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In January, Rock Medicine recognized Gay as the creator of its mission: Take care of patients now, return them to their friends and family, and do away with the necessity of hospitalizing them or getting them involved with the law.

Ironically, war led Gay to pursue a career in medicine and serve the "make love, not war" believers in Haight-Ashbury. His father was a surgeon in World War II and helped establish mobile Army surgical hospital (MASH) units for the D-Day invasion. Gay began following his father's example by serving four years as a Navy combat airman in Korea.

"The whole concept of honor, loyalty and devotion to country was very strong in my family," Gay recalls. "I decided that if I made it back from Korea, I would dedicate myself to the health care of my country the way my father had."

Gay entered the MU School of Medicine at the late age of 26. Before graduating with honors, he served as class president and one of the first editors and cartoonists for the student yearbook, MUtation. His slightly irreverent caricatures and comics set a style that was copied in many subsequent issues.

Gay's training and early career remained on what many consider a respectable course. He completed a surgery internship at the University of North Carolina in Chapel Hill, a residency in anesthesiology at MU and a fellowship in anesthesiology at Boston Children's Hospital. After a stint in private practice in Springfield, Mo., he became an assistant professor at the University of Chicago.

But the country's attention was focused far away on San Francisco. Hoards of reporters, filmmakers and tourists flocked to Haight-Ashbury to see what Time magazine called the "vibrant epicenter of America's hip-pie movement." Caught up in the excitement and intrigue, Gay opened a private practice in anesthesiology in San Francisco in 1967.

"As I look back, I realize that I had lost several years of my youth because I had to grow up fast in Korea," Gay says. "I think I was trying to make up for some of what I had lost by moving to Haight Ashbury, associating with its young people and trying to help them."

Shortly after the move, Gay made a dramatic transformation. He began spending most of his time volunteering at the Haight-Ashbury Free Medical Clinic that David Smith, MD, an expert on addiction, had just opened. Then, Gay gave up his Corvette, Sausalito apartment and Brooks Brothers suits in exchange for tie-dyed shirts and a pad above a burger joint.

"I became completely enmeshed in treating the drug problems in Haight-Ashbury," Gay says. "In the process, I became part of the scene, one of its people.

"I had found my calling."

Hippie Central

The first patients Gay treated at the free clinic represented a new breed of drug abusers. Mostly middle-class youths, they sincerely believed they could increase self-awareness through some combination of hallucinogens, sex and Eastern mysticism. "They were wall-to-wall on Haight Street," Gay says. "They had no concept about themselves, their health needs or their drug problems."

This naïve approach to drugs quickly turned many laid-back hippies into hard-core junkies. In 1969, Gay watched hundreds of young people march down Haight Street with a coffin to express how heroin was killing them and their culture. "We went from treating a few heroin addicts a week to 100 or so a week in 1969," Gay says. "We were suddenly deluged by an epidemic that was destroying our children."  

MISSOURI MEDICAL REVIEW SPRING 2001  Page 6  

That year, Gay testified before a National Institute of Mental Health panel studying heroin abuse. Wearing a ponytail and peace symbols, he dramatically described his clinical exposure to the drug problem. The institute soon gave him grants to create detoxification, rehabilitation and education programs for patients. Gay built the programs using a unique and comprehensive approach that involved primary medical and dental care, withdrawal-management therapies and psychological counseling.

Despite his alternative appearance or because of it, the medical establishment embraced Gay as one of the few vocal physicians treating drug abuse on the street level. There had never been a concentrated pattern of abuse like that documented in Haight-Ashbury, and at the free clinic, Gay had the ideal clinical laboratory to study the problem.

Gay's investigations also brought an academic element to the study of drug abuse that was missing in the work of radicals like Timothy Leary, who actually advocated drug use. In contrast, Gay proved drug abuse was destructive to young people and their way of life. His many published articles - which carry such titles as "I've Tripped and I Can't Get Down!", "It's So Good, Don't Even Try It Once" and "Love and Haight: The Sensuous Hippie Revisited" - mixed scientific discoveries with insightful descriptions of the drug culture.

As director of the free clinic's training programs, Gay shared what he learned with hundreds of medical students. Throughout his first 10 years at the clinic, Gay served as a clinical instructor for state universities in California, Texas and Hawaii. He would go to classrooms to talk with students, and they would come to the clinic and Rock Medicine concerts to learn alongside Gay and other physicians.  

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There had never been a concentrated pattern of drug abuse like that documented in Haight Ashbury,  and at the free clinic, Gay had the ideal clinical laboratory to study the problem.

"Next to helping my patients, I believe my most important contribution to medicine has been serving as a mentor and preceptor and teaching students about the clinic's philosophy," Gay says.

Charles Sheppard, MD '71, trained with Gay and spent two years of his internship serving as medical director of the free clinic. "I've always been grateful to Skip for giving me the opportunity to be at the forefront of treating and documenting a drug population that had never existed before," says Sheppard, an emergency medicine physician in Springfield. "I learned a great deal about not only medicine but also the political and social issues involved in providing free care for everyone."

“HMO for Deadheads”

Gay's commitment to free, non-judgmental treatment was needed not only in the streets but also at concerts. Youths hypnotized by the lyrics of Janis Joplin and Jimi Hendrix had easy access to drugs at the shows. At the same time, basic medical care was lacking at outdoor venues that attracted record crowds and festivals that went on for days.

In 1973, legendary music promoter Bill Graham asked the free clinic to start providing medical care at outdoor Led Zeppelin and Grateful Dead concerts. Gay, who already had been informally providing care at shows, responded by helping to create Rock Medicine. A self-described Deadhead, or Grateful Dead fan, he calls the program an "HMO for Deadheads."

"Rock Medicine was created to provide free care for the fans as well as the artists," Gay says. "The whole idea is to get them back home safely and to make their experience one that is not dreadful because of a police record or worse, like having a deadly accident on the way home."

At concerts covered by Rock Medicine, Gay and other emergency medicine physicians, nurses, technicians and CPR-certified volunteers man MASH-style units. Based in tents, they're armed with everything from lifesaving equipment to Band-Aids. The tents also house a pharmacy and a talk-down room for fans who can't handle being high.

"One problem is when people are in an altered state of consciousness, they are afraid of being arrested," says Raswyck, who succeeded Gay as director of Rock Medicine. "When we tell them we're with Rock Medicine, people are very open with us because Skip helped us earn a reputation for confidentiality."

With Gay at the helm, Rock Medicine evolved from about a dozen volunteers at a handful of concerts to more than 400 volunteers at more than 250 events a year. During the past 26 years, he's trained students at concerts through Rock Medicine and as director of the Bill Graham Memorial Fellowship in Emergency Medicine for Events and Festivals.

These accomplishments have earned Gay his own fan following. "Now when I go to shows, I'm constantly followed around by young volunteers," he says. "Rock Medicine is special because it provides an arena where the highest professional skills are brought together in an atmosphere of friendship and fun."  

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Another reason Rock Medicine has so many volunteers is because they want to get close to performers, and Gay knew many of the greatest performers of his day - Garcia, Joplin, the Rolling Stones. "I was a fan and a friend of many of the early rock artists, but I've always felt strongly that Rock Medicine is about medicine first and foremost, not music," he says. "In fact, I'm not overly fond of the music at many of the concerts I've worked at during my later years."

Rock Medicine has expanded from its days of treating trippin' hippies at Grateful Dead concerts to covering a wide range of musical performances. For that reason, volunteers are trained to respond to a variety of problems. For example, country music lovers tend to swizzle booze and fistfight, while fans of punk rock get hurt slamming into each other in mosh pits.
 

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Gay, a founder and former director of Rock Medicine, sutures a wound during a concertin 1982. Rock Medicine helped 128 fans during the show.

Rock Medicine crews usually walk casually among fans and use trained eyes to spot those who need help, but at concerts where fans tend to be violent, crews frequently let police officers bring patients to them. "We always work closely with the 
officers," Gay says. "We'll subdue the speed freaks or acid heads who otherwise would tie them up for hours with arrests and paperwork."

Outside Haight-Ashbury

Gay hasn't spent his entire career with the free clinic and Rock Medicine. He has maintained a private practice or held hospital positions in anesthesiology, emergency medicine and family medicine over the years to support his volunteer work. Last year, he began practicing family medicine at RCMS Community Healthcare in Gualala, Calif.

For the previous 10 years, Gay worked as a physician for the California Department of Corrections. As chief medical officer of a large correctional center, he created a program that provided emergency care for inmates who battled floods and fires in the state. Gay put himself in these dangerous environments so he could immediately treat injuries such as smoke inhalation, broken bones and chainsaw wounds.

"My instincts have always been like Alan Alda's on M*A*S*H," says Gay, a charter member of the American College of Emergency Physicians. "I work best in the zone -when the going gets tough, time slows down, sounds fade away and every movement becomes purposeful."

Although 28 percent of California's inmates are incarcerated for drug crimes, Gay never participated in prison drug-treatment programs.
 

Prison programs fail dismally because they are imposed on inmates," he says. "It's the opposite of the philosophy at the Haight-Ashbury Free Medical Clinic, where treatment is always available but never imposed. An addict has to want to kick the habit for treatment to work."

Unlike some drug treatment programs, the clinic defines addiction as a disease that is preventable, treatable and - most important - curable. "We are turning people with this disease into criminals by locking them in prisons, where they are victimized by real criminals," Gay says. "We must focus our resources on treatment, education and prevention. We need to dig deep to find the psychosocial and medical resources to help these people. We can't just sweep the problem under the prison rug and pretend it doesn't exist."

Nevertheless, Gay is pleased with the gains he made in Haight Ashbury. The clinic, which treats more than 14,000 patients a year, helped spark America's free-clinic movement. The detoxification unit Gay created is the largest and most successful outpatient detoxification center in the Bay area, and the drug abuse and Rock Medicine programs Gay founded have served as models for programs across the country.

In addition, Gay has formed many friendships at the clinic during the past 34 years. He even met his wife through Rock Medicine while they were volunteering at a Blue Oyster Cult concert 20 years ago. His son Dan, who used to carry supplies to Rock Medicine concerts, will complete a fellowship in nuclear medicine at MU this year.

"What a long, strange trip it's been," says Gay, incidentally quoting a Grateful Dead song from the '70s as he reminisces about his career. "It's been so personally enriching and so much fun along the way that I wouldn't change a moment of it. I just wish I could do it all over again."  

MISSOURI MEDICAL REVIEW SPRING 2001

For University of Missouri-Columbina School of Medicine alumni  Spring 2001
Volume 20 Number 2 Spring 2001

Missouri Medical Review is published four times a year for alumni and friends of the university of Missouri-Columbia School of Medicine. http://www.muhealth.org/~alumni/    

Want another story about Skip and Rock Medicine Free clinic's 'Rock Medicine' crew handles crises at concerts  Oakland Tribune - Sunday, October 25, 1981  by George Estrada, Tribune Staff Writer