Dr. Pedro Jose Greer stands in a cool, dim operating room at Miami's Mercy Hospital, looking at a glowing image of a patient's digestive system on a flat-screen TV.
Greer is a gastroenterologist, and the patient lying on the treatment table has a potentially dangerous cauliflower-like growth on the lining of her colon. The patient's name is Nora Turcios, a 45-year-old woman with a family history of cancer.
"That's a polyp right there," Greer says, more to himself than any of the three nurses in the room. During the 15-minute-long colonoscopy, he snips off part of the mass for a cancer biopsy and then reviews Turcios' paperwork.
Turcios, a housekeeper, doesn't have health insurance. Not important, shrugs Greer.
Greer, known to his patients as "Doctor Joe," tells them all: If they lose their insurance while under his care, that's OK — he'll continue to treat them, regardless of how much, or little, they can pay.
"When did it become acceptable in my profession," says the 53-year-old physician, "to say 'No' to somebody because they have no money?"
It's that attitude that led to Greer's recent honor: the 2009 Presidential Medal of Freedom. He was given the award in August because he cares for the poor with dignity. In 1984, Greer founded the Camillus Health Concern, a Miami clinic providing medical care to more than 10,000 homeless and low-income patients annually. He also founded the St. John Bosco clinic, which treats low-income and immigrant patients in Miami's Little Havana neighborhood. His latest effort is academic: Greer is now the assistant dean of academic affairs at Florida International University's new medical school, where he stresses the need for ethics in medicine.
As one would expect, Greer has strong thoughts on revamping the nation's health care system.
"Maybe," he says, "if we took care of everybody, we wouldn't need reform."
"You fight for what you need to do," he says. "The poor happen to be our sickest. They deserve our undivided attention."
A call to serve the poor
Greer was born in Miami by accident.
In 1956, his mother came to Miami to visit relatives. She was 6 months pregnant. She had what she thought were contractions and went to Jackson Memorial, the city's biggest hospital. The emergency room doctor didn't believe that the young Cuban woman was about to give birth.
"HLF," the doctor said, according to Greer family lore. "Hysterical Latin female."
Greer was born three hours later on a gurney in the emergency room. A few weeks later, when he was strong enough, he and his mother returned to Cuba. But not for long: When Fidel Castro took over the country in 1959, the Greer family fled, eventually settling in Florida.
Greer was raised in upper-middle class Cuban Miami: private Roman Catholic school student, varsity football player, weekends spent boating in the blue South Florida waters.
He attended the University of Florida and was intent on being a lawyer. Maybe a politician. He didn't want to be a doctor, like his father.
"I was going to change the world," he said.
When, after graduating in 1978, changing course and announcing he'd pursue medicine after all, his father was proud and as surprised as anyone. "This had not even been a dream of mine," he said.
His son earned his medical degree at a Catholic university in the Dominican Republic and returned to Miami. His plan was to leave soon, to travel through the Caribbean and Latin America to treat the Third World's poor.
But Greer would soon discover that he didn't have to go far to find those patients.
pagebreakTreating the homelesstrue
Treating the homeless
Jackson Memorial Hospital, 1984: Greer was 28 and an intern in the hospital where he was born.
One day, firefighters brought a patient they had picked up on the street into the ER. The man had tuberculosis. Greer was shocked. "Tuberculosis? In this day and age?"
A little investigating revealed that the patient had no name, family or home; he died in the hospital, anonymous. Greer tried to find out more about the patient by visiting a local homeless shelter. With the encouragement of a Catholic brother who ran the clinic, Greer began volunteering, treating patients two nights a week.
"In America it seemed as if we didn't care if you suffered, but if you were about to die, we'd scramble to save you at (the hospital) — and then send you back to suffer, to the streets," Greer wrote in a book he published in 1999, titled, "Waking Up In America."
Soon after, he walked into the office of Alina Perez-Stable, a Jackson Hospital social worker.
"I want to do something about the homeless," he said.
Said Perez-Stable: "He exuded a genuineness, a passion. He identified a problem and he was going to try to solve it."
Greer and Perez-Stable founded the Camillus Health Concern, the first South Florida clinic to treat only homeless people.
Greer said he swiped supplies from the hospital during the day so he could bring them to the clinic at night, figuring he'd just take care of the patients eventually in the ER anyway.
"That's how I justified it," he wrote. "And then I said two Hail Marys and an Our Father."
Greer soon realized that he was only seeing a fraction of Miami's street people in the shelter, so he eventually went to where they lived: the Mudflats.
Greer, who is tall and burly, wasn't scared by the nickname of the place under an Interstate-95 overpass — but what he saw there frightened his soul.
Some 6,000 homeless people lived on the streets of Miami in those days, and hundreds endured in the Mudflats. Folks had given the encampment its nickname because of how the brown earth would turn to slop in Miami's tropical rains. Zombie-like people sprawled on stained mattresses, cooked on small wood-fueled fires and constructed makeshift walls for privacy with scavenged wood. Malnutrition, gangrene and lung and liver disorders were common.
Greer, with a mix of compassion and wisecracks, got to know the homeless and their problems. Sometimes, diagnosis and treatment were easy: for example, wearing socks to ward off foot infections. Sometimes, they weren't.
Those were dark days in the city's history: It was the era of the cocaine cowboys, 600-plus murders a year and long before the area was considered a tourist playground.
"As a society, we have ignored urban poverty for more than 30 years," Greer told the Sun-Sentinel newspaper in 1991. "No matter how much work you do, the problem doesn't go away."
In the single-room clinic's first year, Greer saw 500 patients. Nearly 10 years later, the clinic — which was the first of its kind in the U.S. — had 30,000 visits from patients, nearly all of them homeless.
Today there are about the same number of homeless people as then, but, thanks to Greer, they at least have a larger health clinic.
Outrage over insurance companies
Over the decade after the clinic opened, Greer was a whirlwind of action and accomplishment, leading him to joke that he has "untreated ADD" or attention deficit disorder.
He launched Saint John Bosco Clinic for low-income immigrants and Spanish speakers in Miami's Little Havana neighborhood. In private practice with his father, also a gastroenterologist, he saw low-income and insured patients.
He collaborated with Cuban-American actor (and friend) Andy Garcia on an HBO film based on Greer's life, which hasn't yet aired.
And he won a MacArthur Foundation "genius grant" for $240,000
Working with the Clinton administration on health care was another task, though he says it didn't go well.
He declined a spot on the health care reform team because it would mean a move to Washington for him, his wife and their two children, but he agreed to serve on a Presidential Health Professional Review Group that was charged with studying policy.
"I gradually realized my presence there would have no impact," Greer later wrote. "Too often the most critical facts never made it to the discussion table because the seats around the table were taken up by influence and money."
Dismayed that "the cards were stacked in favor of the HMOs and the for-profits," he quit. And the experience has kept him from aiding the Obama administration during the current health reform debate.
"I stay out of politics," he says flatly.
Even today, even after receiving the Medal of Freedom from the president in August, Greer doesn't mince words when talking about insurance companies and the impact they have had on U.S. health care.
"I do get outraged," he says. "Is it acceptable when an insurance company refuses someone for a pre-existing condition? Where in hell is that acceptable? Hell is going to be filled with insurance people. I hope they enjoy all the money they're making."
These days, Greer is focused on training doctors at Florida International — he recently took a young group of soon-to-be doctors on a tour of Miami's poorest neighborhoods — and seeing patients in his private practice.
He still cracks bad jokes in-between colonoscopies, like, "We're No. 1 in No. 2."
And he still makes midnight runs to see dying patients — "you try to listen, you try to console, you try to help alleviate suffering."
There's always someone who needs help. On a recent day at Mercy Hospital in Miami, he prepared for an upper GI endoscopy — a look at a patient's esophogus and stomach.
He walked into the operating room. It was dim so he could see the images of the patient's insides. Soft rock played on a radio in the corner, and Greer stood over the patient, who was having trouble swallowing. She was nervous. Greer put his hand on her cheek.
"Just breathe deeply," he said. "It's going to be OK."