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This doctor makes house calls

 She picked up the phone in the lobby.
 
“Hi, it’s Dr. Lee. Will you open the door for me?” she asked the person on the other end.
 
Her silver bracelets clinked as she walked down a long third-floor hallway lined with identical brown doors. She stopped at one, the wrong one, and kept walking. At the correct door, she knocked.
 
Earie Thompson opened the door and smiled at the woman standing there in a turtleneck and slacks, hair perfectly coiffed, carrying a colorful tote bag. Nevada Lee was there to examine Thompson’s sister, Algie Jackson, who had a stroke last October.
 
Thompson, a retired nursing home employee, takes care of her bedbound sister and herself in a two-bedroom apartment in south Kansas City.
 
In a small room crammed with big furniture, 94-year-old Jackson lay in a hospital bed, her right arm hugging a stuffed bunny in a “Jesus Loves Me” T-shirt. A small TV with rabbit ears next to the bed was tuned to “The 700 Club,” and a church choir sang as Lee placed her hands on her patient’s abdomen and gently pressed, checking its firmness and for any pain. Jackson, her eyes barely open, said nothing.
 
“Did the nurse do the enemas at some point and did you get some good results?” Lee asked Thompson, but answered her own question as she continued feeling the woman’s belly. “Yep, she’s a lot softer now,” the doctor announced.
 
After the exam, she and Thompson sat together in the living room, freshly dusted, the sofa and wingback chairs like new under plastic slipcovers. The room was still as Lee jotted notes in Jackson’s medical file, then told Thompson that she’d be back in April but to call if she had any problems.
 
This is not the only house in Kansas City where this level of devotion is evident. Lee sees it every day, and it makes her happy.
 
“Many families are providing care 24/7, and they are providing very good care,” she said. “They monitor vital signs, change diapers, feed and nurture their loved ones every day. It is truly amazing.
 
“These caregivers deserve medals of honor.”
 
Diagnosis: Find a buddy
Last month Lee visited Emma Hutton in her retirement community apartment at the Fountains at Greenbriar in Independence.
 
Hutton was a new patient with few physical ailments. But the aching in her heart seemed quite acute.
 
The women sat knee-to-knee in Hutton’s living room, the 83-year-old former school cafeteria lady in her recliner, Lee perched on a dining chair balancing Hutton’s medical file on her lap.
 
The hearing aids in Hutton’s ears weren’t working properly, forcing Lee to conduct the interview at the top of her voice, repeating herself often.
 
“Are your parents living?”
 
“Am I what?”
 
“Are your parents alive?”
 
She learned that Hutton had broken both hips, had a pacemaker, once had colon cancer and lost her husband of more than 60 years last fall. And she couldn’t sleep.
 
“Tell me about your sleeping troubles. What time are you going to bed?” the doctor asked, loudly.
 
“I go to bed about 7:30 every night,” Hutton said. “Is that too early?”
 
“You know that,” Lee said with a laugh.
 
“I know that. But is it OK? I mean, I just get so lonesome. There ain’t nothing I care about watching on TV, so I just feel better if I go to bed and stretch out.”
 
After more questioning, Lee discovered that Hutton wasn’t participating in activities in the building (“It’s cold when I go down there with the door open and closed”) and fixed her own meals and ate alone in her apartment “because they don’t have no food I like.”
 
“Do you have any friends around here?” Lee asked her.
 
“Well, everybody here is friendly.”
 
The doctor pressed. “But do you have a friend?”
 
“No, not exactly.”
 
“Sounds like you’re missing out on a lot.”
 
“Huh?”
 
“Sounds like you’re missing out on a lot of things here,” Lee said louder.
 
After examining her, Lee took out her cellphone and called Hutton’s son. “I’m here with your mom and she’s looking pretty good, so I need to know if you have any particular concerns,” she told the son.
 
“Well, she does appear to be pretty lonesome and bored,” she continued. “She says when the weather gets better she’ll go out and participate in some of the activities. What she really needs here is a friend, a running buddy, and she doesn’t have that yet. And I know the hearing is quite a bit of a handicap.”
 
As she packed up her bag to leave, Lee told her patient, slowly, loudly: “Looks like you’re doing OK. We just need to get you some activity. We need to get you busy. I’ll be checking on that next time. You tell me where you’ve been.”
 
Sunshine at the door
Lee, who is 64, learned at a young age to honor her elders. Her grandmother lived with her family when she was growing up in a house across from Lincoln High School, Lee’s alma mater. She finished her bachelor’s and master’s degrees at Vassar College in 1970, then came home. She taught high school biology for a few years before starting medical school at the University of Missouri-Kansas City in 1975.
 
She opened her first private practice in 1983 in Brookside, specializing in the needs of an age group that her med school counterparts showed little interest in serving: senior citizens.
 
Later, she worked for a senior health care center in Raytown, then part time for a corporate-owned house call service in Kansas City. But she longed to be her own boss again.
 
Opening her office, Geriatric Internal Medicine, in a remodeled ranch house in Raytown in 2005, she hired a staff of three women who think of themselves more as her family than employees. The days there are so full that when the staff prays together each morning they ask for divine intervention so they can get out the door by 5:30 p.m.
 
Lee’s house-call patients are almost all seniors on Medicare, which covers the cost of the visits.
 
“For many, going to the doctor is a high-anxiety situation. They are more relaxed at home,” she said. “The very frail ones get worn out by any trip out the door, and it takes them a couple of days to recover from any outing. Others just refuse to leave home.”
 
She travels just under 300 miles a week in her minivan, a rolling office with a cargo area stuffed with toys for her grandkids, garden tools, packets of fast-food condiments, medical equipment, yoga clothes in case she ever has time for a class and a Frisbee that her Doberman still hasn’t learned to catch.
 
She makes roughly six to 12 house calls every day but Wednesdays, which she spends in the office.
 
Her “little black bag” is a luggage tote, 12 pounds of stuff including her stethoscope, nail clippers, drug reference books, bandages, blood pressure cuff, umbrella, prescription pads, sticky notes, paper towels, stool sample cards and hand sanitizer.
 
She doesn’t dress like a doctor on her rounds: no white lab coat like the one she wears in the office, no nametag. At all times she carries her cellphone with its hot pink cover and her pager inside a purse slung bandolier-style across her chest. She tries to wear colorful clothing because for some of her homebound patients she might be the sunniest part of their day.
 
‘I love her’
A few days after Lee met Hutton, a woman’s body was found behind an abandoned house in Marie Norrise’s neighborhood just west of Prospect Avenue.
 
Two hours after the body was discovered, Lee stood on the porch of Norrise’s brick bungalow, knocking on the door.
 
Lee has been trying for years to get Norrise to move out of her “prison” — the doctor’s word — and into a senior apartment where she could make friends. But Norrise won’t budge from her home of 46 years, even though the neighborhood clearly isn’t as safe as it once was.
 
She uses an electric wheelchair to get around inside her home but doesn’t want to build a ramp over the front steps because she fears betraying her vulnerability.
 
Lee got right down to business, taking Norrise’s blood pressure, listening to her heart and lungs and checking for swelling in her legs, sheathed in knee-high stockings rolled down just below her knees.
 
Stuck in her wheelchair, she had “gotten to the place where I could not go to the doctor all the time,” Norrise said. “So with her coming to me … I love her.”
 
Norrise has left her home just once in the last five years. The Life Alert bracelet around her wrist gives her, and her doctor, peace of mind.
 
“Many people develop a sense of contentment with being homebound,” Lee said. “They are comfortably ‘nested.’ They are happy, or at least satisfied, right where they are. I try not to judge them or impose my measures of happiness on them. Contentment is truly a blessing.
 
“Sometimes it is difficult for me to decide who to push and who not to push. Every now and then I push someone into the outside world, and they actually enjoy it.”
 
Left behind
Lee lugged her bag up a long wheelchair ramp in front of Ernestine Mace’s white stucco bungalow and ducked under a red fabric awning over the porch. Sometimes patients forget that Lee is coming, and her arrival comes as a surprise. But 91-year-old Mace came as quickly to the door as her rheumatoid arthritis allowed.
 
The retired domestic worker has been living alone since her mother died in 2008. Mace took care of her mom in this house until her mother got too sick and moved to a nursing home. Mace doesn’t leave the house much anymore.
 
Lee pushed back the curtains on a window to let more light into the living room, then sat down on the sofa.
 
“Anything new I need to know about?” she asked as she wrapped a blood pressure cuff around Mace’s arm.
 
“No, so far so good.”
 
“How’s your asthma? Is it bothering you at all?”
 
“Not too much.”
 
Lee next clipped an oxymeter onto one of Mace’s fingers to check the oxygen level in her blood. It was fine, too.
 
Mace told her that she’d been fasting since the night before because she thought the doctor was going to take a blood sample. Lee hadn’t planned on it, but since Mace had gone to the trouble she decided to do it anyway. She went out to her van and came back with her bloodwork kit.
 
Digging around in her tote bag she couldn’t find her tourniquet. So she wrapped the blood pressure cuff around Mace’s arm again, pumping it tight to make the veins in her arm pop out for the needle stick.
 
Said the grateful doctor to her patient: “Thank you for having that good vein.”
 
That’s not Kool-Aid
A few blocks from Mace’s house, Lee hauled her bag up the steep concrete steps in front of Wilbert Smith Sr.’s house and rang the doorbell.
 
Wilbert Smith Jr. answered the door.
 
“Since he won’t let anyone else do (for him), I had to do what you said … move in and take care of him,” he told Lee as she settled onto the sofa.
 
“Is he going to come down?” she asked about his father.
 
“I think so.”
 
And sure enough, a few minutes later, the senior Mr. Smith, an 85-year-old diabetic with mild dementia, came walking down the stairs, a cane in his right hand, his left hand on the wall for balance.
 
“Good morning. Good morning. How are you doing today?” Lee called out to him.
 
“Not too bad.”
 
She weighed him on her scale before he settled into a chair next to the sofa. Lee knelt on the floor next to him, joking that she spends a lot of time on her knees, and took his blood pressure.
 
“OK, we’re making progress,” she told him, liking his numbers. “Taking your medicine is making a difference. And having your son here is making a big difference.”
 
“Yeah, I’m the maid now,” the son laughed.
 
But Lee wasn’t laughing when Wilbert Smith Jr. told her that he hadn’t been taking his father’s blood sugar readings. Wilbert Jr. can’t stand the sight of blood. It was worrisome because of Wilbert Sr.’s refusal to eat anything other than his beloved cookies, cakes and pies.
 
“I just can’t take it,” the son confessed.
 
“Because of the sticking part or what?”
 
“Because of the sticking part,” he said. “I don’t even take mine because I don’t like blood. I go to the doctor to get mine.”
 
“Ohhhhh-kay,” Lee said.
 
Turning to the father, she said, “Mr. Smith, I’m not afraid to stick you.” So she did. And as she pricked his finger with the lancet, drawing a drop of blood, the son sitting on the other side of the room covered his eyes.
 
“So, uh, what can we do to get you some courage?” Lee asked him, laughing.
 
“I just don’t like the sight of blood.”
 
“Can you pretend it’s red Kool-Aid or something like that?”
 
“No, no.”
 
“Do you have a friend or anybody who can do this?” The son thought for a moment, then said, “Maybe my ex-wife can do it.”
 
Packing up her bag to head back to the office, Lee told the son she would be happy if he could get his dad out of the house.
 
“You going anywhere today, Mr. Smith?” she asked her patient.
 
“No, ma’am.”
 
“Yes, you are. You’re going to get your hair cut,” the son reminded him.
 
“All right!” said the pleased physician. “See you in May, Mr. Smith. You take care.
 
“And I’m glad your son’s here with you.”
 
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