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From the outside, Arvonia, Virginia, didn’t look like much. Just a small rural town in the backwater of the Old Dominion State. But it was there, in the late 60s, not long after a storm blew through and deluged the shacks and hillsides with an unprecedented torrent, that Dr. Lester Pittle found his passion ignited. There, he forged his commitment to community medicine.

These days, however, he works as a physician at Pike Market Medical Clinic. Located at 1930 Post Alley, the clinic serves any resident in the area in need of health care, medical insurance be damned. And so, in a back office off the downstairs lobby, Dr. Pittle, 62, listens and counsels, as he tends to patients — the elderly diabetic, the woman with a recent diagnosis of HIV, the man battling hepatitis C made harder to treat due to his mental health struggles — and offers guidance on how they can help to heal themselves.

Or, he used to. Up until July 2, Pittle worked at the downtown clinic as a physician. His recent departure marked the end of a 28-year tenure. And even though weeks have passed since he’s tended to those in search of healing, it’s still hard for people — his former patients, the nurses, even the receptionist with the two-toned nails sitting behind the desk, who smiles and nods at the mention of his name — to believe he’s not there. In their eyes, he’s helped to define what the clinic has become.

“I think he’s irreplaceable,” proclaimed a fellow physician at a June 25 going-away party for Pittle held at Kell’s, an Irish pub a few doors down the alley. “It’s the end of an era,” a staffer bemoaned.

Come Aug. 3, Pittle will begin working in Kent at Qliance, a medical practice focused on primary, preventive care that forgoes medical insurance. For a monthly fee — ranging from $49 to $79 — patients will have access to 24-hour care, seven days a week, with appointments lasting between 30 and 60 minutes.

Through his new position, he hopes he can do his part to address what he sees as one of the most glaring holes in the contemporary healthcare system: the loss of primary care. “I may not be doing all the procedures, but I’m helping the person decide what procedures are necessary: what diet would be best, what exercise,” he says. “That implies following them throughout the system.”

But to follow the path that led Pittle first to the Pike Market clinic and now to an emerging model of health care means stepping back in time, to 1969.

Unbelievable to some, the country still found itself entrenched in the Vietnam War. And Pittle — with a psychology degree from the U. of Michigan — had no intention of going to war. Instead, he focused on studying psychology at the graduate level. His specialty: rat
neuroanatomy.

But working toward a psych degree didn’t provide an exemption from being drafted. To opt out of military service, he could have pursued rabbinical study. Instead, he chose a different path: He decided to become a doctor.

In late August of that year, he entered the UVA School of Medicine, in Charlottesville. That same week, after shuttling across the Gulf of Mexico, a hurricane touched down on the Louisiana coast. The storm took a several-day journey north up the Mississippi Valley. At the Virginia border, the storm turned east.

Camille was her name and from Aug. 20 to 22, 1969, with a seemingly never-ending line of thunderstorms as calling cards, she announced her arrival. Rains fell and fell and fell some more: 10 inches, 20, 30. A portion of the James River crested at 30 ft.; its normal flood stage was 20 ft. Communications with the outside world were wiped out. One hundred seventeen people lost their lives. Virginia had just experienced the worst flash flood in its history. The people needed help.

Med students at UVA were asked to provide flood relief in a town called Arvonia; population: just a hair over 1,000. Pittle — born in S. Orange, N.J. — had never seen such poverty. Few people had electricity. Most used outhouses. “We went there,” Pittle remembers, “ gave out food, sand bags.” But a woman from the Office of Economic Opportunity, seeing the students, informed them something more was needed: “‘Doctors’” Pittle recalls her saying. “That got me interested.”

The school began a needs assessment for a community clinic there. Only two doctors served patients, and they drew a line at the door at who could enter. “They wouldn’t see black people and half the population was black,” says Pittle. But the university persisted, eventually getting the pediatric department to lead the charge to see all patients.

Those days opened his eyes. And his mind. “I felt that if I was going to work as a physician, I wanted to work with people that needed them,” he says, “and had previously had trouble getting that care.”

After getting his degree, he witnessed some of those communities when he ventured out West to Seattle to mooch off his brother while looking for work. From 1974 to 1980, he put his training to use in varied settings: as a physician for the Seattle Indian Health Board, a part-time ER doctor at the Veteran’s Hospital and staff doctor for Riverton Hospital Alcohol Program. He completed a master’s in public health at UW. Then a mentor informed him about a clinic, with an emphasis on community medicine, that had an opening he thought Pittle might want to look into. In 1981, he started at Pike Market Medical Clinic.

The clinic specialized in the treatment of chronic illness with the majority of its patient rolls, in the early days, receiving Medicare. Sixty-five percent of the patients then, he remembers, were 65 and older.

But communities are living beings and as such, they shift, they transform. And as the 80s gave way to the 90s, the clinic began to see a different kind of client: younger people, men, artists, who were entering the doors sick with unseen and unexpected infections. Some patients developed Kaposi’s sarcoma, a rare malignancy that produced lesions that marred the skin, and sometimes lined the gastrointestinal or respiratory tracts. The lesions — often referred to as KS — in young people often signified a compromised immune system, ones weakened, it was eventually determined, by HIV. The clinic found itself in the throes of the AIDS pandemic. “It was frightening, to see people coming in with lethal diseases, [people] your own age,” he remembers. “But it was a great honor and great privilege to take care of that population.”

A male receptionist, aware the clinic was willing to treat people with HIV/AIDS, advised those in need to make appointments there. Eventually, 130 patients who were HIV-positive became a part of the community served. But still there was loss: During one particularly hard year, nearly a patient a week died from complications from AIDS.

Treating these patients, these artists and young people, Pittle couldn’t help but get to know them. He struck up a friendship with a patient, a man named Victor Gardaya. A photojournalist with a growing reputation, Gardaya received a degree in architecture. He began to confer with Pittle, to design a house for the doctor, one to be set in Columbia City, with a deck affording a view of Lake Washington. But Gardaya became sicker. “He had KS in his lungs,” remembers Pittle. Gardaya completed the plans but, before he had a chance to see the house built, he died of AIDS-related complications. Today, Pittle still lives in the only house Gardaya designed.

As the years progressed and ever increasing pharmaceutical regimes extended the lives of those living with HIV/AIDS, the community at the downtown clinic changed yet again. Different illnesses — diabetes, hepatitis C — began to take prominence. And different patients — those confronting mental health or substance abuse issues — began to predominate. But even as the community shifted, Pittle’s dedication to his patients didn’t. Oftentimes, he sat with someone in a room and listened for as long as it took to what was going on in the person’s life. Known as the physician who never wore a watch, he’d could stay there, with his assigned nurse, well past closing. With the paper work he had to complete, some people remember him staying there sometimes until midnight.

But through the long work days, sometimes stretching 15 hours: eventually, Pittle saw that he himself had to change. He had a family, a wife and two sons, whom he saw little of. And so, he made a decision. After 28 years — with nearly three decades of getting an up-close and intimate view of the medical needs of an urban community, after tending to what he estimates were thousands and thousands of people — the time arrived for him to move on.

With his open acknowledgement that our national healthcare system is too complex and woefully broken, he believes that something must be done. He supports a single-payer healthcare option — think of it, he says, as a community-grouped insurance plan, with everyone in the same risk pool: “Healthy, sick, old or young.” — one that others, including President Obama, find faith in as well. But given Congress’ recent admission that Obama’s health care plan won’t be decided upon by the end of the summer session, healthcare reform still seems far away. And in the meantime, individuals, communities, both continue to face poor health.

Perhaps because of this, Pittle’s belief in what it takes to make a community healthy, a belief steeped in a hurricane’s aftermath, remains steadfast.

“I believe that everybody — and this is going to sound hokey — everybody has a spark of divinity in them. And I don’t care whether they’ve got lice or AIDS,” he says. “They all have that.”

By witnessing a person as he or she is, the state the person is in upon entering his office — that’s what it means for him to be a doctor.  The rest is extraneous. “We work with medications and x-rays, but I don’t really delude myself into thinking that that’s where the change occurs,” he says. “Everyone has the ability to heal, to change, to grow, but it can take years before people are ready. I try to let that happen.”

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