Philip Brunschwyler had never walked a picket line before in his life. He makes his living taking care of children, trying to keep them healthy, treating them when they're sick.
But yesterday Brunschwyler was walking the pavement outside the building at 2121 Pennsylvania Ave. NW, where he has been a pediatrician for 17 years, holding a sign that read "Doctors Strike."
"I've been here 17 years and if you think it's easy to strike, you're crazy. I was chief of pediatrics for nine years and here I am repudiating everything I believe in."
He spoke with the twang of his native West Virginia, grappling with the questions he was being asked as though they were heavy stones. Occasionally he stopped to shake hands with a young patient or parent, quietly explaining why he and 55 other physicians are striking their employer, the 109,000-member Group Health Association.
The strike started Saturday after negotiations that began in January between the doctors and the governing board of trustees failed to reach agreement. The strike has left physicians - the 55 striking and the 30 or so still working - upset. It has confused some patients, angered others. Brunschwyler, though on strike, was still struggling with his commitment to his patients and what he finally described as his obligation to himself and his family, trying to equate the traditional view of the physician with his present job as a picket.
"I believe I have the opportunity to do good things to people, more than most people," Brunschwyler said. But walking a picket line made a different kind of statement, he added. "It's an example that the physician is not some lofty, mysterious, godlike figure. He was never that."
He stopped to shake hands with a 4-year-old patient who comes by with his mother. "Hi, Toby. How you doing?" The child and mother smile. Brunschwyler was asked how he feels about not treating his patients, even though their emergency problems are being taken care of. "I'm nervous about it," he said. "A physician, they say, should have a lot of compulsive qualities about him to be a good physician. I realize I may not matter a hill of beans in most situations, but I'd like to be there to help things along."
Three major issues divide the doctors and the board - the adequacy of malpractice coverage, continuation of a ban on outside Practice, the number of hours physicians will be allowed to see hospitalized patients compared to the number of hours they will be required to see clinic patients.
Brunschwyler was asked how, if he was concerned about his patients, he could on strike. "You've got a good question," he said. "I wish I could get as at it You get afraid of your job. You get angry at the board because you don't see things the way they do. No matter how lofty you can be, there comes a time when you have to take care of yourself and your family. I'm not a saint. I'm not a Peace Corps volunteer. I'm right here in Washington, D.C. There comes a time when you have to take care of yourself."
The malpractice issue troubles him the most. Brunschwyler said. He has a wife and six children, ages 7 to 16. If he is sued for malpractice and the coverage is not adequate, he could lose everything he owns. "That's a real fear of something that I do, not just now - but 20 years from now."
Patients came in and out of Group Health. Some, mostly union members themselves, said they think it right and proper for doctors to strike their employer. "They're just like the coal miners," one man said. "They want more. Everybody wants more. I don't resent it. I want more myself."
Edith Morrison, mother of two, stopped to tell Brunschyler, "I feel very distressed." He tried to explain the strike. She told a reporter she didn't like seeing physicians on a picket line. "I just can't remember someone ever saying before, 'doctors are out on strike.' It's kind of shocking. I guess they're the people who are always there when you need them."
Morrison's two children, Jennifer, 5, and James, 10, were treated for colds yesterday and she said they got "normal treatment."
Inside the lobby, however, Elaine Tyler, a secretary at the Department of Transportation's Federal Credit Union, said she was in pain. "I'm pretty sick right now. I can't get the care I need." GHA was having trouble finding her medical records, she said, and without them she could not get a refill on the medication to ease the paid of a gall bladder attack.
"I think it's pretty unfair," she said. "It always seems like the patients, we're the underdogs. We can wait. But we can't in emergency situations." She was asked if she thought it was wrong for doctors to strike. "Public servants and like that? Yes. When someone's health is at stake. I don't know what's going on inside of me."
More than 20 GHA physicians, some of them members of the striking union and others classified as supervisors, were trying to see emergency patients downtown yesterday, the only one of the four GHA locations open.
Those physicians, too, were unhappy. Yesterday afternoon they sent the board a short note, bearing 19 of their signatures, saying that their working did not mean support for the board.
"We are here to maintain patient care not to split the physicians," the letter said. "We feel that patient care is suffering, and the situation will get worse." They urged GHA to negotiate a settlement on issues other than the outside practice question, which they said should not be allowed.
One harassed physician, working inside despite the strike, said that he had worked Saturday, Sunday, Monday and Monday night. "People are tired," he said. "You get tired. Your judgement isn't the best. You get a little bit irritable. And then the tension of being a pawn between sides adds to the fatigue."
Emotionally," he said of the physicians, "I'm with them. But someone has to take care of the people here." Of himself, he said, "I feel very depressed. I'm sure there will be mass member defections if this goes on much longer. That will mean cash shortages and further decline in services."
Negotiators for both the physicians and GHA met again yesterday with a federal mediator to try to resolve the strike. One participant said progress was being made, but it was slow and nothing concrete had been settled.