Is This Heaven? No, It’s Iowa for ‘Doc,’ Patients

Clifford Smith was making his retirement home rounds when a nurse wheeled 87-year-old Marie Moses into the reception room for her checkup. “Hi, Marie,” Smith said, without peering up from her medical chart. Nurses paused in anticipation as Smith pivoted toward Moses. Slowly, a grin stretched across her face, followed by laughter, a full, throaty rumble.

Moses has done this for nearly 20 years--even before the Alzheimer’s--at the mere sight of Smith. Amused at her amusement, Smith put down her chart, leaned toward Moses’s wheelchair so their noses were no more than 12 inches apart, and he began to laugh too. When Moses poked out her tongue at him, he mimicked her, and for a good 20 seconds, there they were, doctor and patient, face to face, laughing with childlike glee.

“I was offended the first time she did it, to tell the truth,” Smith said later. “But the thing I noticed is that she kept coming back to see me, year after year. I know my patients so well that I figure if one of them wants to have a good laugh, shoot, I’ll have one right along with them.”

Smith, 72, is a country doctor with a bedside manner not likely to be found in any medical school textbook. But the black doctor with the unorthodox style has fit in nicely in this virtually all-white Mississippi River town on the Wisconsin border, becoming one of its most cherished citizens.

In this age of managed care and health maintenance organizations, when the public increasingly views physicians as distant bean counters with little time for patients, Smith still makes house calls. If a patient is short of cash, he has been known to accept bales of hay as payment. He knows most of his patients by their first names, and almost everyone here knows him as “Doc.”

The National Rural Health Assn. named Smith its Rural Health Practitioner of the Year in May, although, in truth, there is not much in the way of competition anymore. About 15,600 doctors practice family medicine in rural areas, according to a 1996 survey by the American Medical Assn. While the number of physicians nationally has increased from 443,502 in 1980 to more than 716,000 in 1996, the number of general practitioners in rural America rose by only about 725 during that same span, the survey found.

The city, and more specialized medicine, is where the money is.

“We have major, major problems with the distribution of physicians,” said Tim Size, executive director of the Rural Wisconsin Health Cooperative, which represents about 24 clinics across the state. “The commitment that [Smith] has to his patients is certainly a hallmark of rural medicine, but the idea of an individual being on call 24 hours a day, seven days a week, is one thing that people aren’t as willing to do anymore. I think in the future we’re going to see fewer and fewer people choosing that kind of practice.”

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Smith fled the big city 36 years ago for this farming community of 7,000 souls, and he never left. He has laughed with his patients, cried with them, patched their wounds and massaged their fears. He has delivered their babies and grandbabies, watched them grow old and die. He has healed them, again and again.

“I love my patients,” Smith said. “I’m not brilliant at anything. I’m just average. But two things I know I can do: I can sit down and listen to someone, and I can have compassion for people. A lot of the young guys today are too cool to really listen, and really care just about the bottom line. But I grew up thinking that medicine was about service, and that’s just the only way I know.”

Amid quaint antique stores, dimly lit taverns and bed-and-breakfast inns, Smith’s modest Main Street clinic here represents a way of life that has all but evaporated. In some ways, Smith and his way of practicing medicine are as dated as Ma Bell, drive-in movies or soda fountains.

“You just don’t see many doctors like him anymore,” said Bill Menze, 82, a patient of Smith’s for a quarter of a century. “If you have a problem, you can sit and talk to him and he will listen, however long it takes. Most doctors nowadays . . . it’s in and out, in and out. Everybody has a schedule to keep. But Cliff really cares about his patients.”

It is an odd marriage, really. This overwhelmingly white farming community did not know what to make of the young black doctor and his family when they moved to town in 1962. Even now, many residents here refer to Smith as “colored.”

A native of Waterloo, Iowa, Smith returned to his native state to attend the University of Iowa after World War II, where he was a member of the elite, all-black group of fighter pilots known as the Tuskegee Airmen. He went on to Meharry Medical College in Nashville and, after graduating from the historically black institution, he opened a practice in Jersey City, N.J. Four years was all he could stand.

“I hate the city,” Smith says now. “It was just too much noise, too much congestion.”

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He stumbled on an ad in a trade-industry publication. McGregor, Iowa, with a reputation as a hard-living farm town, needed a doctor. “I decided without ever seeing the town that this is where I’d practice,” he said.

His first years were lean. The only other physician in town was white, and he referred to Smith only patients who had trouble paying their bills. Moreover, Smith was an outsider, and his three-piece Brooks Brothers suits did not go over well with his neighbors in overalls and cowboy boots.

“Man, I just knew I was sharp too, but folks were making fun of me,” Smith recalled. “I got rid of those suits. I own one suit now and it’s too small for me.”

He earned $2,000 in his first year of practice in McGregor. But in the days before Medicaid and Medicare reimbursed health care providers for treating the elderly and indigent, he collected only half that. The next year, he made about $4,000, but again collected only half of what he billed.

“I was having trouble feeding my kids,” he recalled. “I thought about leaving at first, but I was so broke, I couldn’t even afford to get out of town.”

He applied for a $2,000 loan to expand his office, but the town banker told him he would need 25 co-signers to qualify. Smith’s work was beginning to win fans around town, and his patients--all white--co-signed for the loan.

“It was certainly different to have a colored man come to town at first,” said Elizabeth Moe, 83, and a patient of Smith’s virtually since he arrived in town. “The only time we’d see a colored man up until then was maybe someone on the train just passing through.”

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But under Smith’s care, Moe has survived two bouts with cancer, and her husband one.

“It meant everything to us to have our doctor to come see us at our house. It was very reassuring,” she said.

When his father fell ill nearly 30 years ago, Ray Siegele said, Smith would visit the family in their home. Once, during an awful snowstorm that made the roads impassable, Smith walked nearly a mile--mostly uphill--to tend to Siegele’s father, Harry, at the family farm.

“I think everybody felt it was strange to see a colored doctor in town,” said Siegele, 68, a retired sheet-metal worker. “But now everybody wishes we had more like him.”

Smith has become part of the town family, the uncle who has a story to tell, carries a black satchel, drives a pickup truck and loves horses. Although he spends most of his spare time on a small farm with his horses and his second wife, a local white woman, Smith has been part of the town’s main professional and civic activities throughout the years.

“These small towns are pretty prejudiced,” Menze said. “But Cliff is just Cliff to me, and if you ask anybody here, they’ll say he’s a good man and we’d hate to lose him.”

He has never earned as much money as his big-city counterparts, Smith said, and his first marriage ended 22 years ago in part because of financial woes. His two children, both by his first wife, left with her, and now they are grown and live elsewhere. Never a good businessman, Smith sold his practice to the La Crosse, Wis.-based Gunderson Lutheran Clinic in 1987. He has come to work every day since as a salaried employee.

But he has no plans to retire, which is just as well. Few here can imagine the town without Doc, or Doc without his patients.

“I swear,” said Alice McGrath, 79, “that man’s heart beats in his patients.”