Dr. Michael Whitt, a Texas native who forsook a career in petroleum engineering to study medicine, served countless families during his four decades as West Marin’s primary care doctor before he retired in January. General medicine was not always the focus of his practice: in the 1970s, soon after he answered a “Doctor wanted” ad posted in Point Reyes Station, he and his colleagues devoted much of their time to home birth. They delivered close to a thousand babies over 10 years, and the work prompted important changes in Bay Area hospitals that previously left birthing mothers feeling powerless. Dr. Whitt eventually gave up home deliveries, and concentrated on general practice until he retired. His clinic has also undergone changes, welcoming a series of partners over the years and recently becoming part of the Marin Healthcare District, which purchased the clinic as part of an effort to keep small clinics like Dr. Whitt’s in business.
In March, he sat down with the Light and spoke about what attracted him to medicine; the challenges he faced in his early years, when there were no paramedics; shifts he witnessed—both beneficial and regrettable—in the practice; and the only political battles on which he weighed in.
Point Reyes Light: Where are you from?
Michael Whitt: I was born in Little Rock and moved to Texas when I was a boy. I grew up there, and went to the University of Texas as a petroleum engineering student, and the University of Oklahoma, the same. Then in my senior year I took a sharp left turn and went to Berkeley, and majored in English.
I had a job in petroleum engineering in Venezuela, and I realized I wanted something more about the human side of the world, as opposed to the mechanical side. So I took some time off from school and then enrolled at Berkeley.
PRL: Why English?
MW: I’d always liked English. I actually was going for philosophy, but I couldn’t do philosophy in two years, and I had a deferment because it was during the Berlin crises. There was a series of Berlin crises—you might not remember them, but Russia shut off access to Berlin. Berlin was an enclave, but it was an allied enclave and they shut off access. So they alerted the troops in Europe to be ready for possible war, and they were drafting people. Texas was waiting to draft me, because English at Berkeley didn’t seem like a good thing for me to be doing. [Laughter.]
PRL: What year was that?
MW: I went to Berkeley in 1959 and graduated in 1961, just before the free speech movement. Then I went to Europe for two years as a military policeman. But I was lucky to go to Europe, to Germany. You just patrol, pretty much like a cop on a beat, walk around where the bars are.
PRL: How did you make the jump to medicine?
MW: Well, it’s really easy when you have a degree in engineering, because you have all the difficult courses: physics, organic chemistry and everything, so all I had to do was take a few biology courses.
PRL: What was the draw to medicine?
MW: I had a good friend, a boyhood friend, whom I hadn’t seen in a long time and he had become a doctor. He was becoming a doctor, and he took me to an anatomy class, and then I visited him as a resident. I liked it. And even though I thought of being a country doctor, I also thought, with an English degree, that psychiatry might be an attractive field; I could combine my interest in literature and imagination with medicine. But luckily I was saved from that.
When I finished my internship in San Francisco, I decided to take some time off and travel. But my wife had a child, and we couldn’t travel, so I went to work, in the emergency room. I really loved treating all kinds of problems. After a couple years of that—I had a friend from medical school, Dr. [Wes] Sokolosky—and he and I sort of hatched the idea of going into practice somewhere. I came out here to hike one day, and there was a sign in the office that said, “Doctor wanted.” Well, that’s a coincidence. Maybe that’s meaningful. So I went down to the local café and found out who was with the Lions Club, which was handling it. I contacted the person and decided to try it out. So I knew Sokolosky was going to join me, but he had a commitment and he couldn’t join me for a year, so I started the practice.
PRL: So you came into medicine because you enjoyed the human aspect?
MW: Yes. I thought psychiatry was analysis, Freudian analysis. But when I did a rotation in psychiatry, I saw that if you’re doing analysis, you’re dealing with neurotic people. But when I encountered psychotic people, it became a whole different field of psychiatry. You’re using heavy medicines and locked wards and anti-convulsive therapy—a little different. It wasn’t something I wanted to do. So once I got a taste of general medicine and the emergency room, it was an easy switch.
What was funny is, when I was in medical school in Texas, a lot of the residents during my psychiatry rotation were G.P.s who had come back to get a psychiatry residency because they thought their patients needed a psychiatrist. But that’s not what I found at all. Hell, I think they were overworked. They worked in small towns in Texas and they were on-call all the time and they just wanted a different life. Like radiology or psychiatry.
PRL: It must have been a big jump to go from working in an emergency room in the city to working out here.
MW: Yeah, except that the real difficulty in being a country doctor is seeing all kinds of emergencies. It’s different now, but when I came, there were no paramedics. You were all alone. When someone walked into your office with a major problem, the emergency room experience came in handy, because you were used to seeing people who were severely ill. Now, that didn’t happen very often. That’s the other bad thing: you’re always confronting surprises. Sometimes it’s good, and sometimes it’s a little harrowing. [But] I never wanted to work for anyone. Kaiser did offer me a job before that, but I wasn’t an organization man. It wasn’t my style. I hadn’t really decided until I saw that sign. So I thought, I’ll give it a try. I always wanted to work for myself.
PRL: What were your experiences like in those early years?
MW: I did everything. Every accident in West Marin when there was an injury, they called my office. And I went, wherever it was. Whether it was a fatality or what. If it was [a fatality], I pronounced that person dead. And if they weren’t [dead], I administered what I could. Then the ambulance came, but the ambulance drivers were untrained. They were firemen. Before the paramedics, there was virtually no medical training except CPR. They could give CPR, but they carried no medicines, nothing. It was a whole different world. And night calls to people with asthma or something—people couldn’t breathe. You had to go, and you didn’t have any help.
PRL: Did you expect that, coming out here?
MW: Yeah, and I decided to do everything. I assisted at all my surgeries. I wasn’t the lead surgeon, but I’d go in, because they always had two doctors at major surgeries. I always liked that. Partially it was personal gratification, because if you had made a diagnosis, you could see the pathology, and then you could attend the patient in the hospital and watch over his or her interests.
The only thing I excluded was obstetrics. I just didn’t like it in medical school because they anesthetized the women. It just didn’t appeal to me. But you’re an English major; you’ve probably heard of William Carlos Williams. Also a doctor, in Patterson, New Jersey, and he had a poem that began, “They call and I go.” That was my watch word. I would go see anyone that called me. Not like today, where you say, “Are you registered in my clinic or have I seen you before, or what’s your insurance?”
A woman once called me and said, “I’m in labor and I don’t want to go back to the hospital and have this baby. Would you come?” and I said, “You know, I’m not an obstetrician and I don’t have a lot of experience except what I got in medical school, but if you’re gonna be there alone, it’s probably better that someone’s there with you.” So I went. She was in false labor, so I told her go back to the doctor. So she hitchhiked to San Francisco in the rain and they told her, “Yes, you’re in false labor. Why don’t you go home?” So she hitchhiked back to West Marin. It turns out she was connected to a famous rock band in Marin. So when she finally delivered, and I delivered her, I learned something. She had this baby after a long labor, and she popped right out of bed and got her Medi-Cal card and gave it to me, and had a cigarette. I thought, “I didn’t see anything like this in medical school.” [Laughter.]
So she had lots of friends and before long—it wasn’t what I intended to do—but that was our practice for 10 years almost [entirely]: home delivery. Ten years, maybe close to a thousand deliveries. Not all myself—Sokolosky joined me a year later, and later on, I recruited Mike Witte, and he practiced with us for six years before he left and then returned to create the Point Reyes clinic and the Coastal Health Alliance. It became the practice that was associated with the rebirth of homebirth in the country. Just the right time.
You know, no one realizes what it was like for a woman to have a baby then. You went into the hospital, and they took you and put you in a room, alone, with a nurse who came in, every once in a while. You were not allowed to have your husband present. If you had pain, they gave you a shot of morphine. Then you went into the delivery room, alone. As soon as the baby was born, often you weren’t in any shape to take care of it because you were heavily sedated. Then they took the baby, and gave it to you when they wanted to. So women—that was the era of the Aquarian Age, the Summer of Love and all that—the last thing women wanted was to be treated like that. They even got worse treatment if they were Medi-Cal and hippie. One woman told me that the first thing a nurse said to her was—she held her nose and handed her a towel and said—“Go bathe.”
I think there was a real rationale for home birth. There are some risks. But… So for 10 years, what I wasn’t going to do, we did primarily: home birth. We did hospital [births], too, but mainly home [births], and pediatrics. Then all my partners left, and I was alone, and after 24/7 delivering kids, I had to give it up. Then I moved into general medicine.
PRL: Did you come to enjoy obstetrics?
MW: It’s a great part of medicine; it counterbalances all the people that die. New life. So yeah, it was great. I thought for the most part it was certainly better for the woman and the family to be together. But now, you know, it finally changed. Our practice was what made them change in the Bay Area, I think. They didn’t want the Medi-Cal so much, but they were losing other patients who were choosing to have home births because of the rules. Gradually, the hospitals started allowing fathers and coaches in the labor room, and then they were delivering women in bed instead of the operating suite, which has a certain feel to it. Then they were letting people stay together, man and wife, in the room after the birth. I felt good about that.
PRL: What other changes have you experienced over the years?
MW: Well, the hospital tried to insist we have malpractice [insurance], but the neurosurgeons were in the same boat we were. They paid a huge premium, and neurosurgery was not a high-volume thing in Marin. So they refused. You can’t run a hospital without neurosurgeons on call, so we got in with them; [the neurosurgeons] didn’t have it, so [the hospitals] couldn’t very well discriminate against us. But the insurance companies started insisting on malpractice. We finally had to have it. Then I stopped doing obstetrics, so I could afford it. And they had tort reform in California; [it was] one of the earliest states for tort reform for malpractice, limiting damages for pain and suffering. So after 25 years I got malpractice.
Now we [can also] call paramedics, because they can treat them. They can make a diagnosis with a cardiogram. And they stay in touch with the hospital, and the emergency room doctor can look at the tracing and say, “Okay, give them triglycerin or morphine or an anti-arrhythmic.” But before then, you were there in the middle of the night and there’s someone with chest pains and you give them nitro[glycerin] and see if the chest pain goes away. If you thought they were in serious trouble, you called the ambulance. But the ambulance had untrained people. And they’d go to the hospital. Either they made it, or they didn’t. Now you see very few people die of heart attacks.
I think insurance companies taking control has been not good. The changes were gradual. The insurance companies used to pay for whatever you billed for, and some doctors did take advantage of it, it’s true. Like everything else in our society. But for the most part, if you spent a long time with a patient and made a house call, insurance companies would respond. But pretty soon they took their lead from Medicare, which, being a government agency, had to control costs. So they started squeezing you.
But I think the positive changes are in the treatment of illnesses. The paramedics made a big difference because of having someone immediately—two guys who are equipped with equipment and drugs. All I had was a little bag with morphine and maybe some anti-nausea medicine and maybe a tranquilizer and stethoscope and a blood pressure cuff. A thermometer and maybe some antibiotics, if they might have a bad infection or pneumonia. But very little. Some nitroglycerin.
PRL: How did insurance requirements affect your practice?
MW: Well, it made it difficult for me to have a partner. After that first 10 years, I practiced alone for the next 15 years. That was the hardest time. I was alone. [Also], it’s 30 or 40 miles from city, so it was hard to find someone. But there was nothing to do but keep practicing. I could have gone to work for Kaiser, but I didn’t want to. I was set. I liked this place. So after doing obstetrics and not having partners and then giving it up, I did regular medicine. I concentrated on that.
Then I guess the next big thing was when Dr. Margaret Bourne came. She joined me and wanted to stay and she bought the practice. Then after eight years she decided she couldn’t make a go of it here. She lived in Petaluma and had two children and felt like it wouldn’t support her. So she was gonna close it, but I couldn’t let it close. I was too invested. She was good to me, really good to me. It takes another doctor to realize what someone’s been though, working alone for 15 years. So I bought everything back. Then a wonderful woman, Eileen Gleber, who hadn’t gone to medical school till she was in her 50s, came, and she was great. After five years she got multiple myeloma and died. Then the Marin Health Care District came along and wanted to buy it and I said, “It’s time. It’s been 40 years.” So they bought it. Then Dr. Hamblin joined the practice.
The district bought it in 2010. They take over the practice, so they own it, and you work for them. They do the billing and hire and pay employees and they pay you. They do that to try to keep general practices alive.
PRL: Did you ever have a moment—a particularly difficult case—that made you question your work out here?
MW: I was a doctor, for better or worse. I settled on that. I did at times think, “Oh maybe it would be better to work for a group,” but I didn’t want to do it. I liked being here. I love the environment. The Point Reyes National Seashore was just being formed when I was here. And I like the people. It was a great mix then. It still is, to some degree, but there hadn’t been the incursion of wealth that there is now. Property values were like anyplace else, pretty much. But when the park was established and the environmental movement protected the east side of the bay, with MALT protecting agricultural land—pretty soon, property became more and more valuable. When I came, there were retired professors from Berkeley and Stanford in Inverness. On the other side were the ranchers; many [were] patients of mine. Very few commuters. No computers, no one working at home.
It still is a pretty good place. It’s just gotten so expensive that people can’t come here who want to get here, and now we see second homes. Just as poverty can degrade a neighborhood, so can wealth. But anyway, one of the best decisions I ever made was coming here.
PRL: How did you balance work with your private life, and with your opinions on local or political issues?
MW: When I arrived, the environmental movement was just kicking off. What was threatened in Inverness was the watershed. The watershed was [owned by] a private water company [in the 70s]. The owner got permission to separate certain parcels from the watershed so he could continue to run the water company. He was planning to develop the whole area, but develop certain parts first.
It was the only time I was involved in any kind of politics, but I was president of the Inverness Association. We made it our goal to stop that. We got the state park interested in buying the lands he was trying to develop and adding it to Tomales Bay State Park. With the help of a lawyer, we were successful. I don’t know if you could do that today. Later on, Inverness had a water bond and passed that and bought the water company. So we saved all that land, or the land behind Inverness would be just like Fairfax. I just said, “You know, I have to do this.” I knew it could make enemies, and it did make enemies. Then after that was achieved, they wanted to take that parcel across the bay just north of town—a seashore parcel—and put in equestrian estates. We fought that. That made a few enemies because it was a long-established rancher who wanted to sell it, but we defeated it. It would have changed the character of Point Reyes forever, to put those estates out here.
During that period of time, I went full boar. It caused some uncomfortable moments maybe, and I’m sure some people didn’t come to me, but I don’t recall many people leaving the practice.
And once I decided to do it, I didn’t keep weighing the risk and benefits. I just did it. This was a great agricultural area and the only thing threatening it was its proximity to San Francisco. I thought it was worth trying to save from development. And you know the Marks-Whitney decision? [Peter Whitney] was a bit of a curmudgeon. He lived near Chicken Ranch Beach and the guy developing Inverness Water Company wanted to develop a yacht club and marina. And Whitney said, “No, you can’t shut off my access to the beach”. And the guy said, “I can.” They went all the way to the state supreme court and Whitney won, which created the Marks-Whitney decision which opened up all the beaches to public access. A huge decision. And from that came the Coastal Commission, which protects access and views.
PRL After the water issue, were there other big issues you were vocal about?
MW: Well, as you know, there has been another issue, but I didn’t enter into that. When I got older and the major environmental victories were won, like preserving the land, I let the other battles go by. I didn’t need to weigh in on those.
You know, we were the first generation that discovered this place. [When we came], a lot of [homes] were, oddly enough, second homes, vacation homes. But people were all too willing to rent them the rest of the year. You might need to get out for the summer, but so many young people came here looking for a different way of doing things. We felt an obligation to do our part to preserve this place. That drove me: a sense of duty. We tried to inculcate that in newcomers—it’s your turn to step up. Environmental battles never end; if the developers win, they win big. If the environmentalists win, there’s another development on the drawing board.