Peter Wentzel

We're able to do the medicine that I think is the best medicine, which is to know our patients and to take care of them. That model really hasn't changed in probably thousands of years. You know, you come in you tell me what's wrong. You're honest about it. I'm honest about what I think is going on and together, we come up with a plan.

Aryana Misaghi

I'm Aryana Misaghi and this is Appalachian Care Chronicles, a podcast bringing you stories from every corner of West Virginia's health sector. Join me as we journey alongside a variety of problem solvers, changemakers and daily helpers who are all working behind the scenes and on the frontlines to care for our communities. Together, we'll explore what they do day to day, the steps that got them there, and the whys that continue to draw them back. How in the face of some of the most challenging situations possible, do they manage to keep themselves and the rest of us from falling apart? Far from predictable the paths they've walked are full of twists and surprises, discovery and purpose. This podcast is for anyone who's ever even thought about going into the healthcare field, or has a passion for caring for others in times of need.

In this episode, we meet doctors Mary Gainer and Peter Wentzel, a married couple of family physicians in two northern West Virginia counties. After studying and working in medical centers in both major cities and abroad, Peter and Mary put down roots in West Virginia, where Peter spent summers vacationing with his family back in the 80s.

Peter who grew up in DC works in Taylor County, and Chicago native Mary is based in Preston County. Both of their clinics are classified as federally qualified health centers or FQHCs, designed to provide low-cost medical care in underserved areas. Working as a family doctor in a rural health care setting means seeing patients far and wide for all kinds of problems. In Peter’s office in Grafton that can even mean trimming a patient's toenails. A task that may seem simple enough but can be increasingly hard for older patients with mobility issues to do themselves.

Peter Wentzel

We have the best radio of any doctor's office anywhere. I will fight anyone for that. It's just satellite radio, but we always pick cool stations. Today's the 80s. It's the one we fight about the least. So all right, these are the Kuhls! They are the coolest! And all we're doing today is really trimming toenails, which is a more common problem than you would think. It just gets sometimes tough. And it helps avoid ingrown toenails and toenail injuries and that kind of stuff.

Peter Wentzel (to Patient)

So are you ready to rumble? Let's do this. I'm going to bring your feet up, okay? And you're going to just lie back…

Mrs. Kuhl

It makes me feel good, because some doctors just try to go ahead and doctor you and don't try to get to the root of the problem. And he's doctored things, and then he'll say, Well, I think you need to go see a specialist.

Peter Wentzel

I’ll take you as far as I can.

Mrs. Kuhl

Yeah, even though we didn't want to go, but anyway.

Peter Wentzel (to Patient)

I mean I don’t blame you. Who wants to see doctors? It’s the worst!

Peter Wentzel

I just, I think for me to treat you, I have to know you a little bit. And I think if you're going to open up, you probably want to know a little bit about me also. And I think just like any relationship, you know, and so I think, I think if you're not willing to sort of, I don't know, put yourself out there a little bit, you're probably not going to get great results.

I've been here seventeen years as of yesterday. Seventeen years later, married, three kids later. I think the Kuhls have been my patients for, let's see, I started in 2006, and I think it's been since right about then. Let's see, I see you guys. I see your daughter. I see your grandson. Oh yeah and Holly’s fiancée, right! I forgot about that. Yeah, watch out it’s shrapnel.

Aryana Misaghi

While Peter is seeing patients and serving as the clinic's Medical Director, Mary is also seeing patients at a different location fifteen miles down the road. It's a beautiful rolling and wooded drive off Route 50. Despite having found parallel careers practicing medicine in rural West Virginia, the paths that led each of them to this point couldn’t have been more different.

Mary Gainer (to Patient)

That’s just like a scar from it? Okay, but we'll get this one off. This one's bothering you, right?

Patient (to Mary)

Yeah.

Mary Gainer (to Patient)

So, what I'm going to do is I'm going to make an incision like this, and then I'm going to put a few stitches in there. Okay? And I'm just going to have you sit right here, okay, that's more comfortable.

Patient (to Mary)

Okay. Just don't hurt me.

Mary Gainer (to Patient)

I won't hurt you.

Mary Gainer

I was an engineer in undergrad. I had a distant sort of cousin uncle who did medical missions in Honduras. And my parents had visited them previously and that sounded sort of interesting to me, but you had to pay your own way and I didn't have any money. So the owner of the bar that I worked at, Butch McGuire's in Chicago, gave me $600 bucks to go on this medical mission and Honduras. It sort of sparked in me this idea that maybe being a doctor is a little more universal than being a biomedical engineer.

Mary Gainer (to Patient)

I spray your skin with some cold spray before I put the Lidocaine on. Alright, good. And you just sit right there perfect. What's happening with Don? Is he getting on his tractor?

Patient (to Mary)

He's aggravated that he says he can't do anything that he used to do.

Mary Gainer (to Patient)

Yeah, I know.

Patient (to Mary)

It's really upsetting him.

Mary Gainer (to Patient)

It is? I have a lot of patients who feel that way. Especially my patients who are farmers, and they can't get out and work.

Mary Gainer

My last two years of college, I sort of added in all the classes you have to add in for medical school, and then I went to Peace Corps after college because I really wasn't sure what I wanted to do, but I took the MCATs right before I left just in case and then applied to medical school from Honduras, which was wild because the nearest computer was about a three and a half hour bus ride from the village I lived in. And while I was in Honduras, I was actually a health volunteer, and really sort of saw how useful I could be, and just the opportunities there would be if I was a doctor.

Mary Gainer (to Patient)

So, are your boys taking care of the cattle or is that all Don?

Patient (to Mary)

No. We're doing it.

Mary Gainer (to Patient)

You're doing it? Okay, you okay? Can you feel me?

Patient (to Mary)

Maybe being a little.

Mary Gainer (to Patient)

Like you can feel pressure? You okay?

Patient (to Mary)

I don't know.

Mary Gainer (to Patient)

Good. That's good.

Patient (to Mary)

I'm not looking.

Mary Gainer (to Patient)

Don't look. Don't look. Alright, quick pinch. 1-2-3 pinch. You're doing great. You okay? This is the worst part.

Mary Gainer

When I came back, I got into Loyola Medical School and sort of followed a track of doing family medicine with underserved patients, both in med school and residency.

Mary Gainer (to Patient)

Voila!

Patient (to Mary)

Oh, boy!

Mary Gainer (to Patient)

Okay, I'm going to send this one, you see, I'm going to send it for pathology, just to make sure it's not anything more serious. But then if there's more of them, we might just pop them off. All righty. You're done!

Patient (to Mary)

Thank you.

Mary Gainer (to Patient)

You're welcome.

Patient (to Mary)

You didn't hurt me a bit.

Mary Gainer (to Patient)

Good!

Aryana Misaghi

Quick note, you may hear the family dog, Otis, he really wanted to be part of the interview.

Peter Wentzel

So I was an art major in college. I did visual art. I did metal sculpture. Just kind of for the fun of it, there was a kind of an extracurricular you can do, you can become an emergency medical technician. And I went to school in DC, took the EMT class, and rode as an EMT in DC for a couple of years. But it was great. I really liked it. And I was talking to my advisor and I said, “You know, what, what should I do?” I thought I wanted to go into maybe industrial design. And he said, “You know, Black and Decker has like two industrial designers. And it's just a really hard field to get into.” And he goes, “Why don't you try some of the pre-med classes and see if you, you know, if you have any capacity for it, because it's a lot easier to do art as a doctor than the other way around.” So, I always wanted to be in West Virginia and so I took the rest of my pre-med classes after I graduated from college at WVU, applied to med school, but they had really strict rules about taking out of state students. And both years I got waitlisted, a good friend of mine who was a doctor at Georgetown, she said “Why don't you apply for the St. George's Medical School in the Caribbean?” And I was like, “Oh my God, I'm gonna be like a fake doctor? Like this is…” I was so nervous, but I was also tired of, you know, being waitlisted two years in a row. So I applied and I got in. And you do the first two years down there, and then you do the last two years of med school in the US all of your clinical stuff. So I did that in Brooklyn, New York, did a family medicine rotation and in upstate New York and really liked that and decided, okay, yeah, I want to do rural family medicine.

Aryana Misaghi

Such circuitous paths, and diverse experiences are actually really common amongst healthcare professionals. Most of my life was spent preparing for a career in music. It wasn't until the end of my undergraduate degree that I even considered going into medicine. Having a background in music, it gave me the discipline to spend long periods of time in isolation to learn a skill, which is something you really need to study medicine.

My classmates in medical school were a modge podge of experience. We had a former lawyer, coal miner, materials engineer, accounting, manager, and nurse. Each of these personal histories gave us diverse perspectives to share. And it emphasized to me that everyone is truly on their own timeline. It's never too late to get started on something new.

Okay, before we go further, I have to tell you how Peter and Mary got together in the first place. They've been married for thirteen years and have a meet cute straight out of the movies.

Mary Gainer

We were at a meeting for Physicians for a National Health Care Plan…

Peter Wentzel

Like nerds.

Mary Gainer

…and trying to do sort of health policy stuff and we happened to sit at the same table.

Peter Wentzel

And it was my birthday. And I figured as I was leaving, I thought, “It’s my birthday. If I have any game at all, I should just ask her out.”

Mary Gainer

We went out the night after the meeting, I was hanging out with a bunch of my Peace Corps friends, and he met us out. And then the next day, I told him I would be at mass, I was staying with my aunt and uncle…

Peter Wentzel

I was actually way out on Route 66 already, and I was like, man, I’m turning around and totally pretended like “Oh, I was just in DC getting ready to go.”…

Mary Gainer

…and when I came out of mass…

Peter Wentzel

…which was the same church I grew up going to…

Mary Gainer

…Yeah, Holy Trinity in DC. And when I came out of mass, he was standing there.

Peter Wentzel

So we started dating. And then Mary was originally going to go and work in Latin America, right? And I said, you know, there is an underserved population in West Virginia also. So I convinced her to come here. And that was, what twelve and a half years ago?

Mary Gainer

Thirteen. We just had our thirteenth anniversary.

Peter Wentzel

Okay sorry, so thirteen and a half years ago, doh!

Aryana Misaghi

Appalachian Care Chronicles is made possible thanks to the West Virginia Higher Education Policy Commission, and Claude Worthington Benedum Foundation, serving communities in West Virginia and southwestern Pennsylvania since 1944.

Mary Gainer

He was living in West Virginia, and it was a place I'd never been, I had never really heard much about West Virginia. But I had lived in a really small town in Honduras, and while I was there, I definitely realized that I needed to live in a place that was closer to nature. And so I moved out here after we got married. My mom, when I was leaving after our wedding to come back, just told me, “You know, bloom where you're planted.”

Aryana Misaghi

Mary's residency program in Chicago was heavily focused on women's health and obstetrics and it was geared toward aspiring doctors who hoped to practice humanitarian medical care in programs like Doctors Without Borders. Those skills are valuable in Preston County, where until recently, she was the only provider in her county inserting IUDs for birth control.

Mary Gainer

That's a definite area of need. In like the five surrounding counties where I work because a lot of family doctors actually don't do much gynecology at all. Because they would send people the gynecologist but there are no gynecologist where I work, and I teach some of our mid-levels to do IUDs because long acting reversible contraception is really important for women living in rural areas who don't have access to her the doctor robot and young women who want that security.

Aryana Misaghi

Family doctors fill a special roll, and it's exactly what it sounds like. They're taking care of the whole family, and they end up becoming like family. For Peter that might involve sharing a story about one of his Mary's three kids or taking the time out to ask about their families. Sharing their lives with their patients and building a genuine connection helps establish a bond that makes them trusted confidants and allies.

Mary Gainer

Because I've been there long enough, I've been the one, the only person to say like, “Has anybody hurt you in your life? Like, when you were a kid, when you started to have these migraine headaches? or you dropped out of high school, and you've never really told me why that happened, and you've been in a few abusive marriages, so like, what, who hurt you?” Instead of, you know, being vague about it, I'm pretty direct about it. And it's astonishing how many women have never told anybody how they've been traumatized. And even just to let them get it out, is really therapeutic for them. And even if I'm continued to be the only person they've ever told, they can at least like talk about when they come and see me. And we know that when a secret is a secret, it has way more power over you. But once you can get it out, it has less power over you, that causes a lot of really real physical ailments, those kinds of secrets. So that's been something that's been rewarding and has happened with way more women than you would think.

Aryana Misaghi

As rewarding as it can be, this work can also wear you down, Peter and Mary have a roster of patients for whom poverty is a part of life. And as Mary puts it, they absorb a lot of suffering.

Mary Gainer

I'm able to do that because when I come home, like, things are good, and we get to recreate a lot, and I feel really lucky that we do. I work four days a week, and so three days a week, I can recreate and be outside, so I can handle it.

Peter Wentzel

Preston Taylor has now kind of made that the norm for all the providers. I think everybody realizes that, you know, we have all this other stuff to do in our lives, not just to recharge and that kind of stuff, but literally like stuff to do taking care of our families, you know?

Peter Wentzel (to Otis the family dog)

Otis, come on! There you go!

Peter Wentzel

All day long have to kind of put yourself out there. If you want to do a good job, you have to find a way of connecting with people about things that are sometimes challenging, or just to get them to buy in that, “Hey, you should maybe take this medicine, or you should maybe do this, or maybe you need this surgery,” or whatever it is. And so sometimes by the end of the week, I'm pretty tired from just that experience.

Mary Gainer (to Otis the dog)

Come here Otis!

Peter Wentzel

A lot of times, we also bring our kids along, you know, and it's fun walking in the woods with them. Or they ride their bikes or, or I make them identify trees. Yeah. I think there's the potential to feel very alone as a doctor, you're sort of the keeper of all these secrets, which sort of makes you kind of feel like an outsider sometimes, or it makes you feel set apart. And so having a wife who's a doctor, you know, that doesn't happen. So…

Mary Gainer (to Peter)

…and we're the same kind of doctor.

Peter Wentzel (to Mary)

…and the same kind of doctor, right!

Aryana Misaghi

We all got to de stress somehow and West Virginia offers the best nature options for that. Not only does the beautiful scenery, calm the mind, Vitamin D from the sun and exercise, especially if it's fun, are great medicine for the body and the soul.

Peter Wentzel

If you want to paddle, if you want to hike, if you want to rock climb. It's all here. A friend of mine told me when he went to WVU a while ago, and he said, you know, the brochure that got me is WVU said they have four equal seasons. He's like, “I mean, I didn't care what they taught me at the school. I was in!”

Because I work at an FQHC, or at least because I work at this FQHC, I think there's a lot of autonomy still. You know, when I went into med school, I was like, “Well, what are the things, I want to do something where I felt useful, you know, I think we all want to kind of feel useful.” I also knew I was a guy who kind of wanted a fair amount of autonomy. You know, I didn't want somebody breathing down my neck all the time and this place lets me do that. And so on a personal level, I like the population I love being in West Virginia. To me, it's beautiful. I love being outside. Any chance I get, I like being outside. There not a lot of places that are more breathtaking than this. It's pretty easy to raise a family here which is kind of like, you know, when I'm not doctoring, that’s the other big part of my life and so that's really nice. You know, if you look at medicine, like 100 years ago, or, you know, older, the guys who were, who were doctors, then they were kind of crazy. They were like, “Well, there, we think there are these invisible things that we can't see that are making you sick, they're called bacteria. But we're gonna go for it, we're gonna put our money where our mouth is, and we're gonna go for it.” And they were right! And they were super cool for doing that. They were like kind of punk rock.

Aryana Misaghi

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Peter Wentzel

I have this incredible skill set. I've trained for it. How can I go and really push the envelope to make people's lives better? That's the goal, right? But I think the real coolest way to be a doctor is, you know, to go out and just make medicine awesome. Keep building on that amazing stuff that previous generations of doctors have done. So that's what I would say: go and do that, don't think small, think big, and be a little a little bit crazy.

Aryana Misaghi

Mary and Peter are confident in their clinical skills now. But it wasn't always like that, especially when they first started.

Mary Gainer

Most kids in med school have done the straight through thing. And so you will feel older, and feel like they all know what they're doing because they just took Biochem and you're like Biochem…

Peter Wentzel

And in the summer, they took microbiology and they took extra biochem. You know, I remember showing up to med school and I'd taken the premed requirements. “I hope I can pull this off!” And it was scary! But then when I got to my clinical rotations, where you're just dealing with people, it was so much easier and the time management skills I had from having like to wait tables, or whatever, were you know, you could run circles around these guys were like, “Oh, I don't know, I'm really stressed out. I got like four patients.” I'm like, “Dude, I got 10! It's cool.”

Mary Gainer

Peter and I both come from families where we were taught that we were never better than anybody else. I think my dad especially and your mom, there was never any kind of judgment on people who came from came from a background that was different from ours. I think that was a value that was in my family, and I didn't really even realize it, but it made it really like, it was just so valuable because going to the Peace Corps and, and being with people who were totally different and very poor. But there was never an idea that like, you're better than them. Because the minute that your patient sniffs that you even think that, it's over. The care is going to be terrible. And it happens a lot with my patients who have to go and see specialists and get treated like crap. And then so it doesn't matter what amazing skill these specialists have, if your patients feel like they're being looked down on, they're not going to get better.

Aryana Misaghi

Relatability, humility, and connection are some of the qualities Peter and Mary exemplify. And as family doctors, nothing is too weird or gross to talk about. They've literally seen it all. For Mary and Peter, that kind of experience also amounts to an abundance of tips and tricks that anyone can use in their daily life.

Peter Wentzel

…and if you do need to do some trimming, go cautiously. Go in the grain of the hair, the direction of the hair, use beard trimmer. Make sure that the hair is wet for four minutes before shaving. Do it after you take a shower. And don't use a lot of things like Axe or body sprays. These are generally not enjoyed by the rest of the world.

Mary Gainer

I like Axe. I think it smells good. Too much Axe, yes.

Peter Wentzel

Too much. I just think too much.

Mary Gainer

It's a virus. It's a virus. It's a virus. You don't need an antibiotic.

Peter Wentzel

If your symptoms lasts longer than five to seven days, then you might—might—need an antibiotic, until then, you should not ask for an antibiotic.

Mary Gainer

Use a Neti Pot. Neti Pots work.

Peter Wentzel

Vicks Vapor Rub. Probably the single greatest product ever created. Colds, funguses…

Mary Gainer

Vicks and Vaseline. Vaseline is the best thing for your skin. You don't need anything fancy.

Peter Wentzel

Avoid fad diets. Don't actually diet, just eat healthy kinds of food. That should be your diet, but not a specialized name brand diet like keto or paleo or whole 52 or whatever, clean 90. What does eating clean mean? It doesn't make any sense. No, it's a garbage word.

Mary Gainer

The most important thing is to move your body, and if you can move your body out in nature even better. But that's it. You're beautiful, and your body is probably not going to change from what it looks like right now. So just love it.

Peter Wentzel

The voice in your head. We all got one. I'm not talking about mental illness. Just we all have a little voice in our head. Let that be a nice voice that talks to you. If you would talk with the voice in your head to someone else with that voice, and they would be offended, you should not talk to yourself that way. It's not helping you get better.

Mary Gainer

And if that voice in your head is being mean to you, then maybe try to find a good therapist because they really help.

Aryana Misaghi

Appalachian Care Chronicles is a production of the West Virginia Higher Education Policy Commission Health Sciences Division. Special thanks to the Claude Worthington Benedum Foundation, and to Preston Taylor Community Health Centers. For more information about educational opportunities related to health care in West Virginia, visit appcarepod.com. That's appcarepod.com. I'm Ariana Misaghi and you've been listening to Appalachian Care Chronicles. Next time, we feature Greta Nelson, a lead dental hygienist who travels all over in a mobile unit to make sure West Virginians have access to quality dental care. See you then!