Every doctor has some galvanizing memory of medical school. Most involve some dynamic moment of enlightenment, like finally grasping the elusively subtle audible differences between heart rhythms.
For Dr. Mark Renneker, an assistant clinical professor at UC San Francisco Medical School, a staff physician at a local poverty clinic and a cancer prevention and education specialist at Samuel Merritt Hospital in Oakland, the memory is of a different kind.
Renneker recalls clearly the day he and a fellow medical student were at the beach, sitting in a Volkswagen Beetle with surfboards strapped to the roof as they crammed for a cardiology class.
With textbooks spread out in their laps and a tape cassette of heart sounds playing on the car stereo, the pair strained to hear the difference between various heartbeats, all of which, Renneker recalls now, seemed to sound like "La-ta-ta-Dump." All the while, the waves kept crashing in on Ocean Beach, a stretch of sand here that is normally close to deserted but regularly produces better waves than Malibu.
Stashed in the car alongside the cardiology texts were books that chart tidal patterns, and the two young men knew they were only moments away from perfect surf. At the instant the tide books specified, they shut down the cassette player, threw cardiology aside, jumped out of the Beetle, pulled on their wet suits and disappeared into the waves.
Renneker's recollection illustrates the apparent cultural conflict that he and an unknown but clearly not large number of other doctors allow to rule their lives. All are physicians whose lives are driven--sometimes even consumed--by the passion of surfing.
Twenty-seven-year-old fourth-year medical student Kevin Starr, originally from San Diego, ponders a question designed to force him to list his priorities. His answer says a lot about his perspective.
Starr wears his blond hair long and would never be mistaken on the basis of appearance for someone remotely connected to medicine if it weren't for the stethoscope that occasionally falls unexpectedly out of his shoulder bag. His academic record is impeccable, but surfing is what drives his life.
He remembers that his girlfriend once asked which was more important to him, surfing or sex.
"I said, 'Well, sex is,' " he recalls. "But . . . you can always have sex later. That's the bottom line. Surfing is urgent. Sex can be urgent but you know it's going to be there, with a reasonable certainty."
For doctor-surfers like these, the psyche apparently permits coexistence of the two disparate life styles. Renneker, 35, likes to use his medical school recollection to illustrate his argument that the obsessive pursuit of the surfing life style requires organizational skills not unlike those a doctor must develop.
"The surf," he says, "is never good everywhere. It will be best at one spot and that might be two or three hours away.
"To get up there at the right tide and the right wind, you've really got to be on it. It's a very similar process to taking care of a really complicated case where there are so many variables.
"If you're just sort of floundering through it, you'll blow it with the patient, and so, correspondingly, you would miss a swell. Most surfers, they're just not on top of it. They're just happy surfing what comes to their beach. But if you really have the hunger, you'd have to say it's an intellectual curiosity about what the ocean is going to dish up."
Renneker still has the tide book somewhere nearby at all times. While other physicians consult their appointment calendars or personal organizers to check their availability for meetings, Renneker habitually checks the tide book to be certain he does not schedule anything when there is likely to be good surf.
"I started doing that in medical school," he says. "I found that you should never make an appointment with a professor on an outgoing tide. You'd set it up a week in advance and miss the waves. Then you'd show up at the beach and everyone would say, 'Where were you?' "
During his residency in family medicine, Renneker managed to con the UC San Francisco Medical Center into a schedule in which the length of his training was adjusted to provide sufficient surfing time. He treasures a memo from his supervisor noting that "Mark is a devoted surfer" who needs to "be completely off in October and in Hawaii."
Renneker, a psychiatrist's son who was raised on the Westside of Los Angeles and started surfing when he was 11, chuckles when he recalls the strange reactions from some of his fellow doctors in training.
"Usually, if you would say at lunchtime, 'Look, cover for me for the next couple of hours,' residents would do that for one another," he recalls. "But if you said, 'I'm going surfing,' they'd say, 'Forget it. I'm not covering for you.'
"So what I learned to say was, 'I gotta go work out. I gotta go swimming.' It sounds like something that involves pain and suffering."
A Bit Extreme
Even surfing doctors perceive Renneker as a little bit extreme. He has constructed his work world around surfing, carefully fitting together three part-time jobs into a schedule that requires him to work only Mondays through Wednesdays. That leaves the remaining four days available for riding waves.
He owns 20 surfboards, many of them handcrafted in Hawaii by surfing guru Gerry Lopez. Arranged neatly on shelves, they overwhelm his garage. He lives on Great Highway, along the ocean, in a cramped apartment stuffed with surfing paraphernalia, computers (for use in research and writing) and bookshelves filled with the standard medical works and journals that would be expected to line the walls of a doctor's home.
The pad is shared with Jessica Dunne, an artist and painter who does not surf, and a small iguana named Fluffy. Fluffy prefers Jessica, tolerates Mark and generally perceives all other human beings to be despicable enough that Fluffy is seldom invited out of his terrarium when there are visitors.
Like most surfing physicians, Renneker's beach name--sort of like a surfer's citizen's band radio handle--is "Doc." He says he never intended to practice medicine but sees the healing professions as most valuable as an educational tool for health promotion and prevention. He addresses these priorities by working two half-days a week at the poverty clinic, one overnight shift at Laguna Honda Hospital, a large geriatric and rehabilitation facility, and helps to run the cancer prevention education program at Merritt Hospital.
Renneker has several commendations from the American Cancer Society for his work in cancer education, but he says he was never interested in treating cancer as a medical specialty.
'Ultimate Surfer's Job'
In many senses, surfing rules Renneker's life far more than medicine does. He concedes, for instance, that his overnight shift at Laguna Honda could be perceived as "the ultimate surfer's job" in a culture in which many surfers take positions as night watchmen or restaurant workers to leave their days free for the waves.
"It was really a score to land that job," he says, smiling.
The three-day work week is also essential, Renneker explains. "In the spring," he says, "the surf may not be much here but really good three hours north. So I live out of my van." In the summer, he loads the van full of research materials for his cancer education programs and drives south to Big Sur where he is such a fixture parked alongside Highway 1 that some locals think he lives there--never suspecting he is a San Francisco doctor.
The Big Sur location, he confides, is "the ultimate secret spot." He whispers the location, then cautions: "Don't use the name. I'll be lynched."
In terms of life style, Renneker and many of his San Francisco surf doctor colleagues are caught somewhere between 1965 and 1985. "I believe in the yin and the yang and the yong," Renneker says, trying to clarify things. His kitchen is salt-free and butter is never used, he explains, and "I don't eat a whole lot of meat, but I love hamburgers. I actually spent two summers going around the country looking for the best hamburger. I found it in Windsor, Canada."
He takes clinical medical care a good bit more seriously than might at first be apparent from his visible life style. When Renneker's next-door neighbor, San Francisco State economics student Alex Galluccio, suffered a freak surfing injury, sustained in polluted water, in which the fin on the bottom of his board nearly severed one of the major muscles in his thigh, Renneker reviewed the case at UC San Francisco Medical Center, concerned that infection control did not take adequate account of the risks unique to surfing.
So, grabbing a pen, Renneker wrote almost a full page of orders. The next day, he returned and found the attending doctor assigned to the case had noted cryptically: "See surf medicine consultation, above."
Surfers' Medical Group
A couple of years ago, Renneker organized a surfing medicine conference in Fiji. Out of it grew the Surfer's Medical Assn.--membership about 120-- devoted to exploring questions about surfing-related medical problems. The group is currently working on a handbook of surf medicine. But mostly, the organization is an excuse to go surfing.
Not all surfing doctors belong to the association, which since it was founded has held a second Fiji convention and hopes for another meeting next year in the Galapagos Islands off Ecuador. There is no pretense that the conventions are not primarily opportunities to surf, but the association hopes eventually to elevate the field to something more than simply a footnote to the larger specialty of sports medicine.
When Renneker first got interested in determining how broad surfing's constituency is among physicians, he said he assumed surfer doctors would turn out to be those in fields like emergency medicine that allow irregular hours and large blocks of time off. That hasn't turned out to be the case. Surfer physicians, he said, cut across specialty lines, including those in plastic surgery, cardiology, brain surgery, anesthesiology, obstetrics/gynecology, orthopedic surgery, internal medicine, pediatrics and ophthalmology.
Still, the first and most inviolate rule of the Surfer's Medical Assn. is: Surfing takes precedence over any association business.
"Renneker and those guys in San Francisco are a little bit like something out of the 1960s," observed Dr. Tony Moore, chief of the division of community medicine at Scripps Clinic in La Jolla.
Appear to Be Opposites
On the face of it, Moore and Renneker would appear to be opposites. Moore, nonetheless, is one of the founding members of the association.
Renneker--tall and lanky with a beard and long hair most often tied back in a ponytail--eschews all trappings of the medical and life style mainstream. Moore, clean-shaven and, at 38, identified as a hard-charging, upwardly mobile physician who is no stranger to the power structure of intensely political medical institutions, works 80 to 100 hours a week, often staying behind in his office late into the evening to review his patients' medical records.
Next summer, Moore is scheduled to take over new responsibilities as head of Scripps' division of general internal medicine. But in the parking lot outside his office, his Toyota four-wheel-drive truck always carries a surfboard discreetly tucked into the back.
Most surfing doctors soft-pedal their medical credentials in the surfing culture. "If I happen to be taking off on a wave," Moore says with a laugh, "I won't say, 'Hey, coming down! Got priority because I'm a doc! Don't have a lot of time!'
"On the other hand, if I'm out in the water talking and somebody says, 'I'm taking economics,' I tell them I'm in medicine. But I don't have 'SURF DOC' on my license plate."
Launched Into a Tirade
Moore's two younger brothers--one an obstetrician-gynecologist in Los Angeles and the other a Bay Area orthopedic surgeon--also continued surfing after they got into medical school. He recalls that when an older brother--now a surfer-investment manager--took up surfing, their father, also a physician, launched into a tirade in which he called surfing "trivial."
Moore recalls that he got his first surfboard as a Christmas present when he was 10, dragged it down to the beach that very day and promptly gave up the sport for two years because he surfed for the first time without a wet suit and couldn't take the cold. When he returned to the sport, properly equipped, he became a lifelong enthusiast.
Like most surfing doctors, Moore would not accept employment at an inland locale and selected his medical school and residency training based in large part on proximity to acceptable waves.
"He (the father, Dr. Louis Moore, of Palos Verdes Estates) tried to take me to the country club to play golf," Moore recalled, but the example had no effect. "I don't think surfing and medicine are antithetical any more than golf and medicine," Moore says.
To hear Moore tell it, too, surfing plays a head-clearing, mind-cleansing role that is unmatched by skiing or--every surfing doctor's cliche about colleagues--golf. "For me, surfing is not so much of a life style. It's just a great sport," Moore says. "I don't have my woodie at the beach with my huarache sandals and the Beach Boys blaring."
'Surf Medicine Fellowship'
Kevin Starr, an avid surfer for nine years, is taking a year off before the official beginning of his fourth year at UC San Francisco Medical School to do what Renneker and the Surfer's Medical Assn. call a "surf medicine fellowship." It lacks official status as an academic pursuit, but Starr is helping to write and edit the surfing medicine handbook and to organize a new medical self-help column for a surfing magazine.
Playing off the goal of official certification in a doctor's specialty of choice, Renneker likes to observe that when he finishes the fellowship, Starr will be "board certified."
'In the Wilderness'
"On a big day, when you paddle and you make it outside, beyond where the waves break, you're in the wilderness," Starr says. "There's no way to get there except the way you just did. To be able to have a two-hour wilderness experience in the middle of a metropolitan area of 3 million people is worth anything. You can get that almost daily here.
"Surfing is a kinesthetic thing. It is a whole gamut of sensation that can't be had any other way. The sensations are just addictive. When you've been out here on a 15-foot day and you go to a meeting (at the hospital) where some guy is trying to trip everybody out, it doesn't bother you at all because it's so unreal. It's so silly.
"The main reason you surf is so you can walk in the hospital door and know that nothing that happens in there will bother you."
Starr has taken breaks in his college and medical school education before. He took time off from UC Santa Cruz to do health care work in Asia and spent another year's leave from medical school in South America. Until he started thinking about merging his beach-surfing identity with medicine, he says he had always assumed he would end up in the Third World somewhere, as a public health doctor.
But eventually, he says, he concluded that not only was he committed to the surfing life style, but his greatest health impact might be in that cultural milieu. "You can foray out into other communities, but you're best among the people you know best," he says.
"I realized what a powerful tool surfing is for health. It can sell clothes and soda pop and I realized what a powerful base it could be to promote good health. California culture follows from the beach culture. The beach culture follows from the surfer culture.
"I was just back in Minnesota and the kids were all wearing Ocean Pacific shorts. If we can get surfers to live healthier lives and make the beach life style a healthier life style that looks ahead and plans for healthy old and middle age, I think we can have a tremendous impact on health in California and inland in the years to come."
Dr. Jeff Harris, a family physician whose office is off Pacific Coast Highway only about a hundred yards from the beach in Malibu, has managed to continue surfing in spite of having three young daughters, aged 2 to 11. At 42, Harris says he finds that family responsibilities and a body passing into middle age limit his surfing, but he still keeps boards in his Chevy Suburban (skis are added at appropriate times of the year) and tries to schedule two or three hours in the middle of the day for "recreation"--read this "surfing"--as often as possible.
Also Plays Tennis
Like Moore, Harris, who started surfing as a teen-ager growing up in Los Angeles, fills in the fair-weather time between swells with tennis, but it isn't his first love. "When the waves are good and if I don't have a serious conflict with patient care, I'll be out there surfing," he says. "When the waves aren't so good--and I'm a little more choosy now--I'll take a good game of tennis.
"I've been surfing longer than I have been a doctor. I plan on consistently doing this throughout my life."
To Harris, treating surfers presents unfortunate but necessary opportunities to deal with pollution-related infections--a problem he says he believes has grown steadily worse in recent years and which has led him to take active political roles in community controversies--first over a Malibu sewage treatment plant and, recently, over proposals to install sewers in the area.
"Surfing is a great stress reliever," Harris says. "I used to get up at 5 or 6 in the morning and surf for an hour. It's a wonderful way to start the day. Now that I have a family and three girls, it's harder to do that. My wife expects me to be home.
"I used to be a little more consistent about it. There were good offshore winds, (with) great speed and great shape. Sunrises that are spectacular. I miss that."