CHAPTER

7     Delivering Care to Those in the Greatest Need

THE GOOD DOCTOR

IN JANUARY 2016 Lara Johnson, took the stage in a school auditorium in East Dallas, Texas, not far from where she had graduated as valedictorian at Woodrow Wilson High School 23 years before. It was an event to thank high school teachers from around the region, and the crowd in the auditorium was probably expecting a pep talk of sorts—a tribute to Lara’s favorite teacher explaining how she had helped launch her on a path to becoming a primary care physician at nearby Parkland Health and Hospital System.

During her nine-minute talk (captured on video and posted at https://vimeo.com/253774401), the audience laughed as Lara admitted that she was nervous. It was her first time speaking to a large group since that valedictory speech. But then the audience fell silent as Lara said, “I am thrilled that I am here sharing my story with you, and not at a 12 Step Program, because things could have gone really differently.

“Growing up the child of a drug-addicted mother and an alcoholic father presents some unique challenges,” Lara continued. “You learn to read the emotional temperature of a room, and you learn how to defuse things. You learn how to try to put out fires rather than adding fuel to them. Passivity becomes a survival skill, and you spend a lot of your life as a quiet spectator rather than an active participant.

“When the adults around you can barely take care of themselves, you learn early on that you have to take care of yourself. You set your own alarm clock in the morning, you make your own breakfast, you pack your lunch, you do your own laundry, and a lot of days, you have to wake up an adult to take you to school.

“The one thing you learn to rely on is that you can’t rely on anything. The TV that you watched last night might be in the pawnshop today. The toilet might not flush because the water bill went unpaid—again. Your aunt might be sleeping on the sofa, sometimes alone, other times with a boyfriend. Your mom might not come home at night, and you find yourself actually hoping that she is in jail, where at least you know she is safe and not on the street.

“You begin to notice the cycles of the addict. There is the short-lived cycle—the longing, the planning, the doing whatever needs to be done to obtain the money, obtain the drugs or alcohol. Sometimes this meant popping hubcaps off cars at stoplights and other times shoplifting tools from Home Depot. Then there is the release, the relief from the pain, which is always too brief, which is followed quickly by the return of the misery and the ugliness that is left behind when the high fades.

“There is a bigger cycle that you begin to notice, too. Sobriety, followed by employment sometimes, and the blossoming of hope. Occasionally, we would move into our own place. Saving money, being picked up at school on time, and waking up in the morning to the sound of coffee percolating and the local news.

“But this, too, would always crash down, usually in a matter of months. The savings spent, the apartment gone, the job lost, moving back in with the grandparents who were always loving but nevertheless disappointed to see us return.

“These cycles taught me what I did not want for my own life. I did not want to suffer the way I watched my mother suffer when she could not get heroin—or worse, when she tried to kick methadone.”

At this point, Lara paused, then she apologized, her voice cracking. She explained that her mother had recently died, and her story was difficult to tell. She then continued, describing the many other aspects of her childhood that she knew she wanted to avoid. “That’s how I thought of my future—in negatives,” she said. “They were healthy negatives, but they were negatives.”

But then she described how everything changed during her senior year at Woodrow Wilson. A teacher named Patricia Faherty had grasped both Lara’s academic potential and her difficult situation at home. Faherty asked her why she hadn’t applied to college, what she hoped to become. “She helped me to fill in the positive,” Lara continued. “She helped me flesh out my future.”

The deadlines for applying to college had passed, but Faherty told Lara that didn’t matter and that she should try to go. But Lara’s responsibilities at home had only grown during her senior year of high school. Her father had been diagnosed with AIDS (and this was just before the 1994 development of highly active antiretroviral therapy, the combinations of drugs that made HIV a controllable condition). Lara was living with him, preparing his meals, managing his medications.

“He was getting weaker by the week,” Lara said. “And my mom had just started using crack cocaine. She would often show up at Tom Thumb where I worked as a cashier and ask to borrow 20 bucks.

“How could I think about leaving?” she wondered. Faherty told her that she had to go and took steps to change her life. She signed Lara up for Advanced Placement tests without her knowledge—just telling her when to show up. Faherty paid the fees for the tests, and Lara said, “She basically put a pencil in my hand, and said go.

“And then she did something even more remarkable,” Lara continued. “One spring afternoon, she invited me to her East Dallas home. . . . There on her living room sofa, she and her husband offered to pay for my college education. I just had to meet three conditions.

“One, maintain a C or better average . . .

“Two, move at least an hour away from Dallas, so I would be out of hitchhiking range for my mom.

“And three, do the same for someone else someday.”

Lara described how she took the Fahertys up on their offer. She did her best to arrange things for her father, but also shifted her attention to the future. She got into a college that was nearby, but not too nearby. She began to communicate with her future roommate. When the fall came, she left for college.

In her talk, Lara described how eventually she went to the University of Texas Southwestern Medical School. As a child, she had visited UT Southwestern’s Parkland Memorial Hospital countless times with her mother, as she received antibiotics and other care, including brain surgery for complications of her addiction.

“I used to marvel at the doctor and nurses, silently praying that they would not only cure my mother, but also treat her kindly,” Lara said. “For the past eight years, I have been working for Parkland, serving the pediatric and adult homeless population. We take a big medical unit out to homeless shelters, domestic violence shelters, drug rehab facilities, and juvenile detention centers.

“Now I have the honor of caring for people who have the same types of struggles that my family faced,” she said. “I often wonder what would my life look like, where I would be if I hadn’t gone to Woodrow, enrolled in AP English, and met Patricia Faherty. She taught me to believe in myself. There is no question—teachers change lives every day. Thank you for what you do.”

* * *

A few months after giving that talk at her high school and describing how she had gone so many times with her mother to Parkland Memorial Hospital, Lara took on a new role. After a decade as a primary care physician at Parkland Health, Lara Johnson became the medical director for Parkland’s HOMES program (Homeless Outreach Medical Services). It was a big step for her; Parkland is the safety net hospital for Dallas, the place that never turns anyone away because of lack of insurance. That is why Lara’s mother had gone there.

Lara is the key clinical leader for two clinics that are part of homeless shelters in downtown Dallas. The program also has five mobile medical units that go around to about 25 different sites in Dallas County—not only homeless shelters, but also domestic violence shelters, juvenile detention facilities, a day care center for homeless children, family shelters, and drug rehabilitation shelters.

She and her colleagues have an atypical patient population and tight resource constraints, but they basically do what clinicians do everywhere—whatever they can to help their patients be as healthy as possible. They provide primary care preventive services, cancer screenings, and vaccines, as well as urgent care. And like clinicians everywhere, they frequently feel frustrated by the systems around them and experience symptoms of “burnout”—feeling overwhelmed, ineffective, and detached from their work. Yes, the work is noble, but it doesn’t always feel that way.

Lara herself is not immune to burnout symptoms, and she isn’t so sure how she feels about managing about 50 colleagues, compared to rolling up her sleeves and delivering primary care to one patient at a time. But she doesn’t have trouble feeling genuine empathy for the patients she meets in the shelters where she and her team go. After all, she and her family have walked in their shoes.

Today, her life is a happy chaos filled with what so many others seek—a good job, a good marriage to a respected professional, two young children, and a nice house in one of the country’s great cities. But Lara never forgets the difference between happy chaos and unhappy chaos. She grew up with the latter, which is why her current work, even when overwhelming or frustrating, never feels unimportant.

* * *

Until recently, Lara didn’t discuss her past very often, but in 2014 she was sitting around a swimming pool with another mother, keeping their eyes on their children. Conversation turned to their family backgrounds, and what came out stunned Lara’s friend. She was a journalist and said Lara’s story was a great one, and that it should be told. The result was “How a Teacher Changed This Dallas Doctor’s Life,” by Jamie Thompson, published in D Magazine in October 2015. It was a valuable source for parts of this chapter.

The story that emerges from that article and my additional interviews with Lara is beyond complex. Her mother was a heroin addict who worked as a waitress and night-shift office cleaner. Her father was an alcoholic who also was a heroin user for a while and ran a pool cleaning company with his brother. Besides her parents’ addictions and related medical issues, there were other relatives with problems of their own.

The family tree is hard to draw. Both parents had brief first marriages that produced a half-brother and half-sister for Lara. Lara’s parents had younger siblings who married each other. A reasonable reaction is amazement that someone as strong and stable as Lara somehow emerged from this chaos. But to Lara, they are all just her family. She doesn’t try to distance herself from them and their troubles; she talks about them with love and a wry pride.

Both of Lara Johnson’s parents grew up in Dallas, and like she did, both went to Woodrow Wilson High School. There were glimpses of glory in the family tree—an uncle who was a track star, and a grandfather who had played bass in the Tommy Dorsey Orchestra. There were also problems with alcohol. Both of her father’s parents had been alcoholics, but her father’s mother was in Alcoholics Anonymous (AA) and sober for more than three decades.

When Lara talks about her father, she doesn’t just describe his addictions. She also brings up good advice he gave her and funny things he said and did. “My dad was a major character,” she says. “He liked to play pranks on people, but not in a mean-spirited way. I think he enjoyed seeing how they would react. I feel like he was always running his own little psychology experiments.”

After Lara’s father graduated from high school in 1965, he got married, had a child, and went to Vietnam. Lara has a photo of him from those years hanging in a hallway in her home. In the photo, he is smiling, looking handsome and fit in his Air Force uniform, but Lara is pretty sure that he came home from Vietnam with a drug problem.

“It’s funny—no, not funny, but interesting—to think about the kind of conversations that I would have as an adult that of course you don’t have with your parent when you’re a teenager,” she says. “So there are a lot of things that I don’t know, and that I’ll never know.”

Lara’s father’s forebears had come to Dallas from Sicily, New Orleans, and Chicago, drawn by the availability of work. His parents ran a 24-hour bowling alley called the Cotton Bowling Palace. One of the regulars in the years before 1963 was Jack Ruby—the nightclub owner who shot Lee Harvey Oswald after the assassination of President John Kennedy. Ruby used to drop by the Cotton Bowling Palace after his own clubs shut for the night at 2 a.m., sit with Lara’s grandfather, smoke cigarettes, and drink coffee.

Lara’s mother was four years behind Lara’s father at Woodrow Wilson High School, and later told Lara that she began having problems with opioids when she was 19. “Both of my parents had terrible teeth,” Lara says. “My dad had dentures before he was 20, in part because a lot of them got knocked out in a fist fight. My mom just had teeth problems, and she needed major dental work. That’s when she initially got hooked on pain meds, and it escalated through the years. That’s why my sister and I are both crazy fanatics about oral hygiene.”

When Lara looks further back in her mother’s life story, she thinks her mother had mental health struggles from an early age—anorexia and probably more. “My grandmother told me that when my mom was a really young child, like five or seven years old, a pediatrician asked my grandparents to take her to a psychiatrist,” Lara says. “This was the 1950s, and my grandfather just said, ‘No way. My kid is not going to a nut doctor.’” So one of the things that has been painful for Lara is contemplating how her mother’s life could have been better or different if she had gotten the treatment that she needed when she was young.

Lara’s mother was briefly married shortly after she graduated from high school, and she had Lara’s half-sister when she was 19 years old. A few years later, that marriage had ended, and she married Lara’s father, who was now back from Vietnam. They got married on New Year’s Eve of 1972, and Lara was born New Year’s Eve of 1974. “My dad loved parties and threw a party every year on my birthday until he died,” Lara says. “My mom hated parties, so when she went into labor the day I was born, my dad didn’t believe her. He thought she was just trying to get out of the party, so he didn’t go with her to the hospital. He came eventually, but it meant he had to cancel his New Year’s Eve party.”

* * *

Lara’s parents’ marriage only lasted a few years. They both were addicted to heroin, and problems reached a crisis point when Lara was two. “On the night that my mom left my dad, there was some domestic violence, and he actually pulled a gun and fired some shots,” Lara says. “He was too drunk to hit his mark, thankfully, but my mom did a very courageous thing and left. My sister and I spent the night in an emergency shelter.”

Lara, her mother, and her sister eventually moved into the home of her mother’s parents. “They were gracious enough to house us on and off throughout my life,” Lara says. “They were my safety net, and my sister’s safety net.”

But it was still a wild environment, because of the drug addictions of Lara’s mother and her aunt—Lara’s mother’s younger sister—who came to live with them after being released from federal prison, where she had served a sentence of several years.

“She was actually a hilarious person,” Lara recalls. “She was an artist. She and my mom would go out and steal and do drugs, and then they’d come back at night, and my mom would make up lies about what they had been doing. But my aunt would be honest with my sister and me in a way that we found very refreshing.”

That aunt had an unexpected pregnancy when Lara was around 12, and Lara was thrust into the role of helping to raise the baby boy because her mother and aunt were simply unable. “I can remember getting really angry when he’d wake up in the morning and need things,” Lara recalls. “But my mother and aunt would be too altered to address his needs. So I would get up with him and take care of him.

“I am not someone who is quick to anger, but when they would yell at him, that would just push me over the edge,” she says. “And I would walk him to McDonald’s, just to get out. I was 13, and he was a year or so old. People would think he was my kid, and I would get furious. I would say, ‘He’s my cousin. I’m not a teen mom.’”

* * *

Well before this point, Lara had her introduction to healthcare—and to Parkland Hospital at its best. When Lara was in fourth grade, her mother started to have neurological symptoms. She turned out to have a mass in her brain that was caused by a fungal infection—almost surely resulting from injecting heroin with nonsterile needles.

Lara had been to the hospital and various clinics with her mother countless times in the past, often as she sought opioids as treatments for headaches or other symptoms. Her mother frequently complained that she was not being treated with respect because she had a history of drug-seeking behavior.

But this time, the neurosurgery fellow was a young man named Dr. Bruce Mickey, and Lara has never forgotten how he interacted with her mother. “He treated my mom the way he treated all of his patients,” Lara says. “He treated her like a queen. He was respectful. He didn’t seem judgmental. He didn’t blame her for this infection in her brain, which was probably caused by her behaviors.

“It was a revelation for me. She was in the hospital for six weeks after her surgery getting amphotericin (an antifungal medication), and I was up there almost every day after school, camped out at Parkland Hospital as a nine-year-old.”

Dr. Mickey remains on staff at Parkland Hospital today and is vice chair of the Department of Neurological Surgery at UT Southwestern Medical Center. Lara is now his colleague. She has told him of this early memory and how it may have helped plant an early seed in her thinking about becoming a physician.

In any case, when she was in seventh grade, she wrote an essay in response to an assignment to project her future. She wrote that she would be a pediatrician living in New England with two adopted children. When Lara looks back on that essay today, she says that being a pediatrician is not that different from doing what she does in family practice.

She ended up staying in Dallas, though, and having her own biological children. “My sister has no kids,” she says. “Pretty much no one in my family in my generation has kids except for me. Everyone else was too traumatized by the experience, I think.”

* * *

Lara and her mother and sister periodically moved out of Lara’s grandparents’ home and tried to make a go of it on their own. By the time Lara was in eighth grade, she had been to 11 different elementary schools.

At 13, she made a decision that enabled her to have something approaching a normal adolescence. Her father had long since given up heroin, and although he had serious alcohol problems, he had decided to quit drinking and join AA. He had been able to buy a small house in East Dallas with his VA benefits. Lara decided that living with her father was going to be more stable and moved in with him. She was able to stay in the same school from that point until she graduated.

As difficult as things with her father were from time to time, Lara remembers plenty of loving, wonderful moments. “One thing about my dad—he taught me to be independent!” she says. “When I was just 12, he would tell me to take the truck and pick up something from the store. I’d say, ‘Dad, I don’t have a license.’ And he’d say, ‘You can do it. It’s not far. There’s just one stop sign. Just go slow. You’ll be fine.’”

She made those short drives, and things did work out just fine.

Meanwhile, Lara figured out that she liked school—a lot. “It was a place I could go that was structured and calm,” she says. “I could focus on something that wasn’t my family. I could get all this adult attention, and if I did well, it felt pretty good.”

Her senior year yearbook photo lists activities including cross country, swim team, art club, National Honor Society, student council, cheerleading, choir, and school musicals. “I was doing everything,” she recalls. “And I was working, too. My senior year, I worked in a retirement home as waitstaff. A couple of my friends were there, too, and it was a blast. And then in the spring, I was a cashier at a grocery store. So I was kind of busy.”

During these high school years, her father would often keep her company while she did her homework at the kitchen table. But during her senior year, he started to get sick and was in and out of the hospital. “He was struggling with the fact that he couldn’t do all the things he wanted to do,” she says. “He said to me, ‘You need to be comfortable with more quiet in your life. You go all the time, and you’re not always going to be able to do that.’”

But Lara was getting a different type of advice from her English teacher, Patricia Faherty. Early each fall, Faherty had her students write an autobiographical essay. Lara’s began with her mother saying, “I am done. I will never do heroin again.” And then Lara wrote that, even though she had heard those words dozens of times before, she always took them as gospel.

That essay showed Faherty that Lara could not only write, but also had been through so much in life already and remained resilient. Faherty took special interest in Lara, and as the year went on, noticed that Lara did not ask her for a letter of recommendation for college, even though she was one of the school’s top students. Faherty asked the other teachers if they had written recommendations for her. None had. Faherty realized that Lara was not applying to college at all.

That was when they had the conversations that Lara described in her 2016 talk. Lara just didn’t see how she could go away and leave her father when he was so sick, or cut herself off from her mother when she was still using heroin. Besides, she had no money to pay for school. And in any case, the key deadlines had passed.

That is when Faherty and her husband made their offer to pay for her education. In the following weeks, she helped Lara complete applications and round up her recommendations. Lara started to talk about whether she might become a physical therapist. Faherty said she should aim higher—try to become a doctor.

“At the time, when I was 18 years old, the money seemed like the biggest gift,” Lara says. “The money, of course, made it possible and was a phenomenal thing to have happened. But now that I have a lot more years under my belt, I realize that it was so much more than that. It was having someone see the potential in you and help you see it in yourself.”

When graduation came around, Lara was valedictorian, finishing ahead of one student who headed to Princeton and another who went to Stanford. Lara had gotten into Trinity University, a private liberal arts college in San Antonio. Her classmates voted her “Most Likely to Succeed.”

* * *

Despite Faherty’s amazing act of generosity, Lara’s transition to her new life was far from smooth. In March of Lara’s senior year, her father gave her a letter from his physician at the VA with news that was too painful to convey directly himself. He was HIV positive and now had AIDS. He had been trying to delay delivering this news until after her graduation, but he was becoming increasingly ill, and he was worried that he wasn’t going to survive that long. “He passed away on June 20, 1993,” Lara recalls. “It was Father’s Day.”

A couple of months later, Lara left for San Antonio. She and her high school boyfriend were both going to school in San Antonio, and Lara spent a lot of time with her boyfriend’s family before school started. The night before she left for college, her mother showed up at her boyfriend’s house, where Lara was having dinner with his parents. It wasn’t clear how she got there—she didn’t have a car. But what was clear was what she wanted—money. “It was embarrassing, and I was angry,” Lara recalls. “I was thinking, this is the send-off that I get?”

She arrived at school the next day. “I felt like I was the only kid who didn’t have a parent there helping them set up their room,” she says.

* * *

Lara got through her first year at Trinity and came home to Dallas for the summer. She had not been happy at school. She had started as pre-med, but really didn’t like it. “Everyone was super-intense, super-competitive,” she says. “I just felt that these were not my people. It did not feel good.” So she switched to anthropology, and the idea of becoming a doctor faded away.

She also wasn’t happy with her relationship with her high school boyfriend—one more reason that she was not excited about going back to San Antonio in the fall. She was working in a bank doing customer service in August 1994, when she met a young man who had just graduated from medical school. He had come to the bank because his mother had multiple sclerosis and he was organizing her financial affairs. He was also cleaning out her house, and he had a week or so before he himself was going to move to Memphis where he would start his internship in a family practice program. They hit it off, and she started spending her off hours helping him pack up the house. Ten days later, Lara decided to go to Memphis with him.

Lara transferred to the University of Memphis and started working at another bank in her new city—but she liked what she was seeing about medicine. “When I met the other interns and residents that Joe was training with, I thought, ‘Oh, I like these people. They don’t seem crazy and cutthroat,’” she recalls. So she started taking pre-med courses at the University of Memphis. She married Joe, the family practice resident, when she was 21 and then moved back to Dallas when he got a job there after his training. She completed her college education in December 1997 at the University of Texas at Arlington. She was almost 23 years old and graduated summa cum laude. She was accepted for medical school at UT Southwestern.

* * *

Lara had survived a tumultuous childhood, gone to three different colleges, and now was accepted at one of the top medical schools in the country, where she would walk the halls with Nobel Prize winners like cholesterol researchers Michael Brown and Joseph Goldstein.

“Who would have thought?” she says, with a laugh. “It’s funny because when I think of my mom, I have to say she was brilliant. The way her brain worked was just fascinating to me. She was so quick. She would read voraciously—finish a 300-page book in two or three days. She always did crossword puzzles, and she was a math wizard.

“We used to have this game figuring out what we could buy with the money we had when we went to the grocery store. It was a necessity because we didn’t have a lot of money. We never had a credit card or a checking account. We were completely cash-based. But she made it into a game, and she’d like to see who could get the closest to the actual total. In Texas, certain food items aren’t taxed, and certain ones are—so calculating the tax made it complicated. But it was fun, and she was so quick.

“She had a really funny sense of humor,” Lara adds. “When she wasn’t horrible, she was wonderful.”

* * *

Medical school was an eye-opening experience for Lara. She had not realized it, but schoolwork had come all too easily for her in the past, and she hadn’t had to work that hard to get almost straight As throughout high school and college. Now she was working constantly and getting mostly As, but also a few Bs despite her best efforts. “It was a real adjustment, and the first time I really had to study,” she says. “One friend and I became study partners, and if not for her, I don’t know how I would have done. She was so very disciplined and organized. We are still really good friends. But it was hard.”

When her clinical training began in her third year, though, she was thrilled. “It was exhausting, but so much fun,” she says. “I had started medical school thinking I wanted to do family medicine, but then I really loved my surgery rotation. I actually applied to both surgery and family medicine, and ultimately decided that surgery would be fun for 5 or 10 years, but I didn’t see doing it for 30 years.

“I thought family medicine would be something I would always find interesting. I mean, I love hearing people’s stories. As goofy as that sounds, I wanted that continuity and the ongoing relationships with patients, which you don’t have in some of the other specialties.”

After medical school, she did her family practice residency in Fort Worth, in the John Peter Smith Family Practice Residency. It was one of the premier family medicine programs in the country, in part because there were no “competing” programs in internal medicine or emergency medicine. The family medicine residents like Lara did everything. “I did tons of colonoscopies, and delivered 200 babies when I was there,” she recalls. “It was drinking from the fire hydrant. Some of the people I trained with are in rural settings and basically working like general surgeons—doing appendectomies, gallbladders, and C-sections. They are like real doctors. You definitely got confidence that you could do a lot of things.”

Meanwhile, at the end of her second year of medical school, her marriage to Joe had come to an amicable end. They remain good friends today, and he was Lara’s mother’s primary care physician up until the time of her death. He also was the physician for Lara’s grandmother and aunt.

During her fourth year of medical school, she met David Gerber, an internal medicine resident at UT Southwestern. Lara’s best friend at medical school, Elizabeth Dodge, had gone to college at Yale with David, and they met through that connection. They started dating in October 2001. After his residency, he went to Johns Hopkins for a fellowship in medical oncology. They were engaged at that point, and Lara went to Baltimore to be with him when she finished her own training. They married in May 2005.

* * *

Lara and David did not know where they would end up, and Lara took advantage of the uncertainty by getting some new experiences while David was finishing his Hopkins fellowship. “I didn’t want to start a practice or look for a job that I thought I would be leaving after a year or two, and I always feel like I need more training,” she says. “So I did a one-year faculty development and medical editing fellowship at Georgetown. And the clinical portion of my fellowship was at a homeless healthcare center in Washington, DC. I didn’t pick the fellowship because of the homeless care focus, but it turned out to be very important for me.”

After that one-year fellowship, she spent a year as a staff physician at the Baltimore VA Medical Center. That role felt comfortable to her, too. “My dad went to the VA in Dallas, and my mom went to Parkland,” she says. “I knew I wanted to work with underserved populations like the ones I saw there. It’s just always been where my heart is.”

In 2007, David and Lara returned to UT Southwestern and Parkland Hospital—and have stayed. He specializes in lung cancer. Lara became a staff physician in the homeless outreach program. She has also started working at the Good Shepherd Hospice and at Parkland’s transgender clinic. She was appointed medical director for the homeless outreach program in June 2018. They have two children, 10 and 12 years old.

* * *

Lara worked at the Good Shepherd Hospice for three years, but quit in May 2015, shortly before her mother died. “It was too close to home,” she recalls. But thoughts about her parents linger in the professional work that she continues.

Asked how her parents’ medical care had influenced her choices, she says, “I think part of it is still wanting to heal my parents. They are both dead, of course, but I see a lot of people who face the same kinds of struggles that my parents faced. I see a lot of substance abuse, a lot of mental health issues, a lot of tough situations.

“It is simplistic to say that I always want to root for the underdog, but that’s kind of what it feels like.”

She describes seeing a patient in the transgender clinic who did not reveal his heroin use during his first clinic visit, but told a nurse about it during his return appointment. The nurse came and got Lara out of her room, and asked her to talk to the patient.

Lara went in and sat on the floor, because that was the easiest way to make reliable eye contact with him. “I told him that I was glad that he trusted us with that information, and that our goal was to try to help him,” she recalls. “I said that it was human instinct to try to alleviate suffering, and any of us—if we are suffering, we are going to use whatever we have around us to relieve it. Some people use alcohol because it works. Some people use drugs because they work.”

The patient revealed that he had been diagnosed with a psychotic disorder and wasn’t taking any prescribed medications for it. But, he said, when he took heroin, the voices in his head stopped.

“I get it,” Lara says. “I’ve never done heroin, and I’m terrified of it. But if you find something that makes you feel somewhat normal for some amount of time—well, I’m not going to judge someone for that. I’m going to try to help them get to a better place, but I’m not going to look at it like a moral failure.”

* * *

Before Lara’s mother died, she would frequently visit Lara and her family. When Lara’s daughter Allie was only three, Lara noticed that she made a face when she heard that Grandmother Kathy was coming over. When Lara asked why, Allie said, “You get really sad when she is here.”

Knowing that risk of addiction is at least partially genetic, Lara is extremely cautious about alcohol. “I am of course scared about the potential of addiction in me, and I didn’t drink at all during college—zero, none,” she says. “Now, I may have a drink or two a week, but not on the same day. I want to be a model for good responsible behavior for the kids. If we go out and I am going to have a glass of wine, I make a point of mentioning that Dad is going to drive home tonight. This is a decision that we’re making.”

Lara is new to her role as medical director, and there are frustrations in managing dozens of colleagues. “People at work will say, ‘Just go home and have a drink. A glass of wine a day will fix that,’” she says. “I just laugh, and think, ‘Yeah, whatever.’

“I know I need to be a better leader,” she says. “I have to get better at figuring out how to make people tick and fight the tendency to just want to do things myself. And now I only get to see patients myself two half-days a week. When I’m there, I’m thinking, this is what I’m meant to be doing. That is what feels rewarding to me.”

Lara says she understands the symptoms of burnout and has felt them herself from time to time. “But the funny thing to me is that I don’t remember feeling that way when I was doing only clinical care,” she says. “A big reason is that I love my coworkers. I look forward to being on that mobile unit, interacting with the driver, who is also our financial front desk person when we’re on a mobile clinic. I have relationships with all of them. They’re so important to our team. They’re the first people that our patients see, and some of them have incredible stories. The nurses are just phenomenal—so strong.

“Many of them have endured troublesome pasts as well, whether it’s family members with addiction or losing siblings to suicide. So even on the days I am tired and feeling the bed was the better option, the thought of seeing the people that I work with, and then seeing the patients as well is always enough to get me out of bed.”

* * *

Lara quotes one of her paternal grandmother’s favorite sayings: The key to a happy life is a grateful heart. “It sounds goofy,” she says. “But I believe that. I think that every day, if we can think about the things that we’re grateful for, it does change your outlook.

“I try every day to be grateful for my family, my children, their health, the stability that my husband and I have been able to provide for them. I think having lived through a time when things didn’t feel certain, and when bad things could happen and did happen routinely and unexpectedly, helped me really appreciate the predictability and the calm that comes with steady employment and knowing where you’re going to be every day, and having clean clothes, and having reliable transportation, and having mental health and physical health.”

She hasn’t forgotten what she owes to Patricia Faherty and her husband. “Pay it forward—I know I have to do that,” she says. “Help someone else out when you’re in the position to be able to do that.”

She is quick to say that she and her husband have not sent anyone to college—yet. But she mentions someone she knows from the homeless outreach program, whose daughter is thinking about medical school. Lara has her eye on her.