Apaper parasol above his head and black ballet slippers on his feet, Dr. Hunter Adams scampers nimbly, back and forth, across a tightrope in the front yard of his Arlington home.
"Health, like life, is a matter of balance," he asserts, pausing to catch his own. "Exercise, diet, family, friendships, a sense of purpose, are all important. It's easy to get the hang of it, with a little practice. But if you stop paying attention, you'll fall flat on your face."
The 38-year-old physician's fondness for making a medical point with theatrics is a small part of what distinguishes him from most doctors. Another minor difference is his appearance. A neck-craning 6 feet 5 inches tall, he sports a thick ponytail that stops just inches short of his waist and a whimsical handlebar mustache that seems to have a life of its own.
But the major distinction is his unique approach to medicine. "I do not, and I will not, charge," says Dr. Adams, who spends about three hours on an initial interview, invites patients and their families to his home and visits theirs. He refuses third-party payments because he considers medical insurance "an abused system that has skyrocketed costs" and won't carry malpractice insurance because "I won't practice based on fear." (He has never, he says, been sued.)
This notion--"that healing should be a loving human interchange, not a business transaction"--is the philosophy of the Gesundheit Institute, the nonprofit, tax-exempt organization that Adams founded and directs. Comprised of about a dozen people--like-minded physicians and friends--Gesundheit has operated out of a series of group homes in which Adams has lived, in Arlington, Fairfax and West Virginia. In its 12-year existence, they have treated nearly 15,000 people from around the world for free.
Today Gesundheit is based in Adams' rented Arlington home--where he lives with his wife, Linda Edquist, an artisan of "wearable art," his 7-year-old son Atomic Zagnut Adams ("We believe in the 'A Thousand Clowns' philosophy that he can change it anytime he wants"), musician Pam Bricker and communications specialist Gareth Branwyn. The group is supported largely by Adams' part-time job, working nine nights a month as medical officer in the emergency room of St. Elizabeth's Hospital for which he earns about $52,000 per year.
"In the early years I borrowed $3,000 a year to live on from friends who had excess money and liked our work," Adams says. "For the last seven years, since Zag was born, I've had part-time doctor jobs. We have a very inexpensive life style. And people give us things--vegetables from their gardens, odds and ends they can't use. One day someone drove up with 16 wheelchairs that we redistributed, and we've just been offered the use of a 1942 firetruck with three ladders."
The other Gesundheit doctors and support staff--about six people--live on the group's 310-acre property in Pocahontas County, W. Va., where they hope to set up a holistic health community. "We desperately need a facility," says Adams, who recently stopped taking new patients to concentrate on fund-raising for the center, "that will enable us to offer free care to anyone from anywhere."
"WE picked the name Gesundheit mostly because it makes people laugh," Adams said over a bowl of cereal and cashews on a recent morning. Dressed in short green scrub pants and a white T-shirt, he had just returned from his daily four-mile run around the playground of a neighborhood school and was seated at a sturdy wood table in his sunlit dining room explaining why he's not concerned that the name will keep people from taking them seriously.
"Why can't they take us humorously?" he quips, wiggling his bushy eyebrows a la Groucho Marx. A close friend of the now-famous Flying Karamazov Brothers (The Second Greatest Juggling Act On Earth), Adams says, "There's enough seriousness in medicine already. I know a nurse who was fired from a hospital because she laughed too much. Now that's sick."
He sets his spoon down and stares compellingly from blue eyes. "We are serious about what we do. Gesundheit means wellness in German--which is the current medical buzzword--and that's at the root of what we do. Also, people use it to mean 'God bless you,' which fits our notion of the importance of faith to health."
SINCE age 12, Gareth Branwyn has suffered from a severe form of arthritis called ankylosing sponsylitis. "I'd tried a whole host of straight medical options and had cycled through a lot of alternative approaches--the special diets, the exercise," says Branwyn, now 26 and a support staffer at Gesundheit. "I first heard about Gesundheit around 1975, at a time when I was very depressed. I had stopped taking medication because I was having an adverse reaction, and I was pretty miserable."
Branwyn went out to spend a week at Gesundheit, which then was operating out of a 12-acre farm in Fairfax County. "I couldn't believe that the tall guy on the unicycle was actually the doctor," he recalls. "There was a woman there who had tried to kill herself, a man who was a chronic alcoholic. Even though I expected something alternative, I was shocked."
His meeting with Adams, Branwyn says, "was one of the most powerful experiences of my life. He let me talk until I was finished, then we continued talking for hours, then went out to watch the sunset. He was the first person who ever asked me how I felt about my arthritis.
"He asked 'What are you going to do to overcome this?' and, at the time, that really bothered me. I wasn't used to hearing a doctor throw things back on me, to say 'I don't know what I can do for you. Have you thought of trying this or that?'
"At one point Adams reached out to shake my hand, but my shoulder was very stiff and I said 'I can't.' He looked at me and said, 'I don't ever want to hear you say that. You can always try.'
"It was the beginning of a whole new outlook for me. I went to a yoga class they were having and tried my best, and everyone cheered me on. The next day I was even stiffer, but over time things got better. I realized I didn't hurt so much when I listened to music, so I made a tape of my favorite music and listen to it daily. In the years since then, my arthritis has actually gotten worse, but my experience of it is that I've gotten better. I feel a lot less pain. And the arthritis no longer rules my life."
BORN in the District, Adams is a self-described "Army brat" who lived in Germany and Japan before returning to suburban Virginia in 1961 after his father died. "That was right during a very socially conscious period," says Adams, who got his nickname "Patch" ("Just because I didn't like the name Hunter at that time") from classmates at Wakefield High School.
"I got very involved with the civil rights and antiwar movements. I was a C.O. during the Vietnam war. I had seen my father's spirit destroyed by war. He was an artillery officer and had to write a lot of letters home to parents about their dead children.
"I'd always been interested in science. I'd been one of those nerdy little kids who has a lab in the attic and dissected animals for my own pleasure. The health professions just seemed like a great thing to do with my life."
His dream of running a free health-care facility evolved over the course of his senior year at the Medical College of Virginia.
"As a student," he says, "I learned what the model of a doctor was. You spent five, 10, at the most 15 minutes with a patient, got a list of complaints, did some tests, then prescribed some medication.
"That works for some people, but it was unsatisfactory for me. I wanted to get more involved with people's lives, and I knew there were people who needed and wanted a more personal relationship with a doctor, too."
He began to experiment with "being the kind of doctor I wanted to be" during a senior-year elective at a pediatrics clinic run by Children's Hospital. Several nights a week he volunteered at the Washington Free Clinic.
"I went to patients' homes and they came to mine," he recalls. "I could be myself, I could wear a firehat and a false nose if I wanted.
"I tried to develop a relationship that was indistinguishable from a friendship. I wanted them to feel free to come over any time, to call me at four in the morning . . . not as some demigod who can make them better, but as a friend with medical knowledge who could possibly make some suggestions of ways they could help themselves."
LINDA Edquist met Patch Adams when he was in medical school and she was a volunteer in a clinic for adolescents run by the Medical College of Virginia. "It's been a great adventure," she says matter-of-factly about the hundreds of people who have tromped through her home and camped in her living room. "I have my own work, and if it gets too much I just go off by myself for a few hours."
When she married, her parents--who own a construction company in Virginia Beach--cut her off. "They liked the fact I was marrying a doctor," she says, "but not the fact that he didn't charge. But over time they've seen what he does, and they've listened to his advice. I think they're proud of him now."
As for his own mother? Adams smiles: "She says, 'Get a haircut, tuck in your shirt, why don't you charge?' "
THE first patient who "let me be the kind of doctor I am now," Adams recalls, was a teen-age drug addict who the Free Clinic considered "a throwaway, no hope, she'll die. I worked with her a long time. She came to our house, we went to hers. Today she's happily married, has a child and is a nurse herself."
But Adams is quick to stress that he was "just a part of that change. It's really important for us in our practice not to think we've done anything. The patient is responsible for him or herself.
"If a person comes to you with an ulcer and you hear how they hate their job, how they're having problems in their family, how they used to do these hobbies and now they don't do them any more . . . Well, you can admit him to the hospital and get upper GIs and lower GIs and give him a tranquilizer to calm him down. But that's not doing much. For them to get out of an ulcer they're going to have to like their job, make peace in their family, stimulate their friendships. These are all things people have to do themselves."
The role of the physician?
"This is it right here," he says, pointing to a handwritten quote he has taped to a bookcase amidst a blizzard of paper scraps bearing inspiring mottoes as well as pictures of starving children ("To remind me, in my comfortable existence, how much suffering there still is out there"):
"He who has a why to live can bear with almost any how." Nietzsche
"I try to find out what matters to people, what their passions are. Because that's powerful medicine. If they're in a coma, and I know their favorite music, I can suggest someone play it, because it may be useful.
"I try to help people get in touch with their own, personal why."
ADAMS first opened his home to "anyone who wanted to come by" during his internship in pediatrics at Georgetown University. He left the pediatrics program after the first year when he discovered, he says, that "I didn't want to focus on just one stage of life. I wanted the kind of relationship that ends when one of you dies."
That kind of medical practice was emerging in his home. "I saw whoever came by," he recalls. "First friends of friends, then word spread." He explored forms of health care not taught in medical school--such as acupuncture and nutrition. Rarely did he prescribe medicine.
"I probably write as many prescriptions in a year," he says, "as some physicians write in a day. I've found that--over time--the only, consistent long-term improvement comes with assaulting negativity with total enthusiasm, and through positive thinking reestablishing structure to crumbling dreams. In essence, to give people back their dreams as reality."
Seventy-three year old Rose Kupperman met Adams while he was working in one of his "part-time doctor jobs" and did a biopsy on her leg. "I recognized in him a warm, loving human being, and we've been great friends ever since," says Kupperman, who stopped by on a recent afternoon to give Gesundheit a stack of pillows. "I'm unhappy about leaving my grandchildren in this self-centered rat race, and I see in Patch a ray of hope for a better world."
"Patch is probably the healthiest person I think I've ever met," says Virginia physician Elliott Dacher, a friend of Gesundheit who practices a more traditional style of medicine. "And I've studied what makes someone healthy for years.
"He is one of those very unique people in life who is willing to live out his dreams. He's willing to adopt a life style consistent with the nature of his practice, where he can do without money--something that's not possible for everyone given the financial imperatives of life.
"Like all great teachers he gives people visions and dreams of the possible."
In 1974 the 15 to 20 people who made up the infant Gesundheit Institute moved to a 12-acre farm in Fairfax. In 1977 they moved to a larger farm in Jefferson County, W.Va.
"That was our most active period," Adams says. "We were seeing an incredible flow of people--between 500 and 1,000 people per month. They heard of us through the grapevine, and came from all over the country to play Frisbee, to work in the garden, to be sick, to be well."
He has no exact numbers because "We never had the personnel or the strong interest in keeping statistics deciding which person was a patient. We didn't want those labels. Our feeling is that everybody is a patient, everybody is a doctor."
IN 1979, Gesundheit members met and decided they could no longer put up with the numerous patients taking over their home. "We needed," Adams says, "a facility." So a core of Gesundheit members moved back to northern Virginia to try to raise funds for their dream.
"I write between 200 and 400 letters a month," says Adams, offering up a notebook crammed with elegant rejection letters--from the Carter White House, Sen.Edward M. Kennedy's office, the late Margaret Mead's office. "No one ever tells me why they won't fund us, but from talking to foundation people I guess there are frightening elements about refusing to carry malpractice insurance, using our homes, never charging money.
"People say 'What happens if you get sued for malpractice and lose everything?' I say, 'We'll lose everything.' We think the system has to change. We admit we make mistakes, we're sorry for them, and we're going to practice with a lot of doctors so that a lot of people will have input and we'll make fewer mistakes. But we don't want to spend our practice covering up our mistakes or trying to put the blame on the night nurse."
Until recently, Gesundheit doctors refused to be interviewed. "I had fears," Adams says, "that publicity would affect the sanctuary nature of our environment and make the health professionals celebrities." They chose to "go public" with articles in the April issue of Prevention magazine and the Whole Life Times for two reasons.
"First to inspire others to stick to their dreams regardless of the pressure," he says. "And secondly, because we feel we must go to the people for financial help."
Their goal of a half-million dollars, he says, "is getting closer all the time. Before 1982 the most we'd been given in donations was about $3,000--mostly by $10 checks. Last year we were given about $30,000 and this year we're already up to $30,000."
Recently they received a $10,000 grant from the Ruth Mott foundation in Michigan--which funds projects related to preventive medicine--to develop an educational production. Called "Medicine: A Musical Comedy" it will be modeled after street-theater productions Gesundheit members did with the Flying Karamazov Brothers--who taught Adams the fine points of juggling and rope-walking.
"We'd march through a town and set up a stage like a traveling medical show," Adams says. "People would dress in sheets like teeth and others would grab a big rope and floss them.
"It's pretty ironic that we've been turned down hundreds of times for funding for trying to serve people, then we apply for a grant to do something that's pure fun and get $10,000 on our first try."
ALTHOUGH Adams admits his days are "filled with wild-goose chases, following any lead I get," he remains hopeful.
"It's not that I think the current medical model should be replaced by us. But we're part of the team, and we need to be here for people who want what we offer. The American health-care system is at a point of crisis. The patients are increasingly dissatisfied and the doctors are losing the joy of the practice of medicine. Our approach is one answer.
"I know the process is as important as the goal. I have a lot of patience, and I'm totally reinforced in my work. If there is a hard part it's all the mail that comes to me from people all over the country who are suffering, and I do not have a place to offer them."