On one of his first days as Maryland's health secretary, Dr. Martin P. Wasserman called his staff to a series of meetings. They began at 8:30 a.m. and didn't end until 11 p.m.
Such long hours have become routine for Dr. Wasserman, who took office in late December.
At 52, he works six days a week, sleeps five hours a night and swims two miles each morning. Most people still are asleep when he feeds his four horses and cleans their stalls. And just as he cooks too much lasagna for his family, he has thrown himself full force into his new position.
He oversees 9,060 workers and a $3.2 billion budget -- the largest of all state department budgets -- at a time when health care is undergoing a revolution and medical costs for the poor are exploding.
Dr. Wasserman, a lawyer as well as a physician, is a fierce tobacco opponent who organized a statewide anti-smoking coalition in 1993. When he received word one Friday afternoon that an appeals court had decided to let Maryland's tough workplace smoking ban take effect, he was ecstatic.
Dr. Wasserman didn't hesitate that weekend to voice strong public support for the ban -- even before his boss, Gov. Parris N. Glendening, announced what he would do. The ban is due to take effect tomorrow at the close of the business day.
A Connecticut native, Dr. Wasserman graduated from the Johns Hopkins School of Medicine in 1968. He and his wife, Barbara, also a physician, worked on the Navajo Reservation, where he directed pediatric care. Back in Baltimore, he worked as medical director of Mount Washington Pediatric Hospital and studied law at night, earning his degree in three years.
From 1978 until his recent appointment, he oversaw health departments in Arlington, Va., and Maryland's two largest counties, Montgomery and Prince George's. He also headed state and national public health associations, bringing together warring sides and individualists so deftly that colleagues call Dr. Wasserman a great "cat herder."
"I used to get morally outraged," he said. "Now I get morally outraged at people who get morally outraged. You try to be rational. You try to move people towards the center, with social good as the center."
Recently Dr. Wasserman set out to use his consensus-building skills to mediate a dispute between Maryland optometrists and ophthalmologists. They had long feuded about how much primary eye care the lesser-trained optometrists should be allowed to do.
It was 6 p.m. Everyone had already worked a full day. But according to participants, Dr. Wasserman immediately set the tone: "We are going to stay here until we get it done."
In 15 years, rarely had the two sides tried to negotiate differences on a bill. At a second session, with the help of three pizzas bought by Dr. Wasserman, they worked until 12:45 a.m. A compromise is making its way through the legislature.
Dr. Wasserman, widely considered one of the country's top public health experts, is frequently tapped for advice by officials at the national Centers for Disease Control and Prevention. He's also known for getting things done.
When few obstetricians in Montgomery County would care for poor pregnant women, Dr. Wasserman turned the situation around by getting the county to cover the physicians' liability insurance for those cases. Within a month after he took over as Prince George's health officer in 1991, workers at a rural clinic were shocked when Dr. Wasserman walked in the door.
"He drove all the way down here to see the place. He was out of his office and so full of energy that we all had to take a step back," said Karla Roskos, executive director of Greater Baden Medical Services.
Working with health maintenance organizations, hospitals, AIDS advocates and others, Dr. Wasserman helped establish a county clinic in an under-served area.
In Dr. Wasserman's first few months as health secretary, going to work often has meant heading to Annapolis for the legislative session.
During early mornings and late nights in the "Bunker" -- a basement that serves as the crowded headquarters for the health department staff -- aides schooled Dr. Wasserman in the details of dozens of bills. And in the hallways of the State House, lobbyists, advocates, and others swarmed him.
"We feel he was the best selection who could be made," said Brian Scott, director of the Whitman-Walker Clinic of Suburban Maryland and president of the Suburban Maryland HIV Alliance. Despite Dr. Wasserman's stance in Prince George's County that AIDS patients be reported by name in order to track them better -- a recommendation opposed by many in the AIDS community -- Mr. Scott said they have agreed to disagree.
Even with Dr. Wasserman's experience and broad support, his $108,372-a-year job is formidable.
The private health market is in upheaval. Increasingly powerful HMOs, which already cover at least 30 percent of insured Marylanders, are trying to cut costs. And according to the latest figures, roughly 115,000 more state residents lost their health insurance in 1993.
Tied into all of this is the thorny issue of health care for the poor. In the last six fiscal years, the Medicaid budget has doubled to $2.1 billion in 1995, roughly two-thirds of Dr. Wasserman's budget.
Like most states grappling with exploding costs, Maryland is trying experiments like putting more Medicaid patients into HMOs and using case management to rein in the cost of expensive illnesses.
Several weeks ago, at the last of 24 budget hearings before various committees in Annapolis, Del. Martha S. Klima, a Towson Republican, made it clear that wasn't enough. She urged Dr. Wasserman to completely review Maryland's Medicaid program as rapidly as possible.
His training as a physician, public health official and lawyer will be a huge asset to the new secretary. But observers warn that he will have to absorb Medicaid issues quickly and won't have as much time as he'd like to build consensus.
Dr. Wasserman also keeps reminding himself of the painful lesson that his son Brad, now 21, tried to teach him three years ago, when he left a letter on his father's car.
"You are always on time for your family of workers. But there is your other family, Barbara, Torrey and Brad," the letter said. "We've been together a lot over the years as a three-person family, and sometimes you have been able to join us . . .
"But the way I see it, you put work before family, and we resent your not spending as much time with your 'home family' as with your 'office family.' All we want is you to be home more and spend time with us because we love you."
Later Dr. Wasserman read it to a stunned crowd of 400 public health officials from around the country, hoping it might teach them the same lesson, that professionals must seek balance in their lives.
But Dr. Wasserman said he doesn't regret the time he put into his career. "It doesn't help to look back," he said. "You just look ahead and make it better."