Taking care of people, and fighting for their rights, has been Dr. Milton Estes' passion for more than three decades.
One of the first Marin physicians to attend home births in the 1970s, Estes was also one of the only Marin doctors who cared for people with AIDS in the early day of the pandemic. He successfully pressured the county to provide care for low-income people with AIDS, launched the county's only private HIV/AIDS clinic in 2002 and is now medical director of the Forensic AIDS Project at the San Francisco City and County Jail.
For his uncommon commitment to the medical care and social justice, Estes received the Marin Medical Society Physician of the Year Award in 1989, the Marin ACLU Benjamin Dreyfus Award in 1990, the Marin Human Rights Commission Martin Luther King Award in 1992 and the ACLU Frontline Award in 1999.
Surprisingly, the slender, fit, Mill Valley 61-year-old, who ran one of the Marin's busiest family practices for nearly three decades wasn't sure he wanted to be a physician when he graduated from the University of Chicago Medical School in 1968.
"I resigned from my internship in Syracuse, N.Y., after a month," Estes reflects from his office in the Tom Steel Clinic in Mill Valley. Estes sensed that his colleagues in Syracuse disapproved of his anti-Vietnam war work in Chicago helping draft-eligble people avoid conscription if they had medical conditions that disqualified them.
"It was certainly true that everyone knew about my political work and knew I was a 'big radical,'" he says.
Shocking his parents, Estes and his artist wife Marcia packed up their bags and headed to San Francisco, where, for 21Ú2 years he tried his hand at political organizing, worked as a mail-handler for the United States Postal Service, earned a teaching credential, served as a research assistant for a dermatologist at the University of California at San Francisco, traveled in Europe and "did nothing" at times.
"We were sort of middle-class hippies," he says, laughing.
"I finally came to realize that probably a big part of my dropping out of medicine was a lack of self-confidence and a lack of really having tried other things and not being sure. And finally, after 21Ú2 years, I concluded that I could be a good doctor and that was what I really wanted to do, and I was lucky enough to be able to go back."
The oldest of three children, Estes grew up on Chicago's South Side, first in Hyde Park, a racially diverse neighborhood near the University of Chicago. When he was 5, his family moved to the neighborhood of South Shore. "I was a little roly-poly boy who wasn't very athletic and wasn't very coordinated and wasn't very socially comfortable," Estes says. "I was the smart kid in school."
Estes' father was a meteorologist for the weather bureau in Chicago and his mother was a homemaker.
Estes and his sister learned Yiddish at an after-school cultural program run by Labor Zionists, whom he describes as "left-wing liberals - intellectual Jews who cared deeply about the state of Israel and socialist causes."
"Being Jewish has been an extremely important part of my life experience," Estes says. "Though I am not a religious Jew, I certainly have a strong identity of being a Jew, of being part of a tradition that goes back well over 2,500 years.
"In Judaism there is an ethical system in which humans' relationship with others is more important than humans' relations to God. The ethical, moral thing of Judaism says you have to take care of other people; you have to look after the world. It influenced me tremendously."
At the Horace Mann Elementary School in South Shore, a motto hung over the stage in the auditorium that Estes has never forgotten: "Be afraid to die until you've done something for the good of humanity."
Estes returned to medicine in 1970 as an intern at St. Luke's Hospital in San Francisco, then took a job as medical director of a federally funded, community-organized health clinic for migrant farm workers in Orange Cove, about 30 miles from Fresno.
When his son Jacob, now 33 and a filmmaker in Los Angeles, was born, Estes became deeply interested in childbirth, particularly after discovering that he and his wife would have to travel 50 miles to find a hospital that would allow a drug-free birth.
"There was no natural childbirth back then," he says. "It was the exception then anywhere, but especially in rural California, for doctors to even think about allowing women to breast feed, let alone have natural childbirth."
While at the Orange Cove clinic, Estes studied acupuncture, which he'd discovered was helpful in treating chronic pain, particularly from arthritis and muscle problems.
"It was amazing how much it helped people," he says. "That sort of peaked my interest in what is now called complementary medicine."
Ready for a change and eager to find other physicians with similar interests, Estes joined Dr. Jeffrey Anderson's practice in Mill Valley in 1974. By chance, Anderson was already attending home births, and Estes, after studying home birth with an experienced Chicago physician, began to do so as well.
"I didn't necessarily come from the conception that home births were safe," he says. "In fact, I assumed they were dangerous, but I approached it from an empowerment point of view and a choice point of view, and I thought, well, if people are going to chose this, at least they should have the advantage of as much care and safety as possible."
Former Marin Supervisor Annette Rose was one of Estes' patients in the 1970s, as was her son.
"Milton was wonderful," Rose says. "I think Milton should be one of the most admired individuals in the county. He certainly is a hero to me. I think he has done lots of wonderful work beginning with the home birth."
Rose credits Estes for helping convince Marin General Hospital to allow husbands and other members of the family to be present at birth and to create a birth setting that is more like home.
"He was quite a pioneer in that area," she says. "A lot of the medical establishment fought that, but by the time my daughter was born - she's now 21 - my husband and her brother were both present and there was no question."
As Estes' professional life blossomed in Mill Valley, his marriage crashed.
He could no longer escape the fact that he was gay.
"I always knew from the very beginning that I both was sexually attracted to men and loved men, but I fought that," he explains. "I didn't exactly think I was ashamed of it, but I couldn't conceive of a life where that was my whole life, and I loved women, too, I thought. I liked women a lot and I very much wanted to be married to a woman and wanted to have a family.
"I met the man I was with before Tom while I was married, and for a short while the three of us all lived together. I actually thought I could have it all."
In 1976, Estes' wife left him.
"It was a disaster of gigantic proportions, of Shakespearean proportions," Estes says. "She ended it, and at the time I thought it was the biggest catastrophe that could have happened to me, and I said, 'I'll stop this, I'll never do it again,' but she would have none of that and, in retrospect, thank goodness."
During the divorce, Estes was represented by a young lesbian lawyer named Mary Morgan, who subsequently became the first openly lesbian judge in the United States. Another attorney in her building was an up-and-coming civil rights, personal injury and malpractice attorney named Tom Steel.
Estes recalls that a secretary in the law firm often said she wanted Milton and Tom to meet because they would enjoy each other so much.
When they finally got together, things happened fast.
"It wasn't long before I was head over heels in love for the first time in my life - truly, truly in love, what I really recognized as something different. It just went very quickly from there. We had so much in common."
What cemented their relationship was the experience of working in a refugee camp outside of El Salvador in Honduras, during the Iran-Contra wars and the Salvadorian Revolution.
"I did medical work and Tom did interviewing, political work. By the end of that time down there and the work we did afterwards for the Salvadorian refugees, I knew this was the person I would be right to be with for the rest of my life.
"Tom was one of the stars that everyone in the world is attracted to and sees how special he is," Estes says. "He was, for one thing, incredibly good-looking, he was a happy person, whose happiness and good humor and good will shone through all the time. He was incredibly dedicated to his work, devoted to his clients, politically committed, a star athlete. He was just someone who made other people feel good when they were around him."
Steel moved into Estes' home in Mill Valley, and the couple worked hard and played hard, spending romantic holidays southwest of Paris where they rode horses through the "exquisitely beautiful" French countryside, playing tennis, skiing, socializing with their widening circle of friends, and, throughout it all, supporting and encouraging the other's work in medicine, law and social justice.
Steel, who founded the Gay and Lesbian Committee of the National Lawyers Guild and the Bay Area Lawyers for Individual Freedom, won cases against many formidable opponents, including the U.S. military - for operating a train at the Concord Naval Weapons Station that severed the legs of protester Brian Willson as he tried to stop a shipment of weapons to El Salvador - and the FBI - for refusing for 15 years to release documents to San Francisco Examiner reporter Seth Rosenfeld about Berkeley's Free Speech Movement.
While Tom fought political causes, Estes marshaled his own skills to combat a mysterious and alarming medical crisis. A growing number of gay male patients began to show up in his office with a rapidly progressing, usually fatal illness that often began with an unusual form of skin cancer.
"It was pretty clear we were dealing with something new and something of vast proportions," Estes says. "I started getting patients who were quite ill, and it became quite apparent quite quickly that the hospitals in Marin and the public health department were unprepared for this."
Local hospitals were reluctant to admit Estes' patients because, he believes, they were afraid that having people in their institutions with HIV and AIDS might scare other patients away or transmit the disease to others through health-care providers.
"In the early days, it was a battle," Estes recalls. "People were dying left and right, and you felt like you were in a war rather than just a medical practice. A lot of what we did was to help people die in a humane and dignified way. It was very, very trying and emotional for many years."
After years of pressure from Estes and other Marin AIDS activists, the Marin County Department of Health and Human Services opened the HIV/AIDS Program and Specialty Clinic in the 1990s.
With the advent of anti-viral drugs, the prognosis for people with HIV/AIDS improved dramatically, as did death rates from AIDS.
But breakthroughs in drug treatment were not enough to save the love of Estes' life.
On July 18, 1998, Tom Steel died of AIDS at age 48.
"I would say the first two or three years I spent a lot of my life crying," Estes says. "And the only time I felt in any way normal was when I was either in seeing a patient or when I was with my son. Other than that, even with my closest friends, I did not feel like Milton. É The experience was deep and wide and profound and difficult."
Estes says he has thought a lot over the years about the "mystery of life," the transition from non-existence into existence at birth and the loss of that existence at death, when "one minute they're such a strong presence and the next minute they're gone."
Although he says he does not believe in life after death or the continued existence of the soul, he thinks there is "something beyond us out of which we emerge and out of which life emerges and which we're part of whether we're alive or dead, material or immaterial."
For some years now, Estes has found comfort in Zen Buddhist meditation, and he credits horseback riding in the Tennessee Valley with the National Park Service Horse Patrol with easing the pain of losing Tom.
"For me, riding's probably the most grounding, healing, wonderful thing I have experienced," says Estes, who's been in love with horses since he was a child. "I would have to say in some ways riding saved my life after Tom died."
Before Steel's death, Estes gave up his private family practice in Mill Valley but continued seeing his HIV/AIDS patients one day a week. He also became the physician to inmates with AIDS at the San Francisco City and County Jail.
"It's an opportunity to really feel like you've had an impact," he says.
In 2000, Estes opened the Tom Steel Clinic in Mill Valley, a privately funded clinic for people with AIDS and HIV. Most of the doctors, including Estes, volunteer their time.
"The clinic is wonderful because we've created an island of space and an atmosphere and a way of seeing the patients that's very much the way all of us, the practitioners want to do, and I think the patients feel it. The only hard part about it is that keeping it going financially is a struggle, because we have to raise two-thirds of our budget from individual donations. Luckily," he laughs, "I feel OK about fundraising."
Estes is also a tireless fund-raiser for the American Civil Liberties Union. He's served as president of the board of the Marin Chapter, was chair of the board of the Northern California Affiliate of the ACLU and is now a member of the ACLU's national executive committee.
"The ACLU is the most important non-governmental organization in the United States, in my view," he says. "Because it's in some ways the conscience of the government to the extent that it can keep the government in check from overweening power and overweening support of majorities against minorities, whether they be religious or gender or sexual preference or racial or whatever."
Dorothy Ehrlich, executive director of the Northern California Affiliate of the ACLU, has worked closely with Estes over the years.
"Milton is just a remarkable activist," she says. "He is extraordinarily generous. He is sort of one in a million in terms of a person who understands the organization, and he's a particular resource to us in the matter of reproductive rights and public health."
For now, Estes has no plans to cut back on his clinical or social justice work; but since becoming a grandfather, he says, he's had to confront the fact that, like it or not, he's getting older.
"I can't see myself as the 35-year-old I once was," he says. "So far, it's a new experience for me. I'll be a senior citizen, but I prefer to be a kid."