As I was introduced to a guest at my sister-in-law’s baby shower recently, she recognized my name and said, “Oh, you’re the one who worked on the Navajo Reservation, right?” She asked what I was doing now that I had relocated to Los Angeles, and when I told her that I worked as a pediatrician for a free clinic in South L.A., she responded, “Wow, you really want to give back.”
It is a comment that I hear not infrequently. “I get a lot more out of my work than I give,” I told her, and we each drifted off to other conversations.
Ordinarily, I wouldn’t have given the comment more than a passing thought. But a recent visit from my parents made me think about it again. My parents got a first-hand look at a typical week of early morning runs, hectic clinic days, and busy evenings shepherding two overtired daughters through dinner, bath time, and bed. During their visit, my dad accompanied me on a weekend errand outing. As he pushed the grocery cart behind me, he asked, “Why are we walking so fast?” Just before he left, he gave me an intense gaze and then said, “You’ve got to stop sacrificing yourself. I mean, I admire the work you are doing, but how long can you do this to yourself?”
Taken together, the two comments gave me pause. What do they say about how my work is perceived? My father’s comment was certainly protective at heart—he sees me working hard and finds it painful. But I think that many working mothers work as hard as I do, and some harder. Both comments intimated a certain lack of value in working at the fringes of medicine, a vague sense that I am not getting the reward I deserve.
Recently, I was invited to attend a board meeting for my clinic. There was a church pastor, and I recognized one of my patients sitting among several other community members. The Spanish-speakers wore headphones for instantaneous translation, United Nations style. My CEO sat across from me, the medical director to my right. Two white women who looked to be in their 60s sat at the head of the table. Everyone was sharing a sparkling apple juice toast for a recent grant award. Together, we were a diverse group. As I looked around, I wondered what had brought each of us to the table.
On the surface, the answers seem obvious. Religious do-gooders, civil rights era idealists, community members organizing for better access to healthcare. But is that it? And what brought me?
I never exactly set out to do this type of work. I left Boston for the Navajo Reservation after residency with a greater sense of adventure than with a commitment to community service. That the Indian Health Service would combine both was a bonus. Occasionally patients accused me of experimenting or practicing on them. But ultimately, my role as a doctor afforded me a certain trust that allowed me to transcend the boundaries of race and class. I felt at home in my Navajo community. I came for adventure and evolved a powerful attachment.
Living on the reservation in some ways was easy. It was engrossing and rewarding, and my values were transparent. I had some dim expectation that it would develop into a career. But as family concerns drew us to Los Angeles, I was confronted by the need to make some concrete life decisions. My job search began with academic faculty posts, private practice, and Kaiser. But when it came down to making a choice, I finally realized that there was nothing I wanted as much as working in South L.A.
Archie visited our clinic on New Year’s Eve for the first time. Despite two insulin injections, his sugar remained over 500, more than five times normal. It was his first diagnosis of diabetes, and we spent a bit of time discussing his treatment. I was particularly concerned because, with the holiday, he wouldn’t be able to return to the clinic for a recheck the following morning. But he had no evidence of acidosis, which could herald a diabetic coma, and no insurance. So I sent him home with careful instructions.
When he returned to clinic on Jan. 2, his blood sugar had come down, and he felt great. “I could see on your face that you were concerned about sending me home,” he said to me. “But when I saw your smile today as you came through the door, I knew that we did good.”
My clinic can be messy, chaotic, and uncomfortable. But meeting with the board to define our vision for the future made me excited to be part of the process. Perhaps what brings us to the table is less important than that we are all sitting together.
Ellen Rothman, HMS ’98, practices at a community health center in Los Angeles.
