I grew up in what I believe to be one of the most friendly places in the country, a rural area of south-central Wisconsin. Very early in my education, I was one of the gifted and talented students. I understood math so well as a first-grader; they asked me to help third graders when my first-grade classmates got their addition and subtraction lessons. I graduated with honors from high school. I remember informing the high school counselor I wanted to attend the University of Wisconsin – Madison. He advised I should consider one of the smaller University of Wisconsin schools such as Eau Clare or La Crosse. He knew my high school education was not equivalent to the other students I would encounter and compete with at UW-Madison. He seen a history of prior students attending Madison, drop out, and not graduate from the prestigious university. I admit, when I got to Madison, some of the things he warned me about were true. On day one of my calculus class, the professor asked how many of us had calculus in high school. Eighty percent of the two hundred students in the auditorium raised their hands. I did struggle with my studies at the UW-Madison, but eventually proved my guidance counselor wrong and graduated with a professional degree as a Physician Assistant.
I met people from all walks of life at the University. In my first year, I shared a dormitory room with a brilliant man from Cypress who spoke seven languages. His uncle was a professor at MIT and helped invent specific tiles to protect the Space Shuttle so it would not burn up on re-entry into our atmosphere. My sophomore roommate was an African American man who grew up in Oakland. He and I also grew up in such different environments. He often said I trusted everyone. He didn’t trust anyone until they earned his trust. Where he grew up, he could not trust others, for risk of being shot and killed. It never crossed my mind during my entire childhood that I could become a victim of homicide in my hometown area. In my junior year, I became a House Fellow working as a resident assistant with other students. In addition to my studies, I worked as a live-in with two men with disabilities. I donated my time to gain experience at a local community clinic for people with no health insurance. I volunteered at the UW-Hospital Emergency Room and spent time at local homeless shelters. I learned a lot outside of class by integrating with students who were different than me and with other people on campus who came from diverse backgrounds. In my first year of college, I signed up at my church for a week of service at a young men’s retreat, helping people in rural Kentucky. The experience opened my eyes to a different rural culture and my expanding awareness of others’ needs.
I ended up being the only one from my church who signed up. I told my family about my plans and took a Greyhound bus from Madison to Chicago. When I got off the bus in downtown Chicago, I found myself let off after dark, in a station full of unsavory characters. Thankfully, I didn’t wait long until two local men picked me up and brought me back to their residence. The young priests in training fed me dinner that night as well as breakfast the next morning. Then the three of us drove in their vehicle from Chicago to Cincinnati. When we arrived at a large church in Cincinnati, we joined young men from all over the country who flew or drove there as well. After several hours of orientation about the week we volunteered for, we loaded up our luggage into two large vans and made the drive to Vanceburg, Kentucky.
I will never forget the most bright, full moon I viewed when we drove around some foothills just outside of Cincinnati and crossed the state line into Kentucky. The moon was unusually large and low on the horizon. At first, the moon hid behind the peaks of the rounded hills and sandstone rocks. The earth was dark and covered in evergreens. The curvey country road not easily navigated. We came around one corner, and I was in awe of this unusually beautiful moon. I had been to the mountains of Colorado and Wyoming before and never saw such a magnificent moon. At that moment, I felt my soul speak. I was heading to a place I had never been before, I trusted that I was going to be ok, and naively agreed to participate in a retreat that I, in reality, was unprepared to experience.
We arrived at the remote farm where we would be staying for the week. The church vans safely navigated by the two drivers brought the two priests in training and eighteen college men. Half of us got a bed in the main house, the other half of us assigned to the barn. I was fortunate to get a bed in the house as I got to stay in the house all week. One of the two priests in training also got a bed in the house. We bunked together. I didn’t get the best sleep that night, sleeping in an unfamiliar place with many strangers. One of the guys snored, and sharing a cramped room with five other men made it difficult to get comfortable. The next morning after some hot breakfast, we had another session on what to expect.
We met a volunteer carpenter. I don’t recall his name, but he was skilled and a patient instructor. He spoke of how he was the man in charge of the leading project for which we were going to double the size of a local family home. Our goal was to build an addition onto their home. The foundation of the project was already down; we would make the walls and roof this week. The next group of volunteers would eventually finish the interior. He informed us the family paid for the material. Not all of us could work the site at once, so we would take turns. Some of us would do other projects or go to different places until it was our turn to work on the home. On the day I got help, the carpenter told us the family would offer us drinks and cookies. We were informed to politely turn down their offer as the local water was not safe to drink. Thus, we ported in drinking water and food to eat on the site. At the end of our volunteer week, I finally got my turn. My job ended up shingling the roof. The work was hot, tedious, and not very gratifying.
We took a muddy, no gravel road around a few hills and through woods before arriving at a valley where the home was situated. The house was a trailer, and it was in rough shape. It was worn, grey, with thin walls and windows. It had rained the night before, so the enitre site was challenging to walk around. Two unkept dogs were roaming freely on the property. One of two dogs was friendly, the other barked and barked – keeping a safe distance away from us. When we did meet the owners of the home, I was surprised to meet a young couple, likely in their late 20’s and their newborn son.
The man of the home did all of the talking. He was soft-spoken and incredibly humble. He probably thanked us five or six times for coming to help his family. They offered drinks and cookies exactly as the project manager said. The project manager accepted their offering and took the plate of cookies and pitcher of iced tea from them and then excused us so we could start working. He showed us what to do, and it was surprisingly easy. I remember it being a long morning until we broke for lunch. A more painful and hot afternoon followed. When we got back to the farmhouse where we were staying, I had no choice but to go down to the creek to get cleaned up. All week we did not have access to a hot shower. It was still May so the creek water felt ice cold!!! Yet, despite the conditions, I hung in there. The priest in training who got a bed out in the barn was not as gracious. He complained daily about the sleeping conditions, lack of bathing facilities, and he couldn’t get WAIT for the week to be over so he could return to civilization. He longed for his bed in Chicago, and to work with the homeless at the soup kitchens where he was more familiar and comfortable.
On one of the days, we went to a local funeral. I found that odd, not sure who decided we ended up there. I felt uncomfortable about that day. I didn’t want to participate, and it was incredibly awkward. I felt like I was a spectator, not a sympathizer who could relate to the families and friends that gathered to mourn the death of their loved one. However, years later, I was grateful for the experience. One of the other days, I worked at the local church. One day I stayed at the farm and worked on a project there. One of the more memorable nights, we drove a few miles down the road to a modern barn. This barn freshly painted, clean, and inviting. Inside were bails of hay arranged theater-style along with a raised stage and colorful lights. We experienced an authentic Appalachian evening complete with banjo, fiddle, harmonica, and guitars. It added to my love of the week, and I discovered the talents of the local people that before that evening, I didn’t realize came from the area. What little I knew about bluegrass I saw on the television show, Hee Haw. Bluegrass in a barn was one thousand times better than anything I ever saw on television.
When my week was over, I gained so much in a short time. My heart grew and filled with experiences that remain with me thirty years later. I am grateful for knowing I contributed an insulated room and warmer bed for the parents and their newborns. I knew their firstborn child was going to have a better upbringing from having a friendlier environment in the winter. He would be less prone to ear infections, bronchitis, and other respiratory conditions that find vulnerable infants during the winter months.
I stepped out of the comfort I knew growing up, and I am forever grateful I did. That week in Kentucky would eventually lead to another critical decision in my life. The choice to begin my PA career in a medically underserved region. After graduation from the University of Wisconsin – Madison, I moved to Huntington, West Virginia, and started my career working in a rural clinic. For years I was asked, “where are you from.” People were curious about why I moved there. The minute I started talking, my midwest accent would give me away. Everyone who met me for the first time knew I was not local. These types of greetings continued for many years. The work and environment were great for me, and I was an asset to the community. I thrived there for eighteen years.
I provided direct care for people of all ages. After a generation passed, I moved to Florida, where I currently reside. I now correct people who speak poorly of Appalachian people. I inform them the people of Appalachia are hard workers. When I hear someone use a derogatory term, I challenge their perception. I advise why the stereotype is wrong and inappropriate. I also give my account of how the majority of people in Appalachia are very generous and loving people. They are gifted as evidence of the bluegrass, country music, and famous voices who grew up in the region. Why do I bother to speak up? Because it is the right thing to do. Our country must move beyond derogatory stereotypes of all kinds.
As a health care provider, I come into contact with people from different backgrounds: taking into consideration their ability, age, ethnicity, gender identity, health status, intelligence, occupation, race, religious belief, sexual orientation, and unique health history. I have to approach each person as an individual and treat them with dignity and respect. When I learn about their health history, it starts the process to use my critical thinking skills and ask specific questions. Based on their answers, I tailor further questions to discover and pick up on clues that may help to make a diagnosis. In doing so, I then use my evaluation skills to decide what treatment I am going to recommend. I usually explain to patients why I feel the way I do and then allow the opportunity to ask questions. If they agree with the treatment, I proceed. If they need time to research or contemplate their options, we will schedule a follow-up appointment. Not all treatments are pharmacological. Sometimes the advice is prevention, exercise, nutrition, or I might give my viewpoint and then encourage them to seek another medical opinion. I am an advocate for my patients in the best way I know-how. I try to understand what it is like to be in their shoes, and I treat them the way I would treat my sister, father, grandmother, nephew, or spouse. The golden rule has worked well for my patients and me for twenty-five years.
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