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Our Neighbors...Dr. Ricard Puumala

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The Puumala doctoring dynasty in Cloquet all started with a note on a bulletin board in Chicago.

“My father saw a note on a board at the University of Illinois asking if a Finnish-speaking doctor could come to Cloquet,” explained Dr. Ricard Puumala (PUU ma la), who is retiring as a family care physician at the Raiter Clinic at the age of 78. “They (Ricard’s mother was also a medical doctor) had recently started a family and were a little short on cash, so he decided to come work here for a couple of years and then go back to Chicago to get his PhD in anatomy.”

Ricard Puumala was 18 months old when he moved here with his parents and he’s been here (except for school) ever since.

They were welcomed with open arms by the Finnish-speaking members of the local population, if not the Raiter brothers, who had a virtual monopoly on medical care in town, Ricard said.

But the Raiters didn’t speak Finnish. Ricard’s dad did. Raised in Red Lodge, Mont., the elder Puumala didn’t even learn to speak English until he was 8 years old, Ricard said.

“He lived in a community where they spoke primarily Finnish,” Ricard said. “Just like Cloquet and Esko.”

Ricard said he pretty much grew up planning to be a doctor, just like his parents, who had opened the Puumala Clinic.

“One time my dad did say, ‘We hope we aren’t influencing you too much,’” Ricard said, noting that the influence was pervasive, if not intentional. “We’d be eating liver for supper and they’d be talking about someone with liver disease.”

Ricard graduated from Cloquet High School in 1952, and attended the University of Minnesota for both undergraduate studies and medical school. He met his wife, then Barbara Meyer, at medical school.

Like his parents, he and his doctor wife moved to Cloquet after medical school. Unlike his parents, they had a clinic bearing their last name waiting for them here.

Both Ricard and Barbara worked at the clinic with his parents for a time, until the demands of being a family practice doctor started to conflict with the demands of raising four children.

“A gal would come in in the middle of the night and, at the drop of a hat, she had to deliver babies,” Ricard said, explaining that Barbara quit the family practice and worked as a doctor at the state hospital clinic in Moose Lake  for close to 25 years, where the hours were more regular and she could more easily balance the demands of work and home.

Between them, Ricard and Barbara Puumala raised four children: Victoria, Michael, Matt and Laura. Two of them — Victoria and Michael — are medical doctors like their parents and grandparents. Laura is a Lutheran minister and Matt works in information technology (IT).

As for Ricard, he stayed with family practice and then added a second job in 1970, working as the Carlton County Coroner.

He had the background for it, having worked as a “deaner,” or assistant, in the pathology department at St. Luke’s Hospital in Duluth.

“That’s where you learn your anatomy. Also your gross pathology,” he said, explaining that gross didn’t mean yuck, just the opposite of microscopic. “Of course, you also look through a microscope, but for the most part, you pretty much have an idea [from observing gross pathology and anatomy] and the microscope confirms that.”

Since then, Ricard has worked both jobs. And, while he is retiring from family practice, he is not retiring as coroner. In fact, he had done two autopsies in the 12 hours preceding last Friday morning’s interview.

While he enjoys the interaction with patients in his day-to-day practice, Ricard said he also likes being coroner,  for very different reasons (obviously).

“It’s not pleasant — you’re dealing with people’s emotions and they don’t like what you’re telling them sometimes, they don’t want to hear bad news,” he said. “On the other hand, it is intellectually satisfying, because it’s like figuring out a puzzle.”

He plans to continue as coroner at least until this term ends at the end of 2014, the doctor said.

The tools used in both his jobs have certainly changed over the years, but the real core of the work hasn’t, Ricard said.

“They don’t really teach anatomy much anymore — they have all the fancy machines that do the thinking for you,” he said. “But it’s the hands-on physical [exam] and history taking, those are the things that you’ve really got to rely on, not offer someone a CT scan if they’ve got a headache.”

He talks about becoming a doctor “at the start of the industrialization of medicine” for which he credits insurance companies, which he says want everything in black and white, preferably reduced to a single code that fits their accounting purposes.

He’s memorized a few of those codes, the ones he finds most important.

Code ICD.9, for example, which means “pain in the [butt]” comes in handy sometimes, he said. So does 310.1, which stands for “idiot.”

“Has all this coding made the practice of medicine any better? No,” he said. “What it does do is make a lot of work for financial people.

“What I enjoy is talking to people and problem solving.”

Oh, to have been a fly on the wall of his office, which is lined with nature photos he’s taken over the years, a fish carving by former hockey coach Bill Kennedy, along with various awards received — Minnesota Family Physician of the Year 1996 and the Elizabeth C. Bagley Merit Award from the Lake Superior Medical Society among them — and a needlepoint picture from the Finnish Kalavala.

The good doctor has plenty of stories to tell, which he does with his characteristic mix of a gentle manner combined with shock value.

“There was one night I delivered five babies,” he said, estimating that he delivered hundreds of babies over the past 53 years of practice. “It was that night, a lady came in and the baby was already there.”

Where? is the obvious question.

“In her panties,” he said. “So the emergency room nurse extricated the youngster from the extra clothing.”

He asked the new mother where she had actually delivered the baby.

“‘Around Atkinson,’ she told me, adding, ‘I didn’t dare tell my husband or he would have driven off the road,’” he related. “Both she and the baby were fine.”

Puumala Clinic survived until 2005, undone in the end by the demands of “unfunded federal mandates,” Ricard said. (Not to mention the decline of native Finnish speakers in the area.)

“You couldn’t do a white blood count by hand, you had to buy an $18,000 machine to do counts, then you had to buy the chemicals to run the machine. It just wasn’t economically feasible for a small clinic,” he said. “That’s why there are so few clinics now.”

The move to Raiter was a good one though. The people are congenial, he said.

“There are good docs in this town,” he said. “Every one of them has a different personality, but they practice good medicine.”

Now, Ricard Puumala’s patients at Raiter Clinic must find a new doctor.

“I have a tendency to shove them off to my darling daughter,” Ricard said. (Puumala’s daughter is Dr. Victoria Heren.)

Any regrets?

“It all depends on the time of day,” Ricard said, who said it was simply time to retire when asked. “But I can’t think of doing anything else. I think I’ve done a fairly decent job.”