Now, the doctor is out

Wearing stylish but sensible flats, she's walking to a modest brick row house in Brooklyn to call on an elderly homebound patient.

"It's not glamorous, it's not high-paying," Paris said, but she said she won't abandon a patient she is taking care of.

Norman Rockwell's house-call doctor is supposed to be a relic, but New Yorkers are leading the nation in bringing the small-town practice back. More than 40 New York doctors and house-call practices are listed on the Web site for the American Academy of Home Care Physicians - more than anywhere else in the country.

Medicare paid for 2 million house calls in 2005, up from 1.5million a decade before.

Helped by the city's vast public transportation network and the fact that the city's fastest-growing population is people older than 85, many teaching hospitals see house calls as an opportunity.

"Hello, Mrs. Leff," Paris calls as she walks into the small living room of the Borough Park apartment where 91-year-old Rebecca Leff raised her two children.

A series of mini-strokes and probable Alzheimer's gradually immobilized Leff, causing her to hit 187 pounds. It became impossible for her son, Alan, 63, to get her down the seven steps to the sidewalk for the two-block walk to Paris' office at Maimonides Medical Center.

"It's much better having the doctor come here," said Alan Leff. "Before, you'd need an ambulance plus two drivers to take her down."

Rebecca Leff sat patiently as Paris checked her two dozen pills and vitamins, listened to her heart and lungs and examined her feet. The strokes left her unable to speak, and make her cry involuntarily.

"You can't be a geriatrician and stay in your office. It's not spending 15 minutes," said Paris. "It's spending much longer."

Dr. Jeranil Nunez is worried. Her patient, 13-month-old Josue Roldan, isn't feeding right. So she's visiting his family's basement apartment in the Bronx.

Her house call was one of more than 700 made by residents from the Children's Hospital at Montefiore since 1998.

"It's equal part for training of residents and equal part for patients," said Dr. Alex Okun, doubling as adviser and chauffeur to the young doctors as they pile into his tan van once a week to make rounds in apartments.

Josue's mother, Felicia, a Mexican immigrant, shows Nunez how the baby swallows only some of the food she spoons into his mouth. His motor and speech skills are closer to that of a 4-month-old, and no one is sure why.

But Nunez is pleasantly surprised at the performance of "El Gordito," or "the chubby one," as his mother calls him.

"He's going to learn how to eat with a spoon. It just might take him a little longer," Nunez tells his mom in Spanish.

When doctors visit a patient at home, they sometimes end up treating the whole family.

At dusk, Okun and his team arrive at their final call: the dark, overflowing one-bedroom Bronx apartment Pamela Jackson shares with her two children.

Dr. Melissa Tesher wants to better understand the home life of Dorothy, 16, and Decatur, 12, who have asthma. Jackson, 47, has put off her cancer treatment for more than a year - a topic she has not discussed until today.

"Sometimes I say I'm going to let go to God, put myself in his hands," Jackson admits.

Social worker Erin Lauinger says, "You need to take care of you. You're their rock. The only way you can assure you'll be there is to get your treatment."

For Tesher, the visit couldn't have been more revealing.

"That was the best conversation I ever had with her," Tesher said happily as the group made its way back down the dark, cold street.