POCOMOKE CITY -- On Dr. Ritchie C. Shoemaker's office wall, a goldfish-shaped cracker with a gaping hole is taped to a piece of paper with a note addressed to the state health chief, Martin L. Wasserman.
It says: "Marty -- another obvious case of Pfiesteria toxicity. -- Love, Ritchie."
The note was written by Dr. Barry Spinak as a gag, but Shoemaker laughs every time he reads it.
Shoemaker, 46, understands the irony of the joke because he was the first, and most serious, voice that pushed state officials to acknowledge that water from the Pocomoke River was making people sick. Even when the state government said he was wrong -- that the water was safe -- Shoemaker didn't relent.
Now experts acknowledge the link between a microorganism in the Pocomoke, Pfiesteria piscicida, and human illness, as well as the deaths of thousands of fish since late July. On Aug. 29, Maryland and Virginia closed 7 miles of the Pocomoke from its mouth to Cedar Hall Wharf.
When Gov. Parris N. Glendening announced the closure, Shoemaker said he was thrilled.
"There were times when I second-guessed myself," Shoemaker said. "But I knew I was right, and I don't give in."
A graduate of Duke University and Duke Medical School, he had the resume to become a surgeon or specialist; instead, he chose rural medicine. He published a medical journal while he was in medical school for students interested in becoming primary care physicians.
Just as he decided to practice medicine "at the end of the road," he's also created a niche at his Pocomoke City home. There, he has designed his two-story house and built a 15-acre wildlife refuge, with ponds and trees, bogs and pickle-weed.
"I always need a project," Shoemaker said. "Without Pfiesteria now, I guess I need to find a new one."
His wife, JoAnn, 46, and his 13-year-old daughter, Sally, agreed.
The Pfiesteria project began July 30, when a Shoemaker patient complained of burning skin, a pounding headache and memory loss. He had wa- ter-skied in the Pocomoke, about 1,500 feet downstream from the spot where a major fish kill occurred a week later.
During the next two weeks, Shoemaker treated more cases, including two state Department of Environment workers who had been taking fish and water samples, all complaining of similar symptoms.
When the Maryland Department of Health and Mental Hygiene wouldn't acknowledge a possible link between the fish kill and his patients' problems, Shoemaker told anybody who would listen -- the press, his neighbors, experts -- that the water was making people sick. He often clashed with Wasserman.
"He just pushed us to recognize the problem," Wasserman said. "He didn't really understand what our limitations were. I have a great deal of respect for him. He's a very dedicated physician."
Shoemaker remembered reading about Pfiesteria problems in North Carolina, so he sent two patients to doctors there for further testing.
He kept insisting that watermen and others got sick from the Pocomoke -- all despite doubting colleagues and denials by state officials, all seeming to be asking: What does a rural doctor know about this anyway?
During the first week of July -- a month before seeing his first Pfiesteria-related cases -- Shoemaker visited Shelltown after people told him fish were dying. He learned about fish pathology and read about the problems striking North Carolina, mostly because the subject interested him.
And when people started getting ill, Shoemaker knew the cause.
"Luck favors the prepared mind," Shoemaker said. "I didn't know my patients would get sick. But I knew enough about this to help."
Somerset County residents are grateful.
"Without him, I'm sure things would have been different," said Lori Maddox, a patient of Shoemaker's. "He's a wonderful physician. When he gets a hold of something, he doesn't let go."
On Friday in Ocean City, Shoemaker briefed 70 colleagues at the Medical and Chirurgical Faculty of Maryland's semiannual meeting about symptoms five patients exhibited. He considered it an honor to address the state medical society, and doctors said it would help them diagnose similar cases.
Later that day, at his Pocomoke City office, he saw about 30 patients. As he checked a man's breathing, he spoke about what makes this area of the Eastern Shore unique, and what makes him feel at home here.
"You see, people don't understand Eastern Shore men and women," Shoemaker said. "They're a tough bunch."
Waterman Tommy East, a Shoemaker patient who has suffered from stomachaches, headaches and lung infections from Pfiesteria, said Shoemaker stuck with him when everybody else said nothing was wrong.
"I think he's one hell of a doctor," East said. "A good doctor, he's somebody who's not going to give in until he finds a solution. He didn't."
Pub Date: 9/08/97