As a PA in my mid to late career years, I wanted to push myself to achieve the highest degree of training available to better myself as a potential administrator and clinician. I was also seeking completion of my dream to obtain a doctorate in the medical field, largely due to the influence of my Choctaw grandmother. Her influence led me to believe that the practice of medicine (whatever one’s discipline — physician, PA, or NP) is sacred, and that serving those in most need is especially sacred. Taking the plunge in tackling ATSU’s DMSc program has been one of the most rewarding experiences of my PA career.

I am descended from Chief Gilbert Dukes (Chief from 1900-1902) of the Choctaw Nation, later a long-standing Indian Territory judge, who in 1911 was selected as a delegate to Congress in Washington, D.C. in the hopes of procuring funding for the first Native hospital in Indian Country/Oklahoma Territory. Chief Dukes' efforts established the first hospital for Native people in Indian Country. He had attended Spencer Academy (a Choctaw-managed Oklahoma Indian School) as a boy, then later trained as an attorney (in this era, attorneys learned the law in an apprenticeship-type setting), after which he was admitted to practice before the United States Courts in Indian Territory.

During the D.C. congressional session of 1912, Chief Dukes successfully argued that the Indian peoples forcibly relocated to Oklahoma (the atrocity known as the Trail of Tears to the Choctaws, Chickasaws, Cherokees, Creek, and Seminole) were dying in record numbers from tuberculosis, with no aid or medical help, and that the federal government should put facilities in place to provide treatments. While the funding was originally allocated for building a tuberculosis sanitarium, with the building completed in 1937, the Choctaws expanded its use to a general hospital for all Native people in the territory, where most modern medical services could be obtained. Many of my relatives were born at that hospital or worked there (my dad's cousin, Pam Dukes, whom I'm named after, worked there as an RN for 25 years!). It was retired in the 1990s and replaced by a modern medical center in 1999.

Choctaw Nation later opened eight rural family medicine clinics, a substance abuse treatment and rehab center, and many medical programs to serve the community of southeastern Oklahoma. My Choctaw grandmother, Dorothy, was so proud of the hospital her grandfather built; she had watched as it was being constructed during her childhood and felt the growing excitement and pride as the structure became a reality. She had grown up on the reservation and witnessed how valuable it was for the people to be empowered with good health and to have agency in their future. She imagined her children or grandchildren working as doctors at the Talihina Indian Hospital. Grandma Dorothy was the most influential person in my life during my youth. She encouraged me to go into medicine to help those most in need, especially Native people. It is the Choctaw spirit to help others in most need. For example, in 1848 the Choctaws, having recently suffered years of starvation and devastation during the Trail of Tears era, raised money for those in Ireland suffering from the Potato Famine. The equivalent of $5,000 in today's money was delivered to the General Irish Relief Committee of the City of New York. Ireland and Choctaw Nation have continued to have a close relationship since.

When I graduated from PA school, I was offered jobs by Choctaw Nation and the remote Shoalwater Bay Tribe of Tokeland, WA. The Shoalwaters needed me to start immediately, while Choctaw Nation would need me in six months, after an eighth new clinic building’s completion. The Shoalwaters were facing a health crisis that began in the 1990s, with unusually high rates of miscarriages and child mortality. They had just completed the building of a health center paid for with CDC and IHS funds. Before the new building, their clinic had been a mobile trailer with three exam rooms and a tiny lab station. I chose to serve the Shoalwater Bay Tribe.

Fifteen years before the Shoalwater's health center, the tribe's chairman, Herb Whitish, demanded answers from the IHS on why they had lost a generation of children. When the IHS did not have answers, he turned to the media, which led to a CDC investigation. The investigation identified multifactorial issues that had led to the loss of children, including lack of prenatal and women's healthcare, unsafe water sources, and high rates of substance abuse. Through the CDC and IHS, the tribe was awarded funding to build a healthcare center with women's health programs and substance abuse/mental health programs. The new health center building was completed in early 2005, just as I was hired to fill the Native Women's Health Program director role. Like the Choctaws, the Shoalwater Bay Tribe was generous to the community at large and opened the clinic's services to non-Natives and the uninsured.

My son was 11 when he moved with me in March 2005 to the remote Tokeland, WA. We lived above the community room of a trailer park in a small second-level cottage, 100 feet from the Pacific Ocean and a 10-minute walk to the tribe's new clinic building. I felt that through my service to this small tribe of less than 400, I was honoring Grandma Dorothy and the Choctaw Tribe. I kept Dorothy's photo in my office and knew she was with me in spirit. I practiced there for over seven years, and was the only full-time clinician for six of those years. I had been there only six months when the physician who had hired me suddenly quit, leaving me to manage very complex and ill internal medical patients and the mantle of the many health programs that needed tending. I filled many more shoes than women's health and family medicine provider. The clinic needed a Controlled Substance Agreement Program due to out-of-hand narcotics prescribing that had been the standard prior to my hire. So out of necessity, I gained expertise in pain management and developed a successful interdepartmental controlled substance program. The clinic is an hour from an ER attached to a small 50-bed hospital, so I always had to be ready to stabilize random medical emergencies with minimal support. The reservation is also in a tsunami zone, and the area would get pummeled with massive ocean storms in the winter that left residents stranded by mudslides and ocean water. Our first winter, my son and I were stranded in our cottage for nearly two weeks without running water or electricity, and only a gas stove and fireplace to keep us warm. Neighbors with a canoe paddled over the ocean-flooded grassland to check in on us. My car's engine somehow survived being partially submerged in salt water. I became CERT (Community Emergency Response Team) certified in preparation for a tsunami natural and medical disaster.

Through the miracle of the internet and Match.com I met my husband on the outskirts of Grays Harbor County, 50 miles away. I loved the community and it was where I was most needed; if I had not found my husband, I would still be out there. It could not last after gaining a partner, friend, and husband who needed more than the rural Shoalwater Bay Tribe could offer. We moved to Texas to be closer to my husband's Polish immigrant parents after the arrival of our first child.

I continued in Dorothy's Choctaw spirit of serving those in most need and chose to seek employment with the VA or a tribal-affiliated clinic in the North Texas area. The VA needed me at the time, and that is where I continue to serve with pride. Dorothy's photo continues to sit with me in my office today. My ancestor, Chief Dukes, understood the power of good health after so much had been taken from the Choctaws. He appreciated that if the people did not have their health, they could not rebuild. It was an honor to be a part of the Shoalwater Bay Tribe's growth in taking agency over their healthcare. The Shoalwater Bay Tribe no longer has a high rate of infant mortality, and their health center has improved the overall health of rural Grays Harbor/Pacific County.

Practicing medicine as a PA allowed me to make a difference to those in most need, where physicians typically do not want to relocate. Earning a doctorate has rounded me out as a clinician and honors my Choctaw heritage. My successes honor those who struggled before me. I am very grateful to A.T. Still University's Doctor of Medical Science program, which has honed my skills as a clinician-scholar, made me into a published author of peer-reviewed medical journal articles, and given me tools to improve the health outcomes of my patients. I can better serve those in most need, wherever the spirit leads me.