I came to Saint Louis in 1986 after having spent a couple of years in Loris, a small town in South Carolina, fulfilling a National Health Service Corps obligation. I had wanted to work in an inner-city environment ever since I had gone to med school at Creighton University in Omaha. One of the reasons I signed up for a National Health Service Corps scholarship in the first place was that it would require me to work in a federally designated, medically underserved area. That’s what I wanted, to work in a city with people who really needed care. However, what the National Health Service Corps did instead was to assign me to that small town in South Carolina. But that’s another story.
I came to Saint Louis because my mentor, Father Joseph Brown, a Jesuit I knew from Creighton, had grown up in East St. Louis, Illinois. He was one of only about a dozen African-American men in the Jesuit order, and when I said to him, as my time in South Carolina was coming to a close, that I was looking to practice in an inner city community, he said, “Well, if you want an inner city, there’s no city more inner than East Saint Louis.”
He introduced me to a physician, Dr. Fran Gallinatti, who was also a member of an order of sisters called the Poor Handmaids of Jesus Christ. Her order sponsored St. Mary’s Hospital in East Saint Louis (no connection to St. Mary’s Hospital in Richmond Heights), and they ran an outpatient clinic in East St. Louis called the Catherine Kasper Center, named after their foundress. While she was certainly enthusiastic about having me come to East Saint Louis, their clinic was not equipped for pediatric services so she introduced me to a pediatrician who had practiced in the area for a number of years and was looking for a partner. I will call him Dr. Z.
I was told that Dr. Z had been in practiced for some time, and that, like me, he was looking for a way to serve an underserved community. He originally worked in an office close to downtown East Saint Louis, but he had been unable to make it work from an economic standpoint, so he had moved further west to 87th and State Street, a few blocks east of Illinois Highway 157, the border between East Saint Louis and Belleville. Apparently, he felt that people from Belleville, who had better insurance, might be more likely to come there rather than farther into East Saint Louis, thus helping to supplement the finances of the practice.
This was 1986, and one of the realities I discovered very quickly was that Illinois Highway 157 was, if not a physical barrier, certainly a psychological and sociological barrier on the order of the Berlin Wall, separating Black East Saint Louis from white Belleville. Simply put, you stayed on your own side, and unfortunately, Dr. Z’s potential patients from Belleville would not regularly cross that road to come to this new office.
When I started working in the practice in August of 1986, Dr. Z had privileges at four hospitals, Saint Mary’s in East Saint Louis, Centreville Township Hospital, now known as Touchette Regional Hospital, in Centreville, Belleville Memorial Hospital in Belleville, and Saint Elizabeth’s Hospital in Belleville, which in recent years has moved to O’Fallon, Illinois. I got staff privileges at all four hospitals. In addition, Dr. Z had opened a second office at 31st and West Main in Belleville in hopes of attracting those patients who would hesitate to come down the hill to the East Saint Louis office.
We divided the work as follows: I would make rounds at Saint Mary’s and Centreville while he would make rounds at Memorial and Saint Elizabeth’s. He would then go to the Belleville office, and I would go to the State Street office to see patients throughout the morning. After lunch, he would come to the State Street office in East Saint Louis since the bulk of his practice remained there, and we would each see patients there.
Since Dr. Z was so well established in East Saint Louis, his inpatient and newborn census was much greater at Saint Mary’s and Centreville. This is especially true in the nursery at Centreville. Newborn nurseries are wildly unpredictable because you never know how many babies are going to be born overnight so it was not uncommon for me to arrive a few minutes late to the office.
This brings me to Dr. Z’s office manager, a woman whom I will call Pat. Pat had worked for Dr. Z for a number of years as he established his solo practice, during which time he sometimes had other physicians working for him, none of whom had stayed very long. It became apparent very quickly that Pat was very protective, even possessive, of Dr. Z and was wary of anyone else who might come into his orbit. She was, I believe, in her early 30s, and she reminded me of a Tennessee Williams heroine, fluttery, deluded, yet steely. She certainly gave off vibes that she would love at some point to become Mrs. Dr. Z. For his part, Dr. Z was also single, but based on vibes that I picked up from him, I felt that there were probably very good reasons for him to be unmarried, and that ultimately, if he were to enter into a partnered relationship, neither Pat, nor anyone of her gender, would be the person he would choose.
Nevertheless, I went about my business and saw hospitalized kids at Saint Mary’s and newborn babies at Centreville and got to the office as quickly as I could. The first patient was always scheduled at 9:00 AM. However, since the phones opened at 8:00 AM, people would call in for appointments for acute illnesses. For reasons I could never quite understand, those patients were added on at 9:00 AM. This meant that when I walked into the office door perhaps 15 minutes late because there were some new babies I hadn’t counted on in the nursery, I might already have five patients waiting for me, and I would spend the entire morning trying to catch up.
When I did get to the office on those days, I would invariably see Pat pick up the phone while glancing scoldingly at me and saying, sotto voce, “Yes, Dr. Z, he’s just getting here. The waiting room is already full!”
This was becoming a less than ideal situation, but hey, I was still working with patients I cared about in a community where I hoped I could make a difference, and I felt I could put up with the petty annoyances because it was giving me the opportunity to do things that I cared about.
As the months went on, though, I began to notice a curious thing. Our office at 87th and State was in a two-story commercial building. The lobby was at the west end of the building, and patients walking into that main lobby would find that the first door on the left side opened into our waiting room. However, if you went past that door down the hall that went to the left, there was the second door, one that opened directly into the work area of our office where Pat and the other clerical staff worked. Occasionally, I would see a family entering that side door and sitting in the clerical area. I asked Pat what this was about. She said that these were patients who had some acute illness, maybe a fever, and we didn’t want them sitting out with the babies in the waiting room. That made sense, but over time I started to realize that all of these patients were white, they were all primarily seen in the Belleville office, and they were showing up toward the end of the morning or in the afternoon.
One day, as we were beginning the afternoon session, a healthy appearing 7-year-old white boy and his mother came through the side door and sat down in the clerical area. I asked Pat what he was doing there, and she said that he was coming in for a school checkup. I was a bit taken aback. “Why isn’t he out in the waiting room with everyone else?”
“Oh,” she whispered, conspiratorially, “he’s one of our Belleville patients.”
“What does that mean?” I asked
“Well, since we’re only open up there in the morning, if someone from Belleville needs an appointment in the afternoon, we just have them come into the side door of the office.”
Incredulous, I said, “Wait. What? You can’t be serious.”
“Well, yes,” she sighed, “they mostly just don’t want to sit out there.”
“Do you even ask them?”
“No, when they call the other office, we just tell them to come around to the side here.” Not coincidentally, Pat’s mother was the receptionist at the Belleville office.
I was furious. “Pat,” I said, “you realize what you’re doing right? This is, is… segregation. We cannot be doing that, and I cannot have any part in it. It’s not that kid’s fault or his mother’s fault, but I am not going to see that child.”
“What do you MEAN?! You HAVE to see him!” she hissed.
“I’m too angry and too upset now to be seeing that kid. Dr. Z can see him when he gets here. There are other kids here in the waiting room. I’ll see them.”
Pat glared at me. “Well, we’ll see what Dr. Z has to say about this!” she said as she spun on her heel and stormed back to her desk.
Dr. Z did arrive, and we went about our afternoon. It was busy so we didn’t have time to chat. At the end of the day, though, he said, “Ken, can you come to my office for a minute?” He sat down at his desk, and I sat across from him. “What happened today?” he asked.
“I think we have a problem here. This policy of having white kids from Belleville sit in the clerical area while Black patients and family sit in the waiting room is well, illegal and immoral. I mean, this is apartheid, what they’re doing in South Africa. It’s wrong, and we cannot be a part of that.”
He nodded. “I hear you, and I wish we didn’t have to, but Pat has gotten complaints and feels that we really need to do this to keep our patients happy.”
I took a deep breath. “If we have patients who are not going to be happy because they are sitting in a waiting room with Black people, maybe they need to find another doctor.”
He frowned. “Well, we really need all the patients we can get. And you know people hear stories about East Saint Louis. Some of them are just scared.”
“Well, then, isn’t it our job to address that fear? To tell them that in our office there is nothing to be afraid of? And really, afraid of what? We have a waiting room full of mothers and babies. What do they think is going to happen?”
Now, he took a deep breath. “Look, Dr. Z,” I continued, “whether we like it or not, whether we deserve it or not, we are role models in our community. Having MD behind our names gives us immediate respect, so what we do and what we say makes a difference to people. The message they should be getting from us should be that we respect them, that we honor them, that we are always going to look out for them, not that they are somehow ‘less than’ other people.”
“Yeah, I guess so,” Dr. Z said softly. “Of course, you’re right.”
“Beyond that,” I said, “strictly from a business standpoint, the people of East Saint Louis are not stupid. They have lived with discrimination their entire lives, and they know it when they see it. If people pick up on this and word gets out and someone from the East Saint Louis Monitor calls to get a comment for a story about how a pediatric office segregates in their waiting room, this practice and our professional lives are ruined. So not only is this illegal and immoral, but from a completely utilitarian business standpoint, it’s a disaster.”
Dr. Z was silent for a moment. Finally, he said, “You’ve given me a lot to think about. Thank you.”
I went home that night feeling heard, hoping that things would be better. I had made my case. My logic in every sphere was impeccable. I slept well that night.
The next day I made rounds as usual at St. Mary’s and Centreville and then went to the office to see patients just as I had for months. The staff, Pat, Dr. Z, were all cordial, like nothing had happened. Maybe too cordial.
At the end of the day, Dr. Z asked once again if he could see me in his office. Once again, I sat down across from him. This time, he put his elbows on his desk and tented the fingertips of each hand to each other, slowly flexing them like a spider doing pushups on a mirror. He looked down at the desk as he said, “I hate to do this, Ken, but I’m afraid I’m going to have to let you go.”
I blinked. My breath caught in my throat. What? Had I heard this right?
He went on. “I’ve been getting reports from Pat that you are consistently late to the office, that patients are waiting long periods of time to be seen, and she tells me that they’re not happy about it, so that’s a violation of your contract, and I’m afraid that you have to go.” He picked up an envelope on his desk and handed it to me. “Here’s a check for $250. I hope that helps. I’m sorry.”
At last, I exhaled. “You have got to be kidding me,” I said softly.
“Ken, I’m sorry, but it’s just not working out. And by the way, please keep in mind that there is a two-year noncompete clause with a 25-mile radius in your contract.” He stood up and left, still not having looked me in the eye. There was no point in further discussion. I stood up, got my stuff, and walked out of that office forever.
The next couple of days are kind of a blur. I guess I went home, had some dinner, maybe went to the gym to try to work out some stuff. It was January so I know I didn’t ride my bike. I probably had a beer or two. I probably called some friends for advice and for a shoulder to cry on.
One call I was dreading but which was unavoidable was to my father. Here I was, 32 years old, a physician in practice for chrissakes, and now I had to call daddy to get money to pay rent. Just a couple of 1000 bucks. Just enough to tide me over until, whatever new job I was able to find. To say that I was humiliated comes nowhere near the depth of what was going on in my gut as I made that call.
There are a lot of reasons why I went into medicine. But the most practical one is that I would always have a job. I knew that, as a doctor, I could always make a living. Always. I don’t do well with economic insecurity. That’s why I so admire people who make their profession in the arts. One of the reasons I didn’t make writing or performing my primary profession is that I just don’t have the stones to be a person who’s going to wonder in a month or two if I’m going to have a job. And here I was, fired from what should be the most secure job in the world.
Thankfully, my father was not only gracious but amazingly supportive. He told me how proud he was of me for standing up for my principles. That meant everything to me.
My next call was to a lawyer. I got a recommendation for an attorney in Belleville because it made sense for it to be someone in the same state as Dr. Z. I told him what had happened and about the noncompete clause. I asked if I was in a position to sue for some damages. He said that it would be long and expensive and that we likely would not win, but he could probably make sure that the non-compete clause was not enforced.
So, we left it at that. The lawyer sent Dr. Z a letter saying that I did not intend to honor the noncompete clause, and to my everlasting joy, I never heard from Dr. Z again.
I ended up working at Saint Mary’s in East St. Louis for a few months in their emergency room, seeing pediatric patients from about 5:00–10:00 PM, Sunday through Thursday evenings. Eventually, they set up an office for me at 31st and State Street, weirdly in the building where Dr. Z had practiced for years before he moved further west. I had not wanted to go into solo practice, but another pediatrician just out of residency had contacted St. Mary’s about going into practice in East Saint Louis, and so I started there as this other physician was getting her Illinois medical license. Unfortunately, she never did get her Illinois license, so I ended up in solo practice after all, but that is yet another story.
After a couple of years, I joined Southern Illinois Healthcare Foundation, a Federally Qualified Health Center, and I was the first pediatrician to staff a brand new office at 25th and State Street in East Saint Louis. Finally, I moved across the river to Saint Louis University and Cardinal Lennon Children’s Hospital where I still get to see kids from all manner of underserved communities while teaching future generations of medical students and residents the art of medicine.
In the long run, it’s probably best for me that I did not continue in that practice. Even before the disturbing events right before my dismissal, I cannot say that I was truly happy there, and over time as my I’ve moved from place to place, I’ve been able to find situations that are ever more supportive of my personal mission and of the communities that I want to serve.
So, while the day I got fired was devastating, demoralizing, and humiliating, it was also the day I realized that I was always going to find some way to do what I feel I was meant to do.
And now, as I am about to celebrate the 25th anniversary of my starting work at SLU and Glennon on January 17, 1997, I can see that getting fired that one time 36 years ago just some bump in the road.