A good old-time modern doctor

Dr. Diane Noton is another innovator who revives good ideas from the past.

For one thing, she makes house calls. She adopted that anachronism during her mid-1990s medical residency in Casper, Wyo. "One of my patients was a woman who worked as a stripper," she says. "She was pregnant but she'd miss her appointments. So I'd go over to the raunchy hotel where she lived, pick her up and bring her to the clinic and take her back home."

These days, Noton runs the Platte Valley Medical Clinic in small-town Saratoga, Wyo. And she still visits patients in their homes if they're unable to come to the clinic or need help nights and weekends when the clinic is closed.

One recent house call began as an emergency: An elderly man in a wheelchair phoned her to report that his kidney dialysis machine wasn't draining. She drove to his home and spent hours fiddling with the machine without success. Desperate, she called a dialysis nurse who suggested that jiggling the equipment might restart the flow. So she helped the man get to his feet and danced with him around the room. Finally, the man's sister phoned and suggested another trick with the tubing, which worked.

"I still joke with this patient, telling him that he just invited me over because he wanted to dance," Noton says.

Other aspects of her practice hearken back to an earlier era when rural doctors were fully immersed in their communities. She was born in Chicago but chose to settle in the Platte Valley, where her family goes back five generations. The 3,000 people in her "patient base" are scattered over hundreds of square miles. She spends a lot of time driving back roads, getting from her own 20-acre spread to the clinic, visiting patients and going into the mountains to respond to hunter and off-road-vehicle accidents.

She also visits high schools to talk frankly to students about their sexual behavior, even though she's been criticized by conservative Christians who want only abstinence counseling. But her method seems to have worked: In the first year after she bought the practice, there were eight teenage pregnancies in families she cared for; now, the yearly average is one or none.

At 41, she's paid off the loans for med school and buying the practice ($500,000). She relieves stress and stays in shape by rock climbing, skiing and long-distance running on dirt roads, which she finds "meditative." "A physician," she says, "should lead by example."

--Ray Ring, HCN senior editor

Creating public nooks and crannies

Marci Macfarlane and her husband, Chris Radcliffe, uphold their city's unofficial slogan: "Keep Portland Weird."

The two artists, who live in a funky, semi-industrial neighborhood called Overlook, have been embellishing the acre of city-owned grass in front of their home for years, installing whimsical sculptures, such as a Mardi Gras tree strung with beaded necklaces and disco balls.

But the land isn't maintained by the city: People park cars on it; prostitutes and other street people loiter at night, and vandalism is rampant. "It's pretty much been forgotten space," says Macfarlane.

So she and Radcliffe (who helped start the Burning Man anarchy festival in the Nevada desert) are working with the city to turn the land into an official park -- an open-air art gallery for the neighborhood's artists.

This grassroots effort is part of an innovative thread in Portland, where forgotten or unattractive spaces like intersections, sidewalks and even bridges are often transformed into pocket parks, murals and sites for guerilla performance art. Creative types instigate many projects, and a local nonprofit, the City Repair Project, mobilizes people during a 10-day "Village Building Convergence" each spring.

Over the years, they've built bike racks and teahouses, native-plant gardens and landscaping, provocative information kiosks and benches shaped like stacks of books (outside the city library), a lighthouse (sheltering pedestrians from the rain) and a bicycle wheel (honoring a teenage cyclist who was killed nearby in an accident).

"It's some of the most important work," says Mike O'Brien, who's with the city's Office of Sustainable Development. "They're doing what I would call social building -- creating social bonds that are so important to having a sustainable community."

The Overlook project houses an underground tank and is on land owned by the Portland Water Bureau. It's one of seven "hydro parks," a concept that sprang up in 2006, when the city water commissioner decided to turn eyesores into spaces where neighbors can stroll, walk their dogs and have picnics.

City Repair, which was founded in 1996 by a group of young activists, wasn't directly involved at Overlook, but one of the group's artists, Brian Borello, helped with the park's overall design. "What I've been trying to do," Borello says, "is just create cool places, meaningful places in the neighborhoods, but using neighborhood resources (and) local talent, local ideas, trying to create a pride of place."

--Jennifer Anderson, freelancer