{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/2f7jq0vd8b/manifest","type":"Manifest","label":{"en":["Dr. Mario Ramirez"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Date"]},"value":{"en":["1995-02-28 (created)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["Society of Teachers of Family Medicine","family medicine","family physician","Dr. Mario Ramirez"]}},{"label":{"en":["Subject"]},"value":{"en":["Dr. Mario Ramirez (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["english (primary)"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150920/file/278311","type":"Canvas","label":{"en":["Media File 1 of 2 - Ramirez_Mario_1995.02.28_-_Side_2.mp3"]},"duration":2558.27694,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150920/file/278311/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150920/file/278311/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/278/311/original/Ramirez_Mario_1995.02.28_-_Side_2.mp3?1750860080","type":"Audio","format":"audio/mpeg","duration":2558.27694,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150920/file/278311","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150920/file/278311/transcript/81399","type":"AnnotationPage","label":{"en":["Dr. Mario Ramirez interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150920/file/278311/transcript/81399/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Side 1: The purpose of what I want to do is just to talk with you about your life in medicine and your life in Roma, mostly your life in Roma. If you could just maybe start at the beginning, where you grew up and what got you thinking about medicine as a career.\n\nDr. Ramirez:  I was bon on April 3, 1926. My forefathers lived in Roma for 220 years. My immediate family was always there. My father had 6 or 7… I think 7 brothers and sisters. I was the second grandchild to be born to my grandparents. If we were to classify Roma as underserved now, the problems were much worse then. They would have qualified under every dimension. I had a little brother that died at the age of 7 from undiagnosed osteomyelitis until it was too late. But at that time, there were no antibiotics as we know them now. As far as I can remember, I always wanted to be a doctor. It’s very probable that my mother planted the seed when I was just a very small child, maybe because she saw the need. There were only two of us left, my sister and I and my mother and my dad grieved very seriously over the death, according to our culture. My mother went into deep mourning, dressed solid black, no music in the house and not going anywhere, practically seclusion. It hurt her very, very deeply.\n\nHow old were you at the time?\n\nDr. Ramirez:  I was 13 at the time… 14 I’d say. The war started shortly thereafter. I was a junior in high school and several of us decided that it was important that we get as much of an education as was humanly possible, in a short time so we decided to go to summer school that summer and we drove from Roma to Rio Grande City, which was 13 miles away, every day, to a summer school and we were able to get enough credits so we could graduate the following year. I was 15 when I started my senior year. I graduated in May. In April I became 16. I had thought I would go to St. Mary’s in San Antonio and I had been accepted to St. Mary’s to do pre-med. Some of my other classmates said, why don’t you go to the University of Texas? I had never heard of the University of Texas and had never been. In fact, I think I had been to San Antonio once, I hadn’t even visited St. Mary’s but I wanted to go there because my father and some of his brothers and sisters had gone to school in San Antonio. None of them had finished high school but at that time, getting a 10th, 11th grade education was equivalent to having a college education. Most of them had gone to Catholic schools, to St. Mary’s High School, to Incarnate Word. So I came to University of Texas when I was barely 16 in the summer of 42. My idea was to get to medical school as fast as I could. We went straight through. I was supposed to have graduated in 1945. I had applied to all Texas schools and every school I could think of. My grades were average. I didn’t get into Texas schools but was accepted to University of Tennessee. In December of 1944 I had a letter from them saying they had a vacancy for the January ’45 class and wanted to know if I would be willing to change. So I withdrew from the university before getting my degree, but with about 90 hours and I left for Memphis to start my medical school.\n\nHad you ever been to Memphis?\n\nDr. Ramirez:  I hadn’t been beyond Austin whatsoever. I went by train and it was quite an experience. I didn’t know where to stay. Found an old hotel called the King Cotton. I stayed there the first 3 or 4 days until I could find a rooming house. Going from here in Texas which, by standards of that, was one of the large universities in the country, to Tennessee where we were going on the quarter system and they were graduating 100 students every year but you went on a 12 quarter system rather than a 4 year system. It’s quite a difference. There were only 25 of us in the class. I believe I received one of the best educations that anyone could have. I had some trouble during my first year but then I excelled during the last year so I came out overall, average. I graduated and tried to get into the Navy but at the time, they were closed, they wouldn’t take anymore. \n\nWas that in ’48 or ’49?\n\nDr. Ramirez:  That’s when I graduated, ’48, ’49, something like that. I graduated in ’48, so in ’48 tried to do an internship in the Army and they weren’t taking many. My first choice of internship was going to be New Orleans, Louisiana and I applied there and I tried to Shreveport and applied to several others. I heard from Shreveport first, Shreveport Charity Hospital. I went ahead and accepted and the next day I was accepted to Charity New Orleans, which had been my first choice. I tried to change it but they wouldn’t allow me to change so I came to Shreveport. I think I learned more in that one year and I matured more than I had in the whole previous 21 years. It was a great, great year with a lot of experience. A lot of direct patient care. There, one day I saw we were going to dinner and I looked at the line the student nurses were in. I saw a young girl I hadn’t noticed before. She was beautiful. I asked a guy in back of me, who’s that? He said, that’s Sara. I’ve got to meet her. That became an obsession. She agreed to marry me late that year. She was a senior nursing student. It was against the rules for nurses to get married before they graduated. I had a rather good standing with all the staff and everybody in the hospital, had made a lot of friends and went to the nurses -- she saw me and said, I know what you’re here for. I’m sorry, the answer has to be no. I sat down and I looked at her and she looked at me and she said, but if you were to go far away from here where I didn’t hear anything about it, didn’t know anything about it, what you do is your business. So on Thanksgiving weekend, we decided to go to Roma to get married. My sister was engaged so we decided to have a double wedding. Meanwhile, I had a brother that was born late in life to both my parents, which was a joy in the family for all of us. So the nurse who was head of OB went as our chaperone. Her name was Goldstein, we all knew her as Goldie. She was a fabulous lady. I learned a lot of OB from her and from the public health nurses that worked there in the hospital, or around it. We were married, we came back and I had applied for a residency in pediatrics and had been accepted. Because pediatrics had always been a field I liked the most. But after being accepted, I realized I couldn’t go back to Roma and do pediatrics. So I asked the administration if they would change it and give me a rotating residency and they said yes. So in some way I guess, it was a precursor of what we know now as a family practice residency. And I stayed for that extra year.\n\nThat was at Shreveport also?\n\nDr. Ramirez:  At Shreveport also. I had very good rapport with the internists and the pediatricians and surgeons. I had what I felt was excellent training. We had decided to wait for a family but 9 months and 10 days after we had been there, Mario Jr. was born. It was a little difficult because here Sara was a student nurse and was due to graduate and she was obviously pregnant and we had special dispensation in a sort of silent way to get married. We left in 8 months before her completing or my completing and we went to Roma and we established our practice.\n\nIn your mind, had you always thought you’d go back to Roma?\n\nDr. Ramirez:  I always thought I would go back.\n\nThere was never any question.\n\nDr. Ramirez:  Never any doubt or any question whatsoever.\n\nWhat did Sara know about Roma?\n\nDr. Ramirez:  It was very, very difficult for her. In the first place, Roma was about 99% Hispanic, the language was Hispanic, the church services were in Spanish. The only movie theater showed Spanish movies on the weekend only. The food was different than what she had been used to in Louisiana. She helped me when we first opened the office. Had an uncle who was a pharmacist who sort of had been a mentor all his life. I said he was a pharmacist, he actually hadn’t graduated as a pharmacist but he was by all standards, a druggist. Very, very highly thought of in the community, very ethical man. He used to dispense subscriptions the way any pharmacist does. It became that you had to have a degree and then he hired a pharmacist to help out in the drug store. But he built a suite for me and that’s where I had my first office and little by little we expanded, we put in X-ray equipment. At that time we were doing home deliveries. My wife used to go with me all the time. We used to sterilize… my father served as the sterilizer and he would use a pressure cooker and we used to put gloves in brown paper sacks. Our instruments, we’d sterilize in the pressure cooker and that’s what we’d do to use in our OB when we went out on deliveries. But after about a year we realized that it was very difficult and it wasn’t the ideal situation to go 20, 30 miles out to the county on a delivery. There were no phones and there was no way of communicating. There might be another OB at the other end of the county or there might be an emergency. We were the only physician in Roma at the time…\n\nWas there anyone there before you?\n\nDr. Ramirez:  They had, I don’t know if he was an osteopath that came for a little while. Then we had an older man, very old, that was the public health officer but he died. There was one other doctor in the county so there were two of us for the whole county and it was quite difficult. So we decided and built a little maternity ward. There was a house for rent, right in the center of Roma there so we went ahead and rented it. We put in 3 or 4 cots in there and an old, old, old fashioned operating table which would serve as the delivery table. That was in effect, our first hospital. We hired a practical nurse that lived in town to come in and stay with the ladies in labor. We followed them very closely and we were able to bring them in and keep them for 48 hours or 24 hours and then let them go. And it worked out very well. It helped us that we were able to be more effective in the way we delivered care and the number of patients that we saw. Sometime later, 3 or 4 or 5  years later, we rented a bigger house and put more beds in there. Then we started admitting acute cases, such as maybe cardiac or somebody who needed immediate care. We developed very, very good rapport with the physicians in McCallum area and also in the Laredo area. Laredo was 90 miles away, McCallum was 55 miles away but we had very good specialists who were very sensitive to the need of the area where we were, who were very, very supportive with what we were trying to do and they were always willing to give us advice my phone or to accept patients if they had to be transferred for one reason or another. We continued with the OB practice and we were fortunate that we didn’t have any deaths. For the 43 years I worked in Star County, we didn’t have a single maternal death during the whole time I was there.\n\nHow many deliveries do you think you did?\n\nDr. Ramirez:  I imagine there must have been 4,000 or 5,000. I kept record of them, kept a little index card then when we moved, I had to destroy, we didn’t have any place to keep them. We built the second hospital. I remember when -- one of the gentleman that came, developed a heart attack, we hospitalized him in the hospital and then we had a cardiologist from San Antonio come down all the way to consult. We had another gentleman that had a rattlesnake bite and we also hospitalized him. Meanwhile I had been checking with my draft board, asking them, do you need me? Do you want me? They kept saying no, we don’t want you right now, stay where you are, stay put. And then all of a sudden around 1955 I had a letter coming saying, we made a mistake, we should have called you 4 years ago. I said, I have been asking, you have a record of it and you always kept saying just wait. They said, we’d like you to come in now.\n\nIn 1955?\n\nDr. Ramirez:  We had just built our home and we were still the other doctor there and I could have asked for clemency, deferment but I felt, no, let’s go ahead and serve now. They say our number’s come up, let’s go ahead. I was very fortunate in I was able to get a friend of mine who had just obtained his Texas license, Rafael Gaza, to stay in Roma and to take care of our practice. We made all the arrangements to go in and the letter for induction said, if you haven’t heard by such and such a date, call us collect and we’ll tell you where you’re going. I told my wife, if I call collect they’ll probably send me to the other end of the world. Let me go ahead and pay for the phone call to call and see where we’re going. The guy said, you’re going to a small base in Japan. If you ever felt you were being hit with a sledgehammer, I think it would be at that moment. We had never traveled. Tennessee, Memphis was the furthers I had gone and that was only to go to medical school. I came back to Louisiana and then home. We were quite distressed. They said the first three months I would not be able to take my family but I could take them after three months. We made all the arrangements and my mother and my father and my brother and Sara and I drove to the West Coast and we made it the scenic route by going through Carlsbad and going through the Grand Canyon, which he had never seen. It was quite an experience because we tried to take a shortcut to the Grand Canyon,, it turned out to be a disaster. Roads and mountains and snow. I have never been so scared in my life. I finally got on the boat and took my car and it turned out, to my surprise, that they had assigned me to Tokyo International Airport, the Air Force had a base there, had a small hospital and a small group of doctors. It was a wonderful assignment. If I had had all the -- in the world, I don’t think I could have gotten a better assignment. We had a great commander, it was about 5 of us physicians and they had an air-vac unit with about 12 to 15 nurses. Two or three of us who were there, found out real soon that it could be a very pleasurable experience and that we would have minimal work and a lot of time for travel, relaxation, play. But we also knew that if we did that, at the end of two years we wouldn’t be worth very much and we would have forgotten a lot of what we thought we knew so we decided to change everything and to make it more like a family practice clinic and base than anything else. The commander had called us in and said that he had probably the second largest VD rate in the whole Far East and he wanted us to do something about it We told him we were going to see patients much as you do in private practice. And every airman and every officer and every family there would have a decision. They would come to see us by appointment and they would continue with the same physician. As far as the VD rate, there would be no reprimanding, there would be no reporting, there would be an educational session when any airman or any officer came into the base, they would have to come in for an orientation talk. They weren’t going to be scared, just basic facts. That means we were able to bring the rate down to about 30% of what it had been. Not only that but we established a very excellent relationship with everybody, with all the officers, families. Because at that base there was Navy personnel, there was also Army Personnel in the area since it was Tokyo International, we were seeing families from the Air Force, from the Army, from the Navy and really having a family practice clinic. We had our journal club and there was still plenty of time for travel and plenty of time for relaxation. Sara, Mario and Patsy came over in December of that year. We remained there for two years. We enjoyed it, traveled all over the Far East, all over Japan and made many, many friends. But again, 9 months and 10 days after Sara was there, Norman was born. It was a joyous occasion for us. Shortly thereafter, a couple months later I took her to the gynecologist, he said, well, -- for some reason but it wasn’t a bad reading, Hyman was on the way. Sara said, let’s get out of here, this is too fertile. She had a lot of difficulties with her pregnancy, she had a lot of hemorrhaging, practically during the continuous time. She couldn’t travel then but I managed to climb Mt Fuji during that interval. Like I said, we had a lot of friends and a lot of support. When it started getting close to delivery for Hymie, we realized that it would soon be time for us to come back to the states and that she would not be able to travel because she was too far along in her pregnancy. I kept asking friends in the base, they said, don’t worry, we’ll arrange it. Finally I wrote a letter to the Air Force General and said look, we’re here, this is our second pregnancy in two years and my wife has a lot of complications. If it’s humanly possible I’d like to be transferred. There’s an air base in Laredo about 80 miles from our home and if I were transferred there it would be much easier. Immediately I had an answer from him saying, you will be transferred. We were air-vac’d out of Japan, just short of the two years and we came back to Star County. By that time Dr. Gaza had served very, very well, very capably for two years and he wanted to move on to McClaren. He had a friend that he’d grown up with and wanted him as a partner, so I could see. Again, I found myself in solo practice. But then we realized that we needed a hospital in every sense of the word, not just a rooming house with some rooms with beds in it. There was an old building in Times Square that we felt could be converted into a hospital very adequately. It was over 125 years old, solid rock, upstairs and downstairs. So I started negotiations to try and buy it. Took a long time because in Roma, most of that land goes back to the King of Spain and to -- were awarded to the grantors and they had never… in Roma, I’ve never been able to get a clear title. Everybody was an owner to the whole community. You couldn’t sell or you couldn’t mortgage anything so finally the owners agreed to sell to me and we had to sue the whole county, one-by-one-by-one, in order to get a clear title so I could get the money that we needed to remodel. But it was done and we have clear title to it and we proceeded to go ahead and remodel it into an about 18-bed hospital. We had a lab there and I had a lab technician with us. We had two RNs. We were able to get approval from Blue Cross Blue Shield and from the state, as a hospital. But we were not going to do surgery, just obstetrics there. The obstetrics was upstairs. It was difficult going up those stairs, the X-ray was downstairs and we had 200, 300 OBs that needed an X-ray and was in active labor, we had to literally carry her down the narrow stairs.\n\nWhat year was that?\n\nDr. Ramirez:  Oh gosh, ’58, ’59. Just about then… during all this time we had several preceptees (?), mostly from University of Texas. Beulah, the hurricane had happened and we had become close to Galveston. We had a very good relationship with them. Just about then, John Frey came in as a preceptor from Northwestern. He was one of the brightest and one of the best preceptors that we had. We decided to expand the hospital and build a surgical wing. We took one of the rooms and tiled it, from top to bottom, sides and everything else and that was to be our operating room. We put in a separate small air conditioning unit there. The temperatures in our county goes up to 105 very often. That would be our operating room, a little scrub room, a little lounge, 2 x 4, something like that, real small.\n\nWe used to have discussions in that lounge a lot.\n\nDr. Ramirez:  A very good friend of ours from Laredo who was a surgeon, had agreed to come at least once a week, to come in, in emergencies, in between if the had to and he would bring a surgical team with him. Leo -- was one of the most conscientious, best trained surgeons that I have ever known. He would maybe do 5, 6, 7 majors in Laredo and that was huge, every single day and then he would load up the anesthesiologist and his chief operating assisting nurse and himself and maybe one or two more people and they would drive the 90 miles to our county and usually get to our hospital about 5 or 6 in the afternoon. By then we had 4 or 5 major surgical scheduled for him. And he was there until midnight until they finished everything, regardless what hour it was. He would do radical breast, he would do gall bladder, gastric, he would do prostates, he did orthopedic work and did hip pinnings many times. On one occasion he even did a craniotomy of a child that had been hit by a car and was bleeding intercranially. We continued that for about, oh, 4 or 5 years until Leo had a massive stroke and died. By that time, I had one or two partners. I had one who was from Mexico who was a surgeon and the two of us knew that we couldn’t continue at the little hospital because Medicare and government coming in and asking us to do more and more improvements and changes in order to meet the building codes and health codes, which was logical but it was impossible to do because the building was so old. At one time they wanted fire escapes. Well, the Hemisfare was going on in San Antonio and they were raising or refurbishing some of the older buildings and there were fire escapes to be had so we bought one of those, came in and put it outside. The next thing, they wanted a sprinkler system. It was a beautiful old building with high ceilings and we had to destroy the looks of it by putting pipes all over the place so we’d have a sprinkler system within. Then they wanted us to enlarge the width of the halls because we couldn’t turn a stretcher around, then it became impossible because the walls were 46 inches in thickness, solid rock. So we knew we had to get away from there and build a hospital somewhere in the county. It was very much needed. Still, Dr. Gonzales, my partner and myself, in Rio Grande City there was a young doctor, family doctor who had come in a few years before. He was not doing obstetrics, he was doing emergency room or surgery of any type and he was located mostly in Rio Grande City. The old doctor who had been the county judge had died. We had the whole county, between the three of us. I didn’t have the money to build a private hospital, county hospital. We didn’t know where we could get it. Just about then, the county judge decided to retire or to hire jobs and they came to me and said, would you be the county judge? We need somebody real bad. I told him, I’m a Republican and all of you are Democrats and 95% of the people here are Democrats. They said well, don’t tell anybody, just take the job. I went ahead, and of course I knew that would be the road whereby we could build a county hospital and we started on the project shortly thereafter. Being county judge in a little county like Star County, at the time was quite problematic. It didn’t require you be a lawyer, yet you had to try cases and you had to settle matters. One thing that I didn’t do is marry anybody. I didn’t feel that even if I was, by law, qualified or empowered to marry, I didn’t think I had the power to marry anybody. But we did have a lot of trials. They were mostly misdemeanor and smaller cases. A few more major cases. But we formed a committee so we could build a county hospital. The first thing we asked the architect is, now that you have computer capabilities, put into it, all the population of Star County and where they are and try and give us a location which would be the most accessible to all the people. Since my family had lived in Roma 250 years, I much would have rather built it in Roma. My house was there and the old hospital was there but it would not have been fair to the rest of the community. So the answer was, build it about 7 or 8 miles from… no, 2 or 3 miles west of Rio Grande City, going to Roma. We found a gentleman who had some beautiful acreage and he said, I’ll give you all the land for the hospital. We proceeded to make plans and we submitted to the state health department for a Hill Burton grant. And the first plans were rejected.\n\nWhy?\n\nDr. Ramirez:  They said, try again. We went back and we told the architect, be a little bit more innovative. Let’s see if we can come up with something that’ll be different. So he designed a little hospital, a 50 bed hospital whereby four rooms would circle a little patio. The little patio would be where the families would come in to visit without having to go through the inside portion. There was a much bigger patio where he had the chapel, interdenominational. And a big room that was to be used for education purposes, a big back screen and the top part, very high ceiling. Very nice obstetrical, very nice lab, X-ray, emergency room, surgical suites. We were approved and to our surprise, not only were we approved for 50%, we were approved for 90% funding. We would be the first hospital that ever had that amount of funding. And of course, we got the county to put up the other 10%. We also did, probably was the most important part during my judgeship, we were able to create a hospital district. And even though Star County is the poorest county in the nation, there’s a little area that has oil and the taxation would fall on them to a big part and the taxation that would be imposed on the local people would be very, very minimal but at least we would have a base to be able to… meanwhile, both my wife and I had been very active in trying to encourage our younger students to go into health fields. There were a big number of them who had gone into pharmacy and into nursing and into lab technology and into X-ray We thought we had a base whereby we could staff the hospital without too much trouble. We had also had a number of physicians that were graduating from the area. The hospital went out to bid and we were able to build it at one half or less of what all the hospitals were being built in the state, per bed. We had a very nice groundbreaking with officials from the state department, Texas Medical Association. Just about then, I went and ahead and spent 9 years as county judge. It was a time that with the help of the community and with the help of the board of trustees or commissioners, were able to do quite a bit. We built a new international bridge between Roma and Mexico, we were able to build a 4-lane highway between Roma and Rio Grande City, which was heavy, heavy traffic. We remodeled the courthouse and air conditioned it, we built a new jail, were able to fix the avenue and make it four lanes and put a kiosk in the center with fountains and landscaping. Our school had burned down. My daughter had been student council president and gone to the White House with Student Council from Rio Grande City and President Nixon had come down at their invitation, to Rio Grande City and we were the sponsors.\n\nReally? Nixon came to Rio Grande City?\n\nDr. Ramirez:  Sara and I were the sponsors when they went to Washington. We were able to get Braniff to give a special fee and special hotel rates. They told us they wouldn’t see us and the Nixon’s office called me the day we were going to leave and said, the President wants to see the students in the Rose Garden. He was there and he was so impressed. They were good, good kids. Most of them had never been out of Star County, had never flown, they were poor kids. He said, I’m so impressed, I don’t know what to do. He said, I’m going to let you all come into the Oval Office. He said, I never let students in or anything like that but I want you all to see where I do a lot of my work. The kids invited him, they said, would you come to Star County? So he came to Rio Grande City. He promised to help and rebuild the burned down auditorium. We build three community centers and we built the only public swimming pool in the county so it was a very good 9 years. We also built an airport that I thought we’d never use in Star County but we built a road going by the hospital that would join up with the road directly to San Antonio. At the end of 9 years I told them I didn’t want to run anymore, I’m not a politician. I didn’t like campaigning and although I had won very, very big on both occasions, I felt like since we had built the hospital, it was time to move on.\n\nDid you see any connection between your being a physician and becoming a judge? Were there skills you learned as a physician that made you a good judge?\n\nDr. Ramirez:  I don’t know. The judgeship led to a lot of… the old paternal, patronizing system and there was a lot of that. When you have a very poor community, it’s going to happen that people are going to try and take advantage because everybody’s poor. During my administration, I can say it was completely and totally honest and I think that’s what it stands for. I never used a postage stamp out of the judge’s office for my personal use. We had had hundreds of cases that were pending trial, DWIs and cases like that and we reduced it to practically nothing There were a whole bunch of people who had been deputized as deputy sheriffs and we completely got rid of everything of that. The county was in severe financial strain, they owed a lot, a lot of money and we were able to take off the debt, bring it down to practically nothing, even though the needs were great. I didn’t do all that by myself. I had a lot of support. In county, in the trials, the county attorney and a local attorney were very, very helpful and they told me, be very firm be very hard at the beginning, then it’s going to be easier for you at the end because you will have gained respect and they will also know you mean business. There won’t be any patronizing. And I think all that helped, from that respect. I would go one whole day, every Friday I would spend in the courthouse and every morning I would go from about 8 to about","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150920/file/278311#t=0.0,600.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150920/file/278311/transcript/81399/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in the morning and take care of the things. I don’t think I ever neglected that office and I don’t think I neglected my own practice, even though part of that time I was on my own and was the only doctor. It was very, very hard, yes, but there was so much to be done and I enjoyed it. I was especially glad we got our hospital built and so many, many other physical projects. I don’t think in any time period, as much had been done. But again, it wasn’t me, it was the help or it was the time or whatever it was that we were able to do all this.\n\nPart of me, when you talk about how trusting I think people in the community were, of you as their doctor. Somehow you being the judge, they trusted you in a similar way.\n\nDr. Ramirez:  That’s right. And I think that’s the reason I won so big. The first time I won in every single precinct. If I were to go into the -- volume, a big, big book, -- and politics are notorious. I think we brought politics to a higher level where one of those times that I ran, the opposition, which had been lifelong opposition of my family and everything else, put my cousin to run against me. He and I were the closest of friends. I had been best man at his wedding, I had delivered his kids and we were very, very close friends. They abused him to run because the dynasty or whatever you want to call it, the family had been in power so very long and was so extremely prominent that they felt they could get back into power. The only thing he could say against me was that I’m an attorney, I’m trained for the job and I have the time. And he was right on all terms. But I won in every single precinct in the county and I think being a doctor had something to do with it, I think I had the trust and the faith of the people. I think I lived up to the trust. I think it was a very honest administration for the 9 years.\n\nI think it’s hard for… doctors are supposed to be fair, we’re always working for people, which I think on the whole, we do. And if the perception of the community is that that’s the case, then they’re willing to grant you other roles. What year were you elected judge?\n\nDr. Ramirez:  Gosh, I don’t even remember now. It was about 20 years ago.\n\nWas it ‘70 or was it after ’70?\n\nDr. Ramirez:  You came to see me…\n\nIn ’69.\n\nDr. Ramirez:  The second time that you came, you graduated, you’d just gotten hired, I was judge at that time. Back then, at DMA, one of my friends asked, he said, would you run for president? This was San Antonio. I said, well, if my community or if my county society proposes me I’ll run for president. I’d been very involved in a lot of committees and council and the DMA level, mostly dealing with -- insurance, with socioeconomic matters. They said you run…\n\nSide 2: So you were talking about a friend coming and saying, if you would run… if your district would nominate you, you would run.\n\nDr. Ramirez:  Run for president of Texas Medical. You’d be the first Hispanic, you’d be the first from a small town, to achieve that matter and you were on the post. Alright, go ahead and the people in my county were very supportive so we went ahead and put in our name. About 3 or 4 months later… oh, Houston had said they would support me as would the whole state. I had a lot of friends and 3 or 4 months later, a very good friend of mine from Ft. Worth, Derwood Neal, was a family physician and also extremely highly thought of, said he was going to run too. He said Houston and Harris County was going to support him. So we realized that with Harris County and Ft. Worth together, Harris County alone had enough doctors to probably win the election without any help from the outside. And I did have some friends in Houston but I realized it was going to be very, very difficult. When it came time for the campaign, Sara and her friends, made a lot, a lot of tamales and we had one big reception at the St. Anthony in San Antonio the day before the election, the day before Mother’s Day and I went. She and I went downstairs to the campaign headquarters, up to the party, my opponent was there, to wish him luck and say, hope the best man wins. And while we were in our party, the phone rang and Sara picked it up. They want to speak to you from Kansas City. Sara said, take it in the bathroom so it’ll be private. I went to the bathroom and took it and came back, sort of white-faced. She said, what? They just called me that I was elected Doctor of the Year and that we need to be in Washington at the White House next week. She said, what? That’s impossible, there’s no way we can be. They wanted the whole family. She said, there’s no way. Ask them to postpone it a little bit. -- would take them any time. But Sara Ramirez, we need you there next Friday and we want all the kids. Hymie was at Notre Dame, Mario was in San Antonio at St. Mary’s and Norman was at Stanford. It was going to be problematic. Immediately, a couple of our friends -- said, we’ll run out for the election that you’ve been elected Doctor of the Year by the American Academy of Family Physicians and we said no, that would be unfair advantage to use against the opponent. We’ll be completely quiet. The election was held the next day and we won by 5 votes. It was a landslide.\n\nBy how many?\n\nDr. Ramirez:  Five votes out of the whole delegation from Texas, there were several hundred. It was a very narrow election but I enjoyed it.\n\nThat was quite a couple of days for you. What year was that?\n\nDr. Ramirez:  ’79, ’80. We did go to the White House, we had all the kids, President Carter had a press conference in the Oval Office, announced it. It was a beautiful occasion for us. He’s a remarkable person, apparently they had briefed him, the way he talked, for about 15 minutes about Roma and Star County, my just having been elected President of the DMA, he remembered facts and figures that he met with us. My daughter was there with her baby and he held the baby and talked to all the kids. Hymie said something about takyo (?) and I asked him, do you know what takyo is? Of course I know what it means, it means he and I have the same name. After that I called my dad and dad and I were both emotional. We had just left the White House and dad was crying. That’s the first time in my life I’d ever heard or saw him crying. It was an honor. I don’t know how I got it or don’t know if I deserve it but it was very much appreciated. After I finished my year, I ran for Alternate Delegate for the AMA. Meanwhile, I had served on the AMA’s committee of -- for about 6 years and been Vice Chairman and traveled all over the country, trying to learn or see firsthand what the problems were and how we might be able to suggest that they be addressed. I won my position to the AMA as an Alternate Delegate and I about 6 years I became a full delegate. We ran for Council of Medical Services, which is the socioeconomic branch. I lost the first time. I ran again and won big. Then I ran for two others and won very handily, so I was in there 9 years. Meanwhile, I had a call from the White House, to see if I would serve on the Board of Regents of the Military Medical School in Bethesda. And I went ahead and accepted it. Then about 4 years later I was asked if I would accept the position for the Board of Regents -- Texas, at the University, it would be very close, I’d been very much associated in my whole years in practice. Went ahead and accepted it. Just finished serving for 6 years. I was the only physician on the board and very much involved with the whole medical school. Meanwhile, about two years ago I had a bout with cancer of the prostate, had radical surgery and I could not keep up the demands of the practice and the long, long hours. I had served for 19 years on the Board of Directors of Blue Cross Blue Shield and there was an opening for Medical Director. I went ahead and accepted the position and we moved from Roma to Rio Grande to McCallum, which was probably the hardest thing I’ve ever done in my life. Closing the practice and leaving the people there was extremely emotional and very difficult for both my wife and I. I still go to the family practice clinic and supervise one afternoon a week and that keeps me in a little bit of contact with patients and patient care. In the Blue Cross job I’ve tried to be an advocate for the physician, with the company and I have also tried to set standards of high quality in care. I’ve had some experience through my 9 years of socioeconomics and working with insurance companies and working with Medicare and Medicaid and the socioeconomic problems that face the profession -- I was a little bit qualified, a little bit prepared to try and undertake the job that I’m doing. It’s still difficult because I still consider myself primarily a physician but some of my friends tell me that maybe it’s necessary for those of us who have been practicing, who know patient care, to become involved with the process of the changes that are occurring now in medicine.\n\nLet me go back and in a sense, ask you about… you chose Roma because that’s where you grew up…\n\nDr. Ramirez:  That’s where my roots were, we were there.\n\nAnd there was never any conflict in your mind about going back and practicing in a place you grew up? There was never any concern about it?\n\nDr. Ramirez:  No, at the beginning it was hard. It was a little difficult for the older patients or the middle aged patients to say, I used to see him in knee pants and I used to see him ride a bicycle around and now he’s a doctor. I’m not going to let him examine me. But that’s -- and I think the trust I had because they knew you overshadowed any of those little concerns that were so menial, that surfaced at the time.\n\nSo you really had no difficulty taking care of people who were your friends or your family or your neighbors.\n\nDr. Ramirez:  No. I did it pretty naturally, I think.\n\nOne of the things I always am interested in as we talked last night, are the issues around confidentiality that are really different in smaller town in many ways, than they are in larger cities.\n\nDr. Ramirez:  It is. It is a little different and something that you’re always afraid of because of your record, because people you employ, people that are your friends or somebody you delivered, somebody you know very well who knows everybody else. And that was always a concern but we never had any problem arise as a result thereof. I lectured very, very often to personnel about the need for the records to be completely confidential. Toward the ends when we had to move the health clinic, I used to dictate everything, history, physicals and the progress notes. We had two girls transcribing. I’ve always been very much aware of the fact that it’s extremely important to document and to keep good records. And I think the last 4 or 5 years we were in practice, we had good, ideal records and we were able to maintain confidentiality.\n\nDid it ever get to be a problem for you at any point, to have information or to know something about a person or a family that you would know from the office and then be in another situation and feel uncomfortable?\n\nDr. Ramirez:  Occasionally. -- were maintained. The confidentiality was already affected. They know what you’re thinking, they know that you’re aware. You might know something that relates to one person and if there’s 6 or 7 persons involved, the other 6 or 7 don’t know that you know so you never let on that you know anything. It wasn’t very often but there were times that that definitely comes up.\n\nYou were really by yourself for how long?\n\nDr. Ramirez:  Half of that time I was solo. It was a load.\n\nThe idea of being able to have some time where you could be away…\n\nDr. Ramirez:  That probably was the most difficult part of that practice, John. I think if I can pride myself on one thing is that we never left the practice alone. I traveled. I was very active in organized medicine. Probably most of my vacation during the 43 years have been trips involved with medical meetings and very, very few of them were actual vacations in those 43 years. But not one time did we ever leave the practice alone. I would either get physicians from the Air Force Base in Laredo or get family practice residents from the Corpus Christi program or even from San Antonio, to come down on a locum tenens basis and cover while we were gone. Every single time.\n\nIf I remember, Corpus was one of those places where you got a lot of people at a time.\n\nDr. Ramirez:  Yes And Laredo Air Base, when it was active, helped a lot. And we would get some from San Antonio too.\n\nOne of the things I want to talk about is how this whole life affected Sara and your family. Can you just reflect on that?\n\nDr. Ramirez:  It was difficult on Sara at the very beginning. I think she became used to it. She learned the language after the first two years, was speaking fluently. She learned the foods. For a big part of the time, she lived next door to my parents and I was glad that the relationship that they had with her and she with them was extremely, extremely healthy and very, very good. I used to kid, they paid more attention to her than they did to me, which was actually a pleasure to me. She got along beautifully with my sister, with my brother and she got along well with the community. She was accepted. In our culture, sometimes that rarely happens to outsiders. I’ve seen so many people move in and they’re always outsiders, never really accepted by the community. And Sara was. As far as the children, I knew that I didn’t have the time because my hours were very, very long and very erratic always. I tried to make up by the trips that we took and all the medical trips, all the time we went to Austin or went to San Antonio or anywhere, we took the kids with us. I think we were known in medical circles as the Ramirez clan because 4 children or 5 children and it was never resented it was just the opposite. But those trips gave me the opportunity of being in close contact with them. We would drive most of the time. The dog, play game with the kids. I’ve always been very, very close to them. It’s been good trust and a very good relationship with them.\n\nDid Sara actually work in your office at any point?\n\nDr. Ramirez:  Yes. The first several years she worked all the time. She helped with the deliveries and she made house calls. Occasionally I’d have to leave her with an OB, I’d have to go somewhere else. She helped later on, after the kids were grown and left, she’d come to the office and helped with the clerical, paying and…\n\nBut she had other community activities that she was involved with.\n\nDr. Ramirez:  Yes. Very much. She was involved with raising the family, she was always a family person but she was involved in community things. She was active with me on the skilled (?), probably one of the biggest achievements --. She and I had been the ones and the university speaks to that at every chance they get.\n\nThat was the honors banquet that you had, the President of the…\n\nDr. Ramirez:  That we have every year, we have a President -- Texas. Now we include ANA and we include Pan American (?) and Brownsville. We’ve had up to 1,000 honors students. One evening we just --.\n\nDo you think… it’s always interesting to think whether the children of the doctor had an extra, not burden is not the right word, but extra attention or somehow they can’t be regular kids in the schools.\n\nDr. Ramirez:  I worried because through medical school, I had seen that people who devote their lives and time to other people, sometimes don’t have time for their own. I saw that sometimes in ministers kids and I said, maybe that is the one justification for the priest not marrying, if he’s going to care for all the people, he would not have time for his own children. And I was very much afraid of that all the time and I’ve tried to make up for it. The kids were extravert, they did real, real well in school. Mario Jr. and… no, Norman and Patsy were both Valedictorians in the school and Hymie was always up honors and Mario was in the top ten honors and Junior was a football player, an extrovert. They all were highly thought of. A lot of friends. We had kids at our house all the time. And we tried to be involved, we went with the Student Council when Patsy went to Washington DC and then Mario took his class to Disneyland. Again, the kids had never flown. We were asked to go as sponsors. We were involved pretty much in activities and with the kids, as much as time would allow, for me.\n\nI think young doctors always talk about having their personal life and their professional life separated.\n\nDr. Ramirez:  Well, that’s one of the reasons, John, that of all the 20 or 30 preceptors that I had, we didn’t invite them to live in the house because I thought my time was so limited at home that I had to be premium time with the kids and the family and I didn’t have to be on guard, on good behavior and extremely proper and this, after having a stranger living in the house. That was the only reason. I would have liked to, it would have been a closer relationship with the preceptees but the reason that being alone in practice, the time was so demanding and my prime time with the kids at home was so limited that I felt it wouldn’t be fair to Sara, it wouldn’t be fair to them.\n\n I think you’re right. And for me, made me be in the community more because I wouldn’t have learned Spanish if I was at your house a lot.\n\nDr. Ramirez:  That’s right. It would have been a different thing.\n\nOne of the things that I think we all live with is our mistakes, or at least our failures in some ways or the other. It’s a really interesting situation if you work in one town and live in another town and in some ways you don’t have to bump into you in a sense, what you know or you feel are your failures or mistakes. Did you ever have that sense?\n\nDr. Ramirez:  Oh yeah, a lot of times, you felt you should have done things different or that you didn’t quite do what you wanted to do or should have done. It very often comes up. I don’t remember specific incidents but certainly there were many, many.\n\nWho did you talk to? That’s another thing they talk about, isolation. Who were your confidants?\n\nDr. Ramirez:  Well, in later life, my brother, even though there was about 18 years difference. I talked to Sara a lot. There was a vet for awhile and was very close and we would discuss closes. Even though it was a difference in species. Different people. I was never real, real close to anybody.\n\nThat’s one of the tensions I think that are very difficult. A good friend of mine is 10 years now, in a small practice in Maine and he has developed a friendship with a minister in town and there’s a certain kind of place that people go to feel safe.\n\nDr. Ramirez:  We’ve always been close to church, always been close to the priest. There’s been some that we’ve been closer to than others. Times when we had some real good hot arguments. Used to call the Italian priest to come and baptize kids, he had to come at 2:00 in the morning. He said, you can do it just as well as I can, you don’t need to call me for something like that. And I would say, father, yes, but in our culture, the priest comes, he has a lot more meaning than if I pour the water. But we got along very well, very, very well. Had a young priest, an A\u0026M priest that was tremendous for the younger people. The kids really rejuvenated faith. Where masses were empty half the time, he was filling masses all the time. After 10 years, he was moved and he hated to leave Roma. He moved to Michigan. We see him occasionally.\n\nWere there any times during all the years you were in Roma that you felt like you might leave?\n\nDr. Ramirez:  Yes and no. Politically, there was one time when I was county judge. The opposition party, not my cousin but a few other people, one other attorney especially, and his wife was vicious, vicious, started attacking us. He kept saying that the only reason I wanted to build a hospital was because the hospital would be broke and it would be my hospital and I would own it. Something that was so far fetched and so different. She was vehement in her editorials. She accused me of thieving, that because we - company to buy equipment for the hospital… and a lot of insinuations to the point that I really had to get a friend of mine, a lawyer and say look, if you don’t stop this we’re going to have to put in a law suit, a restraining. That stopped it but it was extremely, extremely painful. Since then, they’ve both become good friends. There was a time when I was running for county judge, the opposition, I was taking care of the money and she was the matriarch. Something like Rose Kennedy in a small way. -- because two of her sons and I were running on one side and the other two sons were on the other side. I’d go make a house call and I knew they didn’t trust me and yet I was -- so I felt guilty that I had put them in that position that I had to take care of their mother when I was running against them politically. It was very, very difficult but turned out to be best friends afterwards. I don’t like to harbor any remorse or any revenge or anything like that. For instance, there was a lady that was mean, she wrote me a couple years ago, asking if I’d write a letter of recommendation. And I did. And now they look like little things At the time they looked like big things. I know Sara cried when we had those people attacking the hospital because nothing could have been further from the truth. I was trying to get rid of a hospital, I had no desire of wanting a hospital of my own. That one was being completely, completely with no other motive than being built for the community. You want to do something that’s needed and to leave it…\n\nSo kind of questioning your integrity was the thing.\n\nDr. Ramirez:  That’s the thing that really, really hurt. I felt there was nothing to question, not even the slightest. If anything I could pride myself, was that the Ramirez family had been honest. Even though there’s a big drug scene in Star County now, a lot of people are involved and the county has been called at one time by the press, sordid county, none of my family have ever been involved with drugs or with anything that was in any way illicit or that was unlawful or dishonest, or in any way immoral or anything like that.\n\nWhat comes across when you talk of how strong your values are? The values that have guided everything you’ve done. Where do those come from, do you think?\n\nDr. Ramirez:  Culture, training certainly, my dad and his father before him. Very strict, very honest, very moral.\n\nDid they actually talk to you about that or was it more the way they lived their lives?\n\nDr. Ramirez:  Example, more than anything else. Honesty, that was something that just stood out.\n\nYou said Texas is one of those places that’s legendary.\n\nDr. Ramirez:  There can be extremes. A lot of good people but a lot of people who will take advantage. We wonder now that the county has grown so much and there’s so much drugs and traffic, you wonder why. I think that maybe 25% or less of the people are involved. My brother thinks it’s much, much higher. The truth is probably somewhere in between and there’s no justification because there’s nothing that would justify drug peddling, transporting or anything else. But you can see where a person who is desperately poor, has a whole bunch of kids, cannot scratch out a living because there’s no jobs, there’s no opportunity, there’s no way and welfare is Texas is not designed for the poor, where somebody can lure a bunch of dollars to live and why they would accept it. There’s no justification and it’s a disgrace. Probably the only point that anyone could make for legalizing, which I’m not in favor of but if the profit went out of it, maybe… the sad part of it used to be that we were too poor, the county was too poor to have any addicts, locally. Couldn’t afford it. Now with trafficking, I see so many young people come in, that is painful. Other old families, locals when you see the waste in human potential, in young, 13, 14, 15 years old. One kid brought in by his uncle was 12 years old, not even adolescent. He said, he’s -- bandino. You know what bandino meant, it meant stuck. I said, to what? La coca. I said, how many does he drink a day? Oh, not that kind, the kind you sniff. How much is he using? He said, about 6 or 7 grams a day. I said, my Lord, where does he get that? Where does he get money to buy it? Oh, he steals all over the community. You know there’s not enough to steal in the community to support that kind of a habit. So his -- probably had it in the back shed and he was dipping into it. I told him, it’s going to take time before I can get him into a state program. There’s a line waiting. The kid was scared. I said, I could get him in another way, I could get him arrested and then a court of action, I could get him committed immediately. The boy said, go that way.\n\nWhat have been some of the hardest things about practicing in the poorest county in the United States?\n\nDr. Ramirez:  That and then referrals. Sometimes you do have support, sometimes you don’t. About 3 years ago I had this 15 year old brought in from the -- area, very poor farming community. Clean cut, football player, had a bad headache and it was about the 2nd of January. I asked, when did it start? It started yesterday morning. Maybe you celebrated too much for New Year’s. No, I went to Rio Grande City, I was with my grandma. I said, where does it hurt? The whole head. Vomiting? No. Nausea? No. -- neurological, negative. Could find nothing wrong. I said, well, let’s watch you, come back tomorrow morning, I’ll give you a mild ibuprofen. The next day in the morning the mother brought him, doctor, he hit his head against the wall all night long it was hurting so bad. I said, there’s something drastically wrong. I called one of my friends who was a radiologist and said, I’ve got to have a scan on this kid. No welfare, no nothing, no Medicaid, nothing. He said, let’s just say he has Medicaid or Medicaid pending and send him in. He called me back about an hour later and said, he’s got a great big -- lesion, 15 years old. He’s never flown or anything. I think -- got together and got enough money to pay for the airfare and we called M. D. Anderson, the pediatric neurosurgeon was very supportive. He said, send him in immediately, I’ll take care of him. He said, oh my gosh, how old did you say he was? I said 15. He said, go look at the records, look at the exact dates, I may have to send him to adult neurosurgery. I came back. Good, he’s fine, I’ll take him. We got him, we called the airline, Southwest and had somebody meet him, put him on the plane and we had him on the operating table 24 hours later. But those were some of the difficulties and some of the support that you get. There are good people who are willing to forget that there wasn’t a penny to be had in the family and yet they did everything they did for that kid. Sometimes it wasn’t that fortunate because you had difficulties finding somebody who would have said… but as a rule, there was a lot of support.\n\nWhat about the rural part of it? How do you think practicing in a town like Roma was different than say, practicing in Laredo?\n\nDr. Ramirez:  I think all the things you have said, professional isolation, hardships on your family, your wife. It’s not the cultural aspects, it’s not the opportunities there are in a big city, schools. Regardless how much I brag about our school system, it can’t compare with the opportunities that Dallas has. The cost, that I had to buy all the hospital beds and X-ray equipment and the layout that I had and the fact that when I first had my hospital, the county was no help and the city wouldn’t help and it had to come out of my pocket. I never, never refused a case because they couldn’t pay or never forced anybody. In fact, when I closed my office two years ago, we closed the books, never sent out a bill. Had over quarter million dollars, and the fact that I didn’t have the opportunity to plan for retirement and we don’t have any kind of nest or any kind of retirement we can fall back on, except maybe what little property my dad left us, what little we accumulated and for the children, the lack of opportunities, the lack of entertainment, the lack of… the advantages?\n\nIn some ways, what it sounds like to me is that you and Sara created a life for yourselves and for your children that was… you can’t…\n\nDr. Ramirez:  You can’t complain that you were deprived.\n\nNo, I was just saying, it’s not a matter of complaining, you did limit your life to Star County. You built friendships and made things work.\n\nDr. Ramirez:  Yes. I think maybe God had a lot to do with all of that. It couldn’t have been by chance. I couldn’t have had opportunities. The fact that we went to Japan and saw what the world was like and the world was centered around Star County. We started traveling after that, to the East, to New York, to Canada, to the West Coast and extensively over Mexico. The opportunity that I had to be on the committee or the board and to see things, the contrast between the affluent and the less fortunate and became very sensitive to it. I think that’s what -- to a more open world. When I talked to you about Eddie Vargo (?) yesterday, the fact that he wanted to go to Notre Dame, the fact that he left Star County and went to Chicago and to South Bend and met kids from all over the country was such a bigger education than if he had stayed. Certainly I can’t say the kids didn’t have opportunity when we speak of Yale, Stanford, Notre Dame and Manhattenville. -- but it was a wide…\n\nBut you stayed. If you think about what was the reason that you stayed for all those years. What was it that kept you there?\n\nDr. Ramirez:  Love, devotion to the land, the people. You wonder why the migrant leaves and goes off and then comes back to that little plot of land where he cannot make a living from it or anything else but he keeps coming back. There’s something that draws him back. I guess it was the same thing, it was just roots. It’s hard to explain it, to define why.\n\nIt really is but it’s very strong.\n\nDr. Ramirez:  Very, very strong. I think maybe because 4 of my kids and 9 of the 12 kids lived in McCallum area. And after 70 years old, it’s time.\n\nWhat was it like leaving?\n\nDr. Ramirez:  Very, very hard, very emotional. Priest had a mass for us and the whole community, had a big party at the church grounds. It was hard, there were tears.\n\nIt was like a death almost.\n\nDr. Ramirez:  The hospital had a big, big party at the -- hall, the only hall in the whole area that houses 1,000 people and had American dancers and the Mariachis and -- Cunningham and the president and the chancellor came down to speak. It was touching, very, very emotional.\n\nWhat’s it like to go back there now?\n\nDr. Ramirez:  I went back with an attorney when I had the lawsuit and I took him by the hospital, I took him by the courthouse and the courthouse, of course I still know people there. My secretary’s still there when I was county judge and there were kisses and hugs everywhere we went, into the courtroom with all the attorneys. Even the judges, he tried the case, he eulogized for a little while. I think it was very impressing on the attorney who had never been in Star County, that we had that sort of relationship. I showed him the old hospital and showed him my home -- the same it was when I went back, I think it was last week and tried to recruit Star County as a member hospital for the network of Blue Cross. I took my Chief Operating Officer, my boss for the whole area. He was commenting about it to my advisory committee and my cabinet. Never seen the feeling that he experienced when we went to the old hospital and I saw all the workers, the -- workers, the nurses, the aides, the cleaning people and emergency room people, there were hugs and kisses everywhere.\n\nIt just be that, that sustained you I think, for a lot of those years. That kind of love and affection and community. It’s hard for us sometimes to talk about how much being needed by people is important to us.\n\nDr. Ramirez:  Sometimes. It was very emotional. Two or three standing ovations and that meant more to me than anything. I think you know the service is done and there’s this warmth. 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