{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/hh6c24sr7n/manifest","type":"Manifest","label":{"en":["Dr. Julea Garner"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2016-09-09 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Sam Taggart (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["video file"]}},{"label":{"en":["Keyword"]},"value":{"en":["Rural Medicine","Family Medicine","Arkansas","Family Physician"]}},{"label":{"en":["Subject"]},"value":{"en":["Julea Garner, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/293/388/small/JuleaGarnerM.D.DVD.mp4_1759327580.jpg?1759327584","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/161569/file/293388","type":"Canvas","label":{"en":["Media File 1 of 1 - Julea_Garner_M.D._DVD.mp4"]},"duration":6136.96417,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/293/388/small/JuleaGarnerM.D.DVD.mp4_1759327580.jpg?1759327584","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/161569/file/293388/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/161569/file/293388/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/293/388/original/Julea_Garner_M.D._DVD.mp4?1759327557","type":"Video","format":"video/mp4","duration":6136.96417,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/161569/file/293388","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/161569/file/293388/transcript/84866","type":"AnnotationPage","label":{"en":["Dr. Julea Garner Interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/161569/file/293388/transcript/84866/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Interview with Dr. Julea Garner      \n\nGood morning; my name is Sam Taggart.  This is 9/09/16 and we are at the office of The Arkansas Academy of Family Practice in Little Rock, Arkansas.  Today, we are interviewing Dr. Julea Garner who practices in Hardy.\n\n“The actual location is in Highland with an address of Hardy because it is too small.”\n\nToo small, that’s wonderful. \n\nAgain, this is your interview.  What we want to do is talk about your life and your community.  I think we all know that physicians when they go into training receive a certain amount of scientific training and counseling training, but when they get into the community the community molds them into what it wants.  So, we want to talk about Highland, Hardy, Ash Flat, and your community as well as that community in that part of Arkansas.      \n\nLet’s start at the very beginning.  \n\nTell us about when and where you were born and what were the circumstances of your birth.  \n\n“I was born February 1, 1962 in Walnut Ridge, Arkansas.  My parents were living in Biggers, Arkansas and were both educators.  Within about six months, we moved to Highland into the first house that my parents built when I was about six months old.  It is probably about 500 yards from my current clinic.”\n\nHow big of a community is Highland?\n\n“Highland is less than 1,000 people and the nearest town would be Ash Flat in one direction and Hardy is the other.  They are both less than about 1000 people.”\n\nI was about to say several towns around there are all about the same size.\n\n“Cherokee Village is there, which is more of a retirement community, and that’s going to have a little bit larger population.”\n\nWho delivered you, do you know?\n\n“Um, no; I can’t think of that right now.  I can probably come up with that if you want me to.”\n\nTed Lancaster and his group were there and in place.  He wasn’t there, but his/that clinic was there.\n\n‘Yes; no, it wasn’t one of his but I will think of that and give you that name.”    \n\nSo you mentioned that your mother and father were both educators.  Talk about that a little bit.  Were they high school teachers or elementary teachers?\n\n\n“Mom was a first generation college educated and was a junior high and high school English and History teacher.  She taught a lot of Arkansas History.  My dad also first generation, well no actually he wasn’t because my great grandfather was a physician, but he was college educated and played sports.  He went through college on a basketball scholarship, also baseball, and then he was a coach probably until about 1965 or 1966.  He coached for several years in junior high and high school basketball.”\n\nSo you are from Highland, Arkansas?  That’s where you grew up?\n\n“Um, we moved there when I was six months old.  My mother was raised in Hardy and my dad was raised in Ash Flat.  I’m probably about a seventh generation from the Ash Flat area.”\n\nReally; do you know where the family originally came from?\n\n“It came through the North Carolina area and then into; my great grandfather practiced out of Ash Flat, the local ride the horse/buggy doctor, and his family had lived over around Calico.”\n\nWhat was his name and what was his timeframe?\n\n“Roland Garner and, I should have looked all this up before you got here.”\n\nOh no, just tell us about him.\n\n“There is an Ash Flat history book that has all of this in it.”\n\nReally; good.\n\n“My husband helped write that as his family also is about a seventh generation from that area.”\n\nThat’s a long time.\n\n“Yes, we live on his family farm and still have our local family farm.”   \n\nWhat were your parent’s names?\n\n“My mom was Willie Ann Horrell and then my dad was Elijah Lynn Garner.”  \n\nSo, you people have lived in that area for a long time; are there other families who have lived there for the same length of time as you have?\n\n“Um, there are several in the Ash Flat area.  I’m not as familiar with the Hardy area.  My mom’s family moved in there when she was probably about 2-3 years old and they owned a local grocery store.  They ran a truck out to different areas for produce.  They owned a turkey farm in that area for a while, but my great grandfather who they called “Papa Horrell” ran the grocery store and then my granddad took that over and ran that until he pretty much retired and went \n\n\ninto furniture.  They found one of the first furniture stores in the area on the main street of Hardy.  So, that’s where mom grew up.”\n\nObviously, we were well breed in that area.  I think you were the first person that we’ve had that was a seventh generation from one small area.\n\nDid you have brothers and sisters?\n\n“I have one brother, Thomas Lynn Garner.  He is an attorney in the same area.  He is the Duty Prosecutors in Ash Flat and has a local general practice also, both of them kind of part time.  My brother and my dad still own the family farm and run about 400 head of cattle as a side time hobby.”\n\nWhere is your farm located?\n\n“Um, out of Ash Flat; mostly in the Sharp County area, there is a little bit of it in _________ County.  Its west of downtown Ash Flat.” \n\nNow you’re real close to Mammoth Springs and several other small towns that most of the people would recognize; was there anything unusual about that area?  What people did for work?\n\n“Well a little bit of a connection; Mammoth Spring, my great grandfathers’ brother was a physician that practiced in Mammoth Spring.  Then, he had another brother who practiced in Williford.  My great grandfather, Roland Garner, was a physician trained at Washington University in St. Louis and then he had two brothers that practiced, as physicians that were more trained under him, one in Mammoth and one in Williford.”\n\nBy “trained under him” you mean they just apprenticed?\n\n“I haven’t been able to find the details to know where and if they went to school.  I know they did a lot of training with him before they practiced; so, they may have done a couple of years, but I haven’t been able to track that down.”\n\nDid I hear you mention that somebody on your mother’s side of the family also practiced medicine?\n\n“No.”\n\nThat was just all on your father’s side.\n\n“All on my father’s side.”   \n\nI’d love to see a family tree.  Is it in that book?\n\n\n\n“There is a good portion of it that is in the book.  My husband is well into genealogy and he has pictures of all these people, dates and where they were, and that sort of thing.”\n\nWhat is your husband’s name and what kind of work does he do?\n\n“He is Brian Nix Hall; Nix was the family name for him for the seventh generation around there and we were both educated at Arkansas College, which is now Lyon College in Batesville.  He then went to Duke and got a Masters in Theology and then has a Masters in Social Work with emphasis in Counseling.  He did a tour in Oxford and Israel during that.”  \n\nWhat does your husband do?\n\n“He is retired at this point as he has some physical disabilities.”\n\nTalk a little bit about some of your first memories of your childhood, a little kid growing up in a small rural community in north central Arkansas.  \n\n“We lived in the house that I mention is not far from the practice and it was one of the very first in that area.  Highland consolidated a school, Ash Flat and Hardy, to Highland and our house was built across from the school about 1-2 years before that consolidation happened.  Before that, we were one of maybe two to three houses in a few miles.  That was a rocky build and we did a lot of land; as a child what I remember is picking up rocks and copperheads and things like that.  My grandparents both lived close.  My mom’s parents built a house right next to ours and then my dad’s family in Ash Flat was out on the farm.  That was the big part of life, spending a lot of time with both places either on the farm or down in the grocery store.”\n\nSo you have a substantial extended family and spent a lot of time with them.\n\n“Yes; I grew up with grandparents real close.”\n\nWhere was the grocery store?\n\n“The grocery store was on Main Street in Hardy.”\n\nWho were your best friends when you were growing up?\n\n“My brother, 2 ½ years older than I am, because we were rural enough that there were no other kids around to play with.  My cousins came occasionally, but they lived off; so, growing up it was my brother who was my best friend.  As I got older, my mother was my best friend.  Because we continued to live rural and going to school, by the time I was going to school, my mother was teaching in Salem, which is in Fulton County and we were living in Horseshoe Bend, which was developed by some of my family, and my dad had quit coaching and moved to there.”\n\nWhat the relationship between Horseshoe Bend and Cherokee Village?\n\n\n“There is no relationship other than they are both developed retirement communities.  Horseshoe Bend was developed by Dick and Bill Pratt, Richard and William Pratt out of Newport.  Richard Pratt married my dad’s sister and so that was a connection and then dad started selling real estate there.  It was very rural at the time and started with just a log cabin on Strawberry River and started buying land and developed that.  We lived in Horseshoe by the time I was about 6 years old.  It was still rural and had to drive a distance to catch a school bus to get to the school.  Mom taught, so we rode back and forth with her.  School activities were few and far between as we were several miles from school.”\n\nDid religion play a big role in your childhood?   \n\n“Yes, we grew up in the Southern Baptist Church and that was a big piece in gathering with the community, what church used to be, a lot more community association.  My mom’s side of the family was Catholic and her great aunts were sisters and nuns that helped develop the Catholic Church that is located in Highland and also were a big part in developing St. Barnard’s Hospital in the community there in the Catholics.”  \n\nSo a little unusual, up and outside of the Arkansas River Valley, that you get a catholic population. \n\n“Yeah, it wasn’t a real large Catholic population, but that was a family that had moved in.  My mom’s family was one that as her granddad brought the family in and then the sisters located somewhere there and was assigned to help start that church.  But then, they were out of Jonesboro, which is where St. Barnard’s is and helped develop part of that.”   \n\nSo you lived close to the river right; Strawberry River and fairly close to the Spring River? \n\n“The Spring River is in Hardy, which from my actual house is 20 minutes, and Strawberry River kind of runs through and around Ash Flat, the Horseshoe Bend area.”\n\nDid those rivers play a big role in your life?\n\n“Mom had grown up on the Spring River; so as my brother and I were growing up and lived in Highland, that’s where we used to go and swim and play.”\n\nDo you ever canoe the Spring?\n\n“It’s been a long time since I have; but when we were little, we did.  By the time we were moving to Horseshoe and I was a little older, we were more in that direction and just didn’t as much.”\n\nEither as a young child or when in school, did you have any areas that really caught your interests; things you really enjoyed or were really interested in reading about?  Science or anything like that?\n\n\n“Probably the biggest thing when I started school was that I was with a lot of other kids and we could play, which was being rural I didn’t have that opportunity; so that was big to me.  I went to school to play and education was beside the point.  It was fun and I liked working puzzles, so math was fun.  Science was interesting.  Mom was an English teacher, so that was second nature.  We grew up being corrected with our grammar from early on.” \n\nSo that was the first time I heard that connection about working puzzles and math.   You obviously made that connection early on.\n\n“Yes.”\n\nThat is interesting.  Did you do well in school?\n\n “Yes; I graduated 12 years straight “As.”  I found out once I got into medical school that I’m partially dyslexic, which I inherited, and that played some role but obviously not as big a role as it might have.”   \n\nWere you expected to do well in school with school teachers as parents?\n\n“Um, it wasn’t pushed; it came natural and easy.  I was never in the expectation or felt like I had to do it for somebody else.  I was competitive and that was where I was competitive.  I was not athletic at all and that was not where I was competitive.  My dad being an athlete, my mom an athlete, and my brother was; but, my coordination did not connect.  So, academics were my area.”    \n\nTalk about your first 6-8 years in school, your childhood or adolescent years.  Were there teachers who had a big impact on you? \n\n“Um, grade school was fun.  I had excellent teachers.  People that were part of the community knew the kids and cared.  Portably the biggest impact was my third grade teacher; Patricia Bacout.  It was all about playing, working as hard as you can, and work all day long; we had no homework.  But, we worked hard and she worked hard keeping up to do that and that had a big impact for me.  Whatever we were doing, it could be fun.  You could learn with games and be fun and she or it really excelled me.”    \n\nWhen you were a child did you work?  You mentioned picking up rocks, my version of that in the Delta was picking up chunks of new granite as picking up rocks.  So did you work as a child or did everybody work when you were a child?\n\n“It was more of everybody did their part around the house.  By the time I was big enough, I was helping clean up the kitchen and then learned to make cookies, cook, or whatever momma did.  I was expected to help her, so whether it was cleaning house or whatever.  Did I work outside the house, no; it was more work inside the home with whatever mom did.”    \n\n\nYou grew up in the ‘60s, right?\n\n“Uh huh.”\n\nDo you remember much about the impact of the Vietnam War as that would have been right about the time you were becoming conscience of things.\n\n“About the only thing I can remember is about it being on the news.  My parents watched the news every night and that was a big part of what was on the news every night; what was happening and where it was.  I knew where Vietnam was as we had maps because mom taught history.  I had a little understanding of what was happening, probably not exactly what the war was about, but the understanding of people going and not coming back.  I did understand that.”   \n\nYou already described at least three members of your family that were physicians, ok; were any of those still alive and functioning when you were coming up?\n\n“No.”\n\nThey had all passed away.\n\n“My great grandfather had died in the early 1900s.”\n\nDo you remember when you began to thinking about what you might want to do, a smart person making good grades, with your life when you became an adult?\n\n“Oh, probably about junior high; I began to resonate what people did to make a living and what they did with life.  I didn’t immediately gravitate to medicine.  I remember thinking accounting, because I liked Math.  I remember thinking teaching because that’s what my parents done and as I got into high school and enjoyed science and math, really algebra was fun and easy; I went into trigonometry and it just began to be medicine coming to the forefront.”\n\nHow big was your school?\n\n“The class I graduated in was about 70 and the total school was about 800.”     \n\nAnd that was?\n\n“Salem, I did all twelve years there.”\n\nWhen did you meet your husband?  Was it in high school?\n\n“No, my husband is about 7 ½ years young than I am.  The house he grew up in and where I grew up; we moved into in junior high, are about 8 miles from each other.  We knew the families, but I didn’t know him until he had done all of his education and I had done mine.  I moved home to be with family and he did the same and that’s when we met.  We met at a funeral of a lady who has said that she was going to find each of us a partner.”    \n\n\nAt some point during this process, it sounds like you had several options open to you about what you were going to end up doing, but what was it that informed your decision about where you were going to go to college; obviously you were going to college, but what informed your decision on where you were going to go?\n\n“Um, kind of a little bit of a convoluted; when I began to figure that I needed to be in college and had to do that, with the three years and the eight years to go into medicine, probably was about my 10-11th grade in high school.  I looked at Oral Roberts University and there was the tennis coach there that had been there long term and who grew up in Hardy and played college ball with my dad.  He was my mom and dad’s age and so was a friend of my mom’s growing up.  He encouraged me to come there because they did the straight eight years and I did my first semester there.”\n\nStraight eight, you mean college and medical school?\n\n“And medical school; that’s how Oral Roberts was doing it then.  I did my first semester there and being a country girl got homesick.  My parents had both graduated from Arkansas College, which is now Lyon College.  My brother had gone to Beebe for two years and went to ASU.  He was probably bored because he didn’t have to go to class to make grades; he could show up and take the test.  So close to the end of my semester, on a phone call, we both decided that we would move home and go to Arkansas College, which we had both looked at, both talked about, and so we ended up there; he in his junior year and me in my freshman.”  \n\nWhat year did you graduate high school?\n\n“1980.” \n\nSo you started college in 1980; that’s interesting.\n\nTalk about going to Aransas College.  \n\n“Both of us moved and lived together there.  Arkansas College was perfect for me as it was small with small classes; lots of expectation.  At the time, I didn’t know I was dyslexic and a lot of our exams were either written or oral and that was just right down my alley.  But if I didn’t show up for class, somebody would call me wondering where I was; so, it was that.  A small community college with pretty high expectations.”   \n\nHow big a school was it?\n\n“I believe it was about 400-600 at that point.  There were a lot of commuters and a lot of local people.   My husband attended there after he graduated high school several years later.  It was known at the time for getting people into medical school; they had and still do have 100% rate.  So that was part of it and it was close to home.”\n\n\nWhen you went off to college, whether it was going to be Oral Roberts or Arkansas College, who paid for your college?\n\n“Um, scholarships paid for part of it and then my parents paid for part of it.  My dad took me to the bank and signed a note that had my name on, which was quite a good education.  I could borrow whatever I wanted and I was the one who had to pay it back.  Most of it was scholarship; I did some work programs and scholarship.  Going out of state to OR University, I lost all of my state help that I would have gotten through assistance.  I didn’t get the state, I got academic scholarships through Arkansas College and my brother and I, both, were the first in our community to do the guaranteed student loan; the banks had not done that where we were and we were the guinea pigs for that, we did the guaranteed student loan.” \n\nLet’s talk a little bit about your college years.  Let’s talk about some of the people who taught you during school and the impact it had on you; it can be teachers or other people like: preachers, parents, or family members.\n\n“My parents had a big impact on wanting my brother and I both to be educated.  They didn’t really care what we did, but they wanted us to be educated to be able to make a living.  Their generation, that’s what it meant; have an education, college education, to be able to make a living.  In college, there were 2-3 professors that did have a big impact.  Roberts Buston was a chemistry teacher, just was an absolutely wonderful person, very encouraging for education in science.  She worked at NASA part of the time and brought a lot of that in; science was bigger than we had realized.  She was very encouraging foe me to go to medical school.  The others who had a big impact was Charles Oliver, he was a literature teacher and taught Bible.  He had a very open mind and open personality for the world.  I got to spend a lot of time in his office learning about life outside the classroom.  Terryl Tibbits was another English teacher that had a big impact on me and on my brother.  As far as the education, what’s out in the world, and expansion of that, Charles Oliver was a Presbyterian Minister and opened up the religion world and what religion is as well as education about the difference in religions; that was fascinating to me.  Arkansas College offered at the time traveling abroad and my brother and I, both separately, did trips through them to England.  I was able to do a trip to Austria, where Arkansas College sponsored high school students and I was a counselor for that.  I lived in Austria one spring and summer.  I got some college education hours and didn’t really need that, but the education of living with a family that didn’t speak real good English and in a whole different world was fascinating.  That family and their home had been through WWII and when I first got there, they had all these newspapers as they had run a series before I got there about WWII.  The family each night would bring out a piece and wanted to know what my education was about WWII and their lives.  It was fascinating what I had been taught and what they actually lived.”       \n\nDid they speak German or French?\n\n\n“They spoke German.  I learned to count to 10 in German on my way over there; that’s how much German I had.  So, it was a fun time.  I lived off campus and was a commuter, but I lived within walking distance of campus.  My brother stayed with me a good portion of the time.  We drove back and forth every weekend and he drove back and forth most every day if he wasn’t staying with me.  So, we spent a lot of time around family and around home even while we were in college.”     \n\nWhat was your brother majoring in?\n\n“He majored in English and another in law school after that.” \n\nWhat part did you start thinking seriously about going to medical school and what you were going to do with the rest of your life?  \n\n“Um, when I was in junior and senior high in high school; I began to think I wanted to be a physician.  At the time, I thought I wanted to be a pediatrician.  The only thing I really knew was family doctors, or back then general practitioners.  As I got into college, that was my goal.  I majored in Biology and had extra math in chemistry on the side, but that was my goal to go to medical school at that point.  By the time I was 2nd or 3rd year, that was my goal.  I tried to get in after my junior year and the good Lord was watching out for me and I didn’t get in, but I was pretty much completed by then.  But that was my goal, to get into medical school.”\n\nWhat was your degree in?\n\n“Major was Biology and then a Minor in Math; chemistry.”\n\nSo you’re a Math and Biology type person?\n\n“I’m that side of the brain.  Because my senior year I didn’t have to have many credits, that’s when I took Shakespeare and took some fun stuff.  I took business courses and that sort of thing.”\n\nDid you happen to run into Andrea Buie while you were there?\n\n“No.”\n\nShe is a wonderful poet who taught at Arkansas University.  \n\nDid Dr. Al Hathcock ever come by campus when you were there?\n\n“Uh, no; I know of him, but ….”\n\nHe’s an orthopedist from Fort Smith.  His dad was a family doctor I think in Batesville.\n\n“Yes and his son graduated with me in medical school.”\n\n\nHe did?  His name was…….Hathcock’s son, what was his name?\n\n“Steve.”\n\nYeah, Steve was a character.\n\n“Yes; yes, he was a character.”    \n\nWhat informed your decision on where you were going to go to medical school?\n\n“I don’t think I really considered much beyond Arkansas as that was where I wanted to go.  When I got to the application process, the year that I got in, I had applied to Vanderbilt, George Washington, and several different places.  I got interviews for those and when I got an early acceptance for Arkansas, I cancelled the interviews and cancelled anything else.  Arkansas was where I wanted to go.”\n\nYou eluded to this a minute or so ago, but along this process going from a small town of Highland and Salem to Oklahoma then back to Batesville and going to medical school, were  there any crises along the way that pushed you in one direction or another?\n\n“As far as where I went to school?”\n\nAny crises that might have changed what you wanted to do with life; deaths in the family, changes in the family structure, or anything like that that might have modified what you would have done with your life?\n\n“I can’t think of any.”\n\n So, you graduated from college when?\n\n“1984.”\n\nAnd you started medical school when?\n\n“I spent a year out; spent time with family, traveled, worked in a hospital; everything from cleaning floors to collecting money.”\n\nWhere did you work in a hospital?\n\n“I worked in Cherokee Village, which is closed now, but it was a small rural hospital at the time.”\n\nHow big a facility?\n\n“Um, I think they probably had about 20 beds.”\n\nDid that experience have any impact on you as to what you thought about medicine, what you expected out of medicine, or what you thought you would ultimately do in medicine?  \n\n\n“I think it did.  Probably the biggest impact that it had was working in the position of a non-physician.  I have a great deal of respect for the people who actually make the hospital run.  Physicians walk in, write orders, take care of patients, and make decisions; but to learn what the ward clerks do, what the nurses do on the floor, what the cleaning people do, learn what coding means to collect insurance, and to understand how people struggle to pay and you have to collect from them all had a huge impact on my view of the overall process as I went through on what my role was and could be or should be as a physician in a setting of a clinic or hospital.”    \n\nSo, what year did you start medical school?\n\n“I started medical school in the fall or somewhere of 1985.  I graduated in 1989.”\n\nWe always have to talk about the first year of medical school.  What was it like for you?\n\n“Well, it was quite an eye opener to cover a semesters worth of education in about 3-4 weeks and take a test.  Somebody who was used to reading slow and going through everything in detail a couple of times before I did it, that was not an option so there was struggle in that and part of it with “What have I gotten into?” and “Can I do this?” from somebody who had made straight “As” all the way through school and made probably 5 “Bs” in college, one being P.E. Medical school was a challenge for me.  That first year was a struggle and I was very determined that they would have to kick me out or I’d get through it.”\n\nWhen did you find out you were dyslexic?\n\n“I actually found out I had it when I rotated in psychiatry as a junior.  Once we did some things, one of the professors noticed it and asked me to do some testing and that’s when I did the testing and I knew immediately when he told me what it was; my dad was exactly like that.”\n\nWas it shocking?\n\n“Um, no; I was a straight “A” student, but a slow reader and never really quite understood why and tried to correct that just out of timeframe.  So, when they tested me and could show it to me, I was like, “Ok, I get it” and by then, I had compensated for it in lots of different ways.  I did a lot of oral presentations instead of written presentations if I could.  I never missed a class because listening was where I learned and reading was much more difficult; I could do it, but it just took me longer.  If I went to class and listened and took very few notes as that meant I had to not listen and write, so most of mine was done like that.  My compensation has been helpful as when I hit floors as a junior and I would take a patient history and then come back out and give it back to you, it was a piece of cake.  Yeah, that was….”          \n\nLets back up on subject altogether, not altogether different but maybe a different view, as a female were there any obstacles to you either in high school to college or college to medical school, that were not there for your male colleagues?\n\n“Um, I don’t think I noticed that until I go into medical school and I don’t think I noticed it much in the first two years.  Our class was about 1/3 female.  My classmates didn’t seem to make a big difference in that; I think we were all of the same generation and that was a little different.  When I hit my junior year, there was a huge difference.  The University Hospital was not ready for women.  Anyplace where we had to change for scrubs or anything for surgery, I would be with the nurses and the guys were with physicians.  There weren’t very many female physicians at the time in the training process, so the education piece that went on through that process, I was not a part of.  There was a piece of it where the nurses took care of us because they were happy to see females come through, but that was when it began to be a difference.  The training for us, as we went through some of the rotations, you could tell that some of the older physicians were comfortable and some were very uncomfortable with it. Probably the strongest statement that I was ever part of, even after I had graduated, was that I should have been married and stayed at home to raise babies and left the physician world alone.”\n\nWas this another physician saying this?\n\n“Yes, an obstetrician.  But for me, my attitude was my own.  I was there to learn and their attitude was their problem, not mine.  I didn’t have a lot of bad experiences.  I enjoyed going though medical school.  Residency was the highlight for me.  I was in a residency that was half male/half female and was very strong personalitied females.  The residents got along incredibly well and with the faculty.”         \n\nDid you have any, before we get too far into your residency, role models when you were in medical school?  You said there were very few women teachers at that point.\n\n“Um; for women role models I can’t go back and name one.  Well, there were a couple; I should back up on that.  Jeannie Heard was an internal medicine resident who was a good role model.”\n\nShe was a good friend.\n\n“Yes, she is an excellent physician and was a very good role model.  She was young in the process, but well grounded.  Her attitude was similar to mine that that was not a place for me to focus.  The other person that was at the University at the time was Nancy Snyderman and Nancy was in the Ear, Nose, and Throat.  I rotated in surgery with her and she was a role model in that she was happy, pleasant, sharp, and when she walked into the OR it was fun, but it was all business and she could do her job well; that was a big piece for a young female coming through medical school to see.  She was on the top of her game, but she put herself there.  She had worked all the way up to get there and she was a good role model.”  \n\n What about the second two years of medical school?  Do you have any significant memories, good or bad, about either the academics or the physical act of learning to be a doctor?\n\n“The first two years were more of a struggle for me.  When I hit the floor as a junior, it was like I had found what I was going to do.  It was a lot easier, it was fun, and I enjoyed the patients.  \n\n\nThe learning of the first two years really began to pull together when you did physicals on patients and listened to them.  I am the true family doctor in that I’m very curious about people and talking histories was enjoyable and fun; that really hit for me.  When I went through the senior year, it was pick and choose the rotations and I did some stuff that I felt it was; at the point in my junior year, I knew that family medicine was what I wanted to do and I had worked in the family medicine department at the end of my first year and that had a big influence.  Kent Davidson and Arlo Kahn were both physicians that I did a project with; it was oat bran and cholesterol.  It was one of the first papers published that came out and proved that oat bran would lower cholesterol.  I was allowed to be in the clinic, they taught me to draw blood, they allowed me to see patients with them, I did carry muffin, picked up things, and did lots of things that…..”      \n\nThis was the end of your freshman year?\n\n“The end of my freshman year, I needed a job and Kent had done a presentation and I went over and said, “I’m finishing my first year and I need a job. What do you have?” and he said, “I don’t have anything.”  Then a week later, he called me back and said, “If you’re willing to do this, we’ve got money to pay you to be over here.”  So, that had a big influence and my junior year, I knew that was what I wanted to do.  So when I hit the floors, my mind was learn as much as I could, learn in each rotation to know what to do as a family physician in that respect, and then my senior year was just a lot of fun.”    \n\nWhat all did you do your senior year?  What electives did you take your senior year?\n\n“Um, we took the standard that I had to there.  I took an elective in Charleston, South Carolina and worked in the emergency room just because I thought it would be fun.  I thought at the time the Carolinas was where I wanted to do my residency program because it was strong AHEC base.  Then, I rotated; one of the ones that has stuck out and been so helpful to me, was I rotated with Harley Harbor, a psychiatrist/addictionologist that ran Bridgeway here in Little Rock for years.  His family grew up close to mine and I called him and said, “I don’t know anything about addiction, they have not taught us anything about addiction, I didn’t grow up in it, and I know that I’m going to be at the front line to see it. I need to know at least where to send these people.”  I spent a month with him at Bridgeway and he ran me through much like as a patient and that has had a huge impact on my education as a family physician; the recognition of addiction and what is out there.”    \n\nYou started talking about where you were going to end up doing your residency.  Let’s discuss that process just like we did about medical school.  What informed your decision about where you would go, where you ended up, and that kind of thing? \n\n“Um; after my first year in medical school when I worked in the family medicine department and was very certain at that point that that was what I wanted to do, I joined the Arkansas Academy \n\n\nof Family Physicians. I became the student on the board and served on the Board for the Arkansas Academy of family Physicians For the Student and was active in the Family Medicine Interest Group for three years and helped develop some things in that and when it came to be to the residency piece, I had always thought I would do it in Arkansas.  During my junior year with help of a local family physician, Harold Hedges was running a program and I kind of went through as a guinea pig for Medifast, which was a weight loss program.  I lost over 120 lbs and it had a huge impact on me as I had been morbidly obese most of my life.  At that point, I wasn’t but because it was well known in the hospital that this was an experiment, I was “the girl who has lost all the weight.”  So as I finished, I started looking outside of Arkansas to just experiment being outside and not being labeled here.  I interviewed in Arkansas, in Tennessee, in North and South Carolina, in Pennsylvania, and West Virginia.  I ended up in Harrisburg, Pennsylvania, which was my first choice, and my second choice was an Arkansas program and I didn’t go beyond that; those were my two choices.”   \n\nTalk a little bit about moving off to Harrisburg, Pennsylvania.\n\n“Um, that was a little bit scary.  My parents had made it available for me to travel like I did through Arkansas College and I had interviewed there.  I had been to the student resident meeting in Kansas City for Family Medicine and had met a resident and some colleagues there that were recruiting.  The program sounded interesting because it was a private hospital based residency program.  Family Medicine was the dominant residency in the hospital.  There was also internal medicine and then the specialist from Hershey rotated through in surgery, OB, ER, internal medicine; it was their bread and butter.  I liked that setting, but the residents I resonated with, like I said it was about half and half male and female; they were on target with what they were doing and it was a residency program that was well up to date.  They had two clinics; one was in the city of Harrisburg and the other was in a rural community outside of there.  That was very attractive to me to be able to practice my three years in a rural community clinic.  The first year, we did in the city and then the last two years were in the rural area.”      \n\nWhat years would this have been?\n\n“I graduated in ’89 from medical school and graduated from residency in ’92 in Pennsylvania.”\n\nWas there any possibility that you would have ended up in Pennsylvania?\n\n“Um, I don’t think I ever really considered that.  I was well grounded in Arkansas and when I graduated from residency, I think I was like many of the residents and not really sure what I wanted to do or how I wanted to do it and the confidence of going to a rural community by myself or with one or two others I think frightened me a little bit.  I just wasn’t settled enough to do that.  When I actually graduated, I didn’t have a job and it wasn’t real concerning because I knew as a family physician, I could get a job pretty much anywhere.  I moonlighted a lot, which \n\n\nwas available to us back then and I worked in a lot of different family medicine clinics moonlighting.”       \n\nWhere were you living at that time?\n\n“In Harrisburg.”\n\nSo you stayed up there for a while?\n\n“Well no, that was during residency.  I stayed up there for about three months and got my pilot’s license.  I was finishing up; I started that, I was the Chief Resident during my third year and one of the faculty took the other Chief and I on a flight.  He was getting his instrument ready and I fell in love with that and decided during my third year, I started taking flying lessons.  It was something totally out of medicine and when I walked into the small airport in a pair of over-alls and a t-shirt nobody knew who I was or what I was doing; I was just there learning how to fly.”  \n\nSo, do you still fly?\n\n“I do not.  I haven’t flown since about 1994 or ’95.  I haven’t been the pilot in command, no.  I have been up, but not the pilot.  I’m a big believer that if you don’t do it on a regular basis, you don’t need to be the one in charge of it.  So, at that point, I had moved to Kansas City and that was not an option for me.”\n\nSo, you were in Harrisburg, Pennsylvania and from there to where?\n\n“My first job was at Jonesboro with the AHEC system, I was full time faculty.  I was there for two years.  I moved there after I graduated my residency in ’92 at the end of July and started there in October.”   \n\nDid you enjoy your teaching?\n\n“I did.  I really do enjoy teaching. I think that was kind of part of the nature of going through residency and being Chief Resident was working with others and teaching.  Probably the biggest teaching is with the patients, that’s one of the reasons I have enjoyed Family Medicine is time to do that, and then working with the residents and the medical students coming through.  I really enjoyed that.”             \n\nDid you end up with a lot of debt after medical school and college?\n\n“Um, when I graduated medical school, I owed $120,000 and part of that was a Rural Scholarship Program in Arkansas, but because I went to a residency program I had to pay that back and actually went through legislature and some process to help if somebody came back \n\n\n\nand went through a residency program because they are training, Family physicians, if they go through a rural residency program in Arkansas to help get some of that back.”\n\nSo they would only pay it back if you went to a rural residency program in Arkansas?\n\n“No, I had to go into practice in a rural area of less than 10,000 people in Arkansas in order for it to be forgiven and I had to be there a full year.  I think the rules of that have changed a little bit now.  But, I was at the residency program for two years and then went to Kansas City.”\n\nDid they help you pay back some of that debt?\n\n“No.”\n\nThey did not.   \n\n“No, they did not.”\n\nSo, let’s talk about Kansas City.   \n\n“Um, that was an interesting and really fun job and how I got it was real interesting.  The job became available for the Assistant Director for Education for Family Medicine for the Nation and because while I was in Pennsylvania I had been the Resident on the Board in the Pennsylvania Academy of  Family Physicians for a year.  I was involved in the structure and politics of Family Medicine there and I got 2 or 3 phone calls when the letter went out for applications left on my answering machine saying, “Hey Garner, this sounds like you; you ought to apply.”  I didn’t really consider it, but I thought, “Well, I’ll check into it” and called what became my boss and said, “Can I live in Arkansas and do this job or does it have a lot of travel in it?” and he said, “No.”  I said, “Thank you very much, I’m not interested.  I want to stay in Arkansas.”  About a month or two after that, I had an uncle die in California and my brother needed to help my aunt with some legal issues and I took the opportunity to fly out with him.  On the way back, we couldn’t sit together and couldn’t rearrange that.  So, I sat in the middle seat with the number one person to my left and the number two person to my right for human resources for the American Academy of Family Physicians; so they interviewed me from San Francisco to Dallas.”\n\nSo that was just happen chance?     \n\n“Just happen chance; when I got home, the director of education called me and said, “you have been interviewed whether you knew it or not and we want you to put in an application.” So, I did and I ended up getting the job.  I moved to Kansas City in the fall of 1994 and stayed until; I moved back to Arkansas in January or February of ’99, but continued to work for them part time until they had somebody to replace me which was the fall of ’99.”  \n\nWhat did you do at your job?\n\n\n“As the Assistant Director of Education at that time, I was primarily responsible for most of the activities nationwide for medical students and residents; not the residency piece, but the interaction with the Academy of Family Medicine.  We were kind of in charge from family medicine groups nationwide to give support.  We did the meeting that was in Kansas City that’s for medical students and residents.  We helped with the strolling thought the match, something that had been developed before I got there and then I perpetuated that a lot and had a match to go through to get into family medicine, and then the educational piece and staffed a lot.  There were five physicians on the staff and we had probably 300 at the time; I was one of those physicians.  I had the opportunity to travel nationwide and had about 100 planes a year.  I spoke at places like Harvard that are not real friendly to family medicine, but was able to interact with family physicians all over the nation and with medical students on their structure with the politics that they have an entire structure that they have delegates that go to the national congress and they have an association both with __________ and I was kind of the mediator to keep that going during the year.”      \n\nSo you have a very almost unique view of where Arkansas education and Arkansas Family Practice stands in national family practices.\n\n“Yes; that was a real fun piece.  Our university education for medical school was very good when I began to match it with others.  You always think you don’t know as much, but when I went through the residency program and delivered my first baby as an intern, the OBGYN took me to the side and said, “Where did you learn to deliver and where did you learn to sow up an episiotomy?” and I was scared to death because I thought I had done something wrong and he had never seen an intern who came in that had been trained in that.  Arkansas gave us a lot of training that we didn’t realize; partially because we were able to rotate with some of the rural physicians and work at that time as medical students.  The residency training in rural Arkansas pretty much matches the nation and the education family medicine interest group at the time was well in tune.  Rural state family medicine was high, so it was interesting to see…”\n\nWhat’s the scope of family practice here compared to family practice in other rural states in the nation?\n\n“I think in rural states probably comparable.  We are probably a little more close knit.  Our academy, Arkansas Academy, has maintained that and keeps us well connected with each other and the outside world.  It’s not so much in some of the other rural states.  It has a lot to do with how the state academy is run and how interested the family doctors are and our executive, Carla Cummin, has made a big difference in that.  But, Arkansas physicians have rationally volunteered to be on the board and keep Arkansas on the forefront whether it is legislature or whether it’s keeping up with what’s going on with the nation in education.”         \n\n\n\nWhat about the scope of practice in certain parts of the country; some family physicians don’t do OB and some areas they do surgery and some areas they don’t.  What about in those terms?\n\n“Um, Arkansas scope has been very broad in that we have had physicians that have continued to do OB, we have physicians who have continued to do some surgery; nationwide that has changed a lot.  Hospitalists coming through, a lot of the litigation has changed some of that.  Hospitals don’t give privileges quite as much, but Arkansas is still probably one of the top that is going to have deliveries and that sort of thing.  The rural states; when you go rural to like Alaska, which I had the opportunity to work in at one point during my residency, their scope is also changed.  They do a lot in the rural, but because of the ability to be able to fly people into Anchorage, that has changed some.  Arkansas probably, and this is probably just an opinion, but I’d say we are still on the forefront of that larger scope of practice.”  \n\nGood.  So, you were with the Academy for five years and then what?\n\n“Uh huh, then I moved home.” \n\nWhat informed that decision?\n\n“The job that I took, I took it with the idea that I would do it for 4-5 years.  My goal was always to get back to home and family has a lot to do with that.  When I begin to get toward the end, that was always my goal; to move back to Arkansas.  I liked education; but because of where we are, any residency program or medical school is an hour to three hours away.  So, my option was private practice and that’s what I did.” \n\nWhat was the most important thing that pulled you back to Arkansas?\n\n“Family; being close to my parents.  I was raised, like I said, a very close family.  Grandparents were close and that was the emphasis to move home.”\n\nLet’s switch gears here a little bit; at some point, you got married.  When did this all start?\n\n“After I moved home; I moved home in ’99.  I worked for the academy until the fall of ’99 and started building the clinic.  The clinic was built by my dad and a couple of partners that built the building.  St. Barnard’s out of Jonesboro rented the space and put the clinic in and I was an employee of theirs.  I had worked about a year…..”\n\nHow far are you from St. Barnard’s?\n\n“It takes about an hour and 15 minutes to get there.  I was one of their outlying clinics.  We are an equal distance from St. Barnard’s, Baxter region in Mt. Home, and White River in Batesville.  It’s probably 10-15 minutes in driving to any one of those.  After I had been in practice for about a year, I had trained in a residency program that had nurse practitioners, physician’s \n\n\nassistants, and psychologists .  The psychologists provided therapy for the patients in the residency program, so I had a scope that that was very beneficial to the patients and very beneficial to me as a physician in practice to have somebody do therapy with patients. In a rural area, that’s difficult; behavioral med is not available like we would like for it to be.  So when I met my husband at the funeral that he did, I knew who he was and knew the family where he was from, and just asked him, as I had heard that was what he was doing; he at the time was working for St. Barnard’s in their radiology/oncology.  He had been their office manager and then had moved into a therapist, so they had all of their cancer patients and their families see a therapist as they went through, which is a phenomenal idea.  When I found out that was what he was doing, he asked me what I was doing, and we walked about it and I had been looking for a therapist that would at least do part time in the clinic.  He, in the same time frame that I had moved home, had sold a house in Jonesboro and moved back home to live with his grandmother and take care of her; so, he was traveling back and forth to Jonesboro with an efficiency and that perked him up that he could spend some time at home.  So, that was where we got together and the overall system that I was working for and he was working for and began to put that together.  We started dating before they got the contract there.”\n\nWhat year was it that you met your husband?\n\n“I opened the clinic in May 2000 and then, he and I met in August of 2001.”\n\nSo, you have already described your father as a jack of all trades anyway, but he built the clinic?\n\n“Yes, my father had a Master’s degree in education and coached.  Then, he sold real estate for several years in Horseshoe Bend and then, became, at one point he was president, but the manager for the sales force over there.  He continued to farm and cattle; he had Herefords and then, he and my brother got into Simmental cattle, but now I think it pretty much is back into the Herefords even though they still have some of the Simmental.  He has always done a lot of buying and selling of real estate and so when we were looking for a place for the clinic, he and I drove the stretch between Ash Flat and Hardy in one day 3-4 times looked for a place to put the clinic, looking for the best place, and I picked out the spot and it wasn’t available; but within a month it became available and that’s where we bought.  St. Barnard’s didn’t want to own the clinic, so he said, “Fine.”  He and his business partners that had bought the property built the clinic.”     \n\nDid the folks from St. Barnard’s help you set up the practice in terms of charging, billing, chart systems, and those kinds of things?\n\n“I was an employee.  I was an employed physician by the time it opened, so they set everything up.  The agreement at the time; Mr. Ben Owens was the Chair CEO of St. Barnard’s at the time and he had gone to school with my father at Arkansas College, but he and I kind of had a hand \n\n\nshake agreement that after about 4-5 years, I could probably buy the practice.  For them, that was a good option because they still had a little bit of a friendly face out there but they were not running it.  Being so far away from them, I pretty much ran the practice; but they helped me a lot and taught me a lot.  So when we hit that 5 year point, I got a phone call asking, “Do you want it?  We are ready to sell.”   \n\nSo you were the hiring and firing agent as well?\n\n“Pretty much, they actually pretty much just did what; if I need to hire somebody, I’m the one who did the interviews.  They did the background checks and that sort of thing, but I did the interviews and made the selection.  If we needed to get somebody to leave, I would be the one who…”\n\nWhat was your clinic called?\n\n“Garner Family Medical Clinic.”\n\nWhat was the employee pool like when you went to start hiring people out in the country?\n\n“Um, actually very good; a lot of people trained and having to drive an hour to work.  So, we had a lot of applicants for interviews.  Because I was a hometown girl coming back in, people knew me and my family; so that was a benefit or maybe a detriment in some.”\n\nI think I know the answer to this question, but I’m going to ask it anyway; was there any hesitation or did you sense any hesitation from people in your community as you as a female physician?\n\n“Um, I don’t think so.  I don’t know that I noticed any hesitation.  I opened the clinic in the time that female physicians were highly sought after and knowing that the person in the household that makes the decision is the mother, wife, or female, putting a female physician in that area was something that was welcomed.  There had been a female physician there that had stayed a year or two that was not from the area.  Cherokee hospital had several doctors that kind of came and went; so there was one that had been there, but not while I was there.  There was one that moved in after I did that stayed a year or two and then left.”\n\nDid you do any hospital practice when you first went in?\n\n“I did not; I did not.”\n\nWas Cherokee Village Hospital still open?\n\n“Yes; it was at that time.  I just made the decision because I had been administrator for five years.  I had volunteered and saw patients in Kansas City in a clinic at night that was for people who couldn’t afford insurance, but made too much to have assistance; so I had kept my clinical \n\n\nskills, sort of, and at the time of opening the clinic, I wanted to get back and make sure my clinical skills were good and I didn’t want to go back to the hospital and stretch myself out.  So, I didn’t do hospital and I didn’t do nursing home when I opened.”    \n\nWhere there other physicians in the say 5-10 mile radius where you were practicing?\n\n“Yes, there was a family physician at the time working for White River that had been a young family physician when I worked in the hospital as a general flunky and then there were two internists that had moved in that worked in the hospital.  White River, not long after I was there, hired another family physician and there was a general practitioner in Ash Flat at the time.” \n\nDo you have any partners now?\n\n“I don’t not; I have a nurse practitioner that works with me, but I am still solo.”\n\nSo when you went to practice in Highland, I’m trying to add up the number of years, you must have been mid 30s?\n\n“When I moved home, I was 38 and then I married at 40.”\n\nDo you have children?\n\n “I have one.  She is 13 and I had her when I was into 41; so a little over a year after we got married.”\n\nI was told there are two tough times in a woman’s life; when she is 13 and when her daughter is 13; so, is that true?\n\n“My 13, I don’t remember being difficult; but, her 13 is a little more difficult for me.” \n\nLet’s talk about the tornado.\n\n“Well, that was defiantly a period of stress and struggle in the practice.  I was in the building…”\n\nWhat year was that, about?\n\n“I think it was 2008, I may be wrong; but around 2008.  We knew that it was stormy with a storm coming through; it was a typical finish the day, there doing bookwork, finishing the bookwork as I own the clinic and do a lot of the bookwork as well, and signing off charts.  I have a lady who bills for me a night, she comes in and works part time at night, and she just got there and said, “It looks really stormy; they say were going to have a tornado” and kind of chuckled it off and went back to her office.  I was getting ready to leave all at the same time as I head  towards the back door, I got a phone call from a close friend of ours that said, “It’s close to you, you need to take cover, and I know where you are” as they knew the building person too.  So, I \n\n\n\nhollered at her and said, “Why don’t we get into our safe room” which was our x-ray room towards the back of the clinic.  It’s a concrete room, concrete blocks filled with concrete.  She just picked up her purse can came back there and we had been in the room 2-5 minutes when the tornado hit.  It took 1/3 of the clinic out and took her area out where she had been.  Then obviously, we didn’t have power.  We were able to watch as we were in the back, out the glass door debris and kind of watch the tornado as we were in the middle of it.  When things calmed down, we walked to the front of the clinic and stood there for a few minutes looking out the front window across the street and when lightning struck, we could see that there wasn’t much across the street and wasn’t real sure what we were seeing.  After it struck again, we realized there was nothing across the street and there had been a local family doctor, a pharmacy over there, plus other structures as it was a small shopping center.  I started trying to call people and that wasn’t a possibility with the cell phones and started going through the clinic to make sure; we had felt a pop, but we were really not in the part of the clinic that was gone.  We went to one side of the clinic and all the windows had been blown in with glass everywhere and as we went to the side that we had lost, the doors were all closed and when we opened the door, it was kind of like a movie scene where when you opened the door and stepped out into the world; that’s what we had.  So, that night her father is on the fire department and my husband had gone to vote at the local court house in Ash Flat and had my daughter with him.  As it came through, it was a little bit southeast of Ash Flat and they had put everybody in the vault at the courthouse and as he stepped out of the vault, somebody told him our clinic was completely gone and he knew where I was.  So, he located my daughter and a family member in our basement and then came to the clinic.  By the time he got there, Detta Brink’s, our billing person’s father had got there along with some fireman and was securing the clinic.  We don’t keep a lot of narcotics and we don’t have a lot of money, but we knew other people didn’t know that.  We already had people trying to get in and they pretty much secured the clinic and stayed with it most of the night.  The local police and firefighters were looking for me as they needed somebody for triage and I was then transported to Ash Flat.  The local Church of Christ has a large family center and I spent the next 2-4 hours triaging people who came in.  Fortunately, we didn’t have a lot of people who were badly hurt.  Fulton County Salem Hospital was a small rural hospital was where most people were transported to because that was where we could get them to. Then by the next morning, we had my husband’s family, friends in the community, and people from St. Barnard’s, even though I wasn’t owned by them then, showed up by the next morning and we started putting it back together.  We put on a local radio station that if people needed refills to call the pharmacist.  The pharmacist knew who and what I was and where I was and what was going on.  The local pharmacy across the street was gone, so that wasn’t an option and the other pharmacists were picking up for him and the other physicians were picked up for me;  that was on a Tuesday and we opened for business the next Monday.”\n\nWhere?\n\n\n“In the clinic.”\n\nIn the same building?\n\n“The people from St. Barnard’s took all the computers. I have been electronic since day one in the clinic; so all of our records were safe and secure.  We didn’t have any issues with that.  Had the entire building been blown away, we were backed up through St. Barnard’s and they came in took all the computers out and blew everything out of them.  We had insulation, sandy insulation, inside things that you couldn’t open.”\n\n So you didn’t have to replace your computers?\n\n“That part of the building we had to; the 1/3 that we lost, we lost a lot of that.  The other parts of the building were covered in glass and insulation; so the entire building was pretty much affected.   We boarded up that and there were parts that were still there; we had a small building in the back that had a photographer and his part was essentially gone, but he had easels that were still standing with pictures on them back there.  So, we pretty much got it boarded up.  We moved into the central part and cleaned it all up.  The exam rooms that were there and we could get back up and running, that’s what we did.  It took probably 2-3 days before we got electricity back.  I am located right next to the high school and when they began to get them back on, I would meet with the people who were putting the electricity back to us each night to find out where they were and when we could get electricity back as that had a lot to do with getting us back open.  Like I said, by Monday we were not as pretty as we had been before, but we were open and could see patients and get back to business.”                                                                                                                                                                                                                                                                                                                                                                \n\nAn interesting point to me is a lot of the conversation about rural heath revolves around what happens when this kind of catastrophe hits; what are the MS services like in your part of the country and you had mentioned and maybe won’t mind going into a little detail about the triage; who set that up or who was responsible for that?  Who called you saying, “Hey, we need you to come and do this.”? \n\n“You know, as far as individuals, I’m not sure who exactly set that up.  Our ambulance service is a huge piece of our community because we don’t have emergency rooms close.  We have a kind of band aide emergency room now in the area that has been open now about a year.  But at that time, our ambulance service, EMS, and the first responders played a big piece in the rural community because it’s not like you dial 911 and you’re at the hospital in 5 minutes.”\n\nWas your ER run by White River?\n\n“Yes, that’s the one that has been there about a year or two.”\n\nWho runs your EMS?\n\n\n\n“Um, the Spring River Ambulance service has 3 or 4 bases.  They base out of Ozark Acres, which is towards Williford, they base in Cherokee, and they have been expanded to a base close to Cave City.  At the time, it was privately owned and I’m not sure about their affiliations now.”\n\nDo you use any helicopter services?\n\n“We do; the helicopter service Airvac comes out of West Plains and Arkansas Children’s will come up there.  I’m located where there is a field behind me, and Airvac has set down behind me a couple of times.  Arkansas Children’s wants to set down where there is an emergency room, so I’ve had to transport to Salem, which is 45 minutes away to fly out with them after Cherokee closed.”     \n\nWhen did Cherokee Hospital close?\n\n“It closed in 2007, I believe.”\n\nBecause of insufficient funding or do you know?\n\n“It was privately owned and lots of details, somebody not in the community; it was a tax write off and it begun that the services were not capable to keep it open along with other government issues coming in.”\n\nDid you have privileges there?\n\n“No, I did not.”  \n\nDo you have privileges anywhere?\n\n“I have privileges at St. Barnard’s that are courteously type privileges and at Fulton County, I don’t technically have privileges, but at Salem; I use that a lot.”\n\nSo when you need an MRI or something, you send them to Jonesboro?\n\n“Jonesboro, Batesville, or Mountain Home; wherever they choose to go or Fulton County has one that comes through.”\n\nSo you call and say, “I need an MRI of the Head for this patient” and they do it for you?\n\n“Yes, it’s just ordered from me.”\n\nTypically if you were in Highland and you had a 45 year-old MI come in, generally what would your response be?\n\n“We dial 911 for the ambulance service there and then we treat until they can get there and transport it out.  It’s a combination of being there and working with the people to know what they can do and they know what we can do in the clinic; whether Airvac is available and what’s \n\n\nthe weather like and if they can transport.  With the new emergency room, it has more capability than the clinics do, so the majority of the time they are transported to that emergency room because they are staffed with an ER physician and have all the facilities to do what they need to do and then fly them out.”     \n\nAnd that’s where?\n\n“It’s in Highland, probably about 3 miles from me.”\n\nOh, at White River?\n\n“Yes, the White River ER; it’s affiliated with White River and is owned by White River out of Batesville, but it does not have overnight beds.  It’s just a standalone ER; one of the first in the nation. I think.”\n\nSo if you had an MI come into your office, EKG changes and all that, could you push TPA in your office or do you do that?\n\n“No, no; now, they would probably go up the street; but in the past, it would be ambulance service or helicopter out, whichever, and it kind of depends.  I had a 6 month-old that my front office noticed was green and wasn’t’ breathing in the lobby.  We coded that baby until the ambulance service could get there and the ambulance service was not comfortable taking that baby by themselves, so I crawled in and rode with them to Fulton County, which was the closest place we could get them to fly out.  I worked with there with them until the baby could be transported.  We had bad weather and the baby had to be put in the ambulance again and transported to Mountain Home.”\n\nOther than the tornado, obviously that should make an indelible imprint for the rest of your life, but have you had some scary moments in the practice of medicine since the early 2000s?\n\n“Um, the baby that I just mentioned was a real scary point for me and my staff.  My staff consists of two in the front office that are secretary trained, and then I have two LPNs, and now a nurse practitioner as well as the part time billing person.  So, the training for something like that is limited.  We’ve had 2 or 3 times where we are anxious until the EMS people can get there, but as far as real scary; probably, the biggest scary thing for us is what’s happening with heath care in general for coverage for our patients.  It’s more scary than almost anything.  But, there are moments when you wonder what’s going to happen next.”        \n\nWhat impact has the Affordable Care Act had on your patients?\n\n“Um, the patient load is probably the same.  The patients don’t see care as much as they now have really high deductibles and that has taken them from having co-pays where they will seek services to now where they don’t.  I think that is not good patient care and that’s kind of unfortunate where we are and how things are set up.”   \n\n\nLet’s talk a little bit about Ash Flat, Highland, Hardy, and that area; what or who are the primary employers and what of work do people do in your community?\n\n“Um, farming is a big piece; more cattle farming.  We’re not row crop; hay is probably a bigger crop in the area.  But a lot of cattle farming and school is a big employer.  We don’t have a lot of factory industry.  We have a vacuum cleaner company there that employees a few people.  Wal-Mart is one of our biggest employers and then small businesses; skilled trained plumbers and heating and air.” \n\nDo you see a lot of agricultural injuries or illnesses?\n\n“Probably the biggest we see related to agriculture is tick fever.”\n\nDo you have any epidemics of tularemia or….?\n\n“I have had two diagnosed tularemias out of the clinic since I have been there.  We see Rocky Mountain Spotted Fever Rickettsia every year; so, we see proportionately for our area.”\n\nWhen I lived in Mena, we had a run of tularemia.  It was like everybody was sick.  Titers were elevated.\n\n“Well the CDC has not recognized Lyme disease in Arkansas until this year and we have been treating it for several years there.”\n\nSummer time fever… tick bite.\n\n“Hottest of Lyme titers and you know, they keep telling us our labs are not good or it’s a mistake until this year and has acknowledge that we do have it.”  \n\nHow many physicians are up the road now from Ash Flat to Hardy?\n\n“Sharp County has 6.”\n\nAnd are they all family physicians?\n\n“No, we have 4 family physicians and 2 internists and I am one of the family physicians part time.”\n\nHow many were there when you came here?\n\n“Um, there were 2 internist who are still there, one family doc, and one GP.  The GP is retired.”\n\nDid you all get along? Did you have meetings together?\n\n“We don’t met, but we periodically talk, or at least I do, to about all of them.” \n\nOn the phone or in person?\n\n\n“Um, on the phone or occasionally have lunch; but not very often as we are all doing about the same thing and busy.” \n\nIs there an acclesional atmosphere?\n\n“Um, for me there is; there is a few of them who don’t speak to each other. I get along with all of them as far as I know and if at times I have to have, like when I delivered Lilly and had to have somebody to cover, if I have to have something like that, I call one of them and say, “My nurse practitioner is on call and if she needs help….”  So, I had cover and never had any problems with that.” \n\nThat brings up a subject that we always talk about in these interviews; how has your family adapted to being a family of a busy practicing physician?\n\n“I don’t know that they know any different.  I was already in the clinic practicing when my husband and I married and Lilly was born into it.  So for her, momma is a doctor and for her, when the phone rings, you be polite; that was the way I was raised because real estate was part of ours.  But, we have patients call and talk to Lilly on a regular basis.  When we go out in public, they understand that people will come up and talk and they don’t repeat anything they hear.”    \n\n Are you involved in the community outside your practice?\n\n“Yes; being Lilly’s momma, I am not longer the doctor, but Lilly’s momma and I go to any events for that.  I am on the school board and then anything else in the community that comes along.”\n\nHow long have you been on the school board? \n\n“Three years.”\n\nUp to this point in your career, have you been well compensated for what you do?\n\n“Um, I don’t think so.  I think primary care has a bigger role, particularly in the rural areas.  It’s not just the physician, the staff for all of the clinics in the rural areas don’t make as much as they could if they were in a larger area.  There hours are no different and the requirements of what they do are no different.  Same thing for the physician; our life is a little different than the urban in that everybody in the community knows where I live, everybody has my cell phone, my phone number is in the phone book, when I go to Wal-Mart, there is no anonymity.  So, we are 24/7 before the requirement came to be 24/7.  There is no compensation for a lot of what we do with caring for people outside the walls.  I think primary care is beginning to get recognized for family physicians, it really hasn’t mattered what community you are in, the care of  the patients has gone well beyond the walls for years.  The recognition for that I think is coming.  The compensation changed dramatically when we went electronic and the pitch of electronic was supposed to save time and produce money; that is not the case.  That has to do a lot with the EMR companies; they sell a product.  Among the physician world, the joke is that they will sell \n\n\nyou a car and then they come back and have to sell you each wheel, sell you the air-conditioning, and each time they come back to add a piece that the government or insurance companies are requiring, it’s not only “pay for it, but pay a monthly fee to use it also.”  That has driven our costs in the clinics up significantly, changed the compensation, and the compensation reimbursement has changed a lot over the past few years.”         \n\nYou have practice and lived a varied life, very interesting and very logical; do you see yourself staying in the same kind of circumstances that you are in now until retirement?\n\n“Um, I don’t know.  I think the predictor is not me.  I think the predictor is where the health care world goes.  I’m trying very hard to maintain the practice where I am.  To be so low is not necessarily the necessity; it’s just work and I haven’t had a partner.  The nurse practitioner has been very helpful in the expansion.  Solo docs and docs of 2-3 clinics are being pushed out and selling out right and left.  Because of the requirements of electronic systems, because of the requirements of Medicare and Medicaid insurances and reimbursement, it’s becoming more and more difficult in a small clinic to keep up with the standards, and maintain patient care on a reasonable basis.  So, will I stay and would I like to; yes.  Will I; I can’t imagine to be outside in the community and will my practice look exactly like it is in 5 years from now, I don’t know.”    \n\nWhat has been the most gratifying part of practicing medicine for you?\n\n“For me, it is in the room with the patients and being able to make a difference.  I enjoy people and I enjoy their histories.  To be able to listen to somebody and make a diagnosis, however small or elaborate that may be, and to be able to help people or give them resources that they can go help themselves is probably the most gratifying thing for me.”   \n\nIs there any one change that has happened in your time of practice, it doesn’t even have to be in medicine, it can be technology, or a change in society that has had the largest impact on your life and how you see things going in the future?\n\n“Um, the electronic world has made a huge difference in my life in general.  Google is something that is known worldwide and patients can Google anything; their symptoms.  I find that helpful; though some physicians don’t.  I find that interesting.  My child as a 13 year-old has access to the world that I didn’t even know existed.  So the change that the electronic outside has brought in, some good some bad, but it has changed life dramatically.  If I make a phone call, I expect somebody to answer it right then and used to, I grew up with a party line and who you call might answer or somebody else might answer.  We are impatient and much more a fast world; fast food, fast answers.”\n\nSo your daughter is 13; say she gets to 18-19 years old and is think about going to medical school, would you encourage her? \n\n\n\n“I would encourage her like my parents encouraged me; to do what makes her happy and what she enjoys.  Whether that is medicine; right now, she thinks she wants to go into veterinary medicine and she is quite talented with music, singing, and art.  She likes drama, so her decision is between being a regular on Saturday Night Live or going to vet school.  She went to choir camp this summer and she went to a vet camp at Missouri.  She still enjoys both of those.  So, I would encourage her that if medicine was what she wanted to do, then that’s…..I would encourage her to do whatever and to be educated and enjoy whatever she does.”\n\nIs your husband a pastor?\n\n“Yes.”\n\nWhich church?\n\n“He is retired now.  Out of Duke, he was ordained through the Baptist System and he has worked in the Presbyterian System and the Methodist System.”\n\nSo are you in the Presbyterian Church now?\n\n“Methodist.”\n\nIn Ash Flat?\n\n“The one where he served was in Hardy.” \n\nDo you think the computer has helped or hindered medicine and in the medical field?\n\n“Both, it hinders the interaction in the exam room and depending on how that takes place.  I have arranged mine so that I am looking at the patient and entering the complaints into the computer.  It has helped in keeping the records and that sort of thing; keeping up with what we are doing as you don’t have a paper chart flying around and easier access, but there are some hindrances that it’s caused in patient care also.”\n\nIs medicine what you thought it would be when you were going through med school?\n\n“I don’t know exactly what I thought it would be.  All I knew was the general practitioner and the interaction in the exam room has not changed for me from when I was in residency until now.  It has a lot more business into it than I think I had anticipated that it would.  If I didn’t have my own practice, I might not have seen that side.”\n\nWhat do you think the future of medicine holds?\n\n“Um, I think the future of medicine is going to be a little less hands on.  I think it is going to go more to across the counter.  I think that we are going to see people making their own diagnosis \n\n\n\nfor the simple things.  I think there is going to be less face to face interaction.  I think we are being pushed more and more that direction.”          \n\nDo you use telemedicine or consultations?\n\n“The only telemedicine I use is taking pictures with phones and sending those or using the telephone.  I don’t have the video process to be able to do that and the pictures I take are usually with the patients phone so that they have the picture themselves and if they have to go someplace else, they have it.”\n\nAre there any things that we haven’t brought up that you would like to add? I didn’t ask you if your parents are still alive.\n\n‘I lost my mother about a year ago.  My dad is still living and is 86.  He is fading a little bit and sleeps a lot but he still chases cows, works in the hay, and buys and sells real estate.”  \n\nI have one last question; Assume we are not here and you are talking to your great, great, grandchildren, somebody who knows you as a picture on the wall.  What would you like for them to know about your life and what you would wish for them in their lives?\n\n“Well, I think the most important thing would be is to be happy.  Losing my mom has been real difficult and I’m not sure I can answer that for you; I can, but I’m not going to be able to get through it.”       \n\nYou actually already did answer it.  Thank you very much and this is all the interview that I have.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/161569/file/293388#t=0.0,6136.96417"}]}]}]}