Making A Difference


“We ourselves feel that what we are doing is just a drop in the ocean. But the ocean would be less because of that missing drop.” – Mother Teresa of Calcutta

Jake worked behind the counter in a little country store. If the truth be known, Jake did not do much work. If he were asked a question, he seldom knew the answer. Then one day a customer stopped to buy something and noticed that Jake was nowhere to be seen. He mentioned this observation to the owner, who said that Jake had retired. The customer asked, “What are you doing to fill the vacancy?” The owner answered, “Jake didn’t leave no vacancy.” Though the answer is poor English grammar, it is, nevertheless, a wonderful line – “Jake didn’t leave no vacancy.”

A person about whom it would never be said, “he didn’t leave no vacancy” was Joseph Kramer.

Let me tell you about Joe Kramer.

It was a perfect morning for the seventeen kids from a day-care center to play on the grass in Tompkins Square Park, in Manhattan’s lower East Side. Suddenly, Felipe, a youngster not quite five years old suddenly stood up. “I got pinched,” he disclosed to the supervisor of the group. As he said this, he bravely blinked back his tears. He showed the supervisor his palm. There was a trickle of blood that was smeared across a small puncture wound.

“What pinched you, Felipe?” the supervisor asked. Felipe brought his other hand from behind his back. In that hand, he was holding a syringe and a hypodermic needle. There was a dark spot on the broken tip of the needle – caked blood. No one had to explain the danger to this supervisor who had lived all her life on these streets.

She called out to the rest of the children, “Did any of you find one of these?” Two more children held up the syringes they had found that morning in the park. The supervisor rushed to a phone to call her bosses in the day-care center. They confirmed her instant reaction: get Felipe to Kramer – and fast!

Who was Kramer anyway? Not Cosmo Kramer, Jerry Seinfeld’s eccentric neighbor? God, I hope not!

No, the Kramer in this case was Joseph I. Kramer, M.D. and he was Felipe’s doctor. In fact, he was also physician to hundreds of others who live in this area: to infants and grandmothers, to addicts and prostitutes, to priests and numbers bankers – all sorts and conditions of people. He was a pediatrician. He had been part of a successful practice in a wealthy New Jersey suburb, but for twenty-seven years,  Joe Kramer practiced alone on Avenue D at 7th Street, probably the only solo practitioner in one of the most ravaged and deadly neighborhoods in New York City.

Kramer devoted his life to responding to the human needs of the people in his neighborhood. The head of a medical foundation once said that Kramer personified “what medicine is supposed to be about.”

Every weekday morning, Joe Kramer drove his old battered station-wagon from his home on a quiet, shady street in affluent Bergen County, New Jersey, to his cramped street-level office on Avenue D at 7th Street in Manhattan. Here, he offered himself as a medical practitioner, a healer, and a therapist to a community of some 20,000 people, mostly Hispanic and African-American. On most days, forty or more patients showed up at his clinic, accompanied by three or four relatives. The examining rooms were just big enough to accommodate an anxious parent, a tearful child, and a stooping six-foot, five-inch doctor.

A half an hour after Felipe found the hypodermic needle in Tompkins Square Park, Kramer was swabbing antiseptic on the child’s palm. He knew that this was a high-risk situation. An infection in the palm could quickly spread to Felipe’s arm. Kramer quickly explained this to Felipe’s father, who was about to take his son to the hospital.

An hour later the report came back. There was not enough blood to determine whether the needle was infectious. As a precaution, Felipe was given penicillin and a shot for hepatitis. The outlook was good for Felipe. He would not be infected.

The good news should have left Joe Kramer pleased. He had helped another child survive childhood on the lower East Side of New York. But for him it was not a time for a victory lap. He was a realist and was quoted as saying at the time: “It’s such a crapshoot. If Felipe escapes the needle today, José will die from it tomorrow. Why should a five-year-old kid who never hurt anybody have to suffer from some junkie’s needle? I do this every day, but, jeez, I don’t know what the f_ _ _ difference I make.”

What motivated Joseph Kramer to open his clinic in the first place? Perhaps he did it because he wanted to make his life count for something. Most certainly, he was not a screwball. Eccentric, perhaps! Odd, certainly! Would that all of us were as “odd” as Joe Kramer!

Kramer once said, “I know I don’t have to come down here if I don’t want to, but I feel that the people are going to be here waiting for me, and it’s like standing up a date. I just don’t want to stand up the people down here. I actually watch children grow up here. I get to know families, their problems. I’m really just a country doctor in New York City.”

In 1996, after over a quarter of a century, Joe Kramer finally quit his practice. It was not the forty patients a day. It was not the rise of AIDS, the spread of tuberculosis, or the resurgence of measles. Neither was it his seventy-one years, nor was it the money.

It was the paperwork. Joe Kramer burned out on paperwork.

“I’m crapped out,” he said of his decision to quit his practice. “Patient Encounter Forms,” he continued, lifting a box. “I’m going to send them back to the president of the insurance company with a note: ‘I don’t encounter patients. I treat them.’ Those morons tried to tie me up with their red tape. They buried me with their forms.”

The “they” in that statement were the bureaucrats who had taken over the economics of health care. They were the voices on the line, the signatures on the letters, the ones who determined – as much as the doctor – who was treated and how. And it became too much for Joe Kramer. So he hung up his stethoscope and retired. Now, he says, he wants to practice for a while on an Indian reservation out West where he will not have to worry about office management, and to write about the troubles he has seen.

We can learn an important lesson from Joseph Kramer and it is this: If we live our lives focused only on our personal needs, we will accomplish very little. We will live to work – and work to eat – and eat to live – and that is about it. At some point, the cycle will be broken by our death and there will be little to grieve. Joseph Kramer wanted his life to make a difference in the lives of the people to whom he tended in his clinic. He may have had self-doubts about that, but little Felipe would disagree, as would countless others whom he looked after. As Winston Churchill once remarked: “We make a living by what we get, but we make a life by what we give.” Joseph I. Kramer, M.D.  gave much and made a difference.