After the HMO experience, Bolte longed to open a practice that was relatively free from the influence of insurance and pharmaceutical companies. Today he literally runs his own office. No secretaries. No partners. No insurance forms. (Many patients submit his invoice to their insurance companies for reimbursement.) If you call the number listed on his Web site, it rings his cell phone. “Doctor’s office,” he says. “What’s the problem you’re having?” Then, if you agree to his terms—no insurance, $125 for a 25-minute urgent care visit, $290 for a major 60-minute consult, he’ll enter your appointment into his Palm Treo. When you arrive at the office a few blocks south of Bloomingdale’s, he answers the door himself, unless he’s with a patient. It’s like this all day, all week. When it comes time to pay, he runs your debit or credit card through the machine under his desk, prints out an invoice, and asks, “Want me to staple that?”
Although unusual investigations are his specialty, urgent care cases help pay the rent. Hotel concierges near his office know to call him if an out-of-town guest takes sick. He’s the official on-call doctor for MTV Networks, and if someone there calls, he skates over to the studios on his Rollerblades with a knapsack of medical supplies strapped to his back. A number of celebrities—an Oscar-winning actress, the widow of a famous rock star—regard him as their official New York physician. But you don’t have to be famous to get him to your bedside. He’s one of the last Manhattan physicians who makes house calls. He unhesitatingly gives his number to every patient who visits, even if he knows it could later wreak havoc with his social life, dinners out with his fiancée, or an ongoing home renovation project back on the Island. “Please,” he reminded a recent flu patient who was leaving, “I’m completely at your disposal. If you get worse or it doesn’t clear up, call me at 3 a.m. I don’t care.”
He goes to such lengths to stress this because so many patients have been trained by the medical industry to behave deferentially, as if their doctors are always too busy to bother with them. Yet some of his most fascinating cases were solved precisely because he gave patients the time that their primary care physician could not.
“The first time I met him I thought he was a quack,” says Dustin Palmer, a 29-year-old sales representative. “I hate saying that because I feel I owe my life to him.” Palmer’s teens had been hell, punctuated by crippling abdominal pain and alternating bouts of diarrhea and vomiting. Doctors diagnosed him with irritable bowel syndrome. (“A lazy diagnosis,” quips Bolte.) Palmer lost so many days of school that it took him five years to graduate from college. By then, he had lost his faith in doctors and was depressed. “I couldn’t see any future for myself,” he recalls. Dragged to Bolte’s office by his mother, Palmer—then a kid with unkempt dreadlocks—rocked back in his chair and uttered profanities at Bolte, who just chuckled.
“Whaddaya laughing at?” Palmer demanded.
“I’m laughing because I know I’m going to get you well,” said Bolte.
Oh, the kid thought, you met me an hour ago and you know what’s wrong with me? Sure you do, buddy.
Bolte’s rambling interrogatory style threw the kid off. “I think he’s a genius,” says Palmer, “but kind of like an idiot savant. He sits there and he’s nonchalant, but he’s got a lot more knowledge up there than I first expected. You would not expect it.” For Bolte, the key was hearing specifically what foods Palmer had eaten prior to his attacks. Over time Bolte demonstrated that the young man was suffering from celiac disease, a genetic disorder that meant he could not digest gluten, a protein found in most grains and commercial food products. As many as 2 million Americans have the disease, which attacks the intestines, but doctors routinely misdiagnose it. Over the course of several visits, Bolte studied Palmer’s food diaries and helped him nail down which foods were most likely to trigger the painful autoimmune response.
Another patient, an art gallery owner, arrived one day complaining of chronic headaches that he’d had for 40 years. His primary care physician had him on six different medications, some prescribed for migraines, others for depression, and still others for the side effects from the migraine meds. The suffering was so severe that the patient took to bed for days at a time, tracking his headaches on a calendar, hoping to divine a pattern to the pain. Some days the meds worked, some days they didn’t. But no pattern emerged. Every doctor he saw seemed to be grasping at straws: One prescribed an antifungal medication; another, allergy shots. Bizarrely, Bolte seized upon a single symptom: The man casually mentioned an intolerance to egg yolks. If true, this seemingly innocuous point could narrow his problem down to only one or two possible diagnoses, one of them being heavy metal poisoning. Sifting through the file, Bolte found a hair analysis that the desperate patient had commissioned at an alternative pharmacy: The results showed elevated levels of mercury. Yes, the patient said, he had shared that result with his original doctor, who pooh-poohed the test and told him that if he was concerned about it, he might want to reduce his fish intake. Bolte ordered a DMSA challenge test, in which a drug is taken orally that extracts heavy metals—if they exist—from tissues and excretes them in urine. The urinalysis revealed extremely high levels of mercury. The man responded well to medication and a new diet that flushed much of the dangerous toxin out of his body. Two years later, he celebrated his first headache-free month.
Another time, a woman presented with headaches, fatigue, hives, rash, and countless chemical sensitivities. After a lifetime of fine health, she broke out with the most annoying physical symptoms from using soaps, shampoos, and cleansers.
After a blood workup revealed the presence of hexane, a petroleum derivative known to cause nerve damage, Bolte asked her about her living conditions. What, he asked, makes your home different from other people’s? She boasted that she had a fine new home. After living in a one-bedroom apartment for years, she bought and renovated the apartment next door after the birth of her first child. Now she had a roomy three-bedroom apartment, the kind of place New Yorkers would kill for.
What happened to the extra kitchen? Bolte asked her.
Now it’s my master bedroom, she replied.
You have a gas stove, right? Where did the old stove in the old kitchen sit, exactly? Can you tell me? Do you remember?
The patient’s eyes widened. My bed is right up against the spot, she said.
A few days later, at Bolte’s insistence, the woman had the gas company inspect her apartment. They located and corrected a leak in the woman’s bedroom, not far from her headboard. The patient bought and installed a small sauna unit, which she used to sweat out the toxin. Her symptoms resolved in six months.
Ethel Moore’s was the grandmother of all these cases. When the chemical analysis came back from the lab, Bolte was stunned. He picked up the phone. He told Moore that her blood test had uncovered high levels of two toxic chemicals—2-methylpentane and 3-methylpentane—both derived from petroleum products.
Could there be something in her environment that was exposing her to abnormally high levels of petroleum products? Moore said she didn’t know how that was possible. She’d already had the local board of health to her home to test her tap water and check for natural gas leaks.
He pressed on. Okay, so we’re looking for something outside the house. Have other neighbors been ill? She knew that one man who lived behind her had kidney cancer; that was all. Did she or anyone in her family work in a gas station? Was there a gas station near her home? She said no; she lived in a very nice trailer park in upstate New York, not far from I-87, the New York State Thruway. There was nothing on the site but homes just like hers, all arranged in a subdivision with Hawaiian-sounding names.
In all his years of working on houses, the doctor had never visited a trailer park. He asked Moore to describe what they looked like. How were the homes constructed? In the industry, he learned later, the correct term is “manufactured home.” The structure is built off-site and designed to fit on a trailer bed towed by a big-rig truck. Once at the site, the home is craned off the flatbed and placed onto concrete piers or cinder blocks, or permanently mounted to a custom-built foundation.
Which does your home have? Bolte asked. A foundation? Or does it sit right above the ground?
Above the ground, came Moore’s answer.
Do you know what was on the site previously?
She didn’t. But she promised to look into it and get back to him. He hung up reluctantly, half wondering if he should drive up north to help her, have a look around, and maybe photograph the site for his files. If she had lived there a long time in the presence of contaminated soil, her senses may have become inured to a faint petroleum smell that he would notice immediately.
When she was younger, perhaps, her immune system had been able to fend off the daily onslaught of toxins. But as she got older, they had gained the upper hand. If she spent time outdoors working, living, or gardening, she would have inhaled toxic fumes and consumed particles as part of her daily routine—and at night as she slept.
A few weeks later, Moore called with news. At her urging, the local board of health had pulled the real estate records and discovered she and some of her neighbors were living on the site of a former industrial train depot used by Standard Oil in the late 19th century. An independent lab tested the soil for petrochemicals.
Shortly after, the owners of the property voluntarily offered to excavate, remove, and replace the soil under the homes of Moore and some of her neighbors. Moore’s lesions had begun to disappear. By January 2000, the levels of toxins in her body had dropped to almost nothing, and she was living a normal life once again.
The doctor wishes he knew more about her, but she dropped out of sight sometime after their last meeting in August 2003. Beyond that, the case file is silent on the Adventure of the Petroleum-Poisoned Senior. He thinks he may have a Christmas card from her somewhere in his files. “That’s the problem with my practice,” he says. “They get well and I never hear from them again.”