|Sam Burre M.D.|
|Alan Glaseroff M.D.|
|George Jutila M.D.|
|Ann Lindsay M.D.|
|Ted Loring M.D.|
|Tim Nicely M.D.|
|Richard Ricklefs M.D.|
|Wendy Ring M.D., MPH|
Recipient of 1989 Plessner Memorial Award
Samuel P. Burre, M.D., a physician who started his family practice in his home town of Eureka in 1930 and who has continued to serve his patients without pause ever since, is the Frederick K.M. Plessner Memorial Award winner for 1989.
The year 1930 was not - and there are few physicians still practicing who have had first-hand experience - "a very fine year." The Great depression had started a few months before, although no one then recognized the fact, and young physicians setting out in practice did so without a great deal of economic hope. Dr. Sam, as most Eurekans call him, started as a part-time physician at the Humboldt County Hospital- without wages- as he struggled to open his practice to the few folks around who could afford to pay.
Dr. Burre graduated from Loyola School of Medicine in Chicago, served his internship at St. Mary’s Hospital in San Francisco, and returned to his long time home, Eureka. He first arrived there when he was two, his parents having moved out West from Chicago.
Two incidents from those dire depression days reflect Dr. Sam’s dedication to rural medicine and serve as an excellent base for his nomination for the Plessner Award:
Like most physicians in the 1930's, Dr. Burre made hundreds of house calls during the course of his family practice, but in 1933, three years into it, he made one of the most heroic house calls recorded in California medical history. The famed blizzard of 1933 dropped four feet of snow in the hills back of Eureka the dame day a rancher who lived some 20 miles back accidentally shot himself in the leg and shattered his femur. The Chief Surgeon assigned the rescue mission to Dr. Sam. Two days later, after some very unpleasant horseback trekking, Dr. Sam and his guide reached the rancher, improvised a sled out of fence posts and corrugated iron and pulled him out to safety, where the leg was set and the man recovered.
The second incident is recorded only by a photographer in the local paper, showing Dr. Sam with payment in full from a patient, consisting of one medium-sized pig.
That was then. Today, Dr. Sam’s practice continues. He sees about 40 patients each day in his office- half of them Medi-Cal- and watches over some 50 others in convalescent homes. He says he won’t retire until there is no longer need of his services. There are no signs of that time growing close.
When Mr. Plessner endowed this award, he requested that, when the recipient is chosen, consideration be given to services donated by the physician to the indigent. Dr. Burre is dedicated to serving the needy of his community. He is one of the very few physicians- if not the only one- in Eureka who still accepts new Medi-Cal patients.
But he is also well-known for his artistic talents. His works are on display at local hospitals and in other public buildings in Eureka. He has written more than a hundred editorial pieces for the press as well as many letters to the editor. His other publications go all the way from poetry through personal recollections, history and travel to scientific reporting in the Journal of the American Medical Association. Dr. Burre has coupled his medical practice and involvement in improving his fellow citizens’ life styles. He served as chief fund raiser for St. Joseph’s Hospital when it was undergoing major renovation in the 1950's, making a major personal donation himself, was a member of the Eureka parking Commission and, in 1980, was Chairman of the Board of Directors, Eureka General Hospital.
In 1940, he served as president of the Humboldt-Del Norte County Medical Society and , in 1949, was president of the Eureka Old Town Merchant’s Association.
Dr. Samuel P. Burre has been one of Eureka’s most outstanding citizens for nearly 90 years. He has been one of California’s outstanding rural physicians for nearly 60 years.
And he is a most deserving recipient of the Frederick K. M. Plessner Memorial Award for 1989.
ALLAN GLASEROFF, M.D. 2009
California Family Physician of the Year
Arcata Family Doctor Named Family Physician of the Year
California Academy of Family Physicians Selects Alan Glaseroff, MD, National Expert in Chronic Disease Care
Ceremony on April 17 at CAFP’s 61st Annual Scientific Assembly, San Francisco Marriott
San Francisco - Dr. Alan Glaseroff, a respected member of the Humboldt County medical community, will accept the 2009 Family Physician of the year Award from the California Academy of Family Physicians (CAFP) on Friday evening, April 17, 2009.
“Dr. Glaseroff has worked tirelessly so that family physicians have the tools, support and expertise to manage the chronic disease needs of their patients,” said Jeffrey Luther, MD, who concludes his term as CAFP president on Saturday. “As an enthusiastic advocate for quality care, he’s taught other physicians how to evaluate and improve the care they provide. As a result, an entire community of patients receives better care.”
As a practicing physician, teacher and administrator, Dr. Glaseroff has served as chief medical officer for the Humboldt-Del Norte Independent Practice Association (IPA) since its inception in 1995. He also is the principal investigator for the Humboldt Diabetes Project, a California Health Care Foundation (CHCF)-funded, community-based study of the Chronic Care Model. He is also a musician, band member, civic organizer and proponent of public health.
Dr. Glaseroff developed Type 1 diabetes while training in family medicine. That has been a contributing factor to his compassion and activism for patients. He uses his own story to convey to physicians the devastating impact of a chronic care diagnosis and to convey to patients that such a diagnosis is not a death sentence.
Dr. Glaseroff is a champion for practice improvement and redesign among primary care and subspecialty care physicians, Luther explained. “His goal is to provide medical practices with population-based reporting and reminders that will improve patient care at every interaction,” Luther said. “Today, patients in his community receive recommended services 15 percent more reliably than PPO-insured, non-IPA patients in the same practices.”
Dr. Glaseroff received his medical degree from Case Western Reserve University in 1978 and completed his internship and residency in family medicine at the University of California, San Francisco in 1982. In 1994, as medical director of the local Foundation for Medical Care, he began developing a managed care infrastructure in Humboldt County.
He is a member of the Steering and Technical Committees of the “Pay for Performance” initiative led by Integrated Healthcare Association; served on the faculty for the Pacific Business Group on Health “Breakthroughs in Chronic Care Programs” Collaborative; and chaired the Diabetes Office-Based Collaborative for Lumetra (formerly the Medicare quality of care improvement organization for California). Dr. Glaseroff serves on the advisory board and as faculty for CAFP’s recently concluded New Directions in Diabetes Care Collaboratory project and is a member of the advisory group for California HealthCare Foundation’s (CHSF) new California Improvement Network. He also is president of the CHCF-sponsored Health Care Leaders Network.
GEORGE A. JUTILA, M.D.
Recipient of 2009 Plessner Memorial Award
Physician and surgeon Dr. George A. Jutila, 74, of Fortuna, was presented with the California Medical Association's Plessner Award for outstanding service as a rural physician at the CMA’s 138th annual House of Delegates session.
After his service as an Airman Medical Examiner in the Air Force from 1962-64, Dr. Jutila settled in Fortuna in Humboldt County, where he joined two other doctors in their practice (Drs. Olson and Goble). The Fortuna Family Medical Group would be the only practice his career would know, which he began there in July 1964.
As many rural areas experience shortages of physicians, Dr. Jutila's practice is a testament to a lifelong dedication to providing care to local residents. Over the years he has been known to go to great lengths to provide compassionate care for his patients, even taking the time to feed their pets while their owners were hospitalized.
Outside his practice, Dr. Jutila provides consultations on the management of the local airports and started a nonprofit. The Aviation Community Advisory and New Development Organization (AVI8CANDO) promotes avenues of aviation and serves as a youth educational program that allows students ages 12-19 to complete aviation courses and flight training to earn a private pilot certificate.
Congratulations Dr. Jutila for being chosen as the recipient of the 2009 Frederick K.M. Plessner Memorial Award.
TIMOTHY C. NICELY, M.D.
2003 California Family Physician of the Year
The California Academy of Family Physicians presents this prestigious award to the individual who exhibits the finest qualities of family physicians and who goes above and beyond in service to patients, colleagues and community. This year we proudly announce Timothy C. Nicely, MD of Arcata as the 2003 California Family Physician of the Year. Dr. Nicely has been instrumental to the growth and stability of the United Indian Health Services (UIHS) which services more than 13,000 Native Americans living on and around two reservations and numerous rancherias across Humboldt and Del Norte counties. He has provided hospital, clinic and nursing home care, as well as obstetrical care and home visits to the two counties for at least 20 years. His uncompromising devotion to delivering quality, compassionate health care to each of his patients is noted by many. Dennie Schultheis, MD, states: Home visits have always been a hallmark of Tim’s care. He has logged many miles traveling to and from home visits. At times, these are done during his lunch hour and others after clinic responsibilities are done. Can one imagine home visits as a regular part of medical care, let alone in an Indian clinic, which is sorely under-staffed and under-funded? He is without a doubt the embodiment of the ideal family physician.Dr. Nicely has certainly left his mark on his community and has, as the Chairman of the UIHS Board of Directors says, made his way into the hearts of our people. One patient’s account speaks volumes: When my husband collapsed and was flown to a hospital in Medford, Oregon, Dr. Nicely was there with him, even sleeping on a bed near him, in the same room. My husband told me he felt so honored to have Dr. Nicely there. Do all doctors go to this degree of caring? I don’t think so, as I’ve had many in my 79 years and not one cared for us like Dr. Nicely does, extending himself, even in his rest time, to care for us.In addition to his superior patient care, as the Medical Director of UIHS, Dr. Nicely is intimately involved in the daily workings of each clinic. From PDAs to open access/same day appointments to establishing and staffing a satellite clinic on a reservation where electricity is new and no phone lines exist, he has put UIHS ahead of the curve. Dr. Nicely participates in numerous hospital committees and is a tenacious yet graceful supporter of family practice privileges. When not on-call for UIHS medical admissions, Dr. Nicely is not only on-call for all UIHS obstetrics consultations, but also for other local family physicians obstetrics consultations for cesarian sections, D&Cs, post-partum and laproscopic tubal ligations. He holds advanced family practice obstetrical privileges at hospitals in both Humboldt and Del Norte counties, and is in the unique position of delivering newborn babies for young women he himself delivered 18 to 20 years ago.With the ability to provide full scope family practice, Dr. Nicely helps keep his patients close to home and allows their limited health care funding to be used wisely. His longevity at the United Indian Health Services and his loyalty to his patients makes him an exemplary role model for family physicians and to his community at large. For these reasons, CAFP is honored to award the 2003 California Family Physician of the Year to Dr. Timothy C. Nicely.
ANN LINDSAY, M.D.
Recipient of 2006 Plessner Memorial Award
2006 Frederick KM Plessner Memorial Award
Ann D. Lindsay, M.D., has committed her professional career to promoting public health and energetically caring for her patients in Humboldt County. She has raised both her communities awareness and her government representatives’ awareness on major health issues, and she has diligently served her community as Public Health Officer for the past 12 years. She remains committed to her individual patients through her private practice in family medicine, which has been in operation for more than 20 years in the rural area of Arcata. She is most deserving of this year’s Frederick K.M. Plessner Memorial Award.
Dr. Lindsay received her bachelor’s degree from Swarthmore College in Swarthmore, Pennsylvania, and her medical degree from Case Western Reserve University in Cleveland. She completed her internship and residency at the University of California, San Francisco, in family medicine. At UCSF, Dr. Lindsay noticed that there were very few women in the medical field to serve as mentors. This inspired her to pursue her own goals in the medical field so that she in turn could serve as a role model to the generations that followed.
Dr. Lindsay began her career in Humboldt County in the 1980s at a community clinic, and soon after opened a practice with her husband, Alan Glaseroff, M.D. Dr. Lindsay took immediate notice of health issues in her community. She is recognized for raising awareness about childhood obesity and the need for childhood dental care, for her involvement with teen sexuality education, and for bring attention to the impact of drug abuse in her community.
Dr. Lindsay was appointed Humboldt County Public Health Officer in 1995 after serving in the position temporarily the year before. As Health Officer, Dr. Lindsay was able to direct even more of her efforts toward public health in her community, especially in the most remote areas.
One such public effort brought Dr. Lindsay into the office of Assemblywoman Patty Berg, 1st District, advocating for what became Assembly Bill 547. Signed by the Governor in 2005, the measure removed the need for County Boards of Supervisors and City Councils to declare a state of emergency every two weeks to enact needle exchange programs. The new law further aided in the prevention of HIV and AIDS.
Humboldt County presented Dr. Lindsay with several challenges, especially drug user among residents. Humboldt County has the second highest drug-related death rate of any California county. Dr. Lindsay faced this challenge fearlessly, and collaborated with legislators and drug clinics in an effort to lower the drug-related death rate. “Drug abuse need not be a death sentence,” she said. She established a program that distributed Naloxone, a treatment that can prevent death in cases of drug overdose, to drug users in the community. Subsequently, the California Society of Addiction Medicine awarded her their 2005 Community Service Award for her significant accomplishment in lowering the overdose death rate in Humboldt County. She and CMA also support legislation and policy that would require health insurers to pay for drug and alcohol treatment on par with other illnesses.
Dr. Lindsay’s work excludes no one. She fights for children, recovering drug addicts, the homeless, friends and colleagues. In 2004, she received recognition as the Second Senate District’s “Woman of the Year” for her exceptional service to the public health of Humboldt County and the significant differences she’s made in her rural community. Dr. Lindsay, former president of the Humboldt-Del Norte County Medical Society and a member of CMA and her county since 1981, serves on the county society’s executive board. She also continues to practice medicine with her husband.
Golfing, knitting, running, and bass-playing occupy Dr. Lindsay when she is off-duty. Lindsay lives a comfortable life with her husband, son and daughter, and the family has it’s own country blues band. She and her husband often play music together at local coffee shops.
THEODORE W. LORING, M.D.
1988 Frederick KM Plessner Memorial Award
Eureka physician Theodore W. Loring is the 1988 recipient of the Frederick K.M. Plessner Memorial Award. Doctor Loring stands as a role model, not just for rural physicians, but for all physicians,. As one of his associates has said, “When you think of the medical field in Humboldt-Del Norte Counties, you automatically think of Ted Loring - Dr. Ted, as his patients know him.”
Dr. Loring is truly that rarity, a doctor’s doctor, exemplifying the ethics of practicing medicine and demonstrating the real value of wisdom, caring and concern in the treatment of his patients in his rural community.
He started practicing as an obstetrician and gynecologist in Eureka in 1951, after graduating with his B.S. and M.D. degrees from Stanford University. Dr. Loring immediately became active in the Humboldt-Del Norte County Medical Society, and was elected its president only five years later, in 1956.
In 1958, he became a member of the CMA House of Delegates, in which he served until 1982. He was a member of the CMA Council from 1976 through 1982 and held the post of Council Secretary from 1979 until 1982. He served on the Editorial Board of The Western Journal of Medicine and, at one time or another, nearly every committee of the CMA. He is a member of the AMA and served as a member of its House of Delegates for eight years. He is a member of the American College of Obstetrics and Gynecology, and is certified by the American Board of OB/GYN.
But Ted Loring has also dedicated himself to his community. According to another colleague, Dr. Loring “is tireless in his approach to help mothers, mother’s daughters, and their daughters’ daughters. He is the spirit of our medical community.” It was in that spirit he founded the Humboldt Perinatal Clinic for the indigent, low-risk pregnancy patients. He also has served as advisor and supervising physician for the Certified Nurse Midwives who care for these patients at the clinic and in the hospital.
His other great gift to the people of Eureka was his commitment to the modernizations, improvement and stability of Eureka’s acute care hospital facilities. He twice served as Chief of Staff of The General Hospital, and has been active with the Union Labor Hospital Board since 1980. A hospital representative put it well, in phrasing his thoughts about Dr. Loring: “There are special people in the world who have a strong influence on one’s life because of high personal and professional integrity, unquestioned caring for their community and fellow human beings, and their unbelievable dedication and energy to support programs directed at improving the quality of life of the communities in which they live.”
Dr. Loring’s social conscience has led him to active participation on the Board of Directors of the Boy Scouts of America, the Salvation Army, the Redwood Council, and the Rotary Club, serving as President in 1969. He was also President of the Stanford Medical Alumni in 1972, was on the Stanford Board of Governors for ten years, and was a member of the Board of Directors of Blue Shield of California for five years.
The impressive list of service continues. During the professional liability crisis of the early 1970s, Dr. Loring was instrumental in the formation and was a founding Director of NORCAL Mutual Insurance Company, as well as a founder of the Humboldt-Del Norte Foundation for Medical Care in 1959. It is obvious that Ted Loring has devoted a lifetime to the service of his fellow man.
This account by no means exhausts the endless contributions Ted Loring has made on behalf of the community of Eureka, his patients, the CMA and the practice of medicine. Indeed, he personifies, as well as anyone could, the high personal ethics and practice standards of a Plessner Award recipient.
RICHARD RICKLEFS, M.D.
Richard Ricklefs, M.D., of Hoopa, was awarded the 1998 Frederick K.M. Plessner Memorial Award. The Plessner award honors the California physician who best exemplifies the practice and ethics of a rural practitioner. Dr. Ricklefs settled in Hoopa in 1952, after receiving his medical degree from Hahnemann Medical College and Hospital in 1951. He served the local Native people of the Hoopa Valley and rendered distinguished service for over 30 years to this rural area in northern California. He was quite instrumental in building of the Klamath-Trinity Hospital which opened in 1959. His life and service are so interesting that he was featured on Ralph Edwards' This Is Your Life program in the 1960's. As a result of that program, people were asked to send a $1 contribution to "hospital, Hoopa California". In the subsequent months more than $98,000 was raised to complete the hospital.Doctor Ricklefs started a form of a rural HMO where people paid $25 per year for complete services including medications. However, he provided care even if the patients could not pay. He also performed home deliveries for many years. As a non-Indian physician, he helped to bridge the gap between modern medicine and Indian culture. He was known to utilize both Native American healing practices and traditional Western Medicine, often times on the same patient.Dr. Ricklefs retired from active practice of medicine in 1994. Besides working in Hoopa he spent parts of the last 20 years working in Fairbanks, AK, central valley of California, and even Kenya. He was profiled in the North Coast Journal in April 1996, in an article titled Medicine Man.Dr. Ricklefs met and married Elsie Mae Gardner, one of few surviving full-blooded Hoopa Indians, in 1942 and they remain happily married.The Humboldt-Del Norte County Medical Society being extremely proud to acknowledge Dr. Ricklefs' contribution to health care in North Western California, nominated him for this award. We are thrilled that Dr. Ricklefs was chosen by a state-wide panel who considered nominations from all over California.(Dr. Ricklefs is the third Humboldt County recipient to receive the Frederick K.M. Plessner Memorial Award: Samuel P. Burre, M.D. (1989); Theodore W. Loring, M.D. (1988) being the other two)
WENDY RING, M.D., MPH
California Medical Association
Dr. Ring was this year’s recipient of the Plessner Award for being Rural Physician of the year. She was unable to attend the award ceremony, so she sent in her thoughts in writing. She is also sharing those thoughts with us. Congratulations, Dr. Ring.
Thank you very much for recognizing me with the Plessner Award. Due to the death of my mother, I was unable to receive the award in person, but I wanted to share my thoughts after the fact. I feel especially honored to receive this award because two physicians from Humboldt County whom I greatly respect and admire, Ted Loring and Richard Ricklefs, were previous recipients, and I am proud to be continuing their tradition of caring for rural underserved people.
One of the things that happen when you get an award is that interviewers show up and start asking you questions. I am not a very introspective person. I’m used to getting up in the morning and going mindlessly to work just like everyone else, and I had to think awhile before I could explain why I do the work I do. My actions are based on two related concepts, one scientific and the other philosophic: the conservation of matter and the obligations of stewardship. With the exception of meteors and moonrocks, what was on this planet in the beginning is all there is and all there ever will be. From a long-term perspective, we don’t really own any of it. All we can do is enjoy things for awhile and then pass them on to the next generation.
I believe that medical training, in particular, is not a personal license to go out and make a lot of money but a trust that society places in the individual and collective hands of physicians. In my own story of becoming a doctor, my parents raised me to believe I could accomplish anything if I worked hard enough, a woman cardiologist taught a young EKG tech to read electrocardiograms on her lunch break, neighbors in the ghetto looked after me when I was at college and far from home, a young union organizer drove me halfway across the country to interview for medical school, the federal government gave me a National Health Service Corps scholarship, nurses and orderlies dispensed cocoa and encouragement in the middle of the night, attendings patiently taught and patients graciously let me practice skills and knowledge accumulated and passed down over centuries. When I sit down with a patient in my mobile clinic all of those people are there too. Society has invested in each of us so that we can be its healers, and the role of healer carries responsibilities and challenges that we strive all our professional lives to fulfill.
In the old days, the obligations of a village healer were simple. Care for the people of your village and train someone to take over when you are old and can’t do it anymore. Today I struggle to understand my obligations as a healer in a global village where violence is epidemic, infections travel on airplanes, radioactive fallout rides the wind, and children in one country die of malnutrition, infection, and trauma due to economic policies in another. In a global village, death respects no borders and all the smallpox vaccine and duct tape in the world can't keep us from experiencing the consequences of our actions. As doctors, we know this better than most people, and we must speak out and teach as if the survival of the species and the planet depended on it.
In the face of all this, it is easy to feel helpless. What I thought I would do now, instead of depressing you further, is to cheer you up by telling you some success stories from my practice. The first story I’d like to tell you is about how my clinic got started. I live in rural Humboldt County, which is about a 6-hour drive up a winding two-lane highway north from San Francisco and has an average population density of 35 people per square mile. Back in 1990 when I started the clinic, our county had a severe lack of health services for low-income people.
The mobile clinic idea came to me one day, and I just couldn’t get it out of my head. Having previously been the medical director of two small community clinics, I was not naïve about what was involved. I knew I could never do it alone. But I wondered if I offered to go to underserved areas and provide medical care, would communities want the services enough to provide the resources to make it work? So I bought an old truck and a 24 foot travel trailer, filled a room in my house with medical supplies, and offered my services as a kind of spiritual experiment, or perhaps you could call it a medical stone soup, to see if one person’s intention could bring about something larger than herself.
The result of that experiment is an established community clinic on wheels with a staff of 18 including 2 doctors, a nurse practitioner, 3 counselors, 2 case managers, and 2 mobile medical units which provide services to a homeless shelter, a food bank, two soup kitchens, two public high schools, and 3 small towns without physicians. Let me tell you about some of our patients.
Last year a social worker from another community agency told our administrator a story. Ten years ago when she was addicted to drugs, prostituting herself for money, and on the verge of losing custody of her children, she came to our clinic. That single encounter in which she was touched and treated with respect reawakened her to her own value and humanity, and inspired her to change her life and ultimately return to work with people like her former self.
Another young woman first came to the clinic in early recovery from methamphetamine addiction. At our first encounter, I was struck by two things, her joyous demeanor and her early hypertensive nephropathy. She had never in her life had an ongoing relationship with a primary care physician and didn’t trust doctors because of past encounters where she felt treated like a second class citizen due to being black, female, and poor. Titration of her BP medications brought her to the clinic every two weeks where I was able to note her pressured speech, tangentiality and learn of a life history repeatedly derailed by impulsive bad decisions. After some discussion, we started her on mood leveling medication. Today she is the manager of a halfway house and, after four successful semesters of community college, is transferring to a California State University. She is an outspoken advocate for poor women and an asset to the community.
A former needle exchange patient of ours came by recently to thank us. He has been off drugs six months and is employed at a job he loves. He said we ?planted a spark in his heart? that helped him get off heroin. Another former patient stopped by to tell us that he’s been sober for several years and is now a minister helping others.
Last year a teenaged girl at one of our local high schools came in asking to be tested for sexually transmitted infections. She had been drinking heavily at a party and woke up the next morning naked with a young man she didn’t remember. Further discussion revealed that she was drinking to the point of blackout almost every weekend and smoking marijuana daily. She had no coping mechanisms for stress and no ideas about fun that didn’t involve substance abuse. I did an exam and some lab work, started her on contraception, and referred her to a counselor. When I saw her in follow-up a few months later, she was another person, vibrant and full of energy and enthusiasm. She had a job, was applying to college, and was involved in a peer outreach program. I don’t think she had any idea what kind of future had been narrowly averted.
I particularly remember another patient who first came to the clinic with a prescription he couldn’t afford to fill. He was dirty and ragged from sleeping in the bushes. He told me that he had worked with his hands all his life but had to quit working because he developed painful non-healing sores on his hands from any minor trauma. He had been to the emergency room and the community clinic several times, each time receiving a prescription for antibiotics, which did nothing to alleviate his condition. I pulled a dermatology book off the shelf in the mobile clinic and diagnosed my first case of porphyria cutana tarda. I referred him to an internist who set him up with the blood bank for phlebotomy. The last time I saw him he was clean and well dressed and had come back not for medical care but to tell me that he was housed and back at work. He said, ?Thank you for giving me back my life."
I know these stories sound like Prozac ads, and you’re probably wondering when I’m going to start talking about Jesus and asking for contributions. I’m not. I just want to say that when we treat people as if their lives are valuable, they respond by valuing their lives and the lives of other people. If we treat people as if their lives have no worth, it is not surprising that they end up feeling that all human life is cheap. Sometimes this seems like a huge undertaking beyond what any of us can muster, but surprisingly often all it takes is the willingness to see past the problems and differences to the essential humanity of another person. I have learned from my patients that even when the problems seem insurmountable, one person following his or her heart can make a great deal of difference in the world. If we all did it what a different world this would be.