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Hard to Heal

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"At one point, they got a grant to provide diabetes education to the homeless, and one of the suggestions was refrigerator magnets about healthy eating," Duvic says with a snort. "Refrigerator magnets? How many homeless people do you know that even have a refrigerator? And, I'm sorry -- if given the choice between a cream pie and going hungry, I'm sure a homeless person will choose the cream pie, diabetes or not."

For Rottnek, the discovery of the dispensing fee was the last straw. He resigned from the board in December of 1999. The advisory board disbanded one month later -- because its services were no longer needed, says Appoo. Nevertheless, Grace Hill recently formed a new advisory board -- minus Duvic and Rottnek.

Bureaucratic warfare left an aftertaste that reminded Rottnek of the corporate medicine he left so long ago -- only much more bitter because it was served up by an organization created to serve the poor and the homeless.

"I don't know who is making decisions," he says. "I don't think it is malicious. Sometimes I think it would make me feel better if it was. It would make it easier to stomach. I think there is a void in leadership. There are not a lot of leaders in health care today that have a fire in their belly on pursuing what they should, especially when it comes to taking care of a bunch of homeless people."

Despite the rift with Grace Hill, Rottnek was still committed to the clinic at Harbor Light. He continued to operate for a year-and-a-half without any financial support or prescription privileges from the charity giant.

Other volunteer doctors also continued to serve, despite their disillusions. Bic Stafford, a podiatrist, dipped into her own pocket to buy medication.

"It is just not fair," she says. "Grace Hill has money to do this. I was just a volunteer. I shouldn't have to treat the patient and buy the medication."

Stafford tried to apply for prescription privileges, but Grace Hill bureaucrats never gave her access.

"I told them, 'I will fill out the paperwork; tell me what I need to do,' " she says. "I never got a clear response. It just got to be too much."

Although Grace Hill didn't provide the Harbor Light clinic any financial support, the agency was anxious to keep track of how many homeless patients were served by Rottnek. They hired a receptionist for the Tuesday-night clinic to count each patient.

"It just makes you look good," Appoo says. "It is always nice to say, 'Here this is what we do.' It doesn't count for our grant or helps us get more funds."

Not directly. But these homeless patients could help Grace Hill in its grant-chasing games if they were referred from the Harbor Light clinic to the charity's own physicians and nurses. Those visits would win the agency more federal money, so keeping score at Harbor Light was an important priority even if providing enough money for medication and supplies didn't seem to be.

For Rottnek, providing quality medical care to the homeless was not about counting bodies or looking good. It was a spiritual mission, as essential as breathing or eating. But slamming past all the political roadblocks was wearing him down.

This wasn't clear to him until he started a new job at the St. Louis County Jail and found the support he was missing at Harbor Light. Surrounded by inmates and iron bars, he began to understand the need for strong allies. In the midst of what he expected to be a stifling atmosphere of top-down oppression, he found people who would lend a hand and not worry about what the suits might say.

"I have wonderful, bossy floor nurses who are true patient advocates," he says. "It makes it so much easier to provide quality care when everyone is on the same page."

Barry still prowls Fred Rottnek's memory.

But these days, a new patient also tugs at Rottnek's soul: Willie, an inmate who, like Barry, has lung cancer. When chemotherapy stopped working, Willie wanted to kill himself. He didn't have the nerve, so he robbed a Walgreens, pointed a gun at a cop and hoped the officer would blow him away -- suicide by police.

Instead, the cop wrestled the frail man to the floor and arrested him for armed robbery. Willie pleaded guilty and went to the county lockup. At one point, close to dying, he was given the option of going home.

Willie decided jail was a better place to die.

Rottnek pulls a chair close to the side of Willie's bed. His blue eyes glow with compassion. He takes Willie's thin hand.

"How are you doing today?" he asks softly.

Willie mumbles incoherently.

He is in the final stages of dying. His body is shutting down. He is starting to hallucinate. But Rottnek knows that somewhere, somehow, his words are understood. He patiently explains the medicine he is prescribing for the painful lesions under Willie's arms.

Sarah Lenhart, Willie's hospice worker, says her patient's hallucinations are becoming more terrifying for him with each passing day. Willie thinks he sees rats and wants the door closed. But that's against jailhouse rules.

She pats Willie's hand: "I told him that the door had to stay open and promised I would keep him safe."

"Sarah will take good care of you," Rottnek says. "I promise, too."

One of those bossy floor nurses, Rose Rafferty, watches this exchange unfolding in the tiny cell with the metal toilet and small jail bed.

"He is getting the best care here," Rafferty says. "He knows that. That is why he wanted to stay."

She looks at Rottnek with a mixture of pleasure and respect.

"It doesn't matter who they are or what they did, just that they are here and they are sick," she says, "He cares about all of them -- body, mind and spirit."

Rottnek walks out of Willie's cell and stops at the door. He grins as he whispers: "We've been accused of keeping him alive longer and costing the county more money. We thought he was going to die in July, but he wasn't ready. There were things he had to make peace with. Now, I think, he is ready to let himself go."

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