbors, not cash registers.” 

Okay, lesson received.  But the execution turned out to be the tricky part.  He came ready to pay more, so he handed me a twenty-dollar bill.  Oh goodness, the change must be seventeen.  I, too, had come prepared: five- and ten-dollar bills together in my right side suitcoat pocket, and a roll of ones on the left.  Being a bank teller couldn’t be that hard—after all, I went to medical school.  I took his twenty with my left hand and reached into my right suitcoat pocket for the carefully divided packet of larger bills.  I set the twenty on the desk so I could select one five and one ten from the bundle, and put the rest back in the right pocket, while retrieving the one-dollar bills from the left pocket.  Holding the fifteen dollars pinched between my little finger and palm, I tried to count two singles, but when they stuck together, I dropped the whole wad of ones on the floor.  Scrambling like a pigeon chasing crumbs was ultimately undignified regardless of how impeccably I was dressed.     

Then came Mrs. Smith.  Mrs. Smith’s young daughter had a skin condition (my worst subject was dermatology, which in my mind is akin to sorcery), and Mrs. Smith wanted the cream my dad had prescribed last time.  Once again, I had no idea what she was talking about.  I searched and searched for Mrs. Smith’s record and found nothing on her, her husband, or their daughter. In fact, there was only one Smith in the entire file; it was a most uncommon name in that neighborhood.  I gave up and called the same dedicated nun, who reluctantly turned the phone over to my dad.  “Where is Mrs. Smith’s chart? She wants the cream for her daughter’s rash,” I asked.   My dad chuckled, then said, “Look on the chart labeled ‘Prochaska.’ Lillian Prochaska is Lorain Smith’s mother, and all the family’s records are on one chart.”  Even Mrs. Smith’s husband and daughter? It almost blew my mind.  I recovered the Prochaska family “chart,” three five by eight index cards stapled together, a system from the 1930s when he built his private practice.  Definitely not an EMR.  It took two seconds to find the magic formula.  Not only was the problem solved, but I gained a deeper understanding of the nature of my dad’s private practice.

Twelve years later, my parents went to the Art Institute on a Sunday in January. When they came home my dad shoveled the drive free of snow so he could make rounds the next day, but the next morning he didn’t wake up.  Dr. Bobby Wroten waited in the All Saints doctors’ lounge until I finished my case, then told me my dad had died.  I took the last plane that landed that afternoon before O’Hare was closed due to a gigantic snowstorm, and then caught the last cab home.  Three days later O’Hare had just reopened, and outside the funeral home across the street from my dad’s office, the plowed snow was piled six feet high on the sides of every street, including down the middle of busy Cermak Avenue; the sidewalks were barely passable, and it was 26 degrees.  Once upon a time, an acquaintance had insisted that the number of people who came to a funeral depended on the weather.  The line of people who came to bid my dad farewell filled the funeral home and stretched outside more than a block long. The viewing lasted past closing, well into the night.  

That was my first experience with my dad’s “family practice” and medicine in the sixties.    

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