Hard to Heal

Fred Rottnek, doctor to the downtrodden, tried his luck playing the boardroom politics of one of the city's most prestigious charities, Grace Hill. He lost. So did the homeless of St. Louis.

The differences were all around him. His classmates drove fancy cars to school. They shopped for Izod shirts at Plaza Frontenac. He commuted from his Affton home on a Bi-State bus. When he wasn't studying, he was sweeping out his family's hardware store.

Rottnek was different in other ways. He grappled with chronic depression, not fully understanding what was wrong or how to cope.

"I always felt like I was walking around with a wet army blanket around my shoulders," he says. "I didn't know what it was or that I could feel different, because I always felt that way."

Jennifer Silverberg
Dr. Fred Rottnek: "I don't necessarily love medicine. I just love what I can do with medicine."
Jennifer Silverberg
Dr. Fred Rottnek: "I don't necessarily love medicine. I just love what I can do with medicine."

Despite his working-class roots, there was never any doubt the carpenter's son would be the first person in his family to attend college. The daily routine of college classes was enough to keep a major depressive episode in check. He graduated with an honors chemistry degree from South Carolina's Furman University and was one of 30 students in the nation to receive a full graduate-school scholarship from the National Institutes of Health.

Rottnek applied to four top universities -- Massachusetts Institute of Technology, Harvard, Cornell, Columbia -- and was accepted by all. Only 21, he was on the fast track. But two weeks into his graduate program at Harvard, depression hit and his life unraveled.

"It was probably more fear than anything else," he says. "It didn't feel like the right thing to do and, on the other hand, it felt wrong not doing it. I mean, who flushes a chance to go to Harvard and make lots of money down the toilet? It was like the screen going fuzzy on a television. I felt like I had got on this conveyor belt because it was the only thing to do."

Rottnek dropped out of the program and started teaching high school. He then decided he wanted to be a Jesuit priest.

"Going into the Jesuits was a socially acceptable way of killing myself," he says. "It was a way of allowing somebody else to make all the decisions I couldn't."

After first being rejected for the seminary, Rottnek was accepted on his second try. Once again, depression hit, and two weeks into his training he came back home. The valedictorian of Chaminade's class of 1982 found himself living in an efficiency apartment, cleaning houses just to pay the rent.

When Rottnek was finally given the diagnosis of chronic depression, all those wet-blanket years started to make sense. With his depression under control, the 25-year-old stopped floating aimlessly and took time to think about what he wanted to do.

"I knew it had to be something I could feel was important enough to spend my life doing and had to involve some type of community service," he says. "Because of my own experience, I thought maybe psychiatry. I wanted something where I could incorporate my values and teach, where I would have the latitude to do a lot of different things. I wanted to be my own boss. That is how I ended up in medicine. It wasn't a light-bulb moment -- it was more like a Chinese-lantern moment. It wasn't until my third year in medical school before I really felt sure."

In the past, Rottnek had found solace in the rugged discipline of academics. It was a safe shelter from his internal storms. But inner calm wasn't what convinced him of the righteousness of his decision.

These moments did:

Holding a woman's leg while she pushed out a baby. Watching a doctor brush the hair from an elderly woman's forehead. Seeing a homeless man's eyes light up when he realized he was talking to a doc who really listened.

"I think there is a sacred component to health care," he says. "You are touching people in a personal and intimate way. That is something special and should be cherished."

Rottnek was in his second year at the St. Louis University School of Medicine the first time he volunteered at Harbor Light, in a clinic that was relatively unique because it was one of two in the city that were located in the shelters where the homeless stayed. Other clinics serve this needy clientele, but the homeless must come to them. For those who work, taking time off for medical care is a luxury they can't afford.

Work in the shelter resonated with the man who had always struggled to find his place. At the time, the Harbor Light clinic was only open once a month and was sponsored by Health Care for the Homeless, a small nonprofit agency started in the mid-1980s to catch some of the homeless who were falling through the cracks of the public health system.

HCH was formed by a coalition of three charitable organizations -- Grace Hill, St. Patrick's Center and the Salvation Army -- with a goal of securing one of 14 Robert Wood Johnson Foundation grants.

The coalition failed to win a Johnson grant but decided to fish for other funding. After receiving $100,000 from an anonymous donor and additional money from Comic Relief, a fund for the homeless created by comedians across the country, the new group hired an executive director and became a separate agency. It contracted with Grace Hill to provide transportation to its four health clinics and prescriptions for the homeless.

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