by Joanne Williams
It takes 40 minutes to travel from Mill Valley to Sausalito by battery-operated wheelchair. Last September, Grace Dammann piloted her power chair on the bike path and took the ferry to the city for lunch. It was her first such foray, but she’s planning more independent ventures. This is her story since an accident in 2008 confined her body but not her mind.
Dr. Grace Dammann maneuvers her wheelchair next to the man seated across the room, takes both hands and gently massages his knuckles and joints. He smiles; his shoulders retreat from his ears. “I think you should get more exercise,” she says. “Do you swim in the pool? I know I need more exercise. I got this shiner under my right eye when I tried a new exercise and fell off the treadmill,” Dammann says. He chuckles at the attention as she continues to ask him how he’s doing.
Grace Dammann, MD, a 68-year-old, pixie-sized physician with short dark hair laced with silver, is director, founder (in 2006) and a team member of the first San Francisco in-patient unit for patients with chronic pain, located in a skilled nursing facility at San Francisco’s Laguna Honda Hospital and Rehabilitation Center. Dammann landed there after the near-death head-on collision on the Golden Gate Bridge in 2008 that put her in a wheelchair for life and resulted in a lawsuit against the Bridge District and the eventual installation of a moveable median barrier last year.
Every Thursday in a bright airy room in the new wing of the hospital at the foot of Twin Peaks, she and eight other professionals—acupuncturists, massage therapists, occupational therapists, advanced care nurses, substance abuse workers, pharmacists, physicians and a psychiatrist—attend to disabled residents, one at a time, to tame their pain.
The pain clinic’s mandate of compassionate care is clearing away the underbrush of confusion when it comes to pain management—trying alternative techniques besides medication. Clinic team member Dan Rybold, M.D., an acupuncturist and family practice physician, believes pain is blocked energy. “By releasing blockage the energy can flow again,” he says. The pain clinic uses various techniques, from foot and neck massage, talk therapy and meditation to yoga, Qigong, acupuncture and a vibration acupuncture called acutonics, a method using tuning forks that vibrate and are believed to release blocked energy. Medication, including medical marijuana, can be part of the recommendation, particularly with AIDS patients.
The morning begins at 9am with a staff meeting to discuss patient progress and a new patient, who requires a translator. “There is a family member who wants to direct treatment,” Dr. Dan says. (It’s hard to use their formal title in this relaxed setting). “The patient has multiple system failure. How do we handle this?” The ensuing conversation is off-limits to this reporter. Before the team breaks—they will see 30 patients today—they take time for 10 minutes of meditation together.
At around 10 o’clock, patients arrive, some walking, some in wheelchairs, one lively woman in bed who likes to chat about anything. Dr. Rybold speaks in Spanish to a man from Vera Cruz with a colostomy bag hanging from his waist and places acupuncture needles in his ear and on the top of his head. He makes no sound and accepts the needles while he and Dan converse in Spanish like old friends. “How are you feeling today?” Dan asks. “Where are you hurting?”
On the other side of the room, Alice Wong, an activity specialist, wields the acutonic tuning forks, different colors for various vibrations, smacking them against a small disc strapped to her thigh with the verve of a Taiko drummer, and as the wood and metal forks begin to vibrate she passes them over the painful areas on the patient. “It helps with diabetic pain, arthritis, AIDS inflammation and similar discomfort,” she says. (Alice and Dan met at the pain clinic and were married by Grace at the Zen Center at Green Gulch Farm in Marin.)
Pain is the fifth vital sign, after pulse-rate, respiration, body temperature and blood pressure, and physicians are beginning to pay more attention to it. The pain clinic at Laguna Honda has developed various alternative methods of treatment that have been noticed nationally. “They try to use alternative treatments long enough on a patient to see what works for each patient,” Dammann says. Among them: Mid-morning, the clinic lights are dimmed and the team and the entire group of patients close their eyes for a 10-minute meditation.
If these procedures seem too far out they appear to work. “My own experience after the near-fatal accident on the Golden Gate Bridge that resulted in 15 surgeries and 58 units of blood led me to research pain and palliative care. I was bored being a patient myself,” Dammann says. “When I was cleared to work again and I was offered the pain clinic at Laguna Honda I didn’t want to do it, but as I thought about it, physicians need pain education, and who better to teach it than a disabled physician. I believe in patient-centered care. Pain is under-treated and the medical community realized it needed to be addressed. It is very complicated and has very little to do with physical symptoms but everything to do with how a person experiences it.”
Grace Meigs Dammann grew up in a small town near Winnetka, Illinois, from a long line of physicians—she’s seventh in the chronology, and the oldest of four siblings. Her grandmother was a pediatric physician, a contemporary of Jane Addams who started Hull House, the first Settlement House in Chicago that started the social welfare movement. Grace received her B.A. from Smith College, went on to Yale Divinity School where she graduated as an agnostic but was impressed with the idea of belief.
From there Dammann moved to Wisconsin, where she received her MSW, gravitated further west and asked for guidance from her then deceased grandmother, who advised her in a dream to go to medical school. Dammann enrolled at Mills College for pre-med, and then “all the doors opened,” she says. At 35 she continued her studies, received her M.D. from UCSF in 1986 and in 1990 established the first AIDS inpatient unit in a skilled nursing facility at Laguna Honda.
Before the horrific head-on collision that put her in a wheelchair for life, Dammann had lived for 27 years at the Zen Center at Green Gulch Farm above Muir Beach in Marin with her partner, Nancy “Fu,” Schroeder and their adopted daughter Sabrina. She also maintained an AIDS and family practice in Mill Valley and was directing the first AIDS clinic for poor people at Laguna Honda Hospital.
Both Sabrina and their beloved dog, Mack, survived the accident (Fu was not in the car), but Dammann had so many internal injuries and broken bones she was not expected to survive. But after nearly two months in a coma she woke up. “I was glad to be alive,” she says, even with multiple injuries. Colleagues at Laguna
Honda gave up a year of sick days to maintain her salary during rehab. Her arduous rehabilitation is captured in the 2014 documentary States of Grace by her longtime friends, filmmakers Helen S. Cohen and Mark Lipman.
In 2010 Dammann left the hospital and resumed life at Green Gulch, where she had worked in the garden and in the kitchen while maintaining her public health jobs. It was not an easy adjustment. Fu made a five-year commitment to take care of her partner, yet they had always had differences. “I am an extrovert and Fu is an introvert,” Dammann says. “Being a 24/7 caregiver is an impossible job. Fu wanted a more monastic life, and I wanted to go back to work. I gotta get a job, I told Fu. It was a bad joke. Also I wanted to be ordained as a Buddhist priest. I had missed a year and a half of Sabrina’s life as a teenager. I had arm and leg surgery, foot surgery. When I first woke up I was glad to be alive. Then I became frustrated by my limitations. I wanted to dance, to surf.”
The offer in 2011 to create a pain clinic turned out to be a gift. “I hired Dan Rybold and we quickly pulled a team together who wanted to work with us on this alternative approach to pain management,” she says.
Last month, Dammann was invited by Harvard University Medical School to teach compassionate care to third-year medical students. She also taught the medical staff at Brown University, in both instances using her case history in States of Grace, which has become a valuable teaching tool. The National Institutes of Health and other hospitals nationwide are now studying pain management and compassionate care. Dammann herself is now off of pain medications because she believes in her case that they intensify pain if one becomes dependent on them and then tries to stop.
Today, Dammann has a unique vision of her task. “The role of the healer is to help make patients happier,” she says. “I tell my staff if you are depressed don’t come to the office. I learned from being a patient the importance of relationship-centered care, of compassionate care. To me this is not work.”
During the six-year period that marked the AIDS disease’s deadliest era, Dammann signed more than 1,000 death certificates. The Dalai Lama honored her work with an Unsung Heroes of Compassion Award in 2005.
Perhaps Dammann’s capacity for pain is due to her Buddhist philosophy and her ambition to become ordained. Her left hand is still crippled from the accident, and she struggles to use it, but she managed to finish 15,000 tiny stitches on the garment that she will wear if ordained.
Now living at The Redwoods retirement community in Mill Valley, Dammann starts her day with meditation at 5:30am. A hummingbird feeder hangs above her apartment door facing the marsh and Tibetan prayer flags greet the breezes. Mack’s water dish sits near a smiling Buddha statue. Dammann tried the treadmill again and with a physical therapist makes a strenuous effort to walk. After her trip to Boston she officiated at a wedding in Santa Barbara, then went to Bellingham, Washington to do more professional consultation.
Dammann has learned to accept change. Her Buddhist philosophy helps.
“You can’t argue with what is, that can create more suffering,” she says. “I remember after my accident what pleasure I experienced for my first shower. It was better than sex. You can’t control what happens but you can control how you behave in response. Now I have learned to say yes to everything, to travel, to everything that presents itself.”
Dammann won’t run the Bay to Breakers again, but she anticipates more journeys on her power chair, like her trip to the Ferry Building. She has occasional twinges when crossing the Golden Gate Bridge because of the memory, but for her weekly commute she takes the Whistlestop bus or has a driver with her personal wheelchair-accessible van. To stay engaged at Green Gulch, she spends two days a week in the office, answering the phone and taking reservations for visitors. She’s also a fan of the Golden State Warriors.
As Dammann writes in Lessons from an Accident, published online at Awakin.org, “I realize now that my greatest happiness in life has been in my service to people, particularly the joy that comes from being totally present with my own and their suffering. When I woke up from my coma I had new insight, I understood that I hadn’t completely shown up in life. My new emphasis in service is to remind myself of this motto, ‘Do it now, just do it now.’ Whatever life offers, take it.
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The Lawsuit
Written by Grace Dammann’s attorney, John Stein (Boccardo Law Firm of San Jose)
Grace Dammann sued the Golden Gate Bridge District because she believed head-on collisions could be avoided with a median barrier. After five years of litigation starting in 2009, the Golden Gate Bridge District finally agreed to install a moveable median barrier. From receipt of money to construction, it took another six years to get it done. There is a legal principle called design immunity in the government code that makes it difficult for members of the public to re-engineer public bridges and roadways.
In 1990, the same company that installed a median barrier on the Golden Gate Bridge, installed a moveable barrier on the Auckland Bridge in New Zealand that resulted in a dramatic overall reduction of accidents, and totally eliminated dangerous ‘cross over’ collisions. Caltrans had studied this engineering breakthrough, and in 1998 a moveable median barrier was installed on the Coronado Bridge in Southern California that again resulted in a total elimination of head-on crossover accidents and a 20 percent reduction in overall accidents. The Chief Engineer of the Golden Gate Bridge District, Merv Giacomini, recommended installing the median barrier in 1998 but the report was buried for eight years.
The lawsuit drew the attention of California legislators. Nancy Pelosi and Barbara Boxer earmarked $10 million for the construction of the median barrier. The Metropolitan Transport Commission contributed another $5 million from one of its funds, which finally resulted in the installation of the movable median barrier (January 11, 2015). There hasn’t been a head-on collision since. We lost the battle, but we won the war. It was a painful loss for us but an important victory for Grace and everyone who travels the bridge.
